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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5 Big Questions to Ask About Pet Obesity - How to Check, What to Feed, and How to Exercise

Obesity is becoming prevalent among pets that come through clinic doors. This is an incredibly critical issue because pets with obesity are at increased risk for developing serious weight-related disorders such as diabetes, arthritis, high blood pressure, kidney disease, cancer, and more. We must do better.

To help you better care for your furry loved one, here are the top five questions you need to ask your veterinarian to keep your pet healthy. They’re simple, won’t embarrass you, and just may save a life.

Question #1: Is my pet overweight?

This is the most important question you must ask your veterinarian – and one your vet may not be eager to answer. Unbelievably, many veterinarians are simply afraid to tell if your pet is overweight. This is primarily due to the fact your vet doesn’t want to inadvertently offend you. Weight issues are tricky and loaded with perceived judgment, strong emotions, and social stigmas.

As a concerned pet owner, you need to understand your pet’s weight is one of the most influential factors of longevity, quality of life, and disease prevention. To answer this question, your vet will conduct a couple of measurements, determine a Body Condition Score, and determine your pet's current weight status.

Ask the question. Demand a thorough assessment. Don’t be offended if the answer isn’t what you expected. This isn’t personal; it’s your pet’s future.

Question #2: How many calories should I feed my pet each day?

We’ve got to be specific when it comes to feeding our pets. Don’t fall into the trap of inquiring, “How much should I feed?” You’ll get a generic, inaccurate response. We need precise numbers of calories and nutrients your pet needs. That way, regardless of the type, brand, or formulation of food you feed, you can determine how much to feed. This is a subtle, but incredibly significant difference.

Your vet should then ask you a few lifestyle questions, perform a couple of calculations, and give you a narrow range of calories. Memorize this number. Find out how many cups or cans of your pet food this equals. Feed that amount. Don't forget to include any treats in your daily caloric counts. Those tiny “calorie grenades” can swiftly sabotage the best dietary plans.

Question #3: How much weight should my pet lose in a month?

If your pet is like most dogs and cats, it’ll need to shed a few unhealthy pounds of excess fat. You need to ask how much weight your pet needs to shed and how long will it take to reach a healthy weight. I prefer to think in terms of pounds per month due to practicality and performance. Monthly weight checks are practical and reasonable for even the busiest pet owners. A weight loss plan’s performance is critical to track and monitoring monthly trends is an accurate indicator of success or stagnation.

In general terms, a dog can safely lose 1 to 3-percent of its body weight and cats 0.5 to 2-percent per month. Many dogs can lose 3 to 5-percent and most cats should aim for about a half-pound per month. Losing weight isn’t easy or fast for pets, especially cats. If you put your pet on a crash diet, they can develop serious medical conditions, including a life-threatening form of liver failure that can occur in less than 72 hours. Patience is essential for pet weight loss. Most canine patients will have a 3 to 6-month weight loss plan and cats 9 to 12-months. Your vet will formulate a step-weight loss plan that will gradually decrease the amount you’re feeding over a 1 to 3-month period. This will help curtail cravings, begging, and late-night pestering. There will be some unhappy pooches and purr babies when you institute a diet. Your vet should provide you with tips on preventing these behaviors and transitioning to a new weight-loss diet.

Question #4: What kind of exercise should my pet do?

Most vets and pet owners focus on how long a pet should exercise each day. Instead, ask your vet what types of activities are best based on your pet’s species, breed, age, gender, current physical abilities, and interests.

Walking, swimming, agility, chase, ball retrieving, and remote-controlled toys – the opportunities for physical activity with your pet are endless. The general recommendation is that dogs need at least 30-minutes of physical activity a day and cats should strive for three 5-minute intense play periods. How you spend those minutes will determine if you do it or don’t. Make your outings enjoyable, entertaining, and interactive.
Cat owners, please don’t forget to ask this question. Whether you play with a feather duster or laser pointer, move the food bowl, or use a hip, high-tech toy, engage your cat’s inner predator and encourage it to pounce, leap, and prowl every day.

Did you know there are electronic gadgets that can monitor your pet's activity? They’re a great tool to document how much your pet is walking or playing each day. Better yet, you can share these reports with your vet to spot any deficiencies or ways to maximize your training.

Question #5: Is my pet at risk for a medical problem due to excess weight?

This is a profoundly serious question that you need to understand for your pet’s future. Dogs and cats carrying extra fat are at greater risk for developing debilitating diabetes, crippling arthritis, deadly high blood pressure, kidney disease, and many forms of catastrophic cancer. You need to have a frank conversation with your vet to find out if your pet is potentially facing one of these conditions. If so, what can you do to cut those odds? The most crucial decision you make each day about your pet’s health is what you choose to feed it. Choose wisely; your pet’s life depends on it.

It’s never too late to reduce your pet’s chances of contracting one of these grim disorders. Early recognition and awareness are the best defense against many diseases. Ask the question.

There are many more topics you need to discuss during your time with your veterinarian, but your pet’s weight should be covered at every exam. The few minutes you spend on diet and weight could well be the difference between two additional years of high-quality life or a shortened, suffering final stage of life. Take the time to write down these questions, ask your vet, and act on the answers. Together, you and your vet can chart a course for a better, longer, and happier life for your pet loved one. It’s worth it.

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Reasons to Walk Your Dog

There are few things dogs love more than a good walk, whether yours is the social type who loves meeting people or the type who loves to sniff absolutely everything! That’s why National Walk Your Dog Week (October 1-7) is the perfect opportunity to get outside with your pup!

We love seeing our dogs happy – is there anything cuter than that butt wiggle they do when they’re excited? Knowing that a quick walk can make a positive impact in their day is the least we can do to try and match the joy they bring us every day. Here are just a few reasons to swap your next 30-minute Instagram photo session with your dog for an active walk around the block.

Reasons to walk your dog during National Walk Your Dog Week and year-round:

Keep them healthy

While getting exercise to stay healthy is so often at the top of our minds for humans, we often forget that pets need the same! In the Association for Pet Obesity Prevention‘s 2017 clinical survey, 56% of dogs were found to be clinically overweight. This can reduce the quality of their life, reduce their life expectancy, and cause a multitude of issues for your dog. National Walk Your Dog Week is a great time to set a goal to get your pup out into the world for a substantial walk, around 30 minutes, at least a few times a week.

Chill them out

Not only is the time that you walk your dog a nice opportunity to let your pet get some fresh air and exercise, but it can also prevent them from getting destructive out of boredom while you’re away. If they’re tired out, odds are they won’t have as much time to ponder chewing up your favorite pair of shoes! In addition, it can help energetic dogs expel some energy, which can in turn make them calmer around other people or animals.

Show them love

Pets respond well to interaction, which is why they tend to follow you around the house, or continuously nudge your hand until you pet them! When you walk your dog, it’s a great chance to give your undivided attention to your dog and let them know that you care for them. It may seem like a small task on a mounting to-do list to you but can be a bright spot in your pet’s day!

Focus their training

If your dog needs a little bit of practice learning to heel, sit, stay, or follow other basic commands, a walk is a great time to get them into some of those good habits. Practice makes perfect, so incorporating walks and practicing these skills into their everyday routine will make them even more successful.

Boost your mood

Not only will taking your dog on regular walks make you a more active person, but it can also improve your health in other ways! Spending time with pets can lower anxiety and blood pressure, which is why therapy dogs are so useful. They ease tension, reduce loneliness, and can improve heart health.

This National Walk Your Dog Week, do yourself – and your dog! – a favor and get in the habit of walking your pet regularly. What is your favorite place to explore with your dog? Let us know in the comments!

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Top 5 Important Questions to Ask About Pet Obesity

Pet's with the diagnosis of obesity is not new, however, it is becoming more prevalent. This is an incredibly important issue because pets with obesity are at increased risk for developing serious weight-related disorders such as diabetes, arthritis, high blood pressure, kidney disease, cancer, and more.

To help you better care for your dog or cat, we'd like to provide the top five questions you need to ask your veterinarian to keep your pet healthy. They are simple, non-embarrassing questions, and just may save your pet’s life.

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#1 - Is my pet overweight?

This is the most important question you must ask your veterinarian – and one your vet may not be eager to answer. Believe it or not, many veterinarians are hesitant to tell you if your pet is overweight or has obesity. This is primarily due to the fact your veterinarian doesn’t want to inadvertently offend you. Weight issues are tricky and loaded with perceived judgment, strong emotions, and social stigmas.

As a concerned pet owner, you need to understand your pet’s weight is one of the most influential factors of longevity, quality of life, and disease prevention. To answer this question, your veterinarian will likely conduct a couple of measurements, determine a Body Condition Score (see charts below) and determine your pet's current weight status.

Ask the question. Demand a thorough assessment. Don’t be offended if the answer isn’t what you expected. This isn’t personal; it’s your pet’s wellbeing.

#2 How many calories should I feed my pet each day?

We’ve got to be specific when it comes to feeding our pets. Don’t fall into the trap of inquiring, “How much should I feed?” You’ll probably get a generic, inaccurate response. You need to know the precise numbers of calories and nutrients your pet needs. That way, regardless of the type, brand, or formulation of food you feed, you can determine how much to feed. This is a subtle, but incredibly significant difference. Healthy nutrition is about feeding your pet proper nutrients, not ingredients.

Your veterinarian should then ask you a few lifestyle questions, perform a couple of calculations, and give you a narrow range of daily calories you should feed. Memorize this number. Find out how many cups or cans of your pet food this equals. Feed that amount. Don't forget to include any treats in your daily caloric counts. Less is best, as it can swiftly add up and destroy even the best dietary plans.

#3 How much weight should my pet lose in a month?

If your pet is like the majority of dogs and cats, it’ll need to shed a few unhealthy pounds of excess fat. You need to ask how much weight your pet needs to shed and how long will it take to reach a healthy weight. I prefer to think in terms of pounds per month due to practicality and performance. Monthly weight checks are practical and reasonable for even the busiest pet owners. A weight loss plan’s performance is critical to track and monitoring monthly trends is an accurate indicator of success or stagnation.

In general terms, a dog can safely lose 1 to 3-percent of its body weight and cats 0.5 to 2-percent per month. Many dogs can lose 3 to 5-percent and most cats should aim for about a half-pound per month. Losing weight isn’t easy or fast for pets, especially cats.

If you put your pet on a “crash diet,” they can develop serious medical conditions, including a life-threatening form of liver failure that can occur in less than 72 hours. Patience is essential with pet weight loss.

Most of my canine patients will have a 3 to 6-month weight loss plan and cats 6 to 12-months. Your veterinarian will probably formulate a step-weight loss plan that will gradually decrease the amount you’re feeding over a 1 to 3-month period. This will help curtail cravings, begging, and late-night pestering. Note I said “help,” not “eliminate.” There will be some unhappy pets when you institute a diet. Your veterinarian should provide you with tips on preventing these behaviors and transitioning to a new weight-loss diet.

#4 What kind of exercise should my pet do?

Most veterinarians and pet owners focus on how long a pet should exercise daily. While that’s an excellent approach, it is advised you ask what types of activities are best based on your pet’s species, breed, age, gender, and current physical abilities. Walking, swimming, agility, chase, ball retrieving, and remote-controlled toys – the opportunities for physical activity with your pet are limitless but determined by physical ability and intellectual interest. The general recommendation is that dogs need at least 30-minutes of physical activity a day and cats should strive for three 5-minute intense play periods. How you spend those minutes will determine if you do it or don’t and if you adhere to those activities. Make your outings enjoyable, entertaining, and interactive. They will be not only beneficial but also strengthen the bond between you and your pet.

Cat owners, please don’t forget to ask this question. Whether you play with a feather duster or laser pointer, move the food bowl, or use a hip, high-tech toy, engage your cat’s inner predator and encourage it to pounce, leap, and prowl every day.

If you want to get really technical, try out pet activity monitors. They’re a great tool to document how much your pet is walking or playing each day. Better yet, you can share these reports with your veterinarian to identify any deficiencies or ways to optimize your training.

#5 Is my pet at risk for a medical problem due to excess weight?

This is a very serious question that you need to understand for your pet’s future. Dogs and cats with excess fat are at greater risk for developing diabetes, arthritis, high blood pressure, kidney disease, and many forms of cancer. You need to have an honest conversation with your veterinarian to find out if your pet is potentially facing one of these weight-related disorders. If so, what can you do to reduce their odds of developing one of these conditions? Preventing disease is the primary focus of maintaining a healthy weight and proper nutrition. The most important decision you make each day about your pet’s health is what you choose to feed it. Choose wisely; your pet’s longevity and quality of life depend on it.

It’s never too late to reduce your pet’s chances of contracting one of these serious disorders. Early recognition and awareness is the best defense against many diseases. Begin by asking these questions.

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dog health, cat health