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

---

Hear From Us Again

Don't forget to subscribe to our email newsletter for more recipes, articles, and clinic updates delivered straight to your e-mail inbox.

Related Categories:

dog health, cat health

Diets for Pets with Heart Disease

It is now known that the diet is a very important part of medical therapy for heart disease and one in which owners have the most crucial role. New research is showing that proper nutrition may be able to slow the progression of heart disease, minimize the number of medications required, improve the quality of life or, in rare cases, actually cure the disease.

Maintaining Optimal Weight

A key goal for the nutritional management of heart disease is to maintain optimal body weight, because both weight loss and obesity can be harmful to your pet. Owners should watch their pets for loss of overall body weight and loss of muscle (cachexia describes muscle loss seen in animals with heart disease).

Many pets with heart failure will not eat as much, as frequently, or the same things as when they were healthy—this is called anorexia. This can be an important factor in the weight and muscle loss that occurs. Maintaining your pet's interest in food is a tricky, yet important, task but there are several tips to achieving this.

First, try giving more frequent, but smaller meals. Cats frequently are more interested when the food is warmed. Dogs are less predictable, but will usually prefer one temperature over another (try different temperatures—warmed, room temperature, cold or even near-frozen).

Another method to manage reduced or changed appetite in an animal with heart disease is to gradually replace their current food with a new one. For example, switch from a dry food to a canned food or change to a different brand. However, be sure to talk to your veterinarian about the diet that is most appropriate for your pet.

Finally, flavor enhancers such as cooked meat or fish (without any salt; avoid deli meats) for dogs and cats, or sweeteners (such as yogurt, maple syrup, applesauce or honey) for dogs may be added to the diet to promote eating. Fish oil may be given to help with cachexia.

As it is important to make sure animals are not too skinny, it is also necessary to make sure they are not too heavy. Owners often find that severely overweight dogs and cats with heart disease that successfully lose weight, appear to have less trouble breathing and are more comfortable. A special diet may be prescribed for your dog or cat to help treat the heart disease as well as to maintain their optimal body weight.

Important Nutrients for Pets

Nutritional deficiencies are now uncommon in dogs and cats unless owners are feeding a nutritionally unbalanced diet. If your animal is eating a homemade, raw or vegetarian diet, or a diet made by a small company, please let your veterinarian know this as it could be important in the diagnosis or treatment of your pet.

Even if your pet doesn't have a specific nutritional deficiency, increasing the levels of certain nutrients may have benefits in the treatment of heart disease. Nutrients that may need to be supplemented are described below. It is important to keep in mind that dietary supplements have little regulation so quality control can be a big problem. Cummings School recommends using dietary supplements that bear the logo of the United States Pharmacopeia Dietary Supplement Verification Program (DSVP), which tests human dietary supplements for ingredients, concentrations, dissolvability and contaminants. Another good resource is ConsumerLab.com, which performs independent testing of dietary supplements primarily for human supplements but also for pet products as well.

Taurine

Taurine is an amino acid which, if deficient, can cause a specific heart disease called Dilated Cardiomyopathy (DCM) in cats. Complete and balanced commercial cat foods have enough taurine but diets that are not complete and balanced (labeled as for intermittent or supplemental use only), vegetarian diets or homemade diets can be too low in this nutrient. If your cat is diagnosed with DCM, the cardiologists will usually test their blood taurine level to see if they are deficient and prescribe supplements to help treat the disease.

Dogs, unlike cats, are not thought to require taurine in the diet. However, certain breeds (Cocker spaniels, Newfoundlands, St. Bernards, English setters, Labrador and Golden retrievers) may require some in the diet to avoid a deficiency. Lamb and rice diets, very low protein, and high fiber diets in these predisposed breeds may make it more likely for them to develop taurine deficiency. Dogs of these predisposed breeds that develop DCM may have their blood tested for taurine levels. Most dogs with DCM do not have taurine deficiency but when levels are low then taurine supplementation can help in the management of heart failure.

Omega-3 Fatty Acids (Fish Oil)

Certain types of fatty acids present in fish oil (called omega-3 fatty acids) have been shown have a positive effect in dogs with heart disease. Omega-3 fatty acids do not help to prevent heart disease as they do in people. This is because in people, omega-3 fatty acids have a beneficial effect in coronary artery disease, which does not occur in dogs and cats. In pets with heart disease, fish oil is recommended for dogs and cats who have reduced or altered appetite or any muscle loss (cachexia). Omega-3 supplements can also be used (in addition to appropriate medication) in the treatment of dogs with abnormal heart rhythms (arrhythmias).

Fish oil may be purchased over-the-counter at almost all human pharmacies but dose and quality of the products vary widely. Cummings School generally recommends a one gram fish oil capsule that contains 180mg of eicosapentaenoic acid (EPA) and 120mg of docosahexaenoic acid (DHA). The quality control of the individual product should be checked to ensure your pet is getting the right amount and is not getting unwanted nutrients or contaminants. Various ways to check quality control of dietary supplements are mentioned above.

With capsules of this size most dogs and cats can be given one capsule per 10 pounds of body weight. Fish oil is relatively safe but if your pet has a bleeding disorder or is already eating a diet high in omega-3 fatty acids, supplementation should be carefully considered with your veterinarian. Fish oil supplements should contain vitamin E as an antioxidant, but other nutrients should not be included. Cod liver oil and flax seed oil should not be used as sources of omega-3 fatty acids in dogs and cats.

Restricted Nutrients for Pets

While supplementing important nutrients may prove beneficial, it is equally true that reducing the levels of certain nutrients may have benefits in the treatment of heart disease. Nutrients that may need to be restricted are described below.

Sodium

Depending on the severity of heart disease, decreasing the amount of sodium in the diet can be beneficial. In pets with mild heart disease (those that are not showing any symptoms), only mild sodium restriction is recommended. If the heart disease is more advanced, causing a condition known as Congestive Heart Failure (CHF), greater sodium restriction is advised. Talk to your veterinarian about the diet that would be most appropriate for your dog or cat. Diets that are low in protein should be avoided unless the pet has severe kidney disease. Cummings School provides a reduced sodium diet list in the PDF format for your convenience.

While it is important to feed the most appropriate pet food given your animal's type, level of heart disease and other medical issues, it is also necessary to remember that large amounts of sodium can also come from treats, table food and the foods you might use to give daily medications. A list of treats for dogs with heart disease is also provided in the PDF format. Be sure to talk to your veterinarian about which treats can be safely fed to your pet.

---

Hear From Us Again

Don't forget to subscribe to our email newsletter for more recipes, articles, and clinic updates delivered to your inbox (here). Or, you can keep up to date by liking and following our Facebook page (here).

Related: We have more information under our dog health + cat health categories.