approach to EMS

What is a primary presenting sign of Equine Metabolic Syndrome (EMS)?

Overweight and regional adiposity, such as a cresty neck and fat pads.

What are the common historical questions to ask for EMS diagnosis?

Have they had previous events of laminitis or had EMS before?

What basal test measures insulin concentration after the horse comes off pasture?

Basal insulin concentration.

What indicates hyperinsulinaemia in a resting/starved state?

High insulin concentration measured 1-3 hours after coming off pasture.

What does a low concentration of adiponectin indicate in horses?

Increased risk of laminitis.

What test assesses response to oral sugars in EMS diagnosis?

Oral sugar test.

What is the purpose of the combine glucose insulin test?

To evaluate tissue insulin sensitivity.

What is the recommended dietary management for obese horses with EMS?

Reduce carbohydrate intake and feed 1.75% of body weight, using soaked hay to leach sugar out.

When should exercise be started for horses diagnosed with EMS?

Only after laminitis is under control.

What class of medication is used to decrease insulin concentration in horses with EMS?

SGLT2 inhibitors, including ertugliflozin and metformin.

What are the main risk factors for developing EMS in horses?

Genetic predisposition, obesity, regional adiposity, and pregnancy-associated insulin dysregulation.

What are the three stages of insulin resistance associated with EMS?

1. Compensated IR - normal glucose maintained by increased insulin; 2. Uncompensated IR - increasing glucose and increased insulin output; 3. Type 2 DM - persistent hyperglycaemia due to inadequate insulin output.

What can prolonged high insulin concentrations lead to in horses?

Pancreatic dysfunction and clinical signs such as PUPD, hyperglycaemia, and weight loss.

What is a key difference between EMS-related and sepsis-related laminitis?

In EMS, there is lengthening/stretching of secondary epidermal lamellae without destruction of the basement membrane.

How can the risk of laminitis be reduced in horses with EMS?

By identifying hyperinsulinaemia, conducting dynamic tests, and measuring adiponectin concentration.