INS and obesity due to melanocortin 4 receptor deficiency: It is possible that obesity and insulin dysregulation, a heightened inflammatory state due to increased cytokine and adipokines, and perhaps along with other disorders such as Cushing’s syndrome, set up horses and ponies to be at greater risk of a laminitic episode, with a trigger factor (such as lush pasture or excessive carbohydrate ingestion resulting in a gluco-insulinemic response) eliciting the acute pro-inflammatory event [88,89].