{"id":15491,"date":"2019-05-21T15:33:21","date_gmt":"2019-05-21T20:33:21","guid":{"rendered":"https:\/\/be55915bbd.nxcli.net\/?p=15491"},"modified":"2021-07-25T12:35:58","modified_gmt":"2021-07-25T17:35:58","slug":"metabolic-horse-digging-deeper-insulin-diagnosis-part-two","status":"publish","type":"post","link":"https:\/\/nouvelleresearch.com\/index.php\/articles\/15491-metabolic-horse-digging-deeper-insulin-diagnosis-part-two","title":{"rendered":"The Metabolic Horse; Digging Deeper into Insulin Diagnosis Part Two"},"content":{"rendered":"

The metabolic and insulin resistant horse.\u00a0 Quite a complex situation and one that is often poorly managed, as most chronic health ailments are in the horse and other species.\u00a0 In part one<\/a><\/strong><\/span> of this article, I discussed the underlying biochemical problems in the average horse with metabolic syndrome and insulin resistance.\u00a0 It may appear to be a very complex problem, and it is to some extent, but if you can see the problem and not ignore it, then options become readily available for improved management in the horse.<\/p>\n

\"The
The Metabolic Horse and Insulin<\/figcaption><\/figure>\n

Metabolic syndrome and insulin resistance in the horse is a chronic disease, a direct effect of ongoing inflammatory and oxidative stress damage in the body.\u00a0 As discussed in part one<\/a><\/strong> of this article, oxidative stress is a fact of life, and the reason our horse’s age.\u00a0 However, in many cases, certain factors ignite that pilot light of oxidative stress, fueling the fire, and speed up damage in the body.<\/p>\n

Defining Insulin Resistance and Metabolic Syndrome in the Horse<\/span><\/h3>\n

In part one of this article, I defined metabolic syndrome and insulin resistance in the horse, but let’s take a closer look.\u00a0 In the horse, if blood work is done, normal insulin levels are reported in the range of 10-40 uIU\/ml.\u00a0 That is a pretty wide margin of normal values.\u00a0 Take into further consideration that these normal values were once established by selecting a large group of horses, testing them, and establishing the mean values or average values, which then gives us the ‘normal’ values used by laboratories. Despite this, keep in mind that there are other factors at play.\u00a0 First<\/strong>, we may have ‘normal’ horses that are either above or below this normal range as reported.\u00a0 Second<\/strong>, when establishing those normal values, how do we know the horses in the higher end range were really healthy??<\/p>\n

In my research, what I have found is that the horse often mirrors human values in many regards. Blood sugar levels in the horse are often reported at normal with a range of 75-115 mg\/dl.\u00a0 This is not too far off from human standards.\u00a0 In the not so distant past, human medicine regarded a fasting blood sugar level of 100 mg\/dl to be ideal.\u00a0 Now, in light of developing metabolic and obesity issues in people, physicians are seeing the importance of this number, connecting with insulin levels.\u00a0 They are now pushing for ideal fasting sugar or glucose levels in the range of 90-95 mg\/dl.\u00a0 Bottom line, their standards have been adjusted.<\/p>\n

When it comes to insulin resistance in the horse, most are diagnosed when the levels of insulin rise above that 40 uIU\/ml mark.\u00a0 If they are below that number, they are not deemed insulin resistant and many veterinarians and even owners do not see them at risk of metabolic issues or even pasture associated carbohydrate problems.\u00a0 In my practice, I see stages to metabolic disease in the horse and deem many of them as ‘pre-metabolic<\/em>‘ and at risk of many health issues<\/strong>.\u00a0 Many of my colleagues differ in this regard and some even do not recognize a ‘pre-metabolic’ stage in the horse.\u00a0 It is certainly seen and recognized in human medicine, so why not in horses<\/em>?\u00a0 Why do we wait until that insulin level rises above 40 uIU\/ml to take action?\u00a0 If we did, could it lead to better outcomes?<\/p>\n

I would venture to propose that the insulin normal values in the horse need to be re-evaluated and lowered.\u00a0 I would further propose that a horse with a level of insulin around 20 uIU\/ml is actually insulin resistant<\/em><\/strong>.\u00a0 This is not hard to determine just by looking at the horse physically.\u00a0 They often cannot be discriminated from the horse with a level of 45 uIU\/ml, as both are overweight, have health issues, laminitis, and circulatory disturbances, not to mention thrush, white line disease and carbohydrate sensitivity. So, really, it is just a number that separates them, but that number is often what compels us to either take action or let things be what they are for now<\/em>.\u00a0 My point is that many of these horses are truly metabolic with insulin resistance, despite perceived ‘normal’ values.\u00a0 They are being overlooked and therefore not acted upon appropriately.<\/p>\n

Insulin Resistance in the Horse; A Bigger Problem?<\/span><\/h3>\n

Many of my colleagues do look at insulin:glucose ratios, which is helpful in some situation in determining if there is a problem.\u00a0 While this is helpful, it still does not help us to see the larger population that is at risk.\u00a0 The reality is that many of our perceived ‘normal’ and potentially non-overweight horses are at risk, but it is not diagnosed or tested for in the horse<\/strong>.\u00a0 How about the average 3-day eventer?\u00a0 The upper level dressage or jumper horse?\u00a0 How about the average racing Thoroughbred?\u00a0 Do they develop insulin resistance?\u00a0 You bet they do!<\/strong> But when tested, often their insulin levels are ‘high-range normal’ and thus not deemed to be a problem.<\/p>\n

In our facility, for the most part we are working with OTTB’s and their multitude of health and lameness problems.\u00a0 Honestly, only until recently did I start to dig deeper, testing not just insulin levels but antioxidant and free radical loads.\u00a0 Some of these horses have been on our supplements, yet still had lingering problems or issues that would come and go.\u00a0 I’d scratch my head at times in the past. I’d culture feces<\/strong><\/span> initially, which many had major problems, then with a regimen the problem would be remedied on repeat cultures….yet, some still had lameness or health issues.<\/p>\n

Then, several months ago, while testing metabolic and insulin resistant horses, I decided to start testing our OTTB’s with ongoing issues.\u00a0 Interestingly enough, they shared some similarities with their metabolic and insulin resistant counterparts.<\/p>\n

The average insulin resistant horse demonstrated an insulin around 90 uIU\/ml or sometimes much higher.\u00a0 The average OTTB for rehab would demonstrate an insulin level of 15-25 uIU\/ml.\u00a0 Then, look at blood glucose levels, which the metabolic horse with IR would average fasting in the upper 80-100 mg\/dl, while the OTTB would not be far off from that value.<\/p>\n

Now, let’s look at antioxidant and free radical loads.\u00a0 Normal values here for sake of discussion would be around 250 for free radical levels (d-ROM) and >2500 for antioxidant loads (PAT).\u00a0 The average metabolic and insulin resistant horse demonstrated a d-ROM of 182 and an antioxidant load of 1400-1800.\u00a0 The OTTB had similar values, all a sign of generalized cellular hyporeactivity<\/em><\/strong>, which was discussed in part one of this article. The bottom line, in both groups of horses, their cells were not functioning correctly, which impacted not just insulin function, but cellular energy production, immune response, tissue health, and healing<\/em>.\u00a0 To the average horse owner and veterinarian, these OTTB’s would not be considered for insulin testing, but yet, it was playing a major role in their health.<\/p>\n

Here is the interesting part, at least to me as a researcher and veterinarian.\u00a0 In seeing the global problem of cellular dysfunction or hyporeactivity<\/em>, I took a different approach with these OTTB horses that were in our facility for rehabilitation.\u00a0 I took an approach to improve cellular function and with that, internal antioxidant generation and cellular REDOX balance.\u00a0 As I took this approach, on repeat antioxidant and free radical level analysis, their levels dramatically improved, often just in 48 hours!<\/strong> Free radical levels (d-ROM) went up to 260 and antioxidant potential climbed to 3400 in most on fasting samples.\u00a0 That is pretty incredible and now those levels are more in balance, more protective to the horse’s body, and yet, stimulating to the immune response.\u00a0 All good!<\/strong>\u00a0 The REALLY interesting part is that on repeat blood work in evaluating insulin levels in those same OTTB’s, their insulin levels often dropped to below or at 10 uIU\/ml!<\/strong><\/p>\n

I did nothing directly to impact insulin in regards to medications or specialized low NSC diets.\u00a0 All I did was stimulate the cell to function more effectively, regain balance, and improve internal antioxidant production.\u00a0 As a result, the body naturally lowered the insulin levels<\/em>.\u00a0 This, at least in my opinion, raises the debate regarding our perceived ‘normal’ insulin levels in the horse.\u00a0 If all is well and in balance in the horse’s body, my research experience tells me the insulin levels should be much lower than we think.<\/strong>\u00a0 If I had to take a guess, I would put normal resting insulin levels in the horse at a range of 8-15 uIU\/ml.\u00a0 That is actually just a bit above what is perceived as normal currently in humans. This goes to show us that the average horse with an insulin of 25 uIU\/ml may actually be insulin resistant and signal some significant cellular problems that are not being addressed.\u00a0 Thus, we tend to put them on the back burner, adjust diet, and wait for the insulin levels to rise…which they will, and with that more health and lameness problems.<\/p>\n

In Part ONE of this article, I mentioned that there were some concerning issues regarding this data of antioxidant and free radical levels as compared to 7 years ago.\u00a0 In 2012, we did a pilot study involving some actively racing Thoroughbreds and gathered both d-ROM and PAT levels.\u00a0 The data gathered from that group mirrored horses in our general practice at the time, with an average d-ROM of 240 and PAT level of >2500.\u00a0 This was partly how we arrived at our normal values for the horse.\u00a0 The alarming part is that 7 years later, the average horse has a d-ROM <200 and a PAT level of <2000. These levels are often found in the every day competitor or back yard pleasure horse.\u00a0 This is concerning to me as a veterinarian, as it indicates a potential overall deterioration in the health of the horse, possibly due to contributors in the current diets and forages that are being fed, in addition to many sugar-loaded supplements and poor digestive health.\u00a0\u00a0<\/strong><\/em><\/p>\n

Getting More Information About YOUR Horse<\/span><\/h3>\n

Insulin panels, leptin,<\/a><\/strong><\/span> and ACTH levels are important indicators in the horse.\u00a0 There is no doubt, as when they are abnormal, they signal some problems, however we just tend to see isolated events and miss the bigger elephant in the room.\u00a0 For me, personally, I test for insulin and usually do not go further.\u00a0 The reason being is that I more so rely on antioxidant and free radical loads to indicate a real problem.\u00a0 If insulin levels are high, then often this is reflected one way or the other in the d-ROM or PAT levels.\u00a0 If these two are abnormal, then it would be no surprise to see an increased ACTH or Leptin.\u00a0 In reality, most of these horses also have abnormal fecal cultures, so again, it is not surprising to see the connections.<\/p>\n

Antioxidant and free radical load testing is not a part of normal laboratory work for the horse, nor even for humans.\u00a0 The sad thing is that it is very valuable and actually very reflective and revealing of what is going on in the horse on a cellular level.\u00a0 At this time, we do routine testing in all of our horses, along with fecal cultures, not just once but as a part of their recovery.\u00a0 I view it as a gauge of fitness, health, and a measuring stick for recovery.\u00a0 I don’t just implement a regimen and hope for the best.\u00a0 I choose to monitor their recovery and make adjustments as needed.\u00a0 Antioxidant and free radical levels are an indicator of oxidative stress and a marker of inflammation.\u00a0 It gives you something to monitor and keep tract of regarding health improvement in the horse.\u00a0 If you would like to have your horse tested, feel free to email me (tschelldvm@gmail.com<\/span>).<\/strong><\/p>\n

In PART THREE of this article, I will discuss exactly how we transformed the cell and encouraged it to function more effectively in the horse, which then impacted insulin levels and function naturally.<\/p>\n

 <\/p>\n

Author:\u00a0 Tom Schell, D.V.M., CVCH, CHN<\/p>\n","protected":false},"excerpt":{"rendered":"

The metabolic and insulin resistant horse.\u00a0 Quite a complex situation and one that is often poorly managed, as most chronic health ailments are in the horse and other species.\u00a0 In part one of this article, I discussed the underlying biochemical problems in the average horse with […]<\/p>\n","protected":false},"author":2524,"featured_media":15502,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"default","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"enabled","footer-sml-layout":"","ast-disable-related-posts":"","theme-transparent-header-meta":"default","adv-header-id-meta":null,"stick-header-meta":null,"header-above-stick-meta":null,"header-main-stick-meta":null,"header-below-stick-meta":null,"astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"footnotes":""},"categories":[12],"tags":[298,4829,208,221,207,210,879,280,4828,1135,213],"class_list":["post-15491","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-equine-articles","tag-antioxidants","tag-diagnosis","tag-equine","tag-free-radicals","tag-horse","tag-inflammation","tag-insulin","tag-insulin-resistance","tag-leptin","tag-metabolic","tag-oxidative-stress"],"yoast_head":"\nThe Metabolic Horse; 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