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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Hair Loss in Cats

Does your cat seem to be going bald? And what, if anything, can you do about it? There are, in fact, lots of reasons why a cat can be bald or suffer from hair loss or alopecia.

Sometimes cats are born bald

Some cats, like the Sphynx, are born with hardly any hair. In these cats, the lack of hair is a genetically determined and desirable characteristic among proponents of the breed. Some folks seek out this particular look in a cat just like others might prefer a long-haired cat over a short-haired cat.

Sometimes feline hair loss is benign and temporary

There are also passing reasons for hair loss. Just like people go through stages where they lose more hair, cats can too. Shedding is a natural and normal process that can vary in degrees. Cats that are sick or stressed for other reasons (illness, fevers, respiratory infections, pregnancy, etc.) can shed excessively. These are not conditions that demand treatment since the cat’s coat should return to normal over time.

Sometimes the hair loss is medically important

It is important, however, to consult your veterinarian if you are noticing any changes in your cat’s coat or if they are developing bald areas. Sometimes hair loss is due to a medical problem that does require intervention since the underlying reason for it can cause more serious and systemic problems relating to your cat’s overall health.

Your veterinarian will want to determine if your cat’s hair is falling out on its own or if they are scratching, licking, or chewing the hair off as a result of some inflammation or irritation. This distinction can help to focus the diagnostic approach in your cat’s case. Generally, if your cat is actively causing the hair loss, you and your veterinarian will be looking more for causes of dermatitis or inflammation of the skin (like allergies) or for infectious diseases like bacterial, fungal, or parasitic diseases (like acne/pyoderma, ringworm or mange mites). In these cases, the answer may be found through skin scrapings, cytology, cultures, or allergy testing; and appropriate therapy can result in hair re-growth.

In dogs, hormonal imbalance (underactive thyroid, adrenal dysfunctions, etc.) is a common cause of poor coats and hair loss, but these conditions are not as common in cats. Overactive thyroid (hyperthyroidism), however, does occur frequently in older cats and can cause coat changes as can almost any other systemic or metabolic disease; your veterinarian may want to do diagnostic tests to know for sure.

Sometimes the hair loss is psychological

That is not to say that it’s “all in their head” and that your cat isn’t really going bald. Rather, it means that many cats become obsessive about grooming. Obviously, grooming is a major focus of your cat’s average day, but cats exhibiting psychogenic alopecia can break off their hair right down at the skin and over large areas of their bodies – sometimes any and every place they can effectively reach leaving hair only on their head and neck.

The compulsion may start because of some irritation to the skin (as above), and then potentially continue on habitually, even after the inciting problem has resolved. Other cats will groom excessively for solely emotional reasons – a change in environment, a new family member, or some other stress. Whatever the reason, this form of alopecia indicates that your cat is either physically or emotionally uncomfortable or unhappy, and every effort should be made to determine what the problem is and to correct it either with medical or behavioral therapy.

In summary, hair loss or alopecia in cats can be just a cosmetic issue or it can be due to a primary skin problem. It can also be an external indication of a more serious systemic or psychological disorder. Consult your veterinarian as soon as you see any changes in your cat’s coat so the two of you can address the problem as soon as possible.

If you have any questions or concerns, you should always visit or call your veterinarian -- they are your best resource to ensure the health and well-being of your pets.

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