In healthy horses the pancreas produces insulin—a hormone that helps the body turn glucose into energy—in response to increased glucose levels in the blood from high-starch and -sugar meals. The insulin travels through the blood and attaches to body cell wall receptors that trigger protein reactions that allow glucose to enter. The cells then convert glucose to energy or store it to use later. Insulin is essentially the gatekeeper of this process: If no insulin is attached to the receptor, no glucose can enter the cell. When this process works properly, it efficiently returns blood sugar levels to normal concentrations after eating. When the body’s signaling for how much insulin the pancreas needs goes awry, a condition called insulin dysregulation (ID) causes abnormally high levels of insulin and sometimes glucose to circulate in the bloodstream, putting a horse at risk of regional adiposity, obesity, and/or laminitis.