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TOPIC: Laminitis lesions from insulin

Laminitis lesions from insulin 10 Sep 2009 01:12 #1

  • Katy Watts
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Histology is not the same as with carbohydrate overload.

Equine laminitis: Ultrastructural lesions detected in ponies following hyperinsulinaemia

Authors: Nourian, A.R.; Asplin, K.E.; McGowan, C.M.; Sillence, M.N.; Pollitt, C.C.

Source: Equine Veterinary Journal, Volume 41, Number 7, September 2009 , pp. 671-677(7)

Reasons for performing study: Anatomical changes in the hoof lamellar tissue induced by prolonged hyperinsulinaemia have not been described previously. Analysis of the induced lesions may promote understanding of hyperinsulinaemic laminitis pathogenesis and produce clinical benefit.

Objectives: To use light and transmission electron microscopy (TEM) to document hoof lamellar lesions in ponies clinically lame after prolonged hyperinsulinaemia.

Methods: Nine clinically normal, mature ponies were allocated randomly to either a treatment group (n = 5) or control group (n = 4). The treatment group received insulin via a modified, prolonged euglycaemic hyperinsulinaemic clamp technique (EHCT) and were subjected to euthanasia when clinical signs of Obel grade II laminitis occurred. The control group was sham treated with an equivalent volume of 0.9% saline and killed at 72 h. Lamellar tissues of the right front feet were harvested and processed for TEM.

Results: Lamellae from insulin treated ponies were attenuated and elongated with many epidermal basal cells (EBC) in mitosis. Unlike carbohydrate induced laminitis in horses there was no global separation at the lamellar dermal/epidermal interface among ponies. Sporadic EBC basement membrane (BM) separation was associated with the proximity of infiltrating leucocytes. In 2 ponies, the lamellar BM was thickened. The number of hemidesmosomes/μm of BM was decreased in all insulin treated ponies.

Conclusions: Prolonged hyperinsulinaemia causes unique lamellar lesions normally characteristic of acute and chronic laminitis. Lamellar proliferation may be an insulin effect through its mitogenic pathway. Aberrant lamellar mitosis may lengthen and weaken the lamellar, distal phalanx attachment apparatus and contribute to the clinical signs that developed.

Potential relevance: The study shows that insulin alone, in higher than normal circulating concentrations, induces profound, changes in lamellar anatomy. Medical control of insulin resistance and hyperinsulinaemia may ameliorate lesions and produce clinical benefit.
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RE:Laminitis lesions from insulin 10 Sep 2009 06:25 #2

Thanks Katy, so with carbohydrate overload, cells that form the connection between P3 and the hoofwall are simply torn, while in hyperinsulinaemia cases cells are not torn but change shape and cell division gets troubled, resulting in a mechanically comparable loss of the lamellar bond?

The way I translate hyperinsulinaemia (I'm not even sure I spelled that right :o) it would mean that the insuline level in the blood is high, resulting in low sugarlevels if insuline does what I think it is supposed to do.

So both too much carbohydrates and too little carbohydrates (through insuline) cause the clinical signs of laminitis? Or am I supposed to understand that when high insuline levels result in laminitis the patient is obviously resistant to a degree to insuline and insuline has not enough effect in that horse?


Ronald Aalders
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RE:Laminitis lesions from insulin 10 Sep 2009 18:39 #3

  • Katy Watts
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Ronald Aalders wrote:
Thanks Katy, so with carbohydrate overload, cells that form the connection between P3 and the hoofwall are simply torn, while in hyperinsulinaemia cases cells are not torn but change shape and cell division gets troubled, resulting in a mechanically comparable loss of the lamellar bond?

No mechanically comparable. Carb overload causes detachment of the basement membrane. High insulin does not, but does cause deformation of the lamina.

Ronald Aalders wrote:
The way I translate hyperinsulinaemia (I'm not even sure I spelled that right :o) it would mean that the insuline level in the blood is high, resulting in low sugarlevels if insuline does what I think it is supposed to do.

First part is correct, but horses do not get low blood sugar from high insulin like people do.

Ronald Aalders wrote:
Or am I supposed to understand that when high insuline levels result in laminitis the patient is obviously resistant to a degree to insuline and insuline has not enough effect in that horse?

Yes. When horses are IR, they just keep pumping out more and more insulin, only it doesn't work right. The insulin is what causes the laminitis.

Dr. Pollitt just sent me a draft that has been accepted for publication. They induced laminitis with insulin in healthy, racing fit Standardbreds. So this is not just about a predisposition to IR in ponies. Insulin is bad for feet in any type of horse.
Katy
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RE:Laminitis lesions from insulin 10 Sep 2009 19:52 #4

  • mwmyersdvm
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This observation can also explain the slow and insidious onset of the pain in these IR horses as opposed to a more abrupt event like that seen in an acute carbohydrate overload. I see many horses that are in work and simply experiencing believed behavior problems that are actually laminitic. Once their diet and hoof parameters are corrected they are much more pleasant to work around and more willing to perform.

M. W. Myers, D.V.M.
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RE:Laminitis lesions from insulin 10 Sep 2009 23:24 #5

  • Jan Palmer
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Katy Watts wrote:
First part is correct, but horses do not get low blood sugar from high insulin like people do.
My chronic laminitic horse always had low blood sugar (50-60mg/dl) every time tested, including tests done immediately with a glucometer. Insulin was always 3X higher than the upper range of normal for several years. A carefully controlled diet had little to no impact on insulin or glucose values.

Since the study didn't last very long (72 hours), one is left to wonder what years of uncontrolled hyperinsulinaemia does to the laminae and basal membrane?
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RE:Laminitis lesions from insulin 11 Sep 2009 05:33 #6

mwmyersdvm wrote:
This observation can also explain the slow and insidious onset of the pain in these IR horses as opposed to a more abrupt event like that seen in an acute carbohydrate overload. I see many horses that are in work and simply experiencing believed behavior problems that are actually laminitic. Once their diet and hoof parameters are corrected they are much more pleasant to work around and more willing to perform.

M. W. Myers, D.V.M.


And those two types of laminitic attacks can usually be pretty easily distinguished from each other. Which may allow us to guess what type of laminitis warrants further investigation into bloodsugar levels/IR resistance.

Like the one I was working on recently. http://www.horseshoes.com/forums/showthread.php?t=10757&highlight=unilateral+laminitis

For this horse (a 25 y/o former show horse) that type of investigation may be in order.

Interesting.


Ronald Aalders
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RE:Laminitis lesions from insulin 11 Sep 2009 12:05 #7

  • mwmyersdvm
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Ronald Aalders wrote:
And those two types of laminitic attacks can usually be pretty easily distinguished from each other. Which may allow us to guess what type of laminitis warrants further investigation into bloodsugar levels/IR resistance.

Like the one I was working on recently. http://www.horseshoes.com/forums/showthread.php?t=10757&highlight=unilateral+laminitis

For this horse (a 25 y/o former show horse) that type of investigation may be in order.

Interesting.


Ronald Aalders


This situation was studied a short while back on some show ponies. While the ponies were in work on the show circuit they had normal insulin values. When given to time off to 'let down and relax' 80% of the study group became hyperinsulinemic. A great treatise to exercise being very important in the control of the problem (as long as the hoof capsule stability will allow it). However, I don't believe the study noted if the diet remained perfectly constant. They may have been pastured for longer periods during the 'let down' time.

M. W. Myers, D.V.M.
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RE:Laminitis lesions from insulin 13 Sep 2009 14:28 #8

  • Katy Watts
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The first study showed that the laminitis lesion from high insulin is different from the carbohydrate overload lesion. The second study showed that this is not about ponies being predisposed to insulin induced laminitis. It applies to horses, too.
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