Diabetic ketoacidosis in dogs and cats: What you need to know

Diabetic ketoacidosis (DKA) is a life-threatening complication of uncontrolled diabetes mellitus in dogs and cats. Pets with chronically elevated blood sugar levels due to a poor response to or lack of adequate treatment are at risk for DKA. When blood glucose cannot be used as a source of energy due to insufficient insulin, the body begins breaking down fats and producing ketones that acidify the blood. As blood sugar levels and ketone levels increase, life-threatening DKA occurs. Read on to discover:

• How dogs and cats get diabetic ketoacidosis
• Symptoms of diabetic ketoacidosis in pets
• Treatment for diabetic ketoacidosis in animals
• How owners can decrease the risk of diabetic ketoacidosis in their pets

Most pets who develop DKA initially show signs of elevated blood sugar, such as excessive thirst and urination, for several days or even weeks. Signs that diabetes mellitus has progressed to DKA include vomiting, loss of appetite, lethargy, abdominal pain, and breath that smells sweet or similar to nail polish remover. Treatment requires intensive care in a hospital to regulate blood glucose levels, electrolyte abnormalities, dehydration, and blood pH. Most pets in DKA have another underlying health condition in addition to diabetes that needs aggressive management. DKA is prevented by careful management of diabetes mellitus, including regular insulin administration, nutritional therapy, and ongoing monitoring.

Diabetic ketoacidosis, or DKA, is a life-threatening complication of diabetes mellitus (DM) in dogs and cats.  DKA is characterized by elevated blood sugar levels, acidification of the blood due to an abundance of ketone bodies, and electrolyte imbalances. DKA is a medical emergency that requires immediate care. Unfortunately, many cases of DKA in dogs and cats occur before the owner knows their pet is diabetic. There are other types of ketoacidosis that can occur due to other factors, such as fasting, starvation, electrolyte disturbances, and a lack of adequate carbohydrates in the diet. These are unrelated to DKA.

How pets develop diabetic ketoacidosis

With DM, insulin isn’t present in the body or isn’t working properly, which causes the levels of some hormones, such as glucagon, cortisol, growth hormone, and catecholamines, to go up. This also causes glucose to no longer be metabolized normally. As a result, blood glucose levels increase. When glucose can’t be used for energy, the body begins metabolizing fats for energy and producing ketones as a byproduct. Ketones can be used as an alternative energy source in the short term but become dangerous in the long term as ketones build up and acidify the blood.

The risk of DKA in pets can be increased by various other factors, such as:

• Drugs that alter insulin production or action
• Severe dehydration
• Other medical issues that interfere with diabetes regulation

Most animals with DM have a concurrent disease that increases the risk of DKA. In dogs, these diseases can include:

• Pancreatitis
• Urinary tract infections
• Heart disease
• Cushing’s syndrome

In cats with diabetes, conditions that may increase the risk of DKA include:

• Hepatic lipidosis (fatty liver disease)
• Kidney infection
• Pancreatitis
• Cholangiohepatitis

Clinical signs of DKA in dogs and cats include:

• Lethargy
• Loss of appetite
• Weakness
• Vomiting
• Breath that smells sweet or like nail polish remover (acetone)
• Abdominal pain
• Excessive panting in dogs
• Rapid breathing in cats

Severe DKA can result in coma and other serious neurological signs. It’s important to seek medical care right away when a pet has symptoms such as lethargy, weakness, and a loss of appetite, even if they haven’t been diagnosed with diabetes. The first few weeks or months with a newly diagnosed diabetic pet are difficult, and it’s crucial to monitor any physical or behavioral changes and alert a veterinarian if they occur. Work closely with a vet to manage your pet’s diabetes to minimize the likelihood of DKA and other diabetes complications.

Treating diabetic ketoacidosis involves stabilization in a hospital followed by long-term management of diabetes mellitus. In general, the sooner DKA is recognized and treated by a veterinarian, the better the prognosis. If left untreated, DKA is rapidly fatal.

Initial treatment in a hospital

The initial treatment of DKA requires aggressive treatment and a hospital stay, usually for several days in intensive care. A 24-hour hospital is best so your pet can be constantly monitored. Several parameters must be closely monitored and regulated to stabilize a DKA patient:

• Potassium, sodium, and phosphorus levels
• Blood sugar levels
• Blood pH

Treatment in the hospital involves:

• IV fluid therapy for dehydration
• Long and short-acting insulin therapy to manage blood glucose level
• IV phosphorus and potassium supplementation
• IV sodium bicarbonate if the blood is very acidic
• Managing other underlying conditions that are usually present to trigger DKA

Balancing all of these parameters as the patient recovers can be very complicated, and stabilization can take several days. Lab testing is done frequently to check progress and make treatment adjustments. When a patient is stabilized and eating well, they can be discharged at the vet’s discretion.

Long-term management

Management of diabetes mellitus and other contributing health issues is needed for long-term care. At-home instructions from a vet may include:

• Insulin dosage adjustment
• Adjustment or addition of other medications
• Diet change
• Increase in water intake
• Weight management

Regularly testing the glucose and ketone levels in the blood may be recommended. “Pet parents also need to be aware that DKA is likely to recur in at least 7% of dogs and up to 40% of cats,” states Dr. Jo Myers, a veterinarian on Vetster.

DKA can be reversed, and a successful outcome is more likely with early intervention. Stabilization requires intensive veterinary care and cannot be done at home. DKA is rapidly fatal, but with vet treatment, about 70% of dogs and cats survive. Diabetes mellitus cannot be cured or reversed. However, some cats can go into diabetic remission with a well-managed diet and no longer need insulin injections. DKA is always a possibility in pets with DM if their blood sugar cannot be well-regulated.

DKA does not occur in non-diabetic pets. Many cases of DKA occur in pets who have undiagnosed diabetes. It’s important to know the common signs of DM in pets, such as increased thirst, excessive urination, and weight loss, and to seek treatment early to control the condition before it escalates to DKA. Both dogs and cats usually display normal behavior in the early stages of diabetes, but by the time a pet develops DKA, they have obvious signs of illness.

Most cases of DM can’t be prevented. You can lower the risk of some cases of DM with:

• Weight management
• Healthy diet
• Daily exercise
• Managing underlying health issues such as pancreatitis

In pets with diabetes, you can lower the risk of DKA by:

• Mixing, measuring, administering, and storing insulin according to a vet’s instructions
• Managing diet
• Managing weight
• Using appropriate insulin therapy to prevent elevated blood sugar levels
• Managing other underlying health conditions that make DM more complicated to treat

Talk to a vet if your pet’s diabetes symptoms seem to be getting worse or if their blood glucose level is always high. They may need a change to their insulin dose or other treatment adjustment. If you have questions about your pet’s symptoms or need help administering insulin correctly, online veterinarians are always available on Vetster to help in a virtual vet appointment.

Can my dog or cat survive diabetic ketoacidosis?

With prompt treatment from a veterinarian, about 70% of dogs and cats survive diabetic ketoacidosis (DKA). In general, the earlier DKA is caught and treated, the better the prognosis. It’s important to seek veterinary care right away if your pet is experiencing symptoms such as lethargy, loss of appetite, and weakness.

How do you treat diabetic ketoacidosis in cats and dogs?

Diabetic ketoacidosis in cats and dogs is treated with stabilization in the hospital, usually for several days. Treatment is often complicated, involving IV fluid therapy, electrolyte supplementation, insulin therapy, and frequent laboratory testing.

What are the signs of diabetic ketoacidosis in dogs?

Warning signs of diabetic ketoacidosis (DKA) in dogs include lethargy, lack of appetite, weakness, increased respiratory rate, vomiting, and breath that smells sweet or like nail polish remover (acetone). It’s important to seek medical attention any time a dog experiences these symptoms, even if they have not been diagnosed with diabetes.