Effects of age on serum glucose and insulin concentrations and glucose/insulin ratios in neonatal foals and their dams during the first 2 weeks postpartum

Intra-articular triamcinolone acetonide injection results in increases in systemic insulin and glucose concentrations in horses without insulin dysregulation

BACKGROUND

Corticosteroids are a commonly used, inexpensive intra-articular treatment for osteoarthritis which may increase the risk for laminitis in horses due, in part, to hyperinsulinaemia. Humans with metabolic syndrome experience increases in insulin and glucose concentrations post-injection, but responses in horses are unknown.

OBJECTIVES

To determine the effect of a single intra-articular (IA) dose of triamcinolone acetate (TA) on blood insulin and glucose concentrations.

STUDY DESIGN

Before-after study.

METHODS

Ten horses with normal insulin regulation as assessed by an oral sugar test received 18 mg of TA into one middle carpal joint. Insulin and glucose concentrations were evaluated at baseline and 4, 6, 8, 24, 48, and 72 h following IA corticosteroid injection. Differences from baseline were evaluated using a repeated measures ANOVA with Dunnett's multiple comparison testing or a Friedman test with Dunn's correction (significant at p < 0.05).

RESULTS

Mean ± SD blood insulin concentration post IA TA injection was increased at 6 h (15.8 ± 3.1 μIU/mL, p = 0.01), 24 h (23 ± 5.8 μIU/mL, p ≤ 0.001), and 48 h (29 ± 13 μIU/mL, p ≤ 0.01) compared to baseline (10 ± 12.3 μIU/mL), with the peak at 48 h. Median ± 95% CI blood glucose concentration post IA TA injection was increased at 6 h (112.7 ± 20.3 mg/dL, p = 0.006), 8 h (112.9 ± 21.4 mg/dL, p = 0.004), 24 h (122.6 ± 14.6, p ≤ 0.0001), and 48 h (123.5 ± 15.4 mg/dL, p ≤ 0.0001) compared to baseline (89.2 ± 6.6 mg/dL), with the peak at 48 h.

MAIN LIMITATIONS

Only horses with normal insulin regulation were evaluated.

CONCLUSIONS

Blood insulin and glucose concentrations modestly increased for 48 h following IA TA.

Hematology and clinical chemistry in mule foals from birth to two months of age: A preliminary study

In horses and donkeys, age-related changes in hematological and biochemical parameters preclude the use of normal values of adults in the evaluation of foals. This study aimed to obtain data on hematological and biochemical parameters of mule foals from birth up to the second month of life and to assess age-related changes in order to determine if dedicated reference ranges are required in younger animals. Blood samples from seven healthy mule foals were obtained at birth before colostrum consumption, 24 h, 48 h of life, and then weekly until the second month of life. Results were expressed as mean and standard deviation or median, minimum, and maximum values if showing non-gaussian distribution. Kruskal-Walls and Dunn tests were used to verify the differences among sampling times. Significance was set at P < 0.05. Red blood cell count, packed cell volume and hemoglobin decreased from 24 h to one week of age. Mean corpuscular volume and mean corpuscular hemoglobin decreased over the first month. White blood cells increased from birth to seven days of life. Aspartate amino transferase increased while alkaline phosphatase decreased in the first week of life. Urea, creatinine, and lactate decreased, while glucose concentrations increased at 24 h. Ionized calcium and magnesium and total sodium and potassium showed no changes. In mule foals, several laboratory parameters may be the same or intermediate, lower or higher than in equine or donkey foals, but also compared to all other adult species. The preliminary results suggest that for mule foals, age influences hematological and biochemical parameters.

Clinical evaluation of the Immulite® 1000 chemiluminescent immunoassay for measurement of equine serum insulin

Introduction

Accurate quantitative analysis of equine insulin in blood samples is critical for assessing hyperinsulinemia in horses. Although there are various laboratory methods for evaluating equine serum insulin, different immunoassays show significant discrepancies between the determined insulin concentrations and are often not comparable. The aim of this study was to evaluate the Immulite® 1000 chemiluminescent immunoassay (CLIA) to establish independent laboratory and assay-specific cut values to provide an accurate diagnosis of hyperinsulinemia in horses. Thus, the analytical and clinical performance of Immulite® 1000 CLIA in terms of precision (intra- and inter-assay coefficient of variance, CV) and recovery upon dilution were evaluated and compared with radioimmunoassay (RIA), which has been previously validated for use in horses.

Material and methods

Archived serum samples (n = 106) from six Quarter horse mares enrolled in the glucose phase of a Frequently Sampled Insulin and Glucose Test (FSIGT) study were used to measure blood insulin.

Results

The Immulite® 1000 CLIA had good precision with acceptable intra- and inter-assay CVs, adequate recovery on dilution, and a strong correlation with the RIA (r = 0.974, P &lt; 0.0001), with constant bias resulting in consistently lower values.

Discussion

On this basis, the Immulite® 1000 Insulin Assay is valid for measuring equine serum insulin for diagnostic and monitoring purposes when cut values are appropriately adjusted.

Energy endocrine physiology, pathophysiology, and nutrition of the foal

Most homeostatic systems in the equine neonate should be functional during the transition from intra- to extrauterine life to ensure survival during this critical period. Endocrine maturation in the equine fetus occurs at different stages, with a majority taking place a few days prior to parturition and continuing after birth. Cortisol and thyroid hormones are good examples of endocrine and tissue interdependency. Cortisol promotes skeletal, respiratory, cardiovascular, thyroid gland, adrenomedullary, and pancreatic differentiation. Thyroid hormones are essential for cardiovascular, respiratory, neurologic, skeletal, adrenal, and pancreatic function. Hormonal imbalances at crucial stages of development or in response to disease can be detrimental to the newborn foal. Other endocrine factors, including growth hormone, glucagon, catecholamines, ghrelin, adipokines (adiponectin, leptin), and incretins, are equally important in energy homeostasis. This review provides information specific to nutrition and endocrine systems involved in energy homeostasis in foals, enhancing our understanding of equine neonatal physiology and pathophysiology and our ability to interpret clinical and laboratory findings, therefore improving therapies and prognosis.

Comparison of insulin sensitivity between healthy neonatal foals and horses using minimal model analysis

The equine neonate is considered to have impaired glucose tolerance due to delayed maturation of the pancreatic endocrine system. Few studies have investigated insulin sensitivity in newborn foals using dynamic testing methods. The objective of this study was to assess insulin sensitivity by comparing the insulin-modified frequently sampled intravenous glucose tolerance test (I-FSIGTT) between neonatal foals and adult horses. This study was performed on healthy neonatal foals (n = 12), 24 to 60 hours of age, and horses (n = 8), 3 to 14 years of age using dextrose (300 mg/kg IV) and insulin (0.02 IU/kg IV). Insulin sensitivity (SI), acute insulin response to glucose (AIRg), glucose effectiveness (Sg), and disposition index (DI) were calculated using minimal model analysis. Proxy measurements were calculated using fasting insulin and glucose concentrations. Nonparametric statistical methods were used for analysis and reported as median and interquartile range (IQR). SI was significantly higher in foals (18.3 L·min^-1· μIU^-1 [13.4–28.4]) compared to horses (0.9 L·min^-1· μIU^-1 [0.5–1.1]); (p < 0.0001). DI was higher in foals (12 × 10³ [8 × 10³−14 × 10³]) compared to horses (4 × 10² [2 × 10²−7 × 10²]); (p < 0.0001). AIRg and Sg were not different between foals and horses. The modified insulin to glucose ratio (MIRG) was lower in foals (1.72 μIU_insulin²/10·L·mg_glucose [1.43–2.68]) compared to horses (3.91 μIU _insulin²/10·L·mg_glucose [2.57–7.89]); (p = 0.009). The homeostasis model assessment of beta cell function (HOMA-BC%) was higher in horses (78.4% [43–116]) compared to foals (23.2% [17.8–42.2]); (p = 0.0096). Our results suggest that healthy neonatal foals are insulin sensitive in the first days of life, which contradicts current literature regarding the equine neonate. Newborn foals may be more insulin sensitive immediately after birth as an evolutionary adaptation to conserve energy during the transition to extrauterine life.

Evaluation of Blood Glucose and Lactate Concentrations in Mule and Equine Foals

Information about mule physiology is scarce. Glucose and lactate serve as prognostic tools in neonates; thus, real-time evaluations would be beneficial. Our main objective was to measure glucose and lactate concentrations from healthy mule and equine foals from birth to 720 hours. Glucose and lactate concentrations were evaluated with a benchtop Randox Daytona analyzer (LAB) using plasma and with an Accutrend Plus system (ACP) using whole blood. Data were analyzed using PROC MIXED (P < .05), intraclass coefficient correlation and Bland-Altman analysis. Glucose and lactate concentrations from mule and equine foals were different when evaluated with LAB, but there was no difference when evaluated with ACP. Glucose pattern of variation, evaluated with both analyzers for mule and equine foals, had an increase, with subsequent decrease, whereas lactate pattern of variation had initial higher values with subsequent decrease. Intraclass coefficient correlation for glucose was low and moderate for lactate. Results of glucose and lactate with ACP from our experimental neonates were not highly correlated with LAB. However, the ACP had the same pattern of variation for glucose and lactate, thus can still be used clinically for immediate evaluations if the technique is standardized with the specific samples that will be used.