EQUINE VETERINARY J O U R N A L
Vol. 5. No. 4. Octohcr 1973
The Oral Glucose Tolerance Test
in the Horse
M. C. ROBERTS
F. W. G. HILL
Department of Veterinary Medicine, University of Bristol
ALIMENTARY DYSFUNCTION in the horse presents
many diagnostic difficulties to the clinician because of
the inaccessibility of the tract and the lack of available
tests to monitor the site and degree of dysfunction.
The oral glucose tolerance test (O.G.T.T.) could have
two functions in the horse, firstly to assess the mono-
saccharide transport mechanism across the enterocytes
of the small intestine at the same time determining
mucosal integrity, and secondly to assess pancreatic
endocrine function.
Glucose is actively and efficiently transported against a
concentration gradient across the small intestinal mucosa
by the combination of a sodium dependent glucose-
galactose specific carrier and an energy dependent
sodium pump (Holmes, 1971). Alexander (1955) re-
ported that glucose is wholly absorbed in the equine
small intestine, and under natural conditions the glucose
available to the horse will be provided by the digestion
of dietary polysaccharides and oligosaccharides. The
normal alimentary response to glucose is thus dependent
on an intact functioning small intestinal mucosa.
This paper describes an O.G.T.T. developed for the
horse and which has proved of value in the diagnosis
of small intestinal disease.
MATERIALS AND METHODS
Glucose solutions
On the basis of preliminary studies (Roberts, 1972)
1 .O g. anhydrous glucose/kg. bodyweight or the equivalent
of glucose monohydrate was given as a 20 per cent wjv
solution prepared in warm water immediately prior to
the test.
Experimental animals
The details of the eleven horses used in the test are
Sex
Breed
G F
Thoroughbred 2 1
Arab X 1 1
Welsh Cob 1 1
Pony: New Forest 2 1
Pony: Welsh, Dartmoor 1 4
171
given in Table I, all were clinically examined and in
good health before undergoing the tests.
Procedure
Three horses were tested at a time, two receiving a
20 per cent wjv solution, and the control receiving an
equivalent volume of water. Seven of the horses were
used as controls during the tests. The horses were
weighed, bedded on peat and fasted overnight but had
access to water until the test commenced. The skin
over the left jugular vein was infiltrated with local
anaesthetic and a blood sample, for resting plasma
glucose estimation, was collected into a vial containing
potassium oxalate-sodium fluoride anti-coagulant. The
glucose dose was administered by stomach tube, care
being taken not to excite the horses, and further
blood samples were collected at 30, 60, 90, 120, 180,
240, 300 and 360 minutes after dosing.
Plasma glucose estimation
The plasma glucose concentrations were determined
with the test kit, GOD-Perid Method (Biochemica
Test Combination, Boehringer, Mannheim, GMBH),
the optical density being read at 620 n.m.
RESULTS
The test was conducted over a six hour period, and
the mean plasma glucose values with standard deviations
for the test and control animals are shown i n Table 11,
and illustrated as a tolerance curve in fig. I . The
tolerance curve has two phases, the first lasting 120
minutes during which time glucose is being continuously
absorbed from the small intestine, the plasma glucose
concentration doubling from a resting level of 83.39 f
Age (Years)
<2 I 2-5 5-8 I >8
I
1
1 3 1
I72 EQUINE VETERINARY JOURNAL
TABLE 11
ORAL GLUCOSE TOLERANCE TEST
PLASMA GLUCOSE (mg/100nil) MEAN RESULTS A N D S T A N D A R D DEVIATION
I I
Minutes after dosing
30 60 90 120 180 240 300 360

83.39 121.51 147.52 166.88 177.85 169.33 151.34 125.10 101.7

(n = 11) f10.66 f21.21 i20.88 f27.02 f28.59 i32.54 f26.38 k26.35 i22.97

77.53 78.81 76.07 76.51 75.59 76.49 76.94 76.96 76.90

(n = 7) f5.41 f6.16 f5.06 f5.28 i5.66 i6.03 f5.52 f4.70 f4.51
I I

10.66 mg. to a maximum of 177.85 f 28.59 mg. glucose/
100 ml. plasma.
The second phase extends over a four-hour period
with a progressive fall in the plasma glucose to the
resting level by 360 minutes. The plasma glucose
concentration varied little in the control animals during
the test period, there being no significant difference
between the predosing and six-hour post-dosing plasma
glucose level (fig. 1).
DISC USSlON
The shape of the tolerance curve is affected by the
dose of glucose administered. Thus the test dose of
1 g. glucose/Kg. bodyweight although producing a
maximum increase more than double the mean plasma
glucose concentration gave reproducible results, with
a return to the resting level after six hours.
The second phase of the test was dependent on the
insulin response to the marked hyperglycaemia promoting
an increase in glucose utilisation and glycogen deposition
but inhibiting the continued absorption of glucose.
In preliminary studies (Roberts, 1972), some horses
receiving 0.5 g. glucose/Kg. in a 20 per cent wjv solution
exhibited a hypoglycaemic phase after 240 minutes
followed by a gradual return to the fasting glucose
concentration, but this feature, reported for man
(Cantarow and Trumper, 1955) and the pig (Reed and
Kidder, 1971), was not consistent in the horse and did
not occur with the higher dosage rate.
Alexander (1955) studying glucose absorption in a
pony with an exteriorised loop of ileum, used dosage
rates of 0.5 g. and 1.0 g./Kg. in a 50 per cent solution,
and reported maximum plasma levels from one to two

/
hours after dosing with a return to the fasting level after
four hours.
The quantity and concentration of the glucose dose
is important, for stomach emptying is delayed with
increasing concentrations of glucose ( H u n t , 1956),
and the O.G.T.T. results are dependent on the rapid
entry of the dose solution into the lumen of the small
?
/ intestine (Hill and Kidder, 1972). However, in the
horse a 20 per cent solution gave reproducible results
whilst a 25 per cent solution did not alter the shape of
the tolerance curve. The mass of food contents in the
equine stomach could impair the entry of glucose into
the small intestine, and an over-night fast is necessary,
although it is reported that the horse’s stomach may
: -
still contain food material after a 24 hour fast (Hill, 1970).
In man, the previous dietary history can influence the
O.G.T.T. results as an adequate deposit of glycogen
i
in the liver and other tissues is essential to the production
of a normal alimentary response (Cantarow and Trumper,
TI 1955). Following a low carbohydrate diet a “diabetic”
tolerance curve is produced in man (Cantarow and
Trumper, 1955) and the dog (Hill and Kidder, 1972),
- but in these test horses all receiving a basal carbohydrate
Control ration no such response was recorded.
This O.G.T.T. devised for the horse could be used to
assess pancreatic function, particularly in suspected
cases of diabetes mellitus resulting most probably from
neoplasia of the pituitary gland or pancreas (Tasker,
0 60 120 180 240 Mo 360 Whiteman and Martin, 1966). Another immediate
Minutes clinical use is for the assessment of small intestinal
function, as gross pathological changes in the mucosa
Fig. I . Oral glucose tolerance test in the horse. Mean and interfere with cellular transport mechanisms hindering
standard deviations.
Vertical: plasma ghtcose trig/ 100 ml. the absorption of glucose which is reflected by the shape
Horizontal: mintitcv. of the tolerance curve.
 EQUINE VETERINARY JOURNAL
-
i R ~ S U M ~
“1
-80
. ) -z. 1
m Deux chevaux dont I’examen nkcropsique confirma
a 0 30 60 120 180 240 300
Minutes
Fig. 2. Glrtcose tolerance curves in two horses with
nialabsorprion.
Vertical: plasnia glitcosc nig/ I00 nil.
Horizontal: niinittix
Two horses, subjected to the test, showing symptoms
of malabsorption, namely loss in condition with normal
or increased appetites and transient diarrhoea, gave
“flat” curves suggestive of small intestinal dysfunction
(fig. 2). This was subsequently confirmed at post-
mortem, the mucosa and submucosa of the entire small
intestine being extensively infiltrated with cells of the
lymphocytic series (Roberts, 1972). Normal intra-
venous glucose tolerance tests in both horses indicated
that endocrine pancreatic function was unaffected.
The starch tolerance test developed by Loeb, McKenzie
and Hoffsis (1972) for the horse could be used as an
adjunct to the O.G.T.T. in the investigation of pancreatic
and small intestinal function, but probably offers little
advantage as exocrine pancreatic insufficiency has
not been recognised in the horse.
This test is dependent on the initial digestion of
starch principally by pancreatic a-amylase known to
be present in very low concentrations in the copious
pancreatic secretion of the horse (Alexander and Hickson,
1970), although this protein content may be sufficient for
hydrolysis, and to a lesser extent by glucoamylase,
an enzyme in the small intestinal brush border (Roberts.
1972). Subsequently the products of starch digestion,
the disaccharides, are hydrolysed by other brush border
maltase enzymes to glucose, and these enzymes may be
deficient or missing in the presence of normal glucose
absorptive mechanisms.
Without limiting the usefulness of the O.G.T.T. the
number of blood samples required can be reduced to
six, those at 0, 30. 120, 240 and 360 minutes being
adequate.
SUMMARY
The oral glucose tolerance test in the horse provides
an aid to the diagnosis of pancreatic and small intestinal
dysfunction. A dose of 1 g. glucose/Kg bodyweight is
administered by stomach tube producing a peak glucose
level after two hours, which returns to the resting level
four hours later. Two horses with autopsy-confirmed
small intestinal disease showing symptoms of mal-
absorption gave a “flat” glucose tolerance curve.
173
Le test de tolirance du glucose par voie orale peut
contribuer au diagnostic des troubles du pancreas et de
I’intestin gr&le. Une dose de I gr de glucose par kilo de
poids vif est administree a la sonde; on obtient une
Clevation maximale du glucose plasmatique aprks deux
heures, et retour a la normale aprks quatre heures.
I’existence d’une maladie de I’intestin gr&le avec mal-
360
absorption montrtrent une Clevation modiree de la
glyctmie.
ZUSAMMENFASSUNG
Der orale Glucose-Toleranztest ist beim Pferd ein
Hilfsmittel zur Diagnose von Funktionsstorungen im
Pankreas und Dunndarm. Eine Dosis von 1 g Glucose
pro kg Korpergewicht, per Masenschlundsonde gegeben,
erzeugt nach zwei Stunden eine Gipfelkonzentration der
Blutglucose. Vier Stunden spater sind die Ruhewerte
wieder erreicht. Zwei Pferde mit autoptisch gesicherten
Dunndarmerkrankungen und Malabsorptionssympto-
men wiesen eine flache Glucose-Toleranzkurve auf.
ACKNOWLEDGEMENTS
We are grateful to the Wellcome Trust for the award of a
grant supporting this project, and to Professor C. S. Grunsell
in whose Department the work was carried out. The advice
and criticisni of Dr. D. E. Kidder, the technical assistance of
Miss M. McAvoy, and the help of Messrs. T. Colgan and
A. Johnston with the horses was much appreciated.
REFERENCES
Alexander, F. (1955). Factors affecting the blood sugar
concentration in horses. Quart. J . cxp. Physiol. 40, 24.
Alexander, F. and Hickson, J. C. D. (1970). In Physiology
of Digestion and Metabolism in the Ruminant, p. 375.
Newcastle-upon-Tyne. Oriel Press.
Cantarow, A. and Truniper, M. (1955). Clinical Biochemistry,
5th edition, p. 23. Philadelphia, W. B. Saunders.
Hill, F. W. G. and Kidder, D. E. (1972). The oral glucose
tolerance test in canine pancreatic malabsorption. Br. vet.
J. 128, 207.
Hill, K. J. (1970). In Duke’s Physiology of Domestic Animals,
ed. Swenson, M. J., 8th edition, p. 369. Ithaca, N.Y. and
London. Cornell University Press.
Holmes, R. (1971). Carbohydrate digestion and absorption.
J. d i n . Path. 24, Suppl. (Roy. Coll. Path.), 5, 10.
Hunt, J. N. (1956). Properties of an alimentary osmoreceptor
mechanism. J. Physiol. 132, 267.
Loeb, W. F., McKenzie, L. D. and Hoffsis, G. F. (1972). The
carbohydrate digestion-absorption test in the horse. Tech-
nique and normal values. Cornell Vet. 62, 534.
Reed, J. H. and Kidder, D. E. (1971). The oral glucose tolerance
test in the young pig. Br. vet. J . 127, 318.
Roberts, M. C. (1972). Studies on the digestion and absorption
of carbohydrates in the equine small intestine. Ph.D. thesis,
University of Bristol.
Tasker, J. B., Whiteman, C. E. and Martin, W. R. (1966).
Diabetes mellitus in the horse. J. Ani. vet. nled. Ass. 149, 393.