As a Chartered Physiotherapist working with both horses and their humans, I’m always learning—reading, listening, observing. Sometimes, something new catches my attention not because I read it in a textbook, but because I saw it make a real difference in a real horse.
That’s what happened recently with ertugliflozin.
Two of the horses I’ve been treating—both with long-standing insulin dysregulation—have shown significant improvements in mobility and comfort. These were not quick-fix cases. Both had been carefully managed with diet, restricted turnout, and ongoing veterinary care. And yet, things had plateaued—until their vets tried something different.
That “something different” was ertugliflozin, a medication originally developed to help people with type 2 diabetes. It works by allowing excess sugar to pass out through the urine, lowering blood glucose and, in turn, insulin levels. In people, it’s one of a group of drugs known as SGLT2 inhibitors, and it’s prescribed when lifestyle measures aren’t enough.
It’s not licensed for horses. It’s not something I prescribe or recommend—I’m not a vet. But as a physiotherapist deeply committed to improving quality of life, I’m always paying attention to what’s making a difference out there.
And this medication is making a difference for some horses.
A published study in Equine Veterinary Education looked at 51 horses and ponies who were struggling with hyperinsulinemia and laminitis that hadn’t improved with standard management. Many of these horses had been dealing with laminitis for months—some for years—and their insulin levels were consistently high, despite best efforts.
After just 30 days on ertugliflozin, the results were eye-opening:
Insulin levels dropped significantly—by a factor of seven in many cases.
Laminitis scores, based on the Obel grading system (a scale from 0 to 12), fell from a median of 10 to 1.
Horses became more comfortable, more mobile, and in many cases completely sound.
Owners reported improved quality of life and a noticeable return to normal behaviours—playfulness, movement, social interaction.
Yes, some horses experienced increased thirst and urination, which is expected based on how the drug works. A few had a mild increase in triglycerides (blood fats), but no serious side effects were recorded in the study. And many were able to stop pain relief medication such as phenylbutazone after just a week or two.
That’s quite something, particularly in cases where nothing else had helped.
I’m not sharing this as a recommendation. I’m not a vet, and this is a veterinary decision. But I am sharing it because I believe in awareness. If you’re caring for a horse with insulin dysregulation or laminitis that isn’t responding to traditional management, I think it’s worth knowing that this option exists—and having a conversation with your vet to see if it might be suitable.
Not every case will be right for this treatment. Not every vet will be comfortable using an off-label medication. And not every horse will respond the same way. But for some, it’s been genuinely life-changing.
I don’t think there are any magic cures in equine health. But I do think there are hopeful possibilities—and this feels like one of them.
These cases also reminded me how powerful collaborative care can be. In each situation, it wasn’t just about the drug—it was about the combination of careful veterinary management, daily owner commitment, and a supportive team, including me as the physio.
We all brought something different to the table. We all kept the horse’s well-being at the centre of the conversation. And it worked.
Sometimes, it’s that combination of open-mindedness, curiosity, and cooperation that opens a new door. Even when we’re doing “all the right things,” something new might be the missing piece.
So if you’re in a stuck place with your horse—especially with laminitis or insulin dysregulation—ertugliflozin might be something to bring up in your next conversation with your vet. It may or may not be appropriate. But simply knowing it’s an option gives you a little more ground to stand on.
And in this world of equine care, that can make all the difference.
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🌟 About Sue Palmer, The Horse Physio
Sue Palmer MCSP, The Horse Physio, is an award-winning author, educator, and Chartered Physiotherapist. She specialises in both human health and equine well-being, with a particular focus on the links between pain and behaviour in horses.
Sue is passionate about helping horses feel more comfortable in their bodies and supporting their partners to better understand and respond to what their horses are trying to tell them. Her work focuses on:
Her goal is to enhance performance and promote a more harmonious, pain-free life for both horses and the people who care for them.
Sue is registered with:
✔️ RAMP
✔️ ACPAT
✔️ IHA
✔️ CSP
✔️ HCPC
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