insulin dysregulation is commonly seen in horses with ems, and is associated with obesity. this is similar to type ii diabetes in humans, where the action of insulin is impaired, despite often elevated concentrations. it is of interest primarily because of its link to laminitis. horses with ems will have an increased insulin response after they are given oral sugars, which will cause a subsequent rise in blood insulin levels, or hyperinsulinemia. hyperinsulinemia results in decreased tissue sensitivity to insulin, or insulin resistance, especially by the skeletal muscle, liver and adipose tissue. tissue insulin resistance causes increased insulin secretion, which perpetuates the cycle.