Diabetes Ketoacidosis (DKA) - A Complication of Diabetes in Cats and Dogs

Unfortunately, as veterinarians, we are seeing an increased prevalence of diabetes mellitus in dogs and cats. This is likely due to the growing prevalence of obesity (secondary to inactive lifestyle, a high carbohydrate diet, lack of exercise, etc.). You're probably wondering if you just had a dog or cat diagnosed with diabetes mellitus—what do you do? First, we encourage you to take a look at these articles for an explanation of the disease:

• Diabetes in Cats

• Diabetes in Dogs

This article will teach you about life-threatening complications that can occur as a result of the disease; specifically, a life-threatening condition called diabetes ketoacidosis (DKA) so that you know how to help prevent it.

What is DKA?

When diabetes goes undiagnosed or difficult to control or regulate, the complication of DKA can occur. DKA develops because the body is so lacking in insulin that the sugar can’t get into the cells — resulting in cell starvation. Cell starvation causes the body to start breaking down fat in an attempt to provide energy (or a fuel source) to the body. Unfortunately, these fat breakdown products, called “ketones,” are also poisonous to the body.

Symptoms of DKA

Clinical signs of DKA include the following:

• Weakness

• Not moving (in cats, hanging out by the water bowl)

• Not eating or complete anorexia

• Vomiting

• Excessive thirst and urination (clear, dilute urine)

• Large urinary clumps in the litter box (anything bigger than a tennis ball is abnormal)

• Weight loss (most commonly over the back), despite an overweight body condition

• Obesity

• Flaky skin coat

• Excessively dry or oily skin coat

• Abnormal breath (typically a sweet “ketotic” odor)

• Diarrhea
  

In severe cases DKA can also result in more significant signs:

• Abnormal breathing pattern

• Jaundice

• Abdominal pain (sometimes due to the secondary problem of pancreatitis)

• Tremors or seizures

• Coma

• Death

What can cause DKA?

When DKA occurs, it’s often triggered by an underlying medical problem such as an infection or metabolic (organ) problem. Some common problems that we see with DKA include the following:

• Pancreatitis

• Urinary tract infection

• Chronic kidney failure

• Endocrine diseases (e.g., hyperadrenocorticism [when the body makes too much steroid], or hyperthyroidism [an overactive thyroid gland])

• Lung disease (such as pneumonia)

• Heart disease (such as congestive heart failure)

• Liver disease (such as fatty changes to the liver)

• Cancer

Diagnosing DKA

While diagnosing DKA is simple, by looking at the blood sugar levels of dogs and cats and by measuring the presence of these fat breakdown products in the urine or blood, treatment can be costly (running between $3-5000). A battery of tests and diagnostics need to be performed, to look for underlying problems listed above, and treatment typically requires aggressive therapy and 24/7 hospitalization.

Treatment of DKA

Treatment, typically, is required for 3-7 days, and includes the following:

• A special intravenous catheter called a “central line” (placed to aid in frequent blood draws)

• Aggressive intravenous fluids

• Electrolyte supplementation and monitoring

• Blood sugar monitoring

• A fast acting or ultra fast acting insulin, regular or Lispro, typically given intravenously or in the muscle

• Blood pressure monitoring

• Nutritional support (often in the form of a temporary feeding tube)

• Anti-vomiting or anti-nausea medication

• Antibiotics

• Long-term blood sugar monitoring and a transition to a longer-acting insulin

Thankfully, with aggressive supportive care, many patients with DKA do well as long as pet parents are prepared for the long-term commitment (including twice-a-day insulin, frequent veterinary visits to monitor the blood sugar, and the ongoing costs of insulin, syringes, etc.).

Preventing DKA

By following your veterinarian’s guidelines and recommendations you can help regulate and control your pet’s diabetic state better and monitor your pet carefully for clinical signs. For example, if your pet is still excessively thirsty or urinating frequently despite insulin therapy, they are likely poorly controlled and need an adjustment of their insulin dose (of course, never adjust your pet’s insulin or medications without consulting your veterinarian).

When in doubt remember that the sooner you detect a problem in your dog or cat, the less expensive that problem is to treat. If you notice any clinical signs of diabetes mellitus or DKA, seek immediate veterinary attention. Most importantly, blood glucose curves (when a veterinarian measures your pet’s response to their insulin level) often need to be done multiple times per year (especially in the beginning stages of diabetes mellitus).

If you have any questions or concerns, you should always visit or call your veterinarian.

Related reading:

• Diabetes in Cats

• Diabetes in Dogs

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How to Clean Your Dog’s Ears

Keeping your dog's ears clean and dry is an important part of keeping them healthy and happy. In this article, we explain how to do an easy-does-it ear cleaning.

Have you rubbed your dog’s ears today? Sure you have. It’s one of those things we do almost mindlessly, relishing their softness and our dog’s positive response. But did you know that rubbing your dog’s ears is also a great way to make sure they are healthy? Think about it. If your dog enjoys having them rubbed, you can tell their ears are healthy. If they’re tender from an infection or injury, your dog may pull away from you, unwilling to have them touched. Gently massaging your dog’s ears is a great first step toward checking their condition. If you notice that they are sensitive about having them touched, it’s time to take a closer sniff.

Sniff & See

Yes, sniff. Healthy ears don’t have an odor. Make a habit of sniffing your dog’s ears, starting when they are just a puppy, so you know how they smell normally. If their ears smell yeasty or downright stinky, it’s likely that a bacterial or yeast infection is brewing.

Then take a look inside their ears. The skin should be nice and pink with a light coating of pale yellowish wax. A small amount of wax is part of the ear’s self-cleaning system. If the ears look red or have a dark brown or black discharge, or if your dog frequently shakes their head, paws at their ears, or rubs them against the carpet or furniture, they need a visit to the veterinarian to see what’s causing the problem.

How do you know if your dog’s ears need to be cleaned? If they look and smell good, leave them alone. In fact, cleaning a healthy ear can damage its self-cleaning abilities or irritate it.

Clean the ears yourself (see the step-by-step directions below) if they have a mild odor and you see an occasional head shake. That may be enough to stop an infection before it takes hold. You should also clean the ears if the wax looks dirty gray instead of golden or if the ears look waxier than normal. When too much wax builds up, it can block airflow in the ear and lead to an infection of the outer ear canal.

When it comes to dogs and cats, ears are much the same. Both species get the same allergies and infections. Cats, however, are more likely to get parasitic infections (preventable with monthly or quarterly topical medications), whereas dogs are more predisposed to allergic ear disease.

Avoid Ear Infections

Take your dog to the vet if the signs—or smells—continue or worsen after you clean their ears. They may need a deep cleaning and antibiotic drops or ointment to resolve the infection.

Some dogs are ear-infection magnets. If you have a floppy-eared dog or a dog with a history of ear problems, check their ears weekly. There’s no scientific evidence that dogs with droopy ears have more ear infections, but anecdotally they tend to be the ones that veterinarians see more often with ear infections. That said, allergies are probably the main cause of ear problems, and they are seen in dogs of all types.

Your best bet for preventing ear infections is to keep your dog’s ears clean and dry. Bacteria and yeast love a warm, moist environment. Keep them at bay by drying your dog’s ears thoroughly after a swim or bath.

Step-by-Step Ear Cleaning for Dogs

• Tilt your dog's head downward with one hand and squirt a gentle cleanser (ask your veterinarian for a recommendation first!) into the ear, filling the canal.

• Using the flap to hold the ear closed, give it a nice massage—which will squish the cleanser around and soften any gunk inside.

• Step back and let your dog shake. You may want to hold a towel between you and your pooch so you aren't in the splash zone.

• Wipe away any remaining cleanser with soft, dry tissue, not going any deeper than your first knuckle. That’s all you need to do. (Don’t mess around with cotton swabs that can drive debris deeper into your dog’s ear or q-tips that can drive it down further or do damage to the inner ear.)

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