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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What to do if your pet rabbit is itching and scratching

Rabbits shouldn't scratch themselves any more than you would. If your pet rabbit seems excessively itchy and scratches a lot, it is likely a problem that needs to be addressed. Various issues—from mites to allergies—can cause a rabbit to itch and scratch, but fortunately, these are treatable!

Why Do Rabbits Itch and Scratch?

When an animal experiences severe itching and scratching, it's called pruritus. In a rabbit, it can be due to fur, skin, or ear parasites; dry skin; allergies; or infections. No matter the cause, it's important to take care of it right away for the sake of your rabbit's health and quality of life.

Fur Mites

Cheyletiella parasitivorax are microscopic mites that live in the fur of rabbits. Cheyletiella mites are blood-sucking parasites that bite your rabbit in order to feed, which causes it to itch and scratch.

Fur mites are also referred to as "walking dandruff," because they're often seen moving the dead skin around on rabbits, creating the appearance of mobile skin cells. They may start off in a small area on your rabbit, but if left untreated, they can spread all over its fur, into the environment in which they live, and to other rabbits and pets.

Even if your rabbit never goes outside, it can get fur mites from food or bedding that you bring into your home.

Lice

While not as common as some other parasites, lice do infest rabbits. They're species-specific, so humans and other non-rabbit pets can't get them.

Fleas

Many people don't think that rabbits can get fleas, but the reality is that any pet with fur can. Fleas, like fur mites, are blood-sucking parasites that bite rabbits, which, in turn, causes them to itch and scratch.

Female fleas lay up to 50 eggs every day, so even if you only see one or two adult fleas on your rabbit, they've probably already laid hundreds of eggs. Fleas also bite humans, but female fleas usually can't produce viable eggs when human blood is their only food source.

Indoor rabbits can get fleas just like outdoor rabbits. Other pets in the household can give your rabbit fleas and they can be tracked in from the outdoors. Fleas can also find their own way into homes just like other insects, such as ants.

A flea comb will help you find fleas and flea dirt. Flea dirt is the cylindrical feces that turn red if rubbed with a wet cotton swab. This is a good trick for distinguishing the digested blood from normal environmental dirt.

Dry Skin

Your rabbit may develop dry skin, which can make it itch and scratch. Rooms with very low humidity, dusty environments, poor diets, and bathing your rabbit too often or using inappropriate shampoos can all contribute to dry skin in your pet. If you can determine the cause of the dry skin, then you should be able to reverse it. For temporary relief, ask your vet to recommend a rabbit-safe spray product.

Ear Mites

Psoroptes cuniculiis are ear mites that cause itching and scratching. They can be spread from rabbit to rabbit, so wash your hands after handling a rabbit with itchy ears (and in general!). You may notice hair loss around the ears and/or scabs, or the rabbit's ears may look especially dirty. A head tilt, a flopped ear, and head shaking are all signs of an ear mite infestation, which doesn't always affect both ears. If you notice any of these signs, take your rabbit to see the veterinarian.

Allergies

Just like people, some rabbits are allergic to certain substances that cause them to itch and scratch. Usually, these allergies are environmental and not food-based, so you can make changes to bedding, litter, cleaning solutions, and air purifiers to make your rabbit more comfortable at home.

Common environmental allergens include the dust in certain litters or in the rabbit's hay, as well as laundry softeners and detergents used on blankets.

Rabbits can also be allergic to parasites such as fur mites and fleas. This will make an infestation of these pests even more irritating to your pet.

Skin Irritants

In addition to allergies, rabbits may be irritated by certain products, especially if they aren't meant for rabbits. Shampoos, conditioners, sprays, and air fresheners may all cause skin irritation in your rabbit. If you use a new product, such as a shampoo, and the next day your rabbit is itching, it may be because it was too harsh for your rabbit's skin. This is often the case with products meant for dogs that are used on rabbits.

Ringworm

Caused by two main types of organisms (Trichophyton mentagrophytes and Microsporum canis), ringworm is a fungal infection that causes hair loss, itching, and red "ringworm" lesions in rabbits. People can also contract ringworm from a rabbit.

The main cause of ringworm, as well as mites and fleas, is direct contact with an infected rabbit. When you bring a new rabbit into your home, keep it separate from your other rabbits until you're sure it doesn't have an infection. Rabbits can also contract ringworm from dirty environments and brushes that were used on an infected rabbit.

Skin Infections

Urine scald and feces that have remained in prolonged contact with your rabbit's skin and generally unclean environments may cause your rabbit to develop a skin infection. The infected area may become red, inflamed, and very itchy and should be treated right away.

Treating Itching and Scratching for Rabbits

The methods used to treat a rabbit's itching and scratching depend on the cause. However, a number of problems are solved through the same means.

• Fur mites are highly contagious to other rabbits. If you have other pets in your house and your rabbit is diagnosed with Cheyletiella mites, take care not to spread these parasites to other animals. Wash your hands after handling your rabbit and throw away the food and bedding in its cage.

• For fur and ear mites, lice, and fleas, freeze all unused food and bedding that you purchased from a pet store or online. The parasites can be brought into your home with such items, so freezing them before use is also a good way to prevent an infestation.

• If your exotics vet diagnoses your rabbit with mites, she will most likely prescribe a medication such as Selamectin, which will kill the infestation without harming your rabbit. Over-the-counter products are typically not safe for rabbits, and you should always consult your veterinarian prior to administering such products.

• If you find fleas or flea dirt on your rabbit, treat your rabbit and all the other furry pets in the household with a safe medication, just as you would for fur mites.4 You will also need to clean and treat the environment. Some rabbit owners use boric acid powder in their carpeting and various flea sprays and bombs sold at pet stores. If you choose to use these products, make sure your rabbit is out of the room you're treating for at least 24 hours.

• If your rabbit has environmental allergies, use fragrance-free fabric softeners and detergents meant for babies or sensitive skin to wash its blankets. If symptoms continue, look to other possible allergens in your rabbit's environment—for example, dust or pollen from an open window in spring or summer—and try to correct these.

• Ringworm is usually treated with topical ointments or oral medication prescribed by your exotics vet.

• Skin infections typically require prescription medications. An anti-itch spray is available that's safe to use on rabbits, but if the root of the problem isn't addressed, the spray merely provides temporary relief.

How to Prevent Itching and Scratching

Often, your rabbit's itchiness can be prevented by keeping its environment clean. The freezing recommendation for any rabbit supplies is an excellent place to begin as is the use of fragrance-free laundry products for any washable rabbit bedding.

Beyond these, be sure that your rabbit's cage is as clean as possible. Daily and weekly upkeep can make a significant difference in the health of your pet and prevent many skin infections. When bathing your rabbit, use only products designed specifically for rabbits.

It's also a good idea to regularly examine your rabbit's fur. This will help you to easily recognize any abnormalities and take treatment steps immediately, which can prevent an infestation, ear, or skin problem from getting worse.
At the same time, take precautions for any other pets in your home, using products such as flea preventives on a regular basis. Take care about exposing your rabbit to other animals that could transmit any of these issues as well, especially if it's kept outside or allowed to go outside.

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Types of Skin Problems Found in Cats

If your cat's got a case of constant scratching and licking, a skin problem may be to blame. Cats are susceptible to skin infections, parasites, allergies, and many other conditions commonly seen in people.

Feline Acne

Yes—cats get pimples, too. Feline acne typically appears on and around a cat's chin. Possible causes include stress, poor grooming, a reaction to a medication, an underlying skin condition, or even the plastic bowl you put out with her food or water. Your veterinarian may recommend a specialized shampoo or gel to clear up the breakout, or antibiotics if a bacterial infection accompanies the acne.

Bacterial Infections

In many cases, bacterial skin infections develop as a result of another skin problem. For example, feline acne can make a cat's hair follicles more vulnerable to infection, resulting in folliculitis. Bacterial infections may be treated with antibiotics, but it's important to address any underlying skin conditions to prevent a recurrence.

Yeast Infections

Yeast infections are caused by a fungus and are also more likely in cats that have other medical problems. The ear is one of the most common spots for a yeast infection. Symptoms may include a black or yellow discharge, redness of the ear flap, and persistent scratching of the ear. Yeast infections respond well to treatment with antifungal medicine, but be sure to get a diagnosis from a veterinarian before using anything on your cat.

Ringworm

Ringworm is another type of fungus that affects cats, especially if they are under age 1. It may cause circular lesions on a cat’s head, ears, and forelimbs as well as any other part of the body. The skin around these lesions is often flaky and bald. Ringworm is highly contagious and can spread to other pets in the home, as well as to people. Treatment depends on the severity but may include specialized shampoos, ointments, or oral medications.

Sporotrichosis

Yet another fungus — although rare — sporotrichosis produces small, hard skin lesions that may leak fluid. Sporotrichosis is considered to be a public health concern because the fungus is known to spread from cats to humans. People with a compromised immune system are especially vulnerable. For these reasons, cats with sporotrichosis should be treated promptly, and caregivers should be meticulous about hygiene.

Allergic Dermatitis

Cats can have allergic reactions to grooming products, food, and environmental irritants, such as pollen or flea bites. Scratching the head or neck is a common sign of food allergies. Symptoms of other allergies include chewing on the paws or base of the tail or scratching the ears. Allergies can also cause hair loss or skin lesions anywhere on the body, including the belly. There are a variety of treatments to soothe itchy skin associated with allergies, but avoiding exposure to the irritants is the best strategy.

Shedding and Hair Loss (Alopecia)

If you live with cats, you learn to cope with cat hair on your favorite sweater. But if you notice your cat is losing more hair than usual or has bald patches, see your veterinarian as soon as possible. Abnormal hair loss can be a warning sign of several illnesses, as well as fleas, stress, allergies, or poor nutrition.

Fleas

The idea of tiny insects feeding on the blood of your cat may make you shudder, but fleas are a very common problem. You can look for them or their droppings in a cat's coat, especially where the fur is pale. Other signs of a flea infestation are persistent scratching, crusty skin lesions, and thinning hair above the base of the tail. To eradicate fleas, you’ll need to treat your cat as well as your furniture, bedding, and rugs.

What has been the gold standard of flea control is a monthly flea prevention protocol. It not only kills fleas on your cat, but those in your home should eventually be eliminated as they fail to reproduce. Monthly control, though, is not the only option. There are also products that can be given every other month as well as a collar that can provide protection for up to 8 months. Talk to your vet about what would be best for your cat. And remember: Treating all pets in the home is necessary for whatever plan you use to be effective.

Ear Mites

Ear mites are tiny parasites that are drawn to the wax and oils inside a cat’s ear. As they feed, they cause inflammation that can lead to a serious skin or ear infection. Signs of ear mites include excessive scratching of the ears, head shaking, and a strong odor and a dark discharge from the ears. Suspect ear mites when both ears are affected. Mites can be treated with a topical product prescribed by your vet. Ear mites are also contagious to other animals.

Lice

Lice are parasites that feed on dry skin. They are commonly found on young, neglected cats and often go unnoticed. Large infestations can lead to scratching, restlessness, unusual coat appearance, and hair loss. Like mites, lice can be treated with a topical solution. Because lice are species-specific, you do not need to worry about getting lice from your cat.

Stud Tail

Also called tail gland hyperplasia, stud tail refers to overactive glands on the top of the tail. These glands produce waxy excretions that result in hair loss and crusty lesions. In severe cases, the condition can make the tail vulnerable to bacterial infections. Neutering may eliminate the problem in male cats. Other treatment options include diligent grooming of the tail and the use of specially formulated shampoos.

Eosinophilic Granuloma

If your cat has raised ulcers or lesions on the nose or lips, she may be having a type of allergic reaction known as an eosinophilic granuloma. This reaction can occur anywhere on the body, but is most common on the face, pads of the feet, and thighs. Food allergies or fleas are sometimes to blame, but the lesions can also result from bacterial infections. Treatment depends on what is causing the reaction.

Skin Tumors

A lump in your cat's skin is not necessarily cancer, but should be checked by a veterinarian. Older cats and those with white ears and heads are especially susceptible to skin cancer. To confirm a diagnosis of cancer, a biopsy is necessary. If the lump is small enough, a vet may recommend removing it entirely. For tumors that have not spread, this may be the only treatment needed.

Dry, Flaky Skin

Like people, some cats get dry, flaky skin in the winter. It's usually nothing serious, but have your veterinarian take a look. Persistent dandruff may be a sign of poor nutrition, inadequate grooming, or an underlying medical problem. Special shampoos and supplements of omega-3 fatty acids can help treat feline dandruff.

Compulsive Grooming

Cats are known to be fastidious groomers, but sometimes they overdo it. Compulsive licking, chewing, or sucking on the skin may lead to irritation, infection, and thinning hair (a condition called psychogenic alopecia). Cats may groom compulsively in response to stress, such as moving into a new home, but they may also overgroom due to a medical problem such as arthritis. If this describes your cat, talk to your vet about stress reduction and behavior modification strategies that can help as well as address some underlying medical issues.

When to See the Vet

Check with your veterinarian as soon as possible if you find any oddities on your cat’s skin -- flaking, scaling, redness, or bald patches. Even if the skin looks fine, your cat should be examined if she is scratching, licking, or biting herself excessively.

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