Pathophysiology of EMS compared to other species
Horses can remain hyperinsulinaemic for years without developing diabetes mellitus
You can detect hypernsulinaemia with normal or high-normal glucose concs in horses
Do not develop amylin witin the pancreas and progress to diabetes mellitus (while cats and humans do)
Diabetes mellitus is rarely seen in horses, and when it is, it is associated with PPID or old age
1. Adiposity
Physiological for energy
storage, but this is too much
Adipokine and adipocytokine production occurs
Chronic low grade inflammation
Adiponectin is an adipokine
which is significantly lower
compared to controls with higher
risk of laminitis
2. Insulin
resistance
Caused
by:
Accumulation of intracellular lipids (lipotoxicity) in skeletal muscle, liver and pancreas
Down-regulation of insulin signalling pathways by adipokines
3 stages of
IR
3. Laminitis
Occurs in 7
steps:
1.
Hyperinsulinaemia
2. Endothelial cell dysfunction
Inhibition of NO release by endothelium
Endothelin-1 synthesis and sympathetic nervous activation
3. Digital
vasoconstriction
4. Impaired glucose uptake from lamellar
cells
7. Pro-inflammatory/pro-oxidative state in lamellar
tissue
5. Altered fusion and mitosis
6. Activation of matrix metallopreinase
Basics
Definition
Collection of risk
factors which
predispose laminitis
Obesity
Insulin Resistance
Dyslipidaemia (HyperTAGaemia)
Hypertension
Altered reproductive cycling
Increased systemic markers of inflammation
History
Feed quality/quantity
Exercise
History of laminitis
Look for divergent growth rings on hoof
Season (lush green pastures!)
Presentation
Signalment
5-15yo (younger horses)
Nota:
Compare this with PPID - older horses!
Ponies, minis, coldbloods and arabs
Seasonal
Lush green pastures (see note)
Nota:
During sunshine periods sugars are produced in excess in the grasses
These are converted into
storage carbohydrates (fructans and starches)
Clinical signs
Obesity
BCS 3-5
Enlarged/thickened crest
Regional adiposity may make BCS difficult
HOWEVER
Lean horses may be seen with EMS
§ 11β-hydroxysteroid dehydrogenase-1 (11β-HSD1) is
an enzyme which increases local production of cortisol
in adipose tissue, this promotes insulin resistance
§ Pancreatic disease can result in reduced insulin production and T2DM
Lameness
Remember, owners only
recognise EMS after lameness
has developed