03/02/2026
Thank you Dr. Sammy Pittman for explaining the risks of laminitis due to high insulin levels and its link to corticosteroid use in horses. Know if your horse is at risk with the FIRST and ONLY stall-side whole blood insulin test for horses.
🚨 Steroids, Insulin, and Lamellar Structural Failure: What New Research Means for Our Horses 🚨
As many of you know, at our clinic we frequently discuss the risks associated with corticosteroid use—especially in horses with underlying metabolic risk. A large number of our lamellar structural failure cases each year are steroid-associated.
In many of these horses, the metabolic dysfunction was likely subclinical… until the steroid pushed them over the edge.
📚 Recent Research Adds Important Insight
A recent prospective, controlled crossover study evaluated the effect of the SGLT2 inhibitor ertugliflozin on insulin response after intra-articular corticosteroid administration.
Study Summary
8 metabolically normal geldings
Received intra-articular triamcinolone (18 mg)
Compared no treatment vs. 7 days of ertugliflozin before and after injection
Measured resting glucose, resting insulin, and oral sugar test (OST) responses
Key Findings:
✔ Insulin significantly lower 2 days after steroid injection with SGLT2 inhibitor
✔ Resting glucose significantly lower at 8–48 hours
✔ Resting insulin significantly lower at 12–72 hours
✔ Suggests reduced hyperinsulinemic response after steroid administration
Even in metabolically normal horses, insulin and glucose responses were blunted with SGLT2 inhibition.
The authors concluded that further investigation in insulin dysregulated horses is warranted — particularly regarding laminitis risk reduction.
🧬 Why This Matters Clinically
⚠ Hyperinsulinemia = Lamellar Risk
We now understand that hyperinsulinemia alone can induce lamellar pathology, even in the absence of systemic inflammation. Steroids can:
Increase insulin concentrations
Worsen underlying insulin dysregulation
Trigger lamellar structural failure
In horses with:
Equine metabolic syndrome
Regional adiposity (cresty neck, fat pads)
Obesity
Previous laminitis
Subclinical insulin dysregulation
…the addition of corticosteroids may be enough to initiate failure at the lamellar interface.
🐴 Equine Metabolic Syndrome (EMS)
Equine Metabolic Syndrome is characterized by:
Insulin dysregulation
Regional adiposity
Increased laminitis risk
Many performance horses today are:
Easy keepers
Over-conditioned
Fed high NSC diets
Exercised inconsistently
And importantly — some appear outwardly normal but have abnormal insulin dynamics.
💉 Steroids and the “Metabolic Push”
We use corticosteroids for:
Joint inflammation
Soft tissue injury
Respiratory disease
Allergic conditions
But steroids:
Increase insulin concentrations
Reduce peripheral glucose utilization
Can unmask latent metabolic dysfunction
In our practice, many steroid-associated lamellar structural failure cases are not classic “Cushing’s horses.”
They are subclinical metabolic horses that decompensate after steroid exposure.
💊 Where SGLT2 Inhibitors Fit
SGLT2 inhibitors:
Promote urinary glucose excretion
Reduce circulating glucose
Lower insulin concentrations
Improve insulin dynamics
Over the past few years, we have recommended SGLT2 inhibitors in suspect metabolic cases, particularly:
Prior to or surrounding steroid use
In known insulin dysregulated horses
In high-risk laminitis patients
This new research supports that strategy — showing measurable reduction in insulin and glucose changes even in metabolically normal horses.
🔎 Practical Take-Home Points
✔ Not all metabolic horses look obviously metabolic
✔ Steroids can induce hyperinsulinemia
✔ Hyperinsulinemia drives lamellar structural failure
✔ SGLT2 inhibitors may reduce steroid-associated insulin spikes
✔ Screening (resting insulin + oral sugar testing) matters
🧠 Our Philosophy
We are not anti-steroid.
We are anti-uninformed risk.
Every decision should be:
Mechanically informed
Metabolically informed
Individualized
If your horse requires corticosteroids, especially if:
Overweight
Previously laminitic
Cresty
Has regional adiposity
…let’s discuss metabolic screening and risk mitigation strategies.
Because when it comes to lamellar structural failure, prevention is always easier than rehabilitation.
— Dr. Sammy L. Pittman
Innovative Equine Podiatry & Veterinary Services
Helping Your Help Horses — From the Ground Up 🐴
