The up close and personal smell won’t just make you wrinkle your nose and gag a bit; it’s a bit like the acrid smell of burning rubber or chemical fire that grasps your lungs and hurts your eyes.  If people have this reaction from being next to their pet, imagine what pets, with their highly sensitive noses, feel.

Unfortunately, it is up to you to remove the odor. While you can take them to veterinarian, getting sprayed often happens outside clinic hours. Emergency rooms see some of these cases, although that is a costlier approach than doing it yourself.  You can bathe them yourself with the formula created by a scientist in a laboratory. 

• 1 quart 3% hydrogen peroxide
• 1/4 cup baking soda
• 1 teaspoon of liquid dish soap or hand soap

Hand soap is milder and won’t strip out the oily residue as well as dish soap, so dish soap is preferable, but use what you have available.

It is unlikely that one shampoo with this recipe will be enough to eliminate that odor. Depending on the length of the pet’s coat, the volume of spray, and how long you are able to rub shampoo into the coat, you may need do it more than once, or even a few times.

Mixing

Typically, 3% hydrogen peroxide is sold in pint bottles, so two are needed for this recipe. Anything stronger than 3% is not recommended. If your bottle is expired, get fresh ones instead.

The best place to mix the formula is in a clean plastic bucket with plastic utensils to stir. Metal is not a good choice because it encourages the peroxide to decompose.

If needed to cover your whole dog, up to a quart of lukewarm water (not hot or cold water) can be added to the solution. 

Apply the solution immediately, and do not store it in a bottle or spray bottle to avoid having the bottle explode. Bottles of hydrogen peroxide do not burst in the store because underneath the cap, on the cap liner, the manufacturer has left teeny holes through which the oxygen gas is released.

How Does it Work?

The nasty part of the skunk odor (is there any part that isn’t horrific?) is created by organic compounds called thiols, which are responsible for making other hideous odors such as decomposing flesh. The oxygen created by combining hydrogen peroxide and baking soda neutralizes the thiols.

Bathing

Skunks tend to aim for a dog’s face. Both the skunk spray and the solution you’ve made will sting (and possibly harm) a dog’s eyes, so keep the solution away from the eyes.

As soon as you can, wash your dog in this solution and really work it into the fur, particularly on long coated breeds. Leave the solution on the dog for about 5 minutes. Some areas that reek more than others may need more baths. Wash the dog as many times as it takes for the dog to smell like a wet dog rather than a dog sprayed by a skunk. It is possible that for a few months afterward the dog will smell slightly of skunk when wet.

Rinse the dog with lukewarm water.

Rinse any leftover solution down the drain with added water.

Safety Warnings (There are Several)

DO NOT SMOKE while shampooing as this mixture is flammable.

Toss out what you haven’t used; it can’t be bottled. The chemical reaction of pressure from hydrogen peroxide and baking soda will make it burst, and the explosion can cause injuries.  The chemist who discovered it should have become filthy rich from it, but it can’t be bottled for long enough to package and sell it. It won’t even last an evening, so toss out what you haven’t used. If you intend to bathe your pet again tomorrow, make another batch then; it’s better to bathe them a few times the day it happens.  Remember that a similar eruption in paper mache volcanoes is caused by combining dishwashing soap. baking soda and vinegar.

Hydrogen peroxide will lighten black hair to a bronze color, and that will not return to the usual darker shade on its own; note that hydrogen peroxide is an ingredient in permanent hair dye and some blonde hair dye. The fur will have to grow out. If you plan to show your black dog in conformation, consider some other option instead (see below).

Not unexpectedly, the solution will bleach out towels and fabric, so while you bathe the dog, wear old clothes and towels you don’t mind getting bleached.

Keep the solution out of your pet’s eyes. It can be irritating enough to cause shallow corneal ulcers. That may be difficult to prevent if the dog is sprayed directly in the face.

Other Choices

A water and vinegar douche can work. First wash the dog in liquid soap and rinse it out well. Then apply the douche (a spray bottle works well) and leave it there; don’t rinse it off. Usually, unmedicated varieties do not expire.

For your house or car, keep the windows open, run air conditioning if you have it, and use whatever household product you have to eliminate odors indoors. The product may not help much, or at all, but it can’t hurt.

A Health Risk from the Skunk Spray

Dogs who get a full shot of skunk spray in the face can develop a form of damage to their red blood cells that causes anemia.  This result can make the dog weak and turn their mucous membranes (gums, inside cheeks) a chocolate color. If that happens, veterinary intervention is needed. The dog may need blood transfusions and supportive measures.  Severely skunked dogs should be monitored closely for 12 hours for such signs as lethargy, weakness, lack of appetite. Extremely severe cases of this resulting anemia can be fatal.

Most dogs that get sprayed by a skunk do not get bitten because they retreat after being sprayed. But if a dog is bitten by the skunk, the owner should seek veterinary attention due to rabies risk and for possible wound care.

Some dogs are more likely to encounter skunks, depending on their geographic area and temperaments, and you may need to do this more than once. If that is the case, consider keeping unexpired supplies on hand.

Degenerative myelopathy (also known as DM, German shepherd degenerative myelopathy, or chronic degenerative radiculomyelopathy) is a slowly progressive disease that affects the spinal cord and a dog’s ability to walk. DM results in lost coordination of the hind legs, which progresses to weakness and then to paralysis of the hindquarters.

What happens is that the structures within the spinal cord that are responsible for nerve impulses degenerate. In degenerative myelopathy, the myelin (the insulation around the nerve fibers) and the nerve fibers that carry signals to the muscles do not communicate so the nerve’s signals to move are not followed. While these changes can happen anywhere along the spinal cord, they usually happen in the mid to lower back.

Typically, degenerative myelopathy isn’t seen in dogs under the age of five. The degeneration occurs slowly over a period of several months. Often the first signs noticed are difficulty in the hind quarters when the dog is getting up. This awkwardness is most noticeable when the dog walks on a smooth surface. However, as the disease progresses, the dog becomes uncoordinated and will scuff or drag the rear feet, causing excessive wearing of the toenails.

Sometimes one side is more noticeably uncoordinated than the other. The disease can either wax and wane episodically or progress steadily. It usually takes a few months to a year after onset for a dog to become unable to walk.  

Cause

The cause is a DNA mutation in a gene called superoxide dismutase 1 (SOD1). This risk factor of having this gene was identified in 2009. Prior to this discovery, genetic, nutritional, and immune factors were suggested as possible causes of DM.

The neurologic disease is similar to some forms of human amyotrophic lateral sclerosis (ALS, often called Lou Gehrig’s disease) AND  DM usually affects dogs that are between 8 and 14 years old. Though most of the dogs in early reports were German Shepherd Dogs (GSD), other breeds that have the mutation and clinical signs include American Water Spaniel, Bernese mountain dog, Bloodhound, Borzoi, Boxer, Canaan Dog, Chesapeake Bay retriever, English Cocker Spaniel, German Shepherd Dog, Great Pyrenees, Kerry blue terrier, Pembroke Welsh Corgi, Pug, Sealyham terrier, and Whippet.

Signs

Early signs, such as difficulty getting up or a noticeable sway in the dog’s gait, may be confused with hip dysplasia.  As months go by, “scuffing” of the hind limb toe nails or dragging of the hind limb feet usually is noted. The rear limbs may criss-cross when standing or walking.  The dog may not be able to stand well and during an examination a veterinarian will detect rear limb weakness. Muscles of the rear limbs will become atrophied or wasted away.  As the disease progresses, the front legs may become weak. 

Fortunately, dogs with DM do not appear to be in pain.

Diagnosing

Since the clinical signs of DM can appear the same as those for other diseases such as a herniated disk, cancer, infection, or stenosis of the spine, the diagnosis in a live animal is based on excluding these diseases.  Thus a variety of diagnostic tests is needed, including physical and neurological examinations, routine blood work, spinal radiographs, myelography in some cases, spinal fluid analysis, and computed tomography (CT) or magnetic resonance imaging (MRI) scans.  Unfortunately a definitive diagnosis can only be ascertained after death by looking at biopsy samples from the spinal cord.

DNA testing by the Orthopedic Foundation for Animals can identify the DNA mutation that is associated with the development of DM. The test identifies dogs that are clear and have two normal copies of the gene, carriers who have one normal copy and one mutated copy, and those who are at much higher risk for developing DM because they have two mutated copies. In unpublished studies, dogs who have two of the abnormal genes are the only ones that have developed the disease.  However, there are some dogs in these studies with two mutated genes and without clinical signs; it is unclear yet whether these dogs will later develop the disease or if other factors are necessary for DM to develop.

The DM DNA Test may be performed on any breed or mixed (hybrid) breed.  By testing before breeding, breeders will be able to avoid mating two dogs with the mutated DNA. As part of an ongoing collaborative effort by research scientists at the University of Missouri and the Broad Institute, a DNA test is available for dogs that have been diagnosed with DM, and for older dogs in selected breeds. Details are outlined in the Research section of that website.

Treatment

Unfortunately no treatment has been shown to reverse the signs; DM can be managed but not cured. Supportive treatment can help.

1. Exercise such as walking and swimming should be encouraged. Physical therapy helps to maintain muscle mass and quality of life. In one study¹ of 50 dogs with DM, those that received intensive physiotherapy had longer survival time (mean of 255 days), compared with dogs that received moderate (mean of 130 days) or none (mean of 55 days). Affected dogs who received physiotherapy were ambulatory longer than those that did not receive it. 
   
2. Once the dog reaches the non-ambulatory state, pressure sores, urine leaking, and loss of bowel control are likely to develop, so close attention to daily eliminations and bedding will be needed. 
   
3. A combination of epsilon-aminocaproic acid, N-acetylcysteine, prednisone, vitamins B, C, and E, and exercise therapy has been suggested to slow the progression. However, this regime may have no benefit over doing only the physical therapy. A study evaluating combination therapy with aminocaproic acid, N-acetyl- cysteine with vitamins B, C, and E failed to detect a benefit.

Breeding and Prevention

Because the disease is found in specific breeds, responsible breeding is the only way to prevent degenerative myelopathy. If you plan to get a purebred puppy of an affected breed, ask the breeder about history of DM in the kennel’s line. Understand that clinical signs don’t develop until long after sexual maturity.

The DM gene mutation is very common in some breeds, such as the German shepherd. Overly aggressive breeding programs to remove the gene mutation may create a bottleneck effect, possibly increasing the risk of other diseases and eliminating other desirable qualities of the breed. A realistic approach is to consider the DNA DM results as you would consider any other undesirable trait or fault. Dogs testing at risk should be considered to have a more serious fault than those testing as carriers.

Prognosis

Most affected dogs are euthanized due to disability within 6 to 12 months of onset of signs.

¹Daily controlled physiotherapy increases survival time in dogs with suspected degenerative myelopathy.

Suffocation by drowning is caused by the lungs filling with water or other fluid. Some pets can seemingly recover from a near-drowning incident, only to succumb to a collection of fluid in the lungs (known as pulmonary edema) hours later. This phenomenon is known as ‘dry drowning’ and can be fatal. For this reason, all pets that have fallen into a pool or other body of water should be evaluated by a veterinarian and observed for complications.

• To expel water from the lungs and stomach, pull the tongue forward and gently push on the chest wall and stomach. Take care to avoid being bitten.
• Begin CPR as required.  
• Cover the pet with a blanket to avoid further heat loss.  
• Seek veterinary help as soon as possible. 
• Secure the water source to prevent other pets and children from gaining access and falling in.

What NOT to Do

• Do not fail to seek veterinary help just because your resuscitation is successful and your pet seems to be recovering. Numerous secondary complications (i.e., electrolyte imbalance, hypothermia, pneumonia, fluid in the lungs) can occur. 
• Do not leave the pet unattended as they may be confused and wander back to the water.

Puppies are born 58 to 72 days after mating. Because canine spermatozoa live 4 to 11 days in the bitch’s reproductive tract, it is usually not possible to accurately determine the day of birth from the time of mating. If purposefully breeding, ovulation timing can be performed to determine with much greater accuracy the expected delivery date. A cat’s gestation period is similar at 63 to 65 days.

If the contractions are frequent, regular, and strong, and no young is produced in 15 to 30 minutes, the pet should be taken to a veterinarian. Intermittent contractions with no kitten or puppy should be evaluated after 1.5 to 2 hours as long as the dam appears comfortable. A dark green vaginal discharge called lochia should be followed within 5 to 10 minutes by a puppy or kitten, but only before the first one. Heavy bleeding requires an immediate veterinary examination.

While a few cats can take up to 24 hours to complete the birthing process, most should follow the same protocol as for dogs.

About two out of three cases of difficult birth (known as dystocia) that need to be seen by a veterinarian will need to have an emergency C-section performed. It is good practice to know long before the due date where your local veterinary emergency facility is, and when and if they can perform a C-section. C-sections are risky and expensive surgeries and careful consideration should be given to the decision to breed your pet or not. X-rays taken after the 44th day of gestation (not necessarily from breeding) can show how many babies will be born but they are much easier to count when the skeletons are fully mineralized later in gestation, after day 50. This will allow you to know when the mother is done giving birth.

Reddish to brownish vaginal discharge can continue for several weeks after a normal birth. If the mother is eating normally and is normally active, this isn’t a problem. If she becomes lethargic, stops eating, has a fever or acts ill, prompt veterinary attention is needed.

Some new mothers can experience a condition called eclampsia in which their blood calcium levels drop dangerously low. This is due to the large amount of calcium secreted in milk for newborns. Dogs with eclampsia experience poor mothering, severe muscle tremors, difficulty walking, and seizures. Immediate veterinary care is needed if your dog is showing any of these signs. Eclampsia can happen anytime around birth but is most common during peak milk production (2 to 4 weeks after birth).

• When the baby is born, it will likely be covered in a membrane. If the mother doesn’t remove it, tear this membrane and remove it from the baby’s head region.  
• If the mother doesn’t remove the umbilical cord, or is being rough with it, tie it with a piece of string or dental floss one-fourth of an inch from the baby’s abdomen. Then cut the cord one half of an inch from the abdomen with a sharp scissor on the dam’s side of the cord. Apply 2 percent tincture of iodine to the entire umbilicus (buy this beforehand, just in case).
• Keep the babies warm. It is best to leave them with their mother, but sometimes she doesn’t stay with them. In that instance, put a plastic bottle filled with warm water near the babies. A hot water bottle covered with a towel works as does a Snuggle Safe™ disc. Neonates must have room and be strong enough to move away from the heat source. The room temperature should be around 85F. Allow room for the babies to move toward or away from the heat source.

What NOT to Do

• Do not put your fingers in the birth canal as you can cause trauma or infection. 
• Do not forcibly attempt to remove a baby.  
• Do not assist delivery by pulling on the head of a baby or on the umbilical cord as it exits the mother.  
• Do not lift the baby by the umbilical cord.  
• Do not use a heating pad.
• Most kitten and puppy births go smoothly with the mother doing all the work. The babies contentedly nurse on the mother soon after birth.
• You may not see the afterbirth (placenta) being passed. Many mothers will eat this after it is passed without anyone noticing. It’s usually not a problem if all of the placentas are not immediately passed as the dam usually passes them later, but on occasion retained placentas do not pass and in those cases can cause serious illness.

Dehydration is excessive loss of water from the body (typically through vomiting and/or diarrhea) or inappropriate intake of water into the body (decreased thirst).  The most common mistake with a vomiting pet is to encourage food and water intake while the pet is still vomiting. This actually makes matters worse by not allowing the stomach and intestinal tract time to rest and can cause additional vomiting and water loss. Removing access to food and water for a short period of time may seem like it would make dehydration worse, but it can help your pet avoid further dehydration. Dehydration makes your pet feel lethargic, and can potentially cause severe problems with the kidneys and other internal organs if untreated.

What to Do

• If moderate or severe dehydration, seek veterinary attention.  (See below for how to assess if dehydration is potentially severe in your pet.) 
• If dehydration is mild and the pet is not vomiting, give frequent, small amounts of water by mouth; that means in the range of 1 tsp for a cat or small dog to 1 tbsp to 1/4 cup for a medium to large dog every few hours.
• If your pet is lethargic, in pain, or has not eaten for 24 hours, seek veterinary attention.

What NOT to Do

Eyes: Are they normal, or do they sink into the sockets? Sunken or dry eyes may indicate dehydration, and warrant veterinary attention.

Skin: Do the skin turgor test outlined in the Physical Exam Checklist. If the skin is slow to return to position, the pet may be moderately to severely dehydrated. If the skin does not return fully to its position, your pet may be severely dehydrated and may be in critical condition. Seek veterinary attention immediately. The skin turgor test is not always accurate and several factors such as age, weight loss, and condition of the skin can give misleading results. A veterinary professional can help you determine how dehydrated your pet is, what the cause may be, and the best course of treatment.

(Dry eye is formally known as keratoconjunctivitis sicca or KCS)

Why Tears are Good

Tears consist mostly of water, but also of oil and mucus secreted by their respective eyelid glands. The water portion of tears is secreted by two lacrimal glands in dogs and cats: one just above the eye and another in the third eyelid (or so-called nictitating membrane).

“Conjunctivae” are the moist pink membranes of the eye socket. “Itis” means inflammation and “sicca” means dry. Keratoconjunctivitis sicca, abbreviated KCS, means there is an inflamed, dry cornea and conjunctiva. It occurs when there is a deficiency in the water portion of the tear film, which normally accounts for 95% of the tear volume. Without water, one is left with oil and mucus; hence, the gooey yellow eye discharge characteristic of this condition.

Why do Eyes Become this Dry?

There are many causes of dry eye. Some are:

• Canine distemper infection attacks all body interfaces with the environment including the eyes. Dry eye is part of the constellation of symptoms that can occur with canine distemper infection. 
• In cats, herpes upper respiratory infection can lead to chronic dry eye (see more on herpes conjunctivitis).
• There could be a congenital lack of tear-producing gland tissue (as described in certain lines of Yorkshire terriers).
• Exposure to sulfa-containing antibiotics, such as trimethoprim-sulfa combinations, can lead to dry eye. It can be either temporary or permanent and occurs unpredictably.
• Anesthesia will reduce tear function temporarily (thus eyes are lubricated with ointment by the attending nurse).
• During surgery for cherry eye, removal of the third eyelid tear-producing gland, instead of replacing the gland in its proper location, can lead to KCS. So can too much damage to the gland prior to proper gland replacement.
• A knock on the head in the area of one of the tear-producing glands can lead to KCS.
• The most common cause of KCS appears to be immune-mediated destruction of the tear-producing gland tissue. We do not know what causes this type of inflammatory reaction but certain breeds are predisposed: the American Cocker Spaniel, the Miniature Schnauzer, and the West Highland white terrier.

How We Make the KCS Diagnosis

The moisture of the eye will wet the paper. At the end of the 60-second period, the length of the moistened area on the paper is measured. A length of 15mm or more is normal. A length 11 to 14mm is a borderline result. A height of less than 10mm is dry. A height less than 5mm is severely dry.

Cyclosporine is an immunomodulating drug used to prevent organ transplant rejection in people and treat certain immune diseases in dogs and cats. When applied as an eye drop or ointment, it suppresses the immune destruction that is the most common cause of KCS, and tear production is restored.

The success of this treatment plus its convenient dosing interval (1 -3 times daily) has made this medication the primary treatment for KCS.

Animal hospitals used to make their own cyclosporine eyedrops out of oral cyclosporine and vegetable oil, but this largely ended when Optimmune® eye ointment (containing 0.2% cyclosporine) came out. Occasional patients simply do not show a good response to cyclosporine ointment but will respond when the concentration is increased. Higher-concentration products can easily be formulated by compounding pharmacies or one of the alternative medications listed below can be used. Treatment is almost always required for the lifetime of the pet.

After beginning cyclosporine eye drops or ointment, a recheck in three to four weeks is a good idea to check for improvement. If the Schirmer tear test is still showing poor results, the dosing frequency can be increased to three times a day; similarly, if excellent results are seen, the medication can be dropped to once a day.  Periodic rechecks are needed for dose adjustment and some dogs take as long as three to four months to show a response. Dogs with Schirmer tear tests as low as 2 mm still have an 80 percent chance of responding to cyclosporine. This medication has been a miraculous breakthrough in the treatment of KCS.

Tacrolimus is another medication that is an immune modulator. No commercial products are available for use in the eye, so they must be obtained from a compounding pharmacy. It is often tried in cases that are unresponsive or poorly responsive to cyclosporine. It is used in a manner similar to cyclosporine and is generally similar in cost.

Pilocarpine is a cholinergic drug, which means it works on the autonomic nervous system (the part that controls automatic functions such as glandular secretion). This medication can be given for the particular form of dry eye known as neurogenic KCS. In these cases, neurogenic stimulation of the tear gland is absent, so the pilocarpine is given in an attempt to stimulate the gland. Although the drug comes as an eye drop, for KCS it is actually given orally at an increasing dose until side effects are seen (diarrhea, drooling, vomiting). If side effects are encountered, the dose is reduced to that which the animal tolerates. It is continued indefinitely or until the neurogenic KCS subsides, usually twice daily. Neurogenic KCS typically affects only one eye.

Artificial tear solutions, gels, and ointments can be purchased in most drug stores. These can be combined with other therapies and are soothing. Their use is particularly important early in therapy until cyclosporine or tacrolimus takes effect and in eyes that do not respond to these latter medications. Over-the-counter products may be recommended two-12 times daily, depending upon their formulation and the severity of the KCS.

Topical antibiotics are often needed, especially when starting treatment for KCS because secondary infections are common with inadequate tears. These products do not increase tear production but help relieve the thick discharge.

Topical steroids may be beneficial in decreasing the inflammation associated with KCS. Typically they are combined with topical antibiotics in the same solution or ointment, especially when given to dogs.

Surgical Solutions

Parotid duct transposition is a surgical solution to unresponsive, severe KCS, although it is a delicate procedure, usually done by a veterinary ophthalmologist. The parotid duct is the salivary gland on either side of the face/cheek. It produces saliva that is carried to the mouth via a long duct. This duct can be carefully dissected out and moved to the outer corner of the inside of the lower eyelid in order to deliver saliva to the eye. Saliva is a reasonable substitute for tears, although in time some mineral deposits may form on the eye surface. Mineralization of the cornea can range from mild to severe and there is no good way to predict whether mineralization will be a problem prior to the transposition of the duct. The eye may water uncontrollably when the dog is fed and facial wetting may be objectionable in some cases.

Distichiasis is quite common in dogs. Distichiasis is a condition in which extra hairs grow out of the eyelash area. It happens when there are two or more hairs growing out of a Meibomian gland opening. (Meibomian glands are located along the margin of the eyelid.) These hairs are not supposed to be there. In some cases, these extra hairs can be long and stiff and irritate the eye, resulting in a corneal ulcer. The severity of the problem depends on how stiff the hairs are, how long they are, where they’re located, and how many extra hairs there are.

Distichiasis is different from entropion. Distichiasis involves extra eyelashes; entropion is an inward roll of the eyelid that causes eye irritation from normal eyelashes or hair.

Untreated distichiasis can cause corneal ulcers, chronic eye and eyelid pain, and excessive tearing. It is quite uncomfortable and/or painful for the animal, depending on the amount irritation. If the excessive hair causes any clinical signs at all, the hair should be permanently removed.

Signs include increased blinking, lots of extra tears that often look like a tear streak, and squinting. Dogs don’t typically paw at the eye. The more severe cases are the most easily diagnosed, as the milder cases often involve small softer hairs that can easily be missed.

It’s seen most often in puppies or young adults and is typically diagnosed before a dog is three years old. Any dog can have it, but it’s considered to be one of the most commonly inherited diseases in dogs, and considered by some to be the most common congenital eye problem.

Breeds that seem to be predisposed to distichiasis include:

• Cocker spaniel
• Cocker Spaniel, American
• English bulldog
• Flat-coated Retriever
• Golden retriever
• Lhasa apso
• Miniature Longhaired Dachshund
• Miniature poodle
• Pekingese
• Poodle
• Pug
• Shetland sheepdog
• Shih tzu
• Toy poodle
• Yorkshire terrier

Treatment

There are several treatment options and your veterinarian’s choice will generally depend on how many extra hairs are involved and what equipment the veterinary facility has. General anesthesia is usually needed. Occasionally a very cooperative dog might allow treatment with only a local anesthetic, but that would be extremely rare.

1. Cryosurgery freezes the lid margin at the places where there are extra hairs.
   
2. Surgery will remove the hairs permanently.
   
3. Electrolysis will remove the hairs permanently.

These procedures destroy the hair follicles, preventing hair regrowth. However, no procedure can be guaranteed, so retreatment may be necessary in some cases. Several follow-up visits will be needed, to make sure that the hairs are not going to regrow.

Plucked hairs will just grow back, so plucking is not a permanent solution. Lid splitting and thermocautery can destroy the normal lid margins, leading to severe permanent scarring and entropion, so they are not good treatment options.

The eyelids will have some post-operative inflammation, which your veterinarian will also treat.

Prognosis

Once the hairs have been removed permanently, the prognosis is good. However, dogs with distichiasis should not be used for breeding, because of the hereditary aspects.

Ketoacidosis is one of the most extreme complications of diabetes mellitus that can be experienced. Unfortunately, most cases of ketoacidosis are in patients that were not previously known to be diabetic so the owner (and pet) must deal with two serious diagnoses: one acutely life-threatening and expensive and the other requiring ongoing commitment and daily treatment.

The diabetic patient has an insulin deficiency. To recap, there is a huge amount of glucose in the bloodstream but without insulin, none of it can get inside the cells that need it. It just circulates around uselessly. The tissues, some of which require glucose as their only food, are starving. Add to this some sort of second stressful condition such as infection or pancreatitis, and the tissue demand for food/fuel increases. The tissues, including the brain, become especially desperate and the body begins to frantically break down fat in order to liberate the small amount of carbohydrate (which can convert to glucose) contained therein.

Fat is able to convert to a biochemical called a ketone body. Ketone bodies can be used as an alternative fuel source by tissues that require glucose (brain, red blood cells, etc.). This will save the day in the short term but the problem is that ketone bodies do not “burn clean.” When ketone bodies are burned, pH and electrolyte imbalances ensue. These imbalances create dehydration, which in turn creates more pH and electrolyte imbalances. A metabolic disaster results if this state of glucose desperation persists.

Most patients in diabetic ketoacidosis are lethargic, depressed, and will not eat. They are dehydrated and frequently nauseated. Blood glucoses are extremely high and ketones can be detected in the urine. The goal is to gradually correct all the imbalances, get the patient out of the extreme fat-burning state, and establish some sort of initial regulation of the diabetes. 

Prognosis is generally fair as long as the complicating disease (the disease that is happening on top of the diabetes mellitus) can be resolved. That said, round-the-clock monitoring of electrolytes and blood sugars is needed to safely guide the patient through the crisis, and this kind of care has significant expense. Ketoacidosis involves potential disasters in potassium, phosphorus, pH, blood sugar, and sodium. All of these parameters must be controlled. The goal is to convert the complicated diabetic patient into an uncomplicated diabetic patient, but the patient will still be diabetic at the end of treatment.

What to Expect in the Hospital

The sooner the crisis is recognized, the faster treatment can be started. Because electrolytes can change moment by moment, blood testing is necessary throughout the day to keep track and keep the imbalances corrected. A facility that offers 24-hour care is ideal. Aside from the monitoring required to manage the ketoacidosis, testing to determine the precipitating stress is necessary as well.

In dogs, the most common precipitating/concurrent conditions are pancreatitis, urinary tract infection, and Cushing’s disease. In cats, precipitating/concurrent conditions include hepatic lipidosis, kidney infection, pancreatitis, and cholangiohepatitis.

Intravenous Fluids

Fluid therapy is the key to treatment. The patient is invariably dehydrated from the high circulating blood sugar levels, which cause excess fluid loss in urine, as well as from vomiting or diarrhea, which are common in ketoacidosis. Aside from simply providing fluids, the IV fluid provides a vehicle by which other metabolic derangements can be repaired.

Insulin

Blood sugar must be controlled if treatment is to be successful but to prevent brain damage, blood sugar levels must be dropped slowly. To achieve this, “regular insulin” (typically Humulin R®) is used, given either as multiple intramuscular injections or as a continuous drip. This type of insulin is short-acting and wears off quickly, which allows it to provide small adjustments. It is not until the patient is eating and nausea has been controlled that maintenance insulins can be started.

Potassium

Patients in ketoacidosis are greatly depleted in potassium. While insulin is needed to control blood sugar, insulin makes the problem worse by driving potassium into the body’s cells and out of the bloodstream. Typically, high amounts of potassium must be supplemented in the intravenous fluid solution.

Phosphorus

Low levels of phosphorus also accompany diabetic ketoacidosis and if levels drop too low, the patient’s red blood cells will begin to burst and be unable to maintain integrity. Phosphorus is also supplemented through the intravenous fluid solution.

Blood pH

The term ketoacidosis implies that the blood pH is overly acidic. If the situation is severe enough, sodium bicarbonate must be added to the intravenous therapy.

All these aspects require regular monitoring, which means lab work perhaps four times daily or more. Patients in diabetic ketoacidosis require close monitoring and intensive care.

When urine dipsticks no longer test positive for ketones and the patient is eating well and in good spirits, he or she is able to go home and be managed as a regular diabetic. Diet, monitoring, insulin etc. will be on-going concerns. Ideally, Ketostix, obtainable from any drug store, will be used at home to monitor for ketones to head off problems before they become extreme in the future.

By now you know that diabetes mellitus is about a lack of insulin and a need to balance insulin given by injection with dietary nutrients, especially sugars, fats, and proteins. Regardless of the patient’s species, there are some basic principles that hold true for the dietary management of diabetes mellitus. First, the obvious: the pet must like the food and reliably eat it. For most diabetic dogs, the excessive appetite typical of the disease ensures this but after regulation is achieved and appetite is more normal, it is important that the dog eats on a dependable schedule. Insulin is typically given only after the pet has eaten so the food should taste good and the pet should want to eat it. Second, the food must be of quality and quantity to maintain a good body condition so that the dog is able to build muscle and a healthy amount of body fat. Some diabetic dogs are very thin while others are too fat. It is important to tailor the diet to the individual rather than to adhere to rigid dietary rules.

Most dogs will not need a diet change, but this may be a good time to re-evaluate your feeding strategy. Here are some considerations:

Treats

Basically, minimize them.

The regulation of diabetes mellitus depends on the balance between the carbohydrates going in and the insulin allowing them to be stored. Many people like to offer the dog a treat after insulin injections or after blood sampling. This can add a surprising amount of calories and it is important to realize that every treat works against the insulin injections you are giving. If treats are felt to be necessary it will be important to determine how many calories are being added to the daily intake this way and adjust the meal amount accordingly. Ideally, treats are small and low in carbohydrates. High fiber vegetable bits usually work.

Fiber

Fiber comes in two types: soluble and insoluble. Soluble fibers, such as beet pulp, guar gum, psyllium, and fructooligosaccharides form a gel that holds water inside the bowel contents potentially softening the stool. They also serve as prebiotics, which means they resist digestion higher in the tract and are presented to the bacteria of the large bowel. These large bowel bacteria break down the fiber-containing nutrients to feed not only themselves but also to feed the animal’s colon cells, improve bowel circulation, and generally contribute to bowel health. The problem is that this resulting stool leads to a higher post-meal sugar surge in the bloodstream, which is exactly what we do not want. 

Insoluble fibers, such as cellulose, bulk up the stool which can be stimulating to the colon. Insoluble fiber is not digested by the colon bacteria and does not offer calories to the pet that has consumed them. This is helpful for weight loss programs as the indigestible fiber contributes to a feeling of fullness without contributing calories. 

After a meal, the starches and sugars taken in with the food lead to a postprandial surge in blood sugar level. Since the diabetic dog is dealing with runaway blood glucose levels 24 hours a day, meals, as necessary as they are, raise blood sugar even further. Our goal with dietary therapy is to blunt this effect. Insoluble fiber in the diet helps accomplish this by slowing the digestion and transit of the food in the gut. Too much insoluble fiber, however, will give the pet a false sense of being full and reduce appetite, which may not be what we want if the pet is underweight. So what are we looking for in a food? If the dog is overweight, we probably want a higher fiber diet (say greater than 15 percent of the dry matter as fiber) but for a more average dog, we want a moderate amount of fiber (5-15 percent of the dry matter). The fiber content noted in the guaranteed analysis will likely not specify if the fiber is soluble or insoluble; you will need to check the ingredient list to be sure. 

HOW TO CALCULATE FIBER CONTENT IN FOOD ON A DRY MATTER BASIS

To calculate the percentage of fiber in a diet on a dry matter basis, look for the “crude fiber” and the “moisture content” amounts on the guaranteed analysis on the food label.

SAMPLE GUARANTEED ANALYSIS

Crude Protein (min)…….8%
Crude Fat (min)………6%
Crude Fiber (max)………1.0%
Moisture (max)………78%

The moisture content is the amount of water in the food on an “as fed” basis expressed as a percent (what percent of the food you are feeding is actually just water). Take the moisture content and subtract from 100 to get the dry matter content of the food (the part of the food that is actually food and not water). For example, if the moisture content is 78% (typical canned food) then the dry matter is 22%. 

Now take the crude fiber value from the guaranteed analysis on the label and divide by the percent of dry matter. For example, crude fiber on the label is 1%, and moisture content is 78%. This means dry matter is 22% and 1 divided by 22 = 0.045 or 4.5%. Our hypothetical canned food is 1% fiber as fed but 4.5% on a dry matter basis. When comparing foods, always compare on a dry matter basis so as to compare “apples to apples”.

The above diet is way too low in fiber for an overweight dog and probably a little light on fiber for a dog of normal weight or thin dog.

High Digestibility Diets: Probably not the Best Thing

There are numerous diets on the market designed for dogs with sensitive stomachs. These foods typically are designed for easy digestion and absorption. While this is helpful to the dog with digestive issues, easy digestion and absorption amounts to higher blood glucose levels after eating. This is probably not the best thing for a diabetic dog.

Similarly, soft moist foods are preserved and flavored with sugars. These, as you might guess, raise postprandial blood sugar readily and are poor choices. These diets are not as common as they once were and should not be confused with canned foods.

Low Fat

A common issue that accompanies diabetes mellitus is elevated triglycerides (fats) in the bloodstream. In humans, this is the doorway to vascular disease, cholesterol deposits, heart disease, and stroke. Dogs do not generally have to contend with these issues but dietary fat becomes more relevant if the dog is one of the 30% for whom pancreatitis is believed to have damaged the pancreas and led to diabetes in the first place. If pancreatitis is in play or if the patients circulating triglyceride level is high, then fat restriction is going to be a must. Further, L-carnitine supplementation may also be of benefit as this nutrient is helpful in fat transport and metabolism. Fat-restricted diets may not be a good idea for very thin diabetic dogs, however.

Other Concepts

As long as the diet is consistent, it is generally possible to work with it in achieving diabetic regulation. Here are some additional tips:

• If the dog has an additional medical problem that requires a specific diet in its management, then this trumps the suggestions for diabetic management.
  
• As long as a reputable food that has passed AAFCO feeding trials is being fed, it should not be necessary to add nutritional supplements.
  
• Ideally, a brand of food with a fixed formula is preferred to one with an open formula. Foods with an open formula stick to their prioritized ingredient list on the label and to the guaranteed analysis minimums and maximums, but the exact ingredient amounts are not fixed. A fixed formula food uses specific amounts of each ingredient every time in every lot. In general, non-prescription diets are open formula diets.

Your veterinarian can help you choose the most appropriate food for your diabetic dog. There are several commercial diets made just for this purpose or you may elect to find one on your own. You can also contact a commercial pet nutrition service for further help. Ask your veterinarian if you need assistance.

ake-Homes for Pet Diabetes:

1. Diabetes mellitus is caused by a deficiency of insulin. You will probably have to give insulin injections to correct the deficiency. (Don’t worry. It’s easier than you think.)
   
2. The main symptoms of diabetes mellitus are excessive urination, excessive thirst, excessive appetite, and weight loss. Treatment should control these symptoms. Watching for these symptoms is the best way to know how your pet is doing.
   
3. The starting insulin dose is going to be based on averages and will be tweaked based on trial and error, depending on both test results and control of the symptoms.
   
4. You can save a lot of money if you get your own glucose meter and learn to do blood sampling at home (it’s easier than you think).
   
5. Using too little insulin is a problem in the long term, but too much insulin is potentially an emergency in the short term. Be sure you know how to recognize hypoglycemia and what to do about it. See Summary, below.

What is Diabetes Mellitus?

In order to understand the problems involved in diabetes mellitus it is necessary to understand something of the normal body’s sugar metabolism.

The cells of the body require fuel in the form of fat or sugar to conduct their daily activities.  Some tissues can use either sugar or fat depending on circumstances, and some tissues (such as the brain and nervous system) depend almost exclusively on sugar as fuel. Diabetes mellitus mostly involves the metabolism of sugar (in particular, a sugar known as glucose), so we will focus on the sugar part of the situation. Glucose comes from the diet in the form of starches and sugars that we eat.

Tissues cannot absorb glucose without a hormone known as insulin. Insulin is produced by the pancreas as part of the body’s natural blood sugar regulation. Insulin can be considered to be a key that unlocks the door, allowing sugar in the bloodstream to enter the body’s cells. Once inside the tissues, glucose can be burned for fuel or stored, but without insulin, the sugar stays in the bloodstream and cannot be used by the body.

Ketones in urine for three days or more in a row warrant a visit to the veterinarian. 

The body’s tissues are starving and the bloodstream has plenty of glucose to feed them, but without insulin, the glucose is unavailable.

So What Symptoms Result from this?

Because there is no way to remove glucose from the bloodstream, blood sugar levels are astronomically high. Normally, the kidney is able to conserve the bloodstream’s glucose but its mechanisms are overwhelmed and glucose spills into the urine in high amounts. If we continue our food delivery analogy, all the undeliverable food must be dumped. In the body, glucose dumping happens in the kidney with extra glucose dumping in the urine. This process involves the use of a lot of water with the ultimate result being a lot of urine being produced to process all that glucose to dump. This translates into excessive thirst and urination.

The tissues of the body are unable to access any of the glucose they need for fuel and are basically starving. Fat is mobilized and muscle is broken down to help feed the tissues but it does not do much good without insulin to bring fuel inside the cells. The patient shows excessive appetite because his body is in a state of starvation. Because the body is rapidly breaking itself down, weight loss is also a classic sign.

All the sugar in the urine provides a desirable growth medium for bacteria, and urinary tract infection is a common finding in diabetes mellitus. 

In diabetic dogs (but not cats), a specific type of cataract rapidly develops in the eye when high amounts of glucose enter the lens. Glucose normally feeds the lens, but the amounts of glucose coming into a lens in the diabetic state are much higher. Excess glucose is converted to another sugar called sorbitol, which in turn attracts water. The excess water disrupts the clarity of the lens, creating a diabetic cataract, which leads to blindness in almost all diabetic dogs. 

The main symptoms of diabetes mellitus are:

• Excessive Thirst
• Excessive Urination
• Excessive Appetite
• Weight Loss

Is it like Human Disease? Will We Need to Give Insulin Shots?

Dogs: Diabetes is most likely permanent and yes on the insulin shots.

Cats: Diabetes might not be permanent. Yes on the insulin shots if you want a chance at remission.

Diabetes mellitus is a classical disease in humans and most of us have heard some of the terms used to describe it. In humans, diabetes is broken down into two forms: Type I and Type II. These are also referred to as juvenile-onset and adult-onset diabetes or insulin-dependent and non-insulin-dependent diabetes. In short, Type I is the type where the pancreas produces no insulin at all, and Type II is the type where the pancreas produces some but not enough. Many pet owners wonder if dogs and cats have similar categories for their diseases.

Virtually all dogs have insulin-dependent diabetes and must be treated with insulin. There is no way around it. Their condition is similar to the Type I diabetic human in many ways.

Treatment: Giving Insulin by Injection

Since deficiency of insulin is the problem, it’s not surprising that giving insulin is the solution. You will need to learn to give injections, which is daunting to some owners at first, but almost everyone quickly becomes an expert. 

First, an insulin type and dose need to be selected. There are several types of insulins and it is not possible to know exactly how much insulin your individual pet will require; trial and error is needed. Your veterinarian will make a guess based on what works for other cats and dogs and what has been reported in the literature. Most pets require injections twice a day, approximately 12 hours apart, in conjunction with a meal. Because an overdose of insulin is potentially an emergency, it may be prudent to start with once-a-day insulin, just in case. If you like, discuss the pros and cons of each approach with your veterinarian. 

Insulin has traditionally been given by syringe in a shot, but insulin pens are proving more and more popular. The syringe method involves buying a box of syringes and a bottle of insulin, drawing up a measured amount of insulin, and giving a shot. The pen involves applying a needle tip to the pen, dialing a dose on the pen, sticking the tip into the pet’s skin, and pressing a button on the pen. Most people feel the pen method is much easier to perform but it may be difficult to find needle tips that are long enough for pet use as pet skin is much thicker than human skin.  In some situations, the pen is used as a dispenser for the syringe as the pen cartridges may be more cost-effective than bottles of insulin. Without video or first-hand experience with insulin pens or syringes, it may be hard to visualize the difference. See our section on insulin administration for more details. Not all pet insulins are available in a pen format. Your veterinarian will instruct you regarding options. 

Some insulins are available from the neighborhood pharmacy and some are available only through veterinary offices and veterinary pharmacies. Your veterinarian will either provide you with supplies or will give you the necessary prescriptions. If you are using syringes (instead of a pen) be sure the syringes and insulin concentration match. Insulin syringes are marked in insulin units (either U-100 syringes for 100 unit/cc insulins or U-40 syringes for 40 unit/cc insulins). Whenever you receive more supplies, always double-check these numbers.  

Never alter the insulin dose recommended by your doctor. To determine whether dose adjustments (or even a different type of insulin would be more appropriate), the pet will need a “glucose curve” where sugar levels are tracked over 10-24 hours. This can be done either by testing glucose levels with a glucose meter every 2 hours or so or by using a continuous monitor such as a FreeStyle Libre®. If a meter is used, it is best to test blood glucose in the pet’s own home and send the values to the vet but the curve can certainly be performed in the vet’s office. Note that stress and anxiety will alter blood glucose levels which means that values obtained at home will be more representative of the pet’s situation. 

Treatment: Oral Agents (Cats only)

Some cats will qualify for oral treatment of their diabetes. There are three medications that might be employed for this: bexagliflozin, velagliflozin, and glipizide.  

Bexagliflozin, an oral tablet medication, and velagliflozin, an oral solution (liquid), are options for some cats with diabetes mellitus where insulin injections are not practical.  Both of these drugs increase the kidneys’ ability to remove extra glucose from the bloodstream, keeping blood sugar levels in check. Lower blood sugar levels allow the pancreas to recover some and may alleviate many symptoms of diabetes. On the flip side, only certain cats will qualify for use, and there is potential for some very serious side effects. This includes diabetic ketoacidosis, a condition where insulin becomes so low that blood sugar cannot be used well in the body’s cells.  Following your veterinarian’s recommendations on proper monitoring is crucial. 

Finally, glipizide is a human medication used to reduce glucose levels by causing the pancreas’ beta cells to actually produce insulin.  In order for glipizide to have an effect, healthy beta cells need to be present. Glipizide is not as effective as bexagliflozin or velagliflozin in lowering blood glucose levels, so it does not include the intense monitoring or the same risk for complications as the others do. It is typically used for borderline patients or patients where insulin injections are simply not possible. Approximately 25% of cats will respond to this medication.

The various insulin formulations have different storage requirements. Check with your veterinarian for the proper storage of your pet’s prescribed insulin.

Diet and Feeding

Regulation can generally be worked out on whatever diet the pet is eating but there are some diets and feeding strategies that are helpful. For dogs, high-fiber/low-fat diets are preferred as they slow the absorption of sugars in the diet and help maintain a more regulated blood sugar level. Fiber also seems to make the body’s tissues more sensitive to insulin which also helps with regulation. Rewards are often employed to facilitate the insulin injection experience but these calories can add up and interfere with regulation so be sure your veterinarian is aware of all food items.  Diabetic dogs are best fed in two meals, approximately 12 hours apart. After they have been seen to eat their food, their insulin dose can be given.

For cats the strategy is different. First, cats seem to do best fed in multiple small meals daily so they should be allowed access to food at all times. Second, the high protein/low carbohydrate diets seem to be the most conducive to regulation. There are specific prescription diets, both canned and dry, for diabetic cats.

Learn more details on handling diets and feeding for cats and dogs.

What about Home Glucose Testing? 

Home glucose monitoring has many benefits: glucoses are monitored in the comfort of the pet’s own home without alterations from vet visit anxiety, a lot of money can be saved by monitoring at home, and questions about glucose status can be quickly answered and addressed. There are two ways to monitor glucoses at home: Continuous monitoring and a glucose meter.

Continuous Monitoring 

Continuous monitors have changed the way diabetic pets are monitored. A sensor with a tiny needle is implanted in the pet and paired wirelessly to either a phone or a reader. It reads tissue glucose levels constantly and reports its data to the device of your choice as well as to an internet portal where your veterinarian can access it. The sensor setup lasts up to 2 weeks and typically costs less than an in-house glucose curve run in the hospital. This is a fantastic option when it is time to get get a glucose curve. If one simply wants to spot-check a glucose level, one will need a glucometer and you will need to be able to take a blood sample from your pet.

Glucometer/Glucose Monitoring

 Many pet owners like to check glucose levels prior to insulin injections on a daily basis or simply want the ability to check a glucose level if there is a concern for hypoglycemia. For these situations, a glucometer is needed.  Human meters can be obtained at any drugstore, but we recommend getting a veterinary meter as the calibration is different. AlphaTrak is a popular brand, but there are presently several other brands available. 

The meter kit will contain measuring strips, solutions for calibration, and a spring-loaded lancet device for taking blood samples (usually from the ear margin). For details, please visit the Diabetes Monitoring section of this library. Taking single-drop blood samples turns out to be easier than you might think, and video links are provided in the monitoring section. Still, not every pet is amenable to blood sampling, and we do not want anyone getting bitten or scratched.

If you choose to use a glucometer at home, be sure to keep a log of when your pet was fed, when insulin was given, and what the glucose levels were that you found. (There are many phone apps to assist with this). Bring this log to your veterinarian when you come for checkups. Glucose levels obtained prior to the first insulin administration of the day are particularly useful. Your veterinarian will also be particularly interested in signs associated with poor regulation: excessive thirst, excessive urine production, excessive appetite, and weight loss

See the insulin administration guide for cats.

Hypoglycemia and Other Things to Watch for

The most serious problem to watch for is hypoglycemia (low blood sugar). This results from a mismatch in food consumption and insulin dose. If the dose is too high, you can get hypoglycemia. If the pet doesn’t eat, you can get hypoglycemia.  Your pet may look simply tired, weak, or sleepy. If she is roused, she will seem drunk or may not be able to fully come to alertness. This can be an emergency and can progress to seizures, so it is good to know what to do at home to prevent disaster.

If your pet appears wobbly or drunken, the blood sugar level may have dropped too low. This occurs after an insulin overdose. First, try to get your pet to eat. If the pet will not eat, administer light Karo syrup, honey, or even sugar water at a dose of one tablespoon per 5 pounds. If no improvement occurs, immediately see your veterinarian for emergency treatment. When your pet is more stable, a glucose curve will be needed to determine why this happened and what a more appropriate insulin dose might be.

It is best to make sure that your pet has recently eaten before giving the scheduled insulin dose.

Other Reasons to Return to the Vet

Bring your pet in for a re-check exam and testing if you note any of the following: 

• the pet seems to feel ill.
• the pet is losing weight.
• the pet has a ravenous appetite or loses its appetite.
• the pet seems to be drinking or urinating excessively. 
• the pet becomes disoriented or groggy.

It is important for diabetic pets to have their teeth cleaned annually. Dental tartar seeds the body with bacteria and when blood sugar levels run high, infections in important organs can take root. The kidneys and heart are particularly vulnerable.

Some Pets are Difficult to Regulate

Your pet will probably require re-regulation at some point. There may be an underlying reason to sort out. If your pet seems to fit into this category, some reasons could be:

• Improper administration of insulin. If possible, have your doctor observe you giving the insulin to your pet. Another possibility is that your insulin may be out of date.
   
• Rapid insulin metabolism. Insulin wears off quickly in some animals. Your pet may require a different type of insulin or a second injection during the day, or even additional injections during the day.
   
• Insulin overdose may actually lead to elevated glucose levels (and clinical signs of diabetes mellitus). In this situation, too much insulin brings the blood glucose too low, and other hormones respond to bring it back up (and generally overdo it).  
  
• Steroid administration (such as prednisone, prednisolone, etc.) will interfere with insulin. 
    
• Progesterone, a female hormone, also interferes with insulin. Unspayed female diabetics should be spayed once they are sufficiently regulated.

For more details on trouble with regulation, read about hard-to-regulate cats.

Additional Information on Feeding a Diabetic Pet

Regulation is achieved via a balance of diet, exercise, and insulin. Realizing that therapeutic diets are not always attractive to pets, there are some ideal foods that should at least be offered.

The most up-to-date choice for cats is a low-carbohydrate, high-protein diet. These diets promote weight loss in obese diabetics and are available in both canned and dry formulations. For dogs, high-fiber diets are still in favor as fiber seems to help sensitize the pet to insulin. Talk to your veterinarian to select an appropriate choice for your pet.

Avoid soft-moist diets as sugars are used as preservatives. Avoid bread and sweet treats. If it is not possible to change the pet’s diet, then regulation will just have to be worked out around whatever the pet will eat.

In Summary:

1. Diabetes is caused by a deficiency of insulin. Diabetes mostly involves metabolizing sugar, particularly a sugar called glucose. You will probably have to give insulin injections to correct the deficiency. It’s easier than you think.
2. A body requires fuel in the form of fat or sugar. Glucose comes from a diet of starches and sugars. Tissues cannot absorb glucose without insulin, so the level of insulin affects the glucose level.
3. The main symptoms are excessive urination, thirst, appetite, and weight loss. Watching for these symptoms is the best way to know how your pet is doing.
4. Tissues are unable to access any of the glucose they need for fuel and are basically starving. Rather than going into tissues, unmetabolized glucose goes into the bloodstream but cannot be removed from there, so glucose levels become astronomically high. The kidney compensates by dumping glucose straight into the urine. The kidney needs much water to do that, so a larger volume of urine is made just for dumping, causing a cycle of excessive thirst and urination.
5. Your veterinarian will select the first dose of insulin based on glucose averages and will tweak it thereafter. You can use either a syringe or an insulin pen.
6. While using too little insulin (high blood sugar or hyperglycemia) can lead to problems, using too much insulin (low blood sugar or hypoglycemia) is potentially life-threatening in the short term. Low blood sugar creates listlessness and potential unconsciousness; the fix is to offer food immediately.
   • Extremely low blood sugar can cause tremors, seizures, weakness, collapse, and incoordination, in addition to other signs.
   • Extremely high blood sugar can cause seizures, circling, pacing, weakness, coma, and incoordination, among others.
   • Both are emergency situations, and you should see your veterinarian or an emergency hospital immediately.
7. Never alter the insulin dose without discussing it first with your veterinarian.
8. It’s easiest for your pet if you get a glucose meter, install a continuous monitor, and do blood sampling at home. That way, you can find out their glucose status right away and do something about it.
9. Some pets are difficult to regulate. Yours will probably require re-regulation at some point. Regulation needs a consistent balance of diet, exercise, and insulin.
10. The current choice of food for diabetic cats is a low-carbohydrate, high-protein diet. High-fiber diets are best for dogs. 
11. Dogs: Diabetes is most likely permanent, and they need insulin shots.
12. Cats: Diabetes might not be permanent. To have a chance of remission, they need insulin shots. Some cats might be able to take pills rather than shots.