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    Is it possible to manage EMS without a prescription for metformin and prevent or avoid the onset of endocrinopathic laminitis? Obesity is associated with health problems in horses and leads to equine metabolic syndrome, insulin resistance, laminitis and Cushings. Equine obesity has increased at an alarming rate in recent years affecting horses all over the world. Metformin is the drug commonly used for treating the secondary problems of obesity such as raised blood glucose and insulin resistance. When used in humans Metformin has the effect of lowering blood glucose in type 2 diabetes, however there are doubts about whether Metformin is as effective in the horse with conflicting results from the trials that have been done to date. Two recent trials in Australia found Metformin was not effective against Insulin Resistance when given to 6 ponies at 30 mg per kg daily. The ponies’ body weight, body condition score and cresty neck score were also assessed and neither changed during this study. metformin equivalent Equine Metabolic Syndrome (EMS) is a hormonal disorder of horses, and more commonly ponies, that has been identified in the recent past. It has some similarities with Cushing’s Disease, most notably in its propensity to cause laminitis. Overweight native ponies are most frequently affected, although it has been observed in all breeds and types. There is also a strong link with obesity – any pony can be affected by EMS, but it is observed far more frequently in overweight animals. The role of insulin within the body is to enhance the uptake of glucose from the bloodstream into cells, and in conjunction with glucagon plays the major part in regulating blood sugar levels. Ponies with EMS do not respond to insulin as they should, so glucose remains within the bloodstream. This is very similar to type II diabetes in humans. There are also some abnormalities in fat metabolism that can contribute to the disease – firstly, the production of steroid-like hormones by fat, andsecondly the conversion of inactive steroid hormone (cortisone) back to its active state (cortisol).

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    Equine Insulin Resistance is high Insulin levels with normal Glucose levels. “If lactic acidosis does occur, it can be – used young thoroughbreds and standardbreds that were normal AND which are not even Insulin Resistant. Metformin reduces Thyroid stimulating hormone in cases of underactive Thyroid – up to a 55% increased risk of low TSH. Click here for 2014 Article about Metformin Causing Thyroid and Heart Problems, from the United Kingdom. But Metformin is a human Diabetes drug that has one job – to lower Glucose. Click here for American Diabetes Association Study, Dr. It makes no sense to give a drug to lower Glucose in a horse with already normal Glucose. Oregon State’s Veterinary Research Team in May 2009 found this drug is not absorbed by horses. Metformin is for Type 2 Diabetes which most horses never get. It is going in one end and out the other and so is your time and money. No FDA approval for use in horses – creates liability issues. One small study in England, years ago, thought they saw effect, but no university or institute can replicate these findings. Conclusions of the Study: only 4-7% of Metformin giving orally 2 times a day is absorbed and is “insufficient to achieve plasma concentrations of drug comparable to the therapeutic range achieved by humans.” AJVR 2009, May, Dr. This study was before Oregon State’s Veterinary School found the drug was not even being absorbed in any useful manner. Requires constant/multiple blood testing to monitor. Also, the English study tried 2 times per day dosing which is difficult on clients. “At some point this medicine may stop working and your blood glucose will increase.” Mayo Clinic, 2008.10. “Carry an Emergency ID Card and Glucagon Emergency Kit for emergencies” due to hypoglycemic reactions. “Recent research shows a lack of efficacy of the drug on Insulin Resistance”17. Laminitis is one of the most common and frustrating clinical presentations in equine practice. While the principles of treatment for laminitis have not changed for several decades, there have been some important paradigm shifts in our understanding of laminitis. Most importantly, it is essential to consider laminitis as a clinical sign of disease and not as a disease in its own right. Once this shift in thinking has occurred, it is logical to then question what disease caused the laminitis. More than 90 per cent of horses presented with laminitis as their primary clinical sign will have developed it as a consequence of endocrine disease; most commonly equine metabolic syndrome (EMS). Given the fact that many horses will have painful protracted and/or chronic recurrent disease, a good understanding of the predisposing factors and how to diagnose and manage them is crucial. Current evidence suggests that early diagnosis and effective management of EMS should be a key aim for practising veterinary surgeons to prevent the devastating consequences of laminitis.

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