I remember one summer at the lake when I took a mud wad to the face with my eyes open. There was another time when I took a tennis ball to the eye. I learned several things from these experiences: don’t play tennis, mud fights are not worth it, and most importantly - eye problems are extremely painful!

Danny has his left eye half closed when compared to his right eye. He also observed my white truck and stethoscope.

Since becoming a veterinarian I have learned that some owners prefer to wait for an issue to resolve before scheduling an appointment and owners also do not perceive their animals to be in pain. When it comes ocular conditions my rules of thumb are: the issue can never be checked soon enough or often enough until it is resolved. If the eye is improving by the day (less squinting, less tearing / discharge, less cloudiness) then it is healing. If the level of squinting or tearing is staying the same then a recheck is needed ASAP. Cloudiness is bad. In horses cloudiness or a cloudy discharge is REALLY bad.

Here are some definitions when it comes to talking about eyes for all of you vet. med. curious folks:

cornea - the clear outer membrane of the eye made up of an anterior and posterior membrane. The cornea is clear because there is no blood supply - it receives its nutrients through diffusion. The cornea is sensitive when touched because there are branches of the ophthalmic nerve have endings on the cornea.

sclera - the white part of the eye surrounding the iris and cornea

iris - flat ring of tissue in the eye that adds color, constricts in bright light, and dilates in low light. The color of the iris is determined by how many melanin containing cells are present in the outer layers of tissue. Lots of melanocytes - brown eyes, fewer melanocytes - tan / yellow, even fewer melanocytes - blue, no melanocytes (albinism) - red

pupil - opening in the center of the iris

conjunctiva - pink mucous membranes surrounding the globe of the eye

conjunctivitis - irritation or infection of the conjunctiva

iridic granule - collection of cells present on the dorsal portion of an equine cornea.

corneal ulcer - a break / abrasion in the cornea.

Fluorescein stain - a stain used to test for the presence of a corneal ulcer

Fungal keratitis - a fungal infection within a corneal ulcer to which horses in warm and humid environments are very susceptible. Fungal keratitis is a big reason why any squinting horse needs to be seen by a veterinarian as soon as you notice the squinting. Horses or other animals that eat hay such that they create a hole in a round bale to get to the center of the bale are at increased risk for corneal ulcers and fungal keratitis.

epiphora - overflow of tears onto the face

blepharospasm - involuntary tight closure of eyes

He is being good by allowing an ophthalmic exam without sedation.

I had a farm call the other day to see an accident prone horse named Danny. It was clear on first observation that Danny was keeping his left eye half closed and he had some tearing present. Danny allowed my exam after I applied a topical anesthetic to his eye. I applied some fluorescein stain - no stain uptake was present on his cornea. I flushed each inner eyelid with saline solution to check for dirt / foreign material. None was found. Two days and twice daily eye medication later Danny was back to normal. Thankfully I did not have the opportunity to discuss lengthy medical treatment or referral to Charleston’s veterinary ophthalmologist with Danny and his family.

Foster and all three of his legs helped with moral support during the entire process.

Links of interest:

AAEP information sheet for horse owners regarding eye problems

http://www.aaep.org/info/horse-health?publication=765

Link for Dr. Cook and her awesome team at Animal Eye Care of the Lowcountry

http://www.aeclowcountry.com

Down at the campground Opie had been drinking and urinating more than normally. The litter box was heavy these days. Opie has a pretty large frame and his folks noticed that he seemed to be losing weight. For the past day Opie had also been having diarrhea. In past visits to the veterinary clinic, Opie became really stressed with car travel, then even more stressed with the procedures that were planned once in the examination room. Opie’s mom gave me his history over the phone, was very concerned, and expressed interest in having blood chemistry and complete blood count performed during this visit. She also gave me a full disclosure warning that he can be a misfit with veterinarians.

We entered the motor home and spotted Opie sitting on the dash: curious, collected, reserved. His tail twitched. I went to pick him up. Hiss. “Here we go”, I thought. Getting a blood sample from Opie after my exam required patience, a well trained assistant to help restrain, one towel, clippers, two injections of a sedative, and one trip to the litterbox. Opie’s blood glucose was 289. Before I even knew the results of Opie’s blood chemistry and CBC I had a feeling that diabetes was his problem.

Opie had been on a prescription urinary tract diet that was consequently very high in carbohydrates. We started a discussion about his diet with his mom. She brought out the bag she recently purchased and just opened and realized she had purchased the dog version by accident! In her defense the coloring and name looked very similar to the cat food. She had been feeding this to him for a day, which explained the diarrhea. I had some medicine available for the diarrhea and recommended switching back to his old food. Then we began to discuss the pitfalls and highlights of feline diabetes.

Opie is thrilled to show off his elf hat for Christmas.

Food becomes glucose (sugar) in our blood after we eat. Insulin is released naturally from our pancreas after we eat that allows our cells to become receptive to glucose use or storage as fat. During diabetes the pancreas either does not produce insulin needed to for glucose utilization or our cells are not receptive to the insulin. When blood sugar is high enough it will exert an osmotic effect as our blood is being filtered by the kidneys. The excess glucose in the urine will draw fluid from the blood and increase urine production overall. When a cat like Opie has been urinating more than normal and drinking more than normal to make up for the fluid loss, diabetes is on my disease differential list.

Diet is a major factor in managing feline diabetes. There are a number of cats who are diagnosed with diabetes that can be managed with diet alone. Opie’s diet was a urinary tract specific diet in the dry formulation that was 30% carbohydrates. Cats are obligate carnivores, which means they absolutely have to eat a high percentage of meat (protein) to be completely healthy. Our plan was to transition him to a diabetic prescription food, or at least a diet that had the highest possible protein concentration and the lowest possible carbohydrate concentration. Next Opie’s mom picked up a prescription of insulin and we discussed giving Opie insulin underneath the skin, twice daily every twelve hours. Insulin needs to be given after a meal since that molecule’s job is to allow sugar circulating in the blood safe passage to the cells. If Opie receives just the right amount of insulin, then his high levels of blood glucose will be lowered to so that he begins urinating a normal amount If Opie is not regulated then he will continue to urinate and drink more than normal. If he is regulated properly urination and drinking will be more normal.

I am not going to go into specifics about Opie’s treatment because every cat is different and if you are dealing with a pet that is exhibiting similar symptoms please talk to your veterinarian. The following are pointers that can help you along the way.

Keep Karo syrup on hand. If a diabetic animal receives an insulin overdose, insulin at the wrong time, or is improperly regulated their blood sugar can drop to dangerously low levels. A pet that has low blood sugar is lethargic, has no energy, may have dilated pupils, has trouble holding his / her head up, and may have seizures. If you see these clinical signs with your diabetic pet then place a small amount of Karo syrup on your fingertip and rub it on their gums. The sugar in the syrup will absorb through mucous membranes. You can repeat this step as often as needed. It is better from a medical standpoint to have a blood sugar reading that is too high rather than too low.

Administer insulin after a meal. If the stomach is empty then no glucose will be in the bloodstream. To insure safety train your diabetic pet to eat 12 hours apart and receive the insulin injection after the meal. If your pet is a grazer that has food available all the time then reduce the amount of food available for grazing and offer a higher value canned food for meals before insulin injections.

Diet is really really important! If you have a pet that has recently been diagnosed as diabetic, put your energy toward the proper diet. There are veterinary prescription diets available, many commercial diets will suffice, and some pet owners are preparing their own diets at home to good success. Even if your cat is picky, even if your cat hates veterinary prescription foods, do not give up on nutrition when dealing with diabetes. A sizeable percentage of pets will regulate themselves (that means no insulin injections) with the proper diet.

You can monitor diabetic pets without needles at home! Ketostrips and glucose strips are available at any pharmacy and all you need is a urine sample for these simple tests. A diabetic produces ketones which are a byproduct of muscle and fat metabolism. An unregulated diabetic pet will have high ketones in his / her urine and have fruity (ketotic) odor to their breath. Monitoring urine ketones and urine glucose is easy and noninvasive - all you need is a urine sample. You can use an empty litter box for this, shredded paper, or a pee pad to obtain a sample.

You can monitor your pet’s blood sugar at home! I will not give details about this in an article because it involves needles and blood and pets I have not met. Essentially blood glucose monitoring is less traumatic and easier than you think. Talk to your veterinarian about ways to monitor and how often to do so.

I checked in with Opie recently about 10 days after our first visit with him. He likes prescription diabetic food and is not urinating nearly as much as before. His diarrhea has resolved. We are hopeful that Opie will fall into the group of diabetic cats that will regulate with a diet change alone, but that remains to be seen. For now his insulin injections are going very well and he is allowing his mom to draw blood for blood glucose testing. A veterinary home visit to Opie’s campsite helped him spend more time on the dash of his motorhome and less time going to the litterbox.

The following are links to some helpful sites for owners of diabetic cats:

www.catvets.com/cat-owners/disease-and-conditions/diabetes

www.felinediabetes.com

Russell Bauman DVM

Keep an EYE on it!

Feline Diabetes - Got the sugar?