b'ENDOCRINOPATHIC LAMINITIS EXPLAINEDthin soles were dropped, so he now wasManfredi says results are variable due to relatively flat-footed, adding to his dis- poor oral bioavailability (absorption rate). comfort. He also displayed slight rotationHe received vitamin E and an omega-3 of the coffin bone in both front hoovesfatty acid supplement.and thickening of the hoof walls due toThis horses resting insulin levels before scar tissue from chronic inflammatorystarting the medication were extremely bouts. The veterinarian talked with thehigh; three months later, they were within horses farrier about improving alignmentan acceptable normal range, and his BCS of the coffin bone and hoof capsule andwas 6 for the first time in years. Resting squaring back the toes to decrease theinsulin is not always the most reliable lever-arm pull of the deep digital flexortesting process for predicting ID or lami-tendon on the coffin bone. nitis recurrence, but it provided informa-The owner kept the horse off pasturetion in this case. McGowan says there is and he improved, not experiencing an- merit in using post-feeding insulin values other laminitic bout for two years despiteas a monitoring tool because they more still being overweight. Then, he experi- closely approximate the insulin response enced a recurrence. (A two-year study ofto a horses actual diet. A more labor-300 laminitis cases found that one-thirdintensive evaluation involves dynamic of horses develop recurrent laminitis,testing with standardized sugar admin-ISTOCK.COMparticularly if their insulin elevates and/oristration to compare insulin and glucose they experienced a high lameness graderesponses to levels before and 60 and 120 in their initial diagnosis.) minutes after sugar challenge.Testing showed that the horses hayGrazing muzzles restrict laminitis-prone horsesIn cases like this Manfredi says other was acceptably low in carbohydratesgrass intake while still allowing them turnout. possible therapies, including one shes and s ugarsideally, NSC content shouldinvestigatinga blend of resveratrol and be less than 10%. At this point otherGiven the potential for heart issuesamino acids, including leucinehelp de-medication strategies seemed necessary.secondary to thyroid oversupplemen- crease inflammation and improve insulin The veterinarian placed the horse ontation as shown in recent racehorsesensitivity. Another medication scien-levothyroxine (a thyroid supplement) forresearch, owners should supplementtists are currently studying for use in ID several months to increase his metaboliccarefully, says Manfredi. horses is velagliflozin (a sodium-glucose-rate to burn excess energy and improveThe horse also received metformin (anlinked transport inhibitor), for its ability weight loss. When possible, this strategyoral antihyperglycemic drug used to treatto increase glucose excretion through the works best in conjunction with exercise.type-2 diabetes mellitus in humans) 30-60urinary tract.(Veterinarians dont recommend exerciseminutes prior to feeding to reduce glu-in the painful horse, of course.)cose absorption from the gut, althoughTake-Home Message Seeing your horse every day can make it difficult to recognize body condition changes over time. Controlling obesity is paramount to controlling insulin dysfunc-tion and endocrinopathic laminitis. Take frequent photographs and girth measure-ments to track weight gain or loss. Learn Topical Application how to evaluate body condition scores No Surgery Required and whats ideal. And consult your veteri-Targets the Immune System narian about blood tests to monitor your horses insulin responses, ACTH concen-trations, response to oral sugar challenge tests, and other levels.Refrain from overfeeding your horse, and especially restrict or eliminate pas-ture turnout during periods of high sugar accumulation in grass. Your veterinar-ian can help tailor a dietary program that provides sufficient and safe levels of nutrients compatible with your horses needs. Implement lifestyle changes that include not only dietary controls but also regular exercise for your horse.h24March 2020The Horse|TheHorse.comEndocrineLaminitis.indd 24 2/4/20 9:18 AM'