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ES Insulin dysregulation in horses: a new epidemic or a new perspective?
May 16, 2025
We expect veterinarians to act quickly and effectively — and often that is necessary. But with recurring conditions such as colic or gastric ulcers, I notice how often the fastest solution is chosen rather than the most sustainable one.
Too often I see horses that keep struggling. Not because their problem is complicated, but because nobody bothers to look beyond the protocol. Symptoms are treated, causes are left unaddressed. And meanwhile, the cycle of repetition just keeps going.
In this opinion piece, I share my critical yet respectful view of a system that has reached its limits. Not to point fingers, but to encourage cooperation — between veterinarian, owner, and specialist. Because a horse doesn't deserve symptom relief. It deserves understanding. And above all: real solutions.
I don't know about you, but I run into it more often than I'd like.
A horse with impaction colic. The cause? Dehydration. The treatment? A painkiller, an IV drip, a laxative. And boom, right back at it.
But how can you be sure that it was really dehydration?
I hear it regularly: “The cause of impaction colic is dehydration.”
Uh… no. Dehydration Kan be a cause of impaction colic — especially with limited water intake combined with dry, fibrous roughage. But it is certainly not the Only cause. And without further investigation, you simply don't know.
Other possible causes are poorly digestible hay, reduced intestinal motility, pain when chewing due to dental problems, too little exercise, and even stress.
Yet in practice, the same treatment is often resorted to without much hesitation, regardless of the cause. As if it doesn't matter where things go wrong, as long as the horse even is helped.
But a quick fix is not a solution. And a horse that keeps relapsing deserves more than just symptom management. Just as owners have a right to an explanation, not just repeat treatments without context.
A horse is not the sum of averages or a case study in a textbook. It is a living creature with a unique diet, management, and history. And therefore, potentially also its own distinct cause for its problem.
As a nutritional advisor, I see it happen too often: A horse that keeps struggling because people look at symptoms, not causes. Because they act according to protocol, without looking at the individual.
And yes—I understand that veterinarians are under enormous time pressure.
Let's be honest: as owners, we contribute to that ourselves as well.
We expect our veterinarian to be available 24 hours a day, 7 days a week — and preferably on site within ten minutes. We want quick solutions, preferably right away. But by doing so, we deny them the space to truly investigate, to pause and focus on causes rather than symptoms. We create that pressure ourselves. Unintentionally, but very real.
At the same time, we may also expect something in return. A veterinarian is to a horse what a general practitioner is to ourselves: an essential link, but not a specialist in everything. We cannot demand miracles — but we can demand honesty. And especially from veterinarians working within specialized disciplines or clinics, you can expect them to dare to say: “We don't know for sure yet. We need to look further.”
For nothing is more harmful than routine decisions presented as science.
A horse is not a clinical average. It is a living being with a unique metabolism, management, and medical history, and therefore also a unique cause for its symptoms.
Working symptomatically is sometimes necessary to avert a crisis. But if you stay stuck there, you create a vicious circle. And for anyone who wants the best for their horse, that feels like the problem is being kept alive rather than truly solved.
That is harsh. And I am not saying that to bash. But because we can all do better. By looking beyond the protocol. By working together – owner, veterinarian, relevant specialist. By continuing to ask: Why does this horse keep getting the same symptoms?
Because a horse doesn't deserve a band-aid. It deserves understanding.
A horse that has to return every three or six months with the same complaint – without in-depth research, without an adjusted strategy – that is not a treatment. That is a revenue model.
Let me be clear:
There are horses that are indeed seriously or complexly ill enough to be closely monitored. Regular check-ups are definitely appropriate there.
But I am talking here about the common conditions like stomach ulcers,
which are structurally treated symptomatically, without an objective diagnosis, without differentiation, without explanation to the owner.
Every veterinarian knows that EGUS (Equine Gastric Ulcer Syndrome) is not a straightforward diagnosis.
It is a collective term for two different types of stomach ulcers, depending on where in the stomach they are found:
ESGD (Equine Squamous Gastric Disease): ulcers in the upper, so-called squamous part of the stomach that is lined with a thin, sensitive mucous membrane. This part has no protection against stomach acid and is therefore extra vulnerable during stress, fasting, or high acidity.
EGGD (Equine Glandular Gastric Disease): ulcers in the lower, glandular part of the stomach that does contain glands that produce mucus and bicarbonate to buffer the stomach acid. Inflammation here is often more complex, deeper and more difficult to treat.
Both types differ in:
cause (mechanical vs. metabolic/inflammatory)
medication sensitivity (omeprazole is less effective in EGGD)
approach (management versus medication)
forecast
The the only reliable method to establish and correctly classify EGUS is a gastroscopy. That is scientifically well-founded and the global standard.
And yet...
Decisions to prescribe a course of omeprazole are often made based on visual assessment and intuition. Without a scope. Without analysis. Sort of like “Rennie for horses”, but with a price tag.
And then follows the next check-up. The next treatment cycle. The next invoice.
In human medicine, we also do not accept a patient repeatedly receiving medication without a diagnosis, solely based on suspicions.
Why do we think that is normal when it comes to horses? Because that is actually what happens. With horses. Time and time again.
What happens then?
Owners are getting frustrated.
They don't feel heard. Not helped. And so they look for alternatives.
They find this with supplements featuring vague claims, energy therapists, detox cures, blood and hair tests without any scientific basis, or coaches who are going to ‘scan’ the horse. Without any substantiation. But with a listening ear.
And I understand that.
When nobody is truly helping your horse, you grab onto anything that seems to help. Even if it makes no sense.
That is the real risk. Not that people want to make the wrong choices, but that they feel they have no other choice.
And that brings me to the core: The problem lies not only with individual veterinarians, but with a system that discourages cooperation.
In Belgium – and the Netherlands – the exclusive responsibility for medical decisions lies with the veterinarian — even nutritional advice is formally not allowed to be separate from this.
Legally understandable. But in practice, it leads to the exclusion of other expertises where they are actually needed: nutritionists, hoof trimmers, behavioral therapists, osteopaths…
He are vets who look further. Who take the time, listen, consult and investigate. are vets who are guided not by rules and prejudices, but by the animal. For them: all respect!
But in Belgium those are still exceptions. Not out of unwillingness, but because of a system in which the veterinarian must and may decide everything: As long as you are not a veterinarian, your knowledge is worth little—even if it is sound, scientifically grounded, and practically applicable.
That leads to pigeonholing. And that is not in the best interest of the horse.
I mentioned it earlier:
A horse is not a standard protocol.
Health is not a subscription model.
And symptom management is not a sustainable solution.
If we as owners, practitioners, and veterinarians continue to accept working on the basis of probability rather than veracity – if we continue to repeat without investigating, and continue to act as though a repeat prescription is sufficient as treatment – then we are no longer caregivers.
Then we are merchants of (false) hope instead of providers of solutions.
And no horse deserves that.
I am that woman who constantly loses her glasses, forgets her keys, never finds her phone. But my opinion? I always have it ready.
Half wolf, half woman - literally in my Facebook profile picture, figuratively in everything I do. I am someone of extremes. Intuitive and astute. Calm and storm. Silence and voice. Soft to what is vulnerable. Tough on what deliberately damages. I am not a perfect version of myself. An honest one, though.
I work with people, systems, food, chaos and vision. Sometimes with horses, often with principles. I believe in truth over diplomacy, and in nuance without wooliness.
Here I share what concerns me. What chafes, what moves, what knocks. Welcome to my head. It's a little wild there - but always real.
#more than power supply #MIRA