Insulin
Resistance ~ Cushings Disease ~ Equine Metabolic
Syndrome
Nothing strikes fear
in your heart quite like the diagnosis of founder or
laminitis. Fat horses and ponies are at greatest risk of
laminitis and metabolic founder, but it “can” happen to thin,
fit horses as well. You have to be aware of the warning signs,
and the acute presentation of the condition, and how to treat
it. Hopefully this article will address a few of these
concerns.
Laminitis vs. Founder Is there a difference?
YES! Laminitis refers to inflammation of the sensitive laminae
of the hoof. Founder is a nautical term which means “to sink.”
A ship that is foundering in the water is losing it’s
orientation and buoyancy. Radiographs can determine if your
horse has actually foundered, or if only laminitis is present
without any rotation or sinking of the bone within the
capsule. Laminitis does not always precede founder.
Types of Founder Founder can be either mechanical or metabolic in
nature. Mechanical founder refers to a physical force
mechanically separating the hoof wall from the bone, causing
trauma, swelling, and subsequent death of sensitive laminae.
Another type of mechanical founder is from concussion (too
much hard riding on asphalt, for instance, also known as road
founder.) Metabolic founder refers to a systemic issue where
the body has suffered some type of metabolic insult, whether
it be a flood of mycotoxins, sustained high glucose levels in
the blood (Insulin Resistance or Cushings Disease) or some
other type of inflammation or fever. One way that mares
develop founder is through a retained placenta. Founder caused
by Insulin Resistance or Cushings Disease can be the most
difficult to manage.
What actually happens when a horse
founders? There is a tremendous amount of controversy on what
“exactly” happens to cause a horse to founder, and what
happens during the acute phase. However, one thing most
experts agree on is that when a horse founders, there is acute
swelling and inflammation inside the hoof capsule causing
pain, tissue death, and severe lameness. Circulation is often
affected as the distal phalanx (coffin bone) loses adhesion
with the hoof wall and migrates from its normal position.
 Radiograph showing rotation of distal phalanx of a
foundered pony.
I
found my horse in the founder stance. Now what?! CALL YOUR VETERINARIAN IMMEDIATELY! Articles and
independent research are never an adequate substitute for a
qualified Veterinary opinion, diagnosis, and prognosis. The
nature of this article is to give you general information, but
when your horse is in serious trouble, always call a qualified
equine Veterinarian immediately.
After you have called
the Veterinarian, it is crucial that you provide the horse
with sole support immediately. Any type of firm supportive
foam can be used in an emergency. Building supply stores sell
sheets of construction grade foam, or you can use garden
kneeling pads. Otherwise any type of dense foam chair cushion
or a neoprene saddle pad can be cut up. You can also use thick
clay poultice packed into the bottom of the foot though the
foam is preferred over the poultice. Cut the foam to fit about
¼” larger than the circumference of the hoof, and secure with
vet-wrap and duct tape. If you absolutely cannot secure any of
these supplies, bed a stall deeply with shavings, and get the
horse to stand in there until the Veterinarian arrives.
It is CRUCIAL to limit movement during acute
laminitis, especially if pain medications have been given.
Excess movement can cause more separation of bone from hoof
capsule.
Standing the horse in ice or cold hosing the
legs might be beneficial though most experts agree that it is
most important to provide complete solar support as the first
line of defense.
Your Veterinarian will administer
phenylbutazone or banamine, and then instruct you on continued
care during the acute phase. It is important to ask your
Veterinarian about lateral radiographs, and when they suggest
they be taken. They will likely also instruct you to hire a
therapeutic farrier to shoe the horse. Many horses have gotten
better without the shoeing process, and left barefoot, but
that decision is one only you can make.
How
aggressively and effectively you treat the horse NOW will help
to determine the horse’s long term recovery.
We Survived the Acute Stage, But Now
What? It is extremely important
that you identify WHY the horse foundered. If it was
mechanical, has the leverage or source of trauma been
identified and removed? If it was metabolic, was the source of
the insult identified and removed? If the horse got into the
feed room and at 25 pounds of sweet feed, it’s fairly safe to
say that the horse may not necessarily have a long-standing
metabolic disease, but that this was a one time insult.
However if the horse foundered on spring grass even after
being properly introduced to it, or without a single
identifiable insult, then you may have a metabolic horse on
your hands that needs proper diagnosis, dietary changes,
proper exercise, and possibly medication to keep the horse
healthy and as sound as possible.
Insulin Resistance,
and Cushings Disease are two metabolic disorders that make
horses very likely to suffer laminitis or founder. Talk to
your Veterinarian about the appropriate blood tests to
identify these diseases.
Dietary and Exercise Changes The dietary needs of a metabolically foundered
horse can be intense, expensive, and time consuming. It is
best to consult an Equine Nutritionist or Veterinarian who is
well advised in the dietary needs of metabolic equines. They
can help you to develop a vitamin/mineral supplementation and
dietary program to address all the horse’s needs, without
increasing the carbohydrate load.
Feeding no-molasses
beet pulp or other low sugar, founder safe feed, low NSC (Non
Structural Carbohydrates) grass and/or alfalfa hays, and
moving the horse to a dry lot are all indicated in the
treatment of metabolic founder. It is essential that
carbohydrates and sugars in the diet be maintained at the
lowest level possible. Non Structural Carbohydrates refers to
simple sugars that cause the body to secrete more insulin.
Horses that are insulin resistant cannot effectively control
their blood glucose levels.
 Exercise that
pony!!!!
Exercise is essential for the
laminitic, foundered or founder-prone horse once they have
moved out of the acute phase, and pain is under control.
Supportive hoof boots and pads or shoeing is important to keep
the horse comfortable during exercise. Even if you can provide
15 minutes per day of walking or jogging, the horse will be
better able to utilize insulin. Try to keep the horse on soft
footing like grass, even while using hoof boots and pads.
Concussion can cause more pain and inflammation.
Trimming/Shoeing for the Long Haul I am in favor of keeping horses shoeless as much
as possible. That’s a whole ‘nother article in itself, but I
will summarize it by saying that shoeing should be used when
it is clear that it is not possible to keep the horse
comfortable while barefoot. I advocate the use of hoof boots
and pads as much as possible.
Foundered hooves usually
grow differently than normal hooves due to an interrupted
blood supply and nerve damage causing the horse to weight the
feet differently than she would normally. The heels tend to
grow very fast while the toe seems to hardly grow at all.
Keeping foundered horses on a short trim cycle – 4 to 5 weeks
– is crucial to long term success. The worst thing you can do
for a foundered horse, next to a poor diet, is a trimming
cycle that is too long. Many foundered horses develop what is
known as a laminar wedge. The photo below shows the evidence
of this. As the dorsal aspect of the coffin bone rotates
downward away from the hoof wall, the void that is left fills
with hyperkeratanized laminae. This laminar wedge must be
addressed frequently and thoroughly if the horse is to regain
optimal hoof form and function. It’s important to work with a
trimmer or farrier who has some experience in working with
foundered horses.
 Foundered hooves over a 2 1/2
year span
Medications
and Supplements It has been shown
that magnesium and chromium supplementation is very beneficial
for the support of metabolically challenged horses. Be sure to
talk to your Veterinarian and Equine Nutritionist about this
in more detail. A wealth of information is available on the
Equine Cushings Group, which is linked on this page. Some
sources have reported that their horse’s blood sugar levels
improved when fed a teaspoon of cinnamon everyday. This is
subjective, but cinnamon makes a great flavoring for
no-molasses beet pulp and certainly cannot hurt
anything.
Daily or long-term bute therapy carries
certain risks including gastric ulcers and right dorsal
colitis, so be sure to thoroughly discuss this with your
Veterinarian. However, in certain cases this medication will
extend the comfort and happiness of the horse for many years.
Another option is Equioxx or any number of natural pain
relievers.
Summary No two foundered horses are the same. No two
foundered horses are the same. No two foundered horses are the
same. What works for one might not work for another. Some
foundered horses get better despite lacking good palliative
care and some horses deteriorate even under the watchful eyes
of the most noted founder experts in the world. NO TWO
FOUNDERED HORSES ARE THE SAME!
Be prepared to change
little things, such as giving an anti-fatigue mat to stand on
while in the crossties, or bedding the stall deeper than
normal. Understand that foundered or laminitic horses have
difficulty turning tight circles or going down hills. In other
words, you may need to rethink many aspects of your horse’s
management protocol to be sure that they are comfortable and
happy. Most natural hoof care experts agree that once the
acute phase is safely behind you, MOVEMENT, low coffin bone
angle (short heels), and very frequent trimming are your best
allies. I don't like stalling my foundered horse any more than
necessary. You want to keep circulation at its peak.
 Exercise for the insulin resistant horse can head of
laminitis or founder.
Beet Pulp For
Your Metabolic Equine

If you own an equine suffering from
some type of metabolic disease, you have undoubtedly wondered
about the benefits and risks of feeding beet pulp in lieu of
grain products. There are now plenty of good, low NSC (Non
Structural Carbohydrates) feed mixes available but many of
them are either very expensive, or hard to get and must be
special ordered. Some feed mills are reluctant to order, or
they require you to buy them in bulk. Feeding beet pulp is a
nice alternative for you and your metabolic horse.
Beet pulp comes in a variety of forms – pellets,
crumbles, and shreds are the main types available in the
United States. You can also find an Alfalfa/Beet Pulp feed
called Fibre Beet, which is imported here from the UK. Fibre
Beet pellets are square and flat. Whichever form you decide
upon, make sure that it is available with NO MOLASSES. Beet
pulp is often coated in molasses to increase palatability. It
is possible to soak and rinse this variety of beet pulp, but
that’s just one more thing you have to do everyday. My
preferred brand is Standlee Beet Pulp Pellets. It is
affordable and has a guaranteed low NSC of around
6%.
Beet pulp costs around $11-16 per 40 pound bag,
which surprisingly lasts a LONG time. Much longer than 40
pounds of grain would last. Beet pulp swells and soaks up
water so you have a lot more bulk going into the horse than
the same amount of calories made up in grain. This makes it
perfect for metabolic horses or those on weight restricted
diets because not only does it add beneficial water to the
digestive system, but it is very filling and satisfying.
Feeding 1 cup of soaked beet pulp (expanded to about 4 cups)
is far more satisfying than 1 cup of grain or dry pellets.
Traditional grains like corn and oats are NOT safe for the
metabolic horse.
The nutrition profile of beet pulp
places it squarely on the scale between being a forage and a
grain. It is very high in fiber but the caloric count is low.
One item to note though is that it is deficient in Vitamin A
so good hay or pasture (if the horse can tolerate grass), is
also an important part of the diet. Using vitamin
supplementation programs, many horses have been successfully
maintained for years on beet pulp as the main forage in the
diet.
So How Do You Feed This Stuff?? There is a lot of
controversy regarding whether to soak it or not soak it.
Horses can choke on dry beet pulp but still there is a sect of
the horse world that believes horses will only choke on it if
they have a history of choke. NOT TRUE. My mother’s horse
choked on dry beet pulp so badly that she had to place an
emergency call to the veterinarian, and that horse had no
prior history. I just say SOAK IT. Beet pulp (in any form) is
dry and hard. Some horses eat it dry without any incidents but
the benefits of soaking it far outweigh the benefits of
feeding it dry, in my opinion.
If you buy the
no-molasses form, all you need to do is throw it in a bucket
with either hot or cold water and leave it sit for for
anywhere for 2 or 3 minutes to a couple of hours. If however
the only type available to you is augmented with molasses, you
must soak it and then drain it, and preferably rinse it a
couple of times to remove all the molasses. This can be
accomplished with a large mixing bowl and a colander. It is
not too difficult to do it this way, and not very messy, but
if you are feeding very large quantities, it could be
problematic.
Most horses will readily eat soaked beet
pulp, but if your horse has difficulty accepting it, give him
only a small amount, mixed with some of his regular grain to
start with. Also, adding a teaspoon of ground cinnamon or
fenugreek. Some horses accept it with a tablespoon of salt
added. The wetness of soaked beet pulp makes it perfect for
mixing any other supplements into as well.
Shreds -
Crumbles - Pellets Which should you
choose?
When you decide to soak and feed
beet pulp, you first need to decide how much to feed your
horse per day. A good place to start is usually about 1
cup of shreds, or 1/2 cup of pellets or crumbles. You
want to start off small and increase later. Just like
any new food, introduce it slowly for the best result.
Eventually a mature, 1,000 pound horse can safely consume up
to about 40% of their total fiber needs in soaked beet
pulp. This is something you want to discuss with your
veterinarian and equine nutritionist. Every horse and
every situation is different. You have to be careful not
to overfeed beet pulp because it is more calorie dense than
the average grass hay.
The most common questions people
new to beet pulp ask is "How much water do I soak it
in?" "How long do I have to soak it?" "How much
will it yield once soaked?" I conducted a highly
scientific experiment......ok so it's not very
scientific........on how much water, and how long to soak beet
pulp. The type of beet pulp, and the temperature of the water
are the two things you must consider. But I will break
it down very easily for you:
To start the experiment, I meausred
exactly 1 level measuring cup of shreds, pellets, and crumbles
into 3 separate bowls. Technically the BEST way to
measure any kind of equine feed is by WEIGHT, not by cups,
scoops, coffee cans, or handfuls. But the truth is -
busy boarding barns and horse owners find it very difficult to
weigh everything out on a carefully calibrated scale. So
I have simplified this by simply using the measurement
CUP. (1 level dry measuring cup)
Next I let the tap water run as hot
as possible and took the temperature - exactly 110
degrees.
I added exactly 1 liquid measuring
cup of 110 degree tap water to each bowl.
Then I set the timer for 1
minute.
Made a glass of iced
tea........stirred each bowl once..........
And this is what the experiment
looked like after exactly 1 minute:

The compressed pellets are the
slowest in absorbing water. Only the outer layer of the
pellets has begun to absorb the hot water. 90% of each
pellet is still dry and hard as a rock. The shreds have
water standing in the bottom but they have become soft and
fluffy enough to eat. The crumbles has become the
consistency of grape nuts cereal but is still somewhat firm
and crunchy on the inside of each crumble.
The bowls were left to rest 1 more
minute.
Within 2 minutes, both crumbles and
shreds have absorbed 100% of the water they were given.
The pellets are still sitting in a pool, though a bit more
water has been absorbed.
Next I added 1 additional cup of
water measured to be exactly 110 degrees, to each
bowl.
I continued checking on the
progress of the experiment every 30 seconds for the
next 2 minutes or so.
At this point the shreds have
stopped absorbing water completely. The crumbles have
absorbed all the water they were given. The shreds are
fluffy and moist all the way through. The crumbles are
now the consistency of hot oatmeal cereal and are thoroughly
soft throughout.
The pellets however are still hard
and dry in the middle and they have absorbed all the water
given.
I added 1 more cup of 110 degree
water to the pellets and waited. And waited and waited
and waited. They absorbed all of that and but a few
pellets were still hard and dry in the middle so I gave them
an additional 1/2 cup of 110 degree water.
At this point the pellets have
expanded so much they had to be transferred to a larger
bowl:

The total time elapsed is 30
minutes before the pellets have FULLY absorbed every bit of
water, and are thoroughly fluffed, saturated, and
soft.
At this point I checked each bowl
and discovered that the shreds were standing in water that was
never absorbed. I drained off the water from the shreds
and it measured exactly 2/3 cup. There was NO additional
water in the bottom of the crumbles or the pellets.
YIELD OF SOAKED
FLUFFED BEET PULP
Shreds: 2
Cups Pellets: 5 Cups Crumbles: 3 Cups
AMOUNT OF WATER
ABSORBED
Shreds: 1 1/3 Cups Pellets: 3
1/2 Cups Crumbles: 3 Cups
TOTAL TIME NEEDED TO SOAK
IN HOT (110 DEGREE) TAP WATER
Shreds: 2
Minutes Pellets: 25 Minutes Crumbles: 5
Minutes
SUMMARY
Compressed pellets are the hardest,
driest, and take the longest to soak but they absorb the most
water and produce the highest yield. 1 level cup of dry
fluffs to 5 cups.
The shreds are quickest but absorb
the least amount of water and produce the lowest
yield.
Crumbles take only a couple minutes
longer than shreds to soak but absorbs more water and produces
a little higher yield.
A NOTE ABOUT
TANNINS
I have seen
people comment about all that "dark sugary water" they drain
off their beet pulp shreds. I just want to clarify that
beet pulp is full of tannins, which is the
same organic compound which gives tea it's dark color.
Please do not mistake the dark brown water for being
molasses. Even non-molasses beet pulp will yield dark
brown tannin laden water when soaking is complete.

SOAKING IN COLD WATER
In the future I will conduct this
experiment again but I will use cold tap water instead.
Beet pulp takes much longer to soak in cold water but exactly
how much longer, and how much water is absorbed will be
determined in the experiment. Stay tuned!
Soak Hay - Save A Life
 A
Rubbermaid bin for soaking hay
Studies
have proven that soaking hay in water can significantly reduce
the carbohydrate load(1). This is extremely important for
Insulin Resistant (IR) horses, PPID (pituitary pars intermedia
dysfunction, a.k.a Cushings Disease), horses that have
metabolically foundered, and those with chronic or acute
laminitis. The needs and management of these horses are
similar to humans with Type II Diabetes. When an equine is
diagnosed as IR, it means their body is not as responsive to
insulin as it should be. The body has to elevate the level of
insulin to manage blood glucose. Insulin in itself is a known
inflammatory and injections of insulin was shown to induce
acute laminitis in a clinical study conducted by a team of
researchers at the University of Queensland(2). The management
protocol is to tightly manage the level of glucose in the
horse's blood by feeding a diet low in simple sugar. When the
glucose level is low, the amount of insulin required is also
lower. PPID is an endocrine system malfunction in which there
is an abnormal growth of cells within the pituitary gland.
This causes abnormal hormone levels in the blood, such as ACTH
and Cortisol. PPID horses often suffer recurring bouts of
acute laminitis, and founder. A tightly managed diet is
critical for the treatment of ANY equine metabolic
disorder.
Maintaining a diet low in sugars is very
important for health and healing, not to mention soundness.
Unfortunately this crucial little piece of information is
sometimes neglected by the owners of metabolic horses because
they either don’t know about it, or it is too much work. I
recall a horse I looked at that had deep purple bruises on all
4 of his white hooves. Growth rings, and lameness were also
present. The horse was buried chest deep in a round bale, and
when I questioned his owner, she told me that she doesn't
limit his grass or hay because the vet said laminitis is not
curable, so what's the point? That horse was heading for
metabolic crisis far worse than what he was already in, but
the owner was given faulty information from a veterinary
professional. This is so unfortunate it's heartbreaking. This
article will hopefully serve to inform you of the danger of
non-regulated simple sugar intake and what you can do to make
hay safer for your horse. Soaking hay is a bit of a chore, but
with practice it becomes second nature. I will describe to
you the method that I use most for soaking hay. I’ve tried a
lot of different things, and by far, this works the best, and
strains your back the least.
- Buy at least two medium sized storage bins like the ones
shown here. They cost around $8 each.
- Buy a small to medium sized concrete block or paver
stone to use as a weight the hay as it floats to the top of
the water. Or you can use an ice cream pale filled with
sand, which works great also.
The toughest
part about hay soaking is the water source and drainage. Once
you have 20 gallons of water in the tub, it will be very
difficult to move it to a place where you can drain it, unless
you put it on a cart with wheels, which is another possibility
that works well! It’s important to fill it in the same
location where you will be able to drain it. This may mean
running a hose from the water source to the drainage location.
For those of us who live in the frozen tundra, the thought of
all that water in January is dreadful. But, there ARE ways to
make it easier.
Set the hay on end inside the tub.
Laying it flat can leave dry spots inside the hay, and I've
found it works better to set the flakes on end. Lay the block
on top of the hay to weight it down. Fill the tub with just
enough water to cover the hay. No need to run excess
water.
Leave the hay to soak for a MINIMUM of 30 to 60
minutes for hot water and 2 hours for cold. Or you can leave
the hay overnight, or all day to soak. Don’t leave it longer
than this in hot weather, as it can spoil.
When you’re
ready to drain it, remove the weight, then grab the tub by one
handle and tip it up on end slowly to pour off the water. If
you do this right, you’re using leverage to lift up the end of
the tub, and not brute force. Do NOT strain your back! You are
no good to your horse when you're laying crippled in the feed
room floor with a seized up muscle. Keep your back flat and
straight and squat down to grab the handle, don’t bend
over.
Once you’ve drained off all the water, you can
drag the tub to the horse. This is easily accomplished by
afixing a grass hay string to the handle on one end. Take 3
hay strings and braid them together so you have a nice thick
handle that won't cut your hand in two. Leave the wet hay
inside the tub to keep it clean. Shavings and dirt will stick
to the wet hay and it becomes unappetizing to your horse.
Another hay transporting option is to set the tub onto a
little cart and wheel it to the horse, if it is too heavy for
you to drag, or if you have to drag it halfway across the
farm.
While your horse is eating hay from this tub, set
up the other tub with hay to be soaking for the next
feeding.
If by chance your horse just flat refuses to
get used to eating wet hay, you can lay it out flat on a tarp
or drying rack for a few hours before feeding, but this is
much more work. It’s best if you can slowly accustom the horse
to eating wet hay. People have had success sprinkling white
table salt throughout the hay (no more than 1 ounce {1
tablespoon} per feeding). Still others sprinkle cinnamon, or
ground flax seed on the wet hay. You can also used
non-molasses soaked beet pulp, which is very safe for
metabolic horses. Soak it thoroughly, then dump it on the hay
and mix it throughout. Of course this only works if your horse
already eats beet pulp and he likes it. You don't want to wate
a tub full of hay and a pound of beet pulp on your experiment,
so test it in small quantities first!
Still another
experiment to try if the horse refuses to eat the soaked hay -
mix in some alfalfa leaves, or soaked alfalfa pellets. Alfalfa
is actually lower in total sugar content than most grass hays,
though the sugar in alfalfa is primarily glucose rather than
fructan. Fructan is a safe sugar, glucose obviously is not.
Some metabolic horses can eat a portion of their meals in
alfalfa without any problems, others cannot tolerate it. So
the decision to use alfalfa should be made with your
veterinarian, and your horse's past history of tolerance to
it. One of my metabolic horses tolerates alfalfa extremely
well, but one does not. Each horse is different and it takes
some experimenting. But if you're trying to wean your horse
over to eating soaked hay, shaking out some alfalfa leaves
into the wet hay can be a good way to convince your horse to
eat it. Remember - everything in moderation. Don't dose your
horse with large quantities of anything that might be unsafe
for him. Try it in small amounts first.
Other more
technical and complicated methods involve using a large
Rubbermaid bin on wheels and drilling a hole in the bottom and
installing a plug to drain water. Or placing the hay inside a
hay bag and setting the hay bag in the tub full of water, then
pulling it out with a pulley system. The problem with this
method is that your clothes get soaked while you’re trying to
hang the bag, and also the bag weighs about 60 pounds when
you’re trying to lift it out of the water. Another method is
to place a laundry basket inside the bin full of water then
pull out the laundry basket with the hay. Again, this is
heavier than just tipping the tub on it’s end to drain, but
it’s not as heavy as lifting the bag.
WINTER HAY
SOAKING:
In the winter, it is ok to let the hay
freeze inside the tub, as long as it is not freezing into a
solid block. Horses seem to like the "haysicles" and as long
as they have no tooth problems, or ulcers, the frozen hay
should not cause them a problem. Place the tub inside a feed
room or wash stall if any way possible to protect it from the
elements. It will take much longer to freeze this way. But
again, make sure it is close to a drain, or close to a place
it can be drug and emptied. I soak hay all the way down to -15
below zero with -40 windchills and I have no problem. My feed
room drain freezes up in the winter so I must drag the tub
outside to drain it. This is best accomplished with the
smallest tub possible, or two small tubs with only 2 flakes of
hay in each, versus one big tub with all 4 flakes. If you can
get the tub on the snow, it drags VERY easily. I've never had
a problem with creating an ice slick, as I slightly vary the
dumping location every week or so. Some people have actually
dug a 12 foot square gravel pit where they dump the water.
This lets it drain down and away.
If you have
absolutely NO place to safely drain the water during the
winter, the best option for you is to find a hay source that
sells low NSC (Non Structural Carbohydrate) Hay.
1.
http://www.safergrass.org/pdf/SoakReport.pdf --- Kathryn
Watts, Research Director, Rocky Mountain Research and
Consulting, Inc.
2. The Role of Insulin in
Endocrinopathic Laminitis --- University of Queensland, The
Veterinary Journal August 2007
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