Effects of Ω-3 (n-3) Fatty Acid Supplementation on Insulin Sensitivity in Horses

The objective of this study was to examine the effects of dietary ω-3 fatty acid supplementation on insulin sensitivity (SI) in horses. Twenty-one mares were blocked by age, body weight (BW), and body condition score (BCS) and randomly assigned to one of three dietary treatments. Treatments consisted of (1) 38 g of n-3 fatty acids via fish and algae supplement and diet (MARINE), (2) 38 g of n-3 fatty acids via a flaxseed meal from the supplement and diet (FLAX), and (3) control (CON) no supplemental fatty acid. Treatments were supplemented for 90 days. Frequent sampling intravenous glucose tolerance tests were performed on days 0, 30, 60, and 90. Blood samples were analyzed for glucose and insulin. The minimal model was applied for the glucose and insulin curves using MinMod Millennium. SI increased 39% (P < .007) across all treatment groups. Acute insulin response to glucose decreased 22% (P < .006) between days 30 and 60 and increased (P = .040) again at day 90. Disposition index (combined SI and β pancreatic response) increased (P = .03) by 53% in the MARINE- and 48% in the FLAX-supplemented horses and did not change with time in the CON group. In insulin-resistant mares, MARINE- and FLAX-treated horses had an increase in SI (P = .09). It would be interesting to test this supplement in a larger group of insulin-resistant horses. If proven effective, supplementation with ω-3 fatty acids would help to reduce problems associated with insulin resistance in horses.     

The Effect of Feeding Two or Three Meals Per Day of Either Low or High Nonstructural Carbohydrate Concentrates on Postprandial Glucose and Insulin Concentrations in Horses

Eight mature idle gelding horses (mean body weight [BW], 558 ± 45 kg) were used in a replicated 2 × 2 Latin square design study. Horses received either two or three meals per day (MPD) for 7 days, of either a high (H; 43%; 215 g/100 kg BW) or low (L; 18%; 90 g/100 kg BW) nonstructural carbohydrate (NSC) concentrate feed to achieve four treatment groups: low NSC in two MPD (L2), low NSC in three MPD (L3), high NSC in two MPD (H2), and high NSC in three MPD (H3). On day 7 of the treatments, blood was collected before (baseline) and for 5 hours after feeding the morning meal (10, 20, 30, 40, 50, 60, 90, 120, 150, 180, 210, 240, 270, and 300 minutes after feeding). Baseline insulin concentrations tended (P = .093) to be higher for horses fed high NSC than low NSC, and horses fed two MPD tended (P = .092) to have higher baseline insulin concentrations than horses fed three MPD. In addition, baseline glucose-to-insulin ratio (GIR) was higher in horses fed high NSC compared with low NSC (P < .001). Horses fed high NSC had higher area under the curve of insulin and higher peak insulin after feeding than those fed low NSC. These findings suggest that NSC content of a concentrate feed has an impact on baseline insulin and GIRs and on postprandial insulin concentrations. Meanwhile, the number (and therefore size) of MPD had fewer impacts on glucose metabolism.     

Assessment of Insulin and Glucose Dynamics by Using an Oral Sugar Test in Horses

Straightforward testing procedures are needed to facilitate the diagnosis of insulin dysregulation in horses because hyperinsulinemia and insulin resistance are associated with laminitis. Results of an oral sugar test (OST) were compared with those of the intravenous glucose tolerance test (IVGTT). We hypothesized that OST and IVGTT area under the curve values for glucose (AUCg) and insulin (AUCi) would be closely correlated, as defined by a correlation coefficient value ≥0.90. Both tests were performed in 10 horses meeting the criteria for equine metabolic syndrome (EMS) and 8 Quarter horse crossbred mares from a university teaching herd (control group). The OST was also performed in 21 Quarter horse crossbred mares from the same herd, and test repeatability was evaluated in 8 of these horses. All testing was performed under fasting conditions. Median AUCg and AUCi values were 1.3- and 9.0-fold higher, respectively, for the IVGTT and 1.3- and 6.8-fold higher, respectively, for the OST in the EMS group than those in the control group. AUCg (Spearman correlation coefficient [r_s] = 0.58; P = .012) and AUCi (r_s = 0.90; P < .001) values for the two tests were positively correlated. Mean ± SD coefficients of variation for repeated tests in 8 mares were 6.4% ± 3.1% and 45.1% ± 36.2% for AUCg and AUCi, respectively. We conclude that OST and IVGTT insulin results are closely correlated, so the OST warrants further consideration as a field test for insulin dysregulation in horses.     

Assessment of Resting Insulin and Leptin Concentrations and Their Association With Managerial and Innate Factors in Horses

The purpose of this study was to determine how insulin and leptin concentrations varied in a large population of privately owned horses. Further, the study was designed to examine the relationships between insulin and leptin with innate (sex, age, breed) and managerial (diet, exercise) factors in these horses. Resting blood samples (for determination of glucose, insulin, and leptin concentrations), body condition scores, feed information, and health history were collected from 366 privately owned horses. In this group of horses, 48% were considered overweight (Body Condition Score ≥6) and 8% were considered hyperinsulinemic (insulin concentrations >30 μU/mL). Confirming the findings of studies within research herds, both insulin and leptin concentrations were found to be correlated with body condition score (P < .001). It was also found that geldings had higher insulin concentrations than mares (P < .05). Ponies were found to have higher insulin and leptin concentrations as well as higher body condition scores, than several other breeds examined. While not a specific measure of insulin sensitivity, resting insulin concentrations have been associated with quantitative measurements of insulin sensitivity and may be useful in large-scale studies for estimating insulin and glucose dynamics. Because of the association between insulin resistance and obesity with diseases such as laminitis, the findings of the present study may help owners identify horses that may be at risk for the development of such conditions.     

The Effects of Nonstructural Carbohydrate Content and Feeding Rate on Glucose and Insulin Response to Meal Feeding in Equine

The following research encompassed two experiments and involved feeding horses two isocaloric diets (diet A and diet B), with an approximate 50% difference in nonstructural carbohydrate (NSC) content. There were three main objectives: first, to test the hypothesis that feeding an approximately 50% lower NSC concentrate feed would cause a lower glucose and insulin response; second, to test the hypothesis that feeding meals equal in NSC content would create similar responses in glucose and insulin dynamics; and finally, to test the hypothesis that the time spent eating is correlated with glucose/insulin response. In experiment 1, in which diet A and diet B were fed at the same rate, the main finding was that feeding a meal lower in NSC resulted in a lower glucose and insulin response to the feed. In experiment 2, in which the effects of feeding diets A and B at a rate to provide 0.3 g/kg body weight (BW) NSC per meal were explored, the main finding was that, although glucose responses were similar, the meal containing more NSC/kg and fed at the lower rate resulted in a substantially lower insulin response. Consumption time also was found to be significantly different between treatments.In conclusion, a low NSC formulation and small meal size appear to be sensible recommendations for horses that may benefit from a low glucose and insulin response to feeding. In addition to NSC content, meal size, and nutrient:calorie ratio, nutrient requirements of the individual horse and the entire nutritional balance of the diet also should be addressed.     

Glucose and insulin responses to different dietary energy sources in Thoroughbred broodmares grazing cool season pasture

The objectives of this study were to characterize the glycemic and insulinemic responses of Thoroughbred broodmares fed late spring pasture only or a mixture of pasture and a high starch or low starch feed and to test hypotheses about differences in the glycemic and insulinemic effects of these dietary regimes. A group of 15 mares were divided into three treatment groups; pasture and high starch feed (PHS), pasture and low starch feed (PLS), and pasture only (PO) and maintained in these groups for 4.5 months prior to this study. These groups were maintained on a single pasture that was temporarily divided into three sections. The study protocol was conducted over two days. On day 1 the mares were fed their respective treatments and on day 2 all mares were allowed access to pasture only. On both days plasma glucose and insulin were measured in samples taken over a 7.5 h period. Baseline measurements for glucose and insulin were not different between any of the treatment groups on either day (P > 0.05). The baseline insulin concentrations of these pasture-kept mares (26.7 ± 8.3 mIU/L) were high compared to those reported from stall-kept horses. Plasma glucose and insulin on day 1 were influenced by treatment group, sample time, and an interaction between treatment and time (P < 0.05). On day 2 there was no significant influence of treatment group (P > 0.05). Glucose and insulin rose to higher (P < 0.01) peak concentrations in the PHS group on day 1 when compared to the PLS and PO groups, with no difference (P > 0.05) detected between the PLS and PO groups. These results are reflected in greater areas under the concentration-time curves for glucose and insulin in the PHS group on day 1 (P < 0.05). On day 2 there were no differences in any of the glucose and insulin characteristics for any of the treatment groups (P > 0.05). These results indicate a clear difference in the glycemic and insulinemic effect of the PHS feed compared to the PLS and PO groups. Of further interest are the glucose and insulin characteristics of these pasture-kept mares that indicate a low insulin sensitivity and high insulin secretory response. This study provides further information on factors influencing glycemic and insulinemic responses in horses.     

Insulin Sensitivity in Thoroughbred Geldings: Effect of Weight Gain,Diet, and Exercise on Insulin Sensitivity in Thoroughbred Geldings

The effects of dietary energy source, controlled weight gain, and exercise restriction on insulin sensitivity (SI) were studied in mature Thoroughbred geldings with body condition scores (BCS) of 4.3 ± 0.1. Two dietary energy sources were used, one high in starch and sugar (HS; n = 9) and one high in fat and fiber (HF; n = 7), and horses were fed 20 Mcal digestible energy (DE)/day above maintenance requirements to encourage weight gain. Using the minimal model of glucose and insulin dynamics, no differences in SI between groups were noted before initiation of treatment concentrate feeding. After dietary acclimation, SI was decreased in HS (P < 0.01) as compared with HF. After 32 weeks of controlled weight gain (90.8 kg; final BCS, 7.0 ± 0.1), SI remained lower in HS (P = 0.07) but did not change from the preweight gain value. SI in HF did not change between the start and end of weight gain. After completion of weight gain, exercise was restricted for 2 weeks, resulting in a reduction in SI in HF (P = 0.03) but no change in HS. It was concluded that dietary energy source may be more influential than weight gain on SI in the mature Thoroughbred gelding between BCS 4 and 7. The higher SI found in horses consuming the HF diet appeared to be partially dependent on some level of physical activity.     

Comparison of Insulin and Glucose Metabolism in Horses with Pituitary Pars Intermedia Dysfunction Treated Versus Not Treated with Pergolide

Equine pituitary pars intermedia dysfunction (PPID) is known to alter glucose/insulin metabolism. This study evaluated changes in parameters relating to glucose/insulin metabolism and determined whether there is a difference between pergolide-treated and untreated animals. We hypothesized that glucose/insulin dynamics in PPID horses receiving pergolide would be different than those in untreated horses. A total of 38 horses with diagnoses of PPID were included in the study (average age: 24 years). A total of 25 horses were untreated; 13 horses were treated with pergolide (>3 months). Parameters relating to glucose/insulin metabolism were determined in all horses, as follows: adrenocorticotropin-releasing hormone (ACTH), insulin, fructosamine, triglyceride, glucose, modified insulin-to-glucose ratio (MIRG), and reciprocal of the square root of insulin (RISQI). A combined glucose-insulin test (CGIT) was performed in 23 horses as not all owners agreed to the testing. Treated animals showed a tendency to have lower ACTH, but results were not significant. All animals had fructosamine levels exceeding reference values (mean value 314 ± 32 μmol/L; reference range: <280 μmol/L). There were no statistically significant differences between insulin, glucose, ACTH, triglycerides concentrations, RISQI/MIRG calculations, and CGIT results of pergolide-treated PPID and those of untreated horses. Five horses (13.2%) had combined hyperglycemia/hyperinsulinemia, whereas 7 horses (18.4%) displayed hyperglycemia, and 3 horses (7.9%) showed hyperinsulinemia alone. Forty percent of the horses with altered glucose/insulin metabolism were treated with pergolide. Based on RISQI and MIRG calculations, 19 animals displayed changes in glucose/insulin metabolism. Fourteen of twenty-three horses (61%) showed signs of insulin resistance in CGIT results. In conclusion, PPID horses frequently show alterations in glucose/insulin metabolism, but no significant differences were found between treated and untreated animals. Changes in insulin/glucose dynamics may not be a useful indicator of response to pergolide treatment.     

Glycemic and Insulinemic Responses Are Affected by Age of Horse and Method of Feed Processing

The objective of this study was to examine age-related differences in glycemic and insulinemic responses of horses that were fed various feedstuffs, with particular attention to method of feed processing. A 16 × 16 Latin square design was used with eight 2-year-olds and eight mature Arabians. Horses were maintained on a roughage diet and were subjected to a glycemic response test once weekly. A control treatment consisted of an oral dextrose drench (0.25 g dextrose/kg of BW). Ten treatments consisted of variously processed feed ingredients fed at the rate of 1.5 g/kg of BW. Five other treatments were commercial feeds of a proprietary nature and are not reported. Fasting blood samples were taken once a week for 16 weeks. Thirty minutes later, another baseline sample was taken and horses were administered their respective treatment. Further blood samples were taken every 30 minutes through four hours. Samples were analyzed for glucose and insulin concentrations. Differences in glucose response between 2-year-olds and mature horses were minimal. However, mature horses had a higher insulin response (P < .01) suggesting young horses had greater insulin sensitivity. Additionally, differences (P < .05) existed between treatments with pelleted steam-processed corn having the highest glycemic response and cracked corn the lowest. Results from this study confirm that mature horses have reduced insulin sensitivity and that both glycemic and insulinemic responses are altered with feed processing techniques. Thermal processing produces the greatest response; however, a low glycemic response may not be desirable if starch escapes into the hindgut.     

Correlation of Plasma Insulin Concentration with Laminitis Score in a Field Study of Equine Cushing's Disease and Equine Metabolic Syndrome

This study aimed to investigate endocrinologic test values and the response to treatment of two commonly encountered causes of endocrinopathic laminitis, equine Cushing's disease (ECD) and equine metabolic syndrome (EMS), in a veterinary practice setting. In particular, the study aimed to determine whether insulin concentration correlated to the severity of clinical laminitis in horses with EMS or ECD. Twenty-five horses were included in the study and assigned to one of three groups: ECD (n = 6), EMS (n = 10), and controls (n = 9). Blood samples were collected at an initial visit and then at regular intervals for the next 12 months. Plasma concentrations of adrenocorticotropin (ACTH), cortisol, and insulin and serum concentrations of glucose and total thyroxine (T4) were obtained. Horses with ECD had significantly higher plasma ACTH concentrations than EMS horses or controls. Horses with EMS and ECD both had significantly higher plasma insulin concentrations than control horses, which was correlated with the Obel grade of laminitis (r = 0.63). After treatment, there was a trend for a reduction in plasma ACTH concentration in horses with ECD. A program of diet and exercise for horses with EMS resulted in reductions in both plasma insulin concentrations and bodyweight, which was variable, depending on the individual. There was a significant correlation between the change in plasma insulin concentration and Obel grade of laminitis (r = 0.69). This study has highlighted the importance of baseline plasma insulin concentration as a potential indicator of the susceptibility of horses to laminitis and the response to a program of diet and exercise.     

Effects of Epinephrine,Detomidine, and Butorphanol on Assessments of Insulin Sensitivity in Mares

Sympathoadrenal stimulation may perturb results of endocrine tests performed on fractious horses. Sedation may be beneficial; however, perturbation of results may preclude useful information. Four experiments were designed to 1) determine the effects of epinephrine on insulin response to glucose (IR2G), 2) assess the effects of detomidine (DET), alone or combined with butorphanol (DET/BUT), on IR2G and glucose response to insulin (GR2I), and 3) assess the effects of BUT alone on IR2G. In Experiment 1, mares were administered saline or epinephrine (5 μg/kg BW) immediately before infusion of glucose (100 mg/kg BW). Glucose stimulated (P < .05) insulin release in controls at 5 minutes that persisted through 30 minutes; insulin was suppressed (P < .05) by epinephrine from 5 to 15 minutes, rising gradually through 30 minutes. Experiments 2 (IR2G) and 3 (GR2I) were conducted as triplicated 3 × 3 Latin squares with the following treatments: saline (SAL), DET, and DET/BUT (all administered at .01 mg/kg BW). Glucose stimulated (P < .05) insulin release that persisted through 30 minutes in SAL mares; DET and DET/BUT severely suppressed (P < .0001) the IR2G. Sedation did not affect resting glucose and had inconsistent effects on the GR2I when mares were treated with 50 mIU/kg BW recombinant human insulin. Butorphanol had no effect on IR2G. In conclusion, adrenergic agonists severely suppress the IR2G and cannot be used for sedation for this test. The use of DET did not alter the GR2I, and therefore may be useful for conducting this test in fractious horses.     

Psyllium Lowers Blood Glucose and Insulin Concentrations in Horses

A total of 16 mature healthy horses (body weight: 515.3 ± 37 kg [mean ± SD]) were used in two experiments to determine (1) how psyllium affects postprandial blood glucose and insulin concentrations, and (2) how psyllium affects blood glucose and insulin concentrations after an intravenous glucose infusion. Psyllium was fed along with a grain and hay ration (given twice daily) for 60 days. Treatments were as follows: (1) 90 g psyllium/d, (2) 180 g psyllium/d, (3) 270 g psyllium/d, (4) an isocaloric, no supplemental psyllium control. Pre- and postprandial blood samples were collected on day 60 for experiment 1, and blood samples collected before and after intravenous glucose infusion were analyzed for experiment 2. In experiment 1, horses fed with psyllium for 60 days had lower (P < .01) mean postprandial blood glucose concentrations and there was a treatment × time effect for glucose (P < .001) and insulin (P = .03). Plasma glucose was lower at 90 minutes (P = .05) and 120 minutes (P < .001) after a meal in horses fed with psyllium as compared with an isocaloric control. Postprandial serum insulin concentrations were lower at 90 minutes (P = .002) and 300 minutes (P < .001) after a meal in horses fed with psyllium as compared with an isocaloric control. In experiment 2, peak glucose concentrations were lower (P = .01) in horses fed with psyllium for the previous 60 days compared with untreated horses and there was a treatment by time effect for glucose (P = .05). Peak blood glucose response was lower (P = .01) in horses fed with psyllium as compared with an isocaloric control after intravenous glucose infusion, whereas peak insulin concentrations and average insulin concentrations remained similar. Psyllium fed daily for 60 days alters postprandial glycemia and insulinemia in normal, nonobese, and unexercised horses.     

Investigation of the Effects of a Dietary Supplement on Insulin and Adipokine Concentrations in Equine Metabolic Syndrome/Insulin Dysregulation

High insulin concentrations are a common clinical feature of equine metabolic syndrome (EMS) and insulin dysregulation. Hyperinsulinemia can induce laminitis, so reduction of insulin concentrations in response to an oral challenge should decrease risk. In human studies, diets containing a polyphenol (resveratrol) led to improvements in insulin sensitivity. In rodents, the addition of leucine to a resveratrol supplement caused a decrease in the amount of resveratrol needed to achieve a clinical effect. We hypothesize a supplementation with a low dose of a synergistic polyphenol and amino acid blend including leucine (SPB+L) would improve metabolic health in EMS/insulin dysregulated horses. Fifteen EMS/ID horses received a high or low dose of SPB+ L daily for 6 weeks. Insulin during an oral sugar test (OST), body condition score, weight, baseline high-molecular-weight (HMW) adiponectin, triglycerides, nonesterified fatty acids, and tumor necrosis factor alpha were assessed before supplementation (PRE) and after supplementation (POST) via paired Student’s t-tests and a repeated-measures mixed-model analysis of variance (significant at P < .05). There were no differences between doses. Horses in the POST group weighed significantly less, had significantly higher baseline HMW adiponectin concentrations, and had significantly lower insulin concentrations at 60- and 75-minute time points (P < .05). Insulin concentrations of the horsesin the POST group, but not in the PRE group, were lower and similar to results from the study conducted three years before the present study (PRIOR) for 0- and 60-minute time points (P < .002). An increased HMW adiponectin level supports increasing insulin sensitivity after supplementation. These results suggest that SPB + L supplementation at either dose leads to improvements in the clinical manifestations of EMS/insulin dysregulation, potentially reducing laminitis risk.     

Novel findings regarding Glut-4 expression in adipose tissue and muscle in horses--a preliminary report

One of the hallmarks of insulin resistance is a reduction in glucose transporter-4 (Glut-4) expression in adipose tissue but not in skeletal muscle. However, while Glut-4 has been demonstrated in skeletal and cardiac muscles in horses it has not been demonstrated in adipose tissue. The initial objectives of the present study were: (1) to test the hypothesis that Glut-4 expression would vary between selected key skeletal muscles; (2) to test the hypothesis that it would also vary between representative adipose tissue depots, and (3) to see whether expression would be greater in adipose tissue compared to muscle. Glut-4 expression was determined by Western blot using samples obtained from post mortem biopsies obtained from four muscles (gluteus medius, semitendinosus, heart, and diaphragm), and four adipose tissues (subcutaneous, retroperitoneal, mesenteric, and omental) in three horses. There were no differences (P>0.05) in Glut-4 protein expression between the muscles sampled. Likewise there were no differences (P>0.05) in Glut-4 protein expression between fat depots. There was a significant difference (P=0.03) when pooled means for Glut-4 expression in muscle (58.8+/-2.5 densitometry units) were compared with adipose tissue (115.8+/-15.7). This difference in Glut-4 expression in these two tissues with distinctly different metabolic reasons for taking up glucose may warrant further investigation to see if there are more pronounced differences in Glut-4 expression in muscle and adipose tissue in various populations of horses.     

Equine Metabolic Syndrome

Equine metabolic syndrome (EMS) is important because of its association with laminitis. Obesity and insulin resistance are two important components of EMS, and the underlying cause of this syndrome is likely to be enhanced metabolic efficiency. Affected horses are often referred to as “easy keepers” because they require fewer calories to maintain body condition, and enhanced metabolic efficiency is an inherent risk factor for EMS that may be genetically determined. Pony breeds, Morgan horses, and Paso Finos are predisposed to EMS, but this problem can be prevented through effective management. Overfeeding, abundant pasture grass, and inadequate exercise are risk factors that relate to modern management practices. Obesity and adiposity induce insulin resistance, and recent research suggests that this is the determinant of laminitis susceptibility in ponies. Increased plasma insulin concentrations are detected in most affected horses and ponies, so this serves as a useful screening test for EMS. Physical characteristics also should be examined because horses with EMS exhibit regional adiposity in the form of a cresty neck or abnormal adipose tissue deposits close to the tailhead. All horses with enhanced metabolic efficiency, obesity, or regional adiposity should be screened for EMS. The combined intravenous glucose−insulin test can be performed to diagnose insulin resistance in mildly affected horses and quantify insulin sensitivity. Most horses with EMS can be effectively managed by reducing caloric intake, decreasing the starch and sugar content of the diet, increasing exercise, and limiting or eliminating access to pasture, but medical therapy is warranted in select cases.     

Characterization of Glucose Response Curves after Insulin Injection in Sensitive versus Insensitive Mares

The glucose responses to intravenous injections of a range of doses of recombinant human insulin were determined for six mares known to be insulin sensitive and six mares known to be insulin insensitive, with the goal of better characterizing the regression lines resulting from the two categories of mares. Insulin doses between 8 and 198 mU of insulin per kg of body weight (mU/kg BW) were administered intravenously between September 13 and 26, 2010, starting with 50 mU/kg BW on the first day. Higher and lower doses were administered on alternate days to obtain percentages of decreases in blood glucose concentrations between 10% and 70%. Linear regression analysis revealed that insulin-insensitive mares have glucose response curves with higher y intercepts (P = .066), less steep slopes (P = .0003), and less goodness of fit (P = .053) in addition to the expected greater dose required to produce a 50% reduction in blood glucose concentrations (ED50; P = .006), despite the similarities between their body weights and those of insulin-sensitive mares. Linear and nonlinear regression of responses to the 32, 50, and 79 mU/kg BW insulin doses with the overall estimates of ED50 and the natural log of ED50 indicated that the 50 mU/kg BW dose had the greatest coefficient of determination (>0.95). Generally, it appears that estimates of insulin sensitivity based on a single injection of insulin or on multiple injections of insulin are least variable for insulin-sensitive mares.     

Glucose homeostasis and the enteroinsular axis in the horse: A possible role in equine metabolic syndrome

One of the principal components of equine metabolic syndrome (EMS) is hyperinsulinaemia combined with insulin resistance. It has long been known that hyperinsulinaemia occurs after the development of insulin resistance. But it is also known that hyperinsulinaemia itself can induce insulin resistance and obesity and might play a key role in the development of metabolic syndrome. This review focuses on the physiology of glucose and insulin metabolism and the pathophysiological mechanisms in glucose homeostasis in the horse (compared with what is already known in humans) in order to gain insight into the pathophysiological principles underlying EMS. The review summarizes new insights on the oral uptake of glucose by the gut and the enteroinsular axis, the role of diet in incretin hormone and postprandial insulin responses, the handling of glucose by the liver, muscle and fat tissue, and the production and secretion of insulin by the pancreas under healthy and disrupted glucose homeostatic conditions in horses.