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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Is your bird overweight?

Believe it or not, there is such a thing as a fat bird. Too many seeds, too little flying or climbing and suddenly you could be looking at a serious health problem. Here’s what you need to know to make sure your bird stays in shape.

Why Birds Become Overweight

Obesity is a common health problem in captive birds, typically caused by poor nutrition and an all-seed diet.

In the wild, birds get a lot of exercise flying from tree to tree, escaping predators and searching for food. In captivity, birds usually have their wings clipped. If they go anywhere, they usually walk or climb. Their diet is frequently high in fat and low in important nutrients. This situation is the avian equivalent of the person who sits on the couch all day long eating French fries and cheesecake!

How to Know If Your Bird Is Overweight

Obesity in birds can lead to a variety of illnesses with the potential to be deadly. The most devastating is fatty liver disease, which is extremely common in Amazon parrots that eat an inappropriate diet. There are also fatty tumors called lipomas, which are particularly common in some of the smaller birds like budgerigars. Here’s how to know if your bird is overweight:

• Check the breast muscle. The best way to tell if your bird is carrying an appropriate amount of weight is by looking at their breast muscle, which lies over a bone called the keel. When you look at your bird from the front, there should be a bone running down its midline. This is the keel. To either side of that bone, there should be a rounded muscle. If your bird is too fat, they will have “cleavage.” In other words, the keel bone won’t be the most prominent part of your bird’s chest. If your bird is too thin, they will feel bony to the side of the keel and the area alongside the keel will feel concave (curved in) rather than convex (curved out).

• Look for fat. You can also look for subcutaneous fat (below the skin). Feathers grow in tracts, so there will be areas that are non-feathered. One of these areas is along the side of the neck beginning at the base of the jaw. If you part your bird’s feathers to look at this area, you should easily be able to see their jugular vein. If the vein is difficult to see, and there’s a yellowish tint beneath the skin, your bird likely has subcutaneous fat and is gaining unnecessary weight.

• Telltale signs. Other less specific signs of obesity may also be present. For example, if your bird gets out of breath with a small amount of exercise, it may be from carrying extra weight. Also, if your bird’s beak grows excessively long, it may be a sign of fatty liver disease, which is caused by obesity.

• Weigh your bird. Of course, you can weigh your bird periodically using a gram scale. Your veterinarian should also be keeping track of your bird’s weight during their annual physical examination.

Helping Your Bird Lose Weight

Just as it is with people, it’s all diet and exercise. Get your bird on an appropriate diet of pellets, vegetables, some beans, rice, pasta, and a very small amount of fruit. High-fat seeds and nuts are only for treats (the exception is the hyacinth macaw) and should be given in small amounts (one or two seeds) once or twice per week. Pellets should be left in the cage at all times. Home food should be left in the cage for no longer than 30 to 45 minutes at a time.

Try to increase your bird’s activity. If you have access to an outdoor flight cage, use it. If you’re in a situation where you can bird-proof your house so that they can fly indoors under close supervision, give them the opportunity to fly. Increase the frequency of showers because the preening and movement associated with bath time will burn calories. Increase activity by regularly changing the toys in their cage to increase stimulation. (However, be careful with this – if your bird is afraid of strange things, and is prone to feather picking, too frequent changes can be detrimental.)

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