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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Why You Should Routinely Clean Your Pet’s Food and Water Bowls

Did you know your pet's food and water bowls are a hot spot of risk? Dirty food and water bowls can lead to parasites, affecting your pets and household. In the context of hygiene, pet food bowls are definitely an important part of your cleaning routine to be meticulous about.

We will cover a variety of things:

Good Hygiene & Safety Measures

4 Ways Your Dog’s Water Can Make Them Sick

Determining the right bowls for your pet

Where Do the Bugs Come From?

Zoonotic diseases are diseases that normally infect an animal, but poses a risk to people.

The most common zoonoses with regard to food and water bowls are salmonella, campylobacter, and worms.

These bugs have different mechanisms of causing infection, but they can all be shed into the environment through feces and travel indoors on the pet’s paws or coat.

When your pet licks their fur and then eats from a bowl, this can spread infection onto an object you touch. When you pick up the bowl, you run the risk of getting that same bug on your hands.

Also, with salmonella, the food itself may contain bacteria, with raw meat and eggs posing a special risk. We normally rely on thorough cooking to kill salmonella, so feeding a raw diet to your pet increases the risk.

Food Hygiene

Knowing raw meat could contain salmonella should make you think twice about where you store it.

It should be refrigerated (below 40° F) to slow down the growth of contaminating bacteria. Avoid storing raw meat or any pet food immediately beside human food. Make sure it’s securely wrapped and put in a different section of the fridge whenever possible.

The longer food sits in the open at room temperature, the greater the chance of bacterial contamination and multiplication. With this in mind, serve only the portion your pet can eat in one go so that food isn’t left sitting around. To streamline this and avoid the risks, buy packs of moist food in smaller sizes so you can throw unopened food away rather than store open sachets for days.

Related: Salmonella Infection in Pets & People and Zoonotic Diseases

What’s the Safest Way to Wash Bowls?

Wash them every day: Rinse them under running water and either hand-wash them in hot soapy water or put them on the top rack of the dishwasher (so the dishwasher’s heat doesn’t melt plastic dishes).

When hand-washing, do the pet’s dishes last, using a separate sponge or scourer kept just for the pet’s things. Make the water as hot as you can stand without burning yourself and use liquid or detergent soap. Rinse them well — your pets won’t enjoy a soapy aftertaste, and there’s a slim chance it could make them ill.

Fresh drinking water must be available for your pet at all times, so have at least 2 sets of everything so you have one bowl that’s clean and full of water for your pet while you are cleaning the other one.

Other Safety Measures

Always keep separate utensils for the pet’s food, such as serving spoons, forks, or scoops. Never use the pet’s things (toys, bowls, etc.) as a scoop.

Although some pets have nasty tummy upsets as a result of salmonella and campylobacter—not all do. Some pets are carriers, meaning the bug is in their system—they’re not ill, but they excrete it in their waste. Some of those bacteria (and also worm eggs) get onto the pet’s coat and then onto your hands when you stroke them. Delightful imagery, right? Wash! Your! Hands!

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4 Ways Your Dog’s Water Can Make Them Sick

Your dog’s water bowl is the 3rd most germ-laden place in the house!

We all know clean and fresh water is vital for good health. With this in mind, you probably top up the bowl every time it goes down.

But as it happens, this isn’t sufficient to ensure good health. Merely topping up the water level does nothing to control harmful bacteria or even toxins that can be lurking in the water. Not only are these bugs unpleasant, but also they can cause illness in people, especially those with weak immune systems. So what bugs could be lurking in your pet's water bowl? Surprisingly, quite a few!

1. Giardia

This single-celled parasite may be better known to you as “traveler’s diarrhea.” It can infect people too—not just your pets.

Giardia is shed in feces inside a hardy oocyst. The latter is tough and can survive for long periods of time in warm, humid conditions, and thrives in water.

When a dog drinks infected water, the parasite passes into its gut. Some dogs show no symptoms, but others can develop sickness and weight loss in addition to diarrhea.

A diagnosis is made by examining a fecal sample under a microscope. Most cases respond well to 3-10 days of medication tailored to your pet.

Related: How do pets and people become infected with Giardia?

2. Cryptosporidium

Cryptosporidium is similar to giardia but a whole lot tougher. It’s so tough that it can survive chlorine treatment. Similar to giardia, oocysts are passed in feces that, if they get into the water, are a source of infection for animals and birds.

• Your vet will prepare a treatment of fenbendazole or metronidazole to kill the parasite in the gut.

• Bathe and shampoo the dog on the last day of treatment to wash away any oocysts clinging to the coat. Not doing so risks reinfection should the dog lick their fur.

Related: What Can I Catch From My Dog?

3. Leptospirosis

Leptospirosis is a particularly nasty infection with the potential to kill. It’s also a devious infection because signs can range from mild stomach upsets that last for weeks to months to an acute liver and kidney failure that are fatal in hours.

Other symptoms include:

• Fever

• Muscle weakness

• Blood in the urine

• Loss of appetite

• Vomiting

• Diarrhea

• Collapse due to organ failure

Leptospirosis can be spread by rat urine and especially loves water sources such as standing water, puddles, and birdbaths. The unpredictable nature of leptospirosis means prevention is the best policy.

Luckily, there are vaccines available for your dog. If you live in a risk area for lepto, then your vet will advise giving the vaccine. A word of caution, though: The vaccine must be given yearly, as immunity is often gone completely 12 months after the previous dose.

Humans, however, don’t yet have a vaccine. Did you know pets can pass lepto to people? If your dog shows similar symptoms to those above and you feel unwell, see your physician as a matter of urgency.

Related: You and Your Pet Are at Risk For Leptospirosis

4. Blue-Green Algae

You may be aware that dogs shouldn’t swim in water with an obvious algal bloom—but do you know why?

Cyanobacteria, also known as blue-green algae, are a toxin-producing form of bacteria. This toxin can affect any mammal (yes, including people), causing nerve and liver damage.

Signs of toxicity include:

• Weakness

• Muscle tremors

• Drooling

• Vomiting

• Diarrhea

• Breathing difficulties

• Collapse and death

There is no antidote to blue-green algae poisoning. Treatment includes rinsing out the stomach to remove contamination and supportive care with intravenous fluids.

So don’t let your dog swim in dirty water or drink from containers of “old” water — give them the fresh stuff.

Related: How Red Tide Affects Your Pet

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Biofilms on Your Pet’s Water Bowl Are Bad

Spot the biofilm in your pet’s water bowl.

Does your dog or cat have a stainless steel drinking bowl? Next time you rinse the bowl under the tap, look for that misty, smoky layer covering the metal.

If you can’t see it, try wiping your finger across the wet metal surface. If your fingertip leaves a clean streak in its path, then you’re looking at a biofilm.

The definition of a biofilm is: “A thin but robust layer of mucilage adhering to a solid surface and containing a community of bacteria and other microorganisms.” So, basically a thin layer of stickiness rich in bacteria that coats a surface. Yum!
You will have experienced a biofilm for yourself the last time you skipped brushing your teeth. Do you know that unpleasant stickiness that coated your teeth? Well, this is a biofilm made up of mucin, which is a mucous-like glue and bacteria combination.

When water comes into contact with a biofilm, it then becomes a weak bacterial soup. When the pet drinks that water, it’s tantamount to challenging their immune system to a duel. If the dog is very young, elderly, or on immune-suppressive drugs, then there’s a risk of them becoming ill.

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Ditch The Plastic!

Plastic is riddled with risks.

Plastic bowls have more than their fair share of problems when it comes to drinking water.

The plastic surface is easily scratched, which provides inviting nooks and crannies for bugs to hide in.

But more than this, plastic bowls are made of chemicals. One in particular, p-benzyl hydroquinone, inhibits the production of melanin (dark pigment).

It’s melanin that gives a black, leathery nose its rich, deep color. When a nose has regular contact with p-benzyl hydroquinone, such as when the dog drinks, it can cause depigmentation. This can lead to a black nose turning mottled or patchy-looking.

Just think—if this substance can do this to the outside of the body, what’s it doing to the inside?

We know that BPA (a chemical that hardens plastic) can interfere with the production of natural hormones in the body. In people, BPAs are linked to diabetes, impaired brain function, and cancer. When you think about how small dogs and cats are compared to people, the dose of BPA they get must be relatively higher.

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Micro-Cracks Lurk in Ceramic Bowls

Surely, a good, heavy-duty ceramic bowl is better, right? Yes and no.

Ceramic bowls aren’t regulated in terms of what goes into making them. There is concern that some originating from China contain lead. Lead is a toxic substance that causes destruction of the red blood cells and nerve damage and is generally a substance best avoided.

In addition, the glaze on a ceramic bowl is subject to microfractures. This is called “crazing” within the glaze and can be seen on a microscopic level.

Scientists investigating biofilms found them to be just as bad on ceramic bowls as plastic. They suspect this ultra-fine crazing somehow provides “grip” for the microfilm to stick to.

Stainless Steel Is Best

The hands-down winner when it comes to drinking bowls is stainless steel. However, this is only if they are washed regularly, preferably on a daily basis.

Even a stainless steel bowl builds up a biofilm if it’s not washed properly. Get into the habit of washing your dog’s water bowl daily, preferably with hot, soapy water or by putting it through the dishwasher.

Don’t be tempted to merely top up the water level— this is feeding the bacterial soup. For optimal health for your pets (and family) choose stainless steel and empty it out daily, wash it with hot, soapy water, rinse and fill with fresh water.

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