30/11/2025
Really useful post x
🎓Understanding Laminitis: Why No Evidence-Based Treatment Choice Should Carry Stigma
Laminitis for many years has been stigmatised, even to the point owners will fail to disclose episodes when selling a horse.
Using medications like ertugliflozin (or other “flozin SGLT2” inhibitors) to help manage laminitis should also not carry stigma.
Ertugliflozin can allow equines with metabolic disease to live normal lives on pasture (restricted such as stripped grazed or with grazing muzzles).
The best thing about Ertugliflozin (currently being widely used off label) is that not only can it rapidly bring symptomatic metabolic disease under control, there is increasing veterinary evidence that it can also be “protective” in the sense that equines that have blood test results indicating very early stages of metabolic disease (e.g slight increase insulin but no evidence of laminitis), if placed on Ertugliflozin may never go on to develop laminitis despite remaining at pasture (controlled as above). These equines often have to remain on Ertugliflozin to enable this. If you have one of these equines and don’t have access to a track, this could be a good option for you.
Equines that you hear of that are stabled yet do not start to recover from laminitis likely have metabolic disease which is still out of control and for these horses eating inappropriate hay can be enough to maintain symptomatic disease. Hay/haylage is not necessary “safer” for equines with metabolic disease which is out of control. If you cannot change hay supplier you can use Ertugliflozin. There are ways to work with what you have available to you.
Ertugliflozin works by blocking a protein in the kidney called SGLT2, which is responsible for reabsorbing glucose (sugar) back into the bloodstream. The effect is that glucose is excreted via the urine.
Laminitis is a complex medical condition, and no single approach works for every horse.
Ertugliflozin is one of several scientifically explored options that veterinarians may consider when appropriate. Choosing this medication isn’t a sign of failure—it’s a decision made out of responsibility, care, and a desire to give a horse the best chance at comfort and recovery.
Managing laminitis requires compassion, evidence-based guidance, and open discussion, not judgment.
When owners feel safe talking about all available options with their veterinarians, horses benefit from better outcomes and a more supportive community.
Meier, A., Reiche, D. B., de Laat, M. A., Pollitt, C. C., Walsh, D. M., & Sillence, M. N. (2018).
The sodium-glucose co-transporter 2 inhibitor velagliflozin reduces hyperinsulinemia and prevents laminitis in insulin-dysregulated ponies. PLoS One, 13(9), e0203655. https://doi.org/10.1371/journal.pone.0203655
Meier, A., de Laat, M. A., Reiche, D. B., Sillence, M. N., & Walsh, D. M. (2019).
The efficacy and safety of velagliflozin over 16 weeks as a treatment for insulin dysregulation in ponies. BMC Veterinary Research, 15, 65. https://doi.org/10.1186/s12917-019-1811-2
Sundra, T., Kelty, E., & Rendle, D. (2023).
Preliminary observations on the use of ertugliflozin in the management of hyperinsulinaemia and laminitis in 51 horses. Equine Veterinary Education, 35(6), 311–320. https://doi.org/10.1111/eve.13738
Menzies-Gow, N. J., & Knowles, E. J. (2024).
Sodium-glucose transport protein 2 inhibitor use in the management of insulin dysregulation in ponies and horses. Equine Veterinary Journal. https://doi.org/10.1111/evj.14047
Lindåse, S., Nostell, K., Forslund, A., Bergsten, P., & Bröjer, J. (2023).
Short-term effects of canagliflozin on glucose and insulin responses in insulin-dysregulated horses: A randomized, blinded, placebo-controlled study. Domestic Animal Endocrinology, 87, 106940. https://doi.org/10.1016/j.domaniend.2023.106940
