Insulin dysregulation is a key component of equine metabolic syndrome (EMS) in horses, ponies, and donkeys. Insulin resistance is when the body is unable to convert glucose into energy. A horse with insulin resistance might cause a horse to develop insulin dysregulation.

The 5th Global Equine Endocrine Symposium (GEES), brought to you by Boehringer Ingelheim, was held in 2023. There were several exciting presentations about possible new treatments for insulin dysregulation in the horse. Individuals presented on initial research concerning medicines that hopefully can be used to treat insulin dysregulation in horses.

Specific drugs researched to combat insulin dysregulation were velagliflozin (developed and researched for veterinary use) and canagliflozin (the human drug Invokana®).

Velagliflozin and canagliflozin are both sodium-glucose co-transport 2 (SGLT2) inhibitors. Those drugs reduce renal glucose reabsorption, promote glucosuria (reduced sugars in the urine), and consequently decrease blood glucose and insulin concentrations.

Velagliflozin and Canagliflozin for Insulin Dysregulation Treatment in Horses

In horses, velagliflozin has been researched to counteract the effects of insulin dysregulation, including the development of laminitis. The study presented at the GEES meeting was “The sodium-glucose cotransporter-2 inhibitor velagliflozin decreases basal plasma insulin concentrations in horses with moderate-severe insulin dysregulation.” Kristen Thane, DVM, DACVIM-LA, of Tufts University, presented the research findings.

She noted that velagliflozin decreased plasma insulin concentrations in horses with moderate/severe hyperinsulinemia (when the amount of insulin in the blood is higher than what’s considered healthy). Thane said that serum triglyceride concentrations increased in all horses treated with velagliflozin; this hypertriglyceridemia typically improved gradually during the 40-week trial. However, development of marked hypertriglyceridemia was observed in some horses after starting treatment with velagliflozin, therefore serum triglycerides should be monitored when initiating therapy with an SGLT2 inhibitor. No laminitis developed while horses were receiving velagliflozin treatment.

Development of marked hypertriglyceridemia was observed in some horses after starting treatment with velagliflozin. Because of that, Thane said serum triglycerides should be monitored when initiating therapy with an SGLT2 inhibitor. An SGLT2 inhibitor acts to lower blood sugar levels by preventing the kidneys from reabsorbing sugar created by the body. Extra sugar is excreted in the horse’s urine.

No laminitis developed while horses were receiving velagliflozin treatment.

Canagliflozin in previous research showed it had the ability to lower insulin levels in horses. It also was shown to reverse or reduce fat pads and eliminate laminitis pain in horses with refractory hyperinsulinemia and laminitis.

Editor’s note: You can access the full Proceedings of the 5th GEES Symposium here.

Further Reading

The Role of Insulin in Equine Laminitis. Dr. Melody de Laat. MySeniorHorse.com

  • Kimberly S. Brown is an award-winning writer and publisher. She is the Editorial Director for My Senior Horse. Brown spent 10 years at Equine Network, parent company of My Senior Horse. Prior to that she worked for three years in equine nutrition after she retired from nearly 30 years working at The Blood-Horse. Brown spent the last 15 years of her time at that organization creating and developing The Horse and TheHorse.com.
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