What is diabetic ketoacidosis?
Diabetic ketoacidosis (DKA) is a medical emergency that occurs when there is not enough insulin in the body to control blood sugar (glucose) levels or the body cannot use the insulin effectively. Without insulin, the body cannot use glucose properly, so blood glucose levels get very high, and the body creates ketone bodies from fat as emergency fuel.
Using fat as fuel is fine in an emergency, but if glucose regulation is not restored, ketone levels increase, resulting in a shift in the body's acid/base balance. The body becomes more acidic (acidosis), and it can't maintain an appropriate fluid balance. The electrolyte (mineral) balance becomes disrupted, which can lead to abnormal heart rhythms and abnormal muscle function. If left untreated, diabetic ketoacidosis is fatal.
What causes this disorder?
Unregulated or untreated diabetes leads to DKA. Also, if a diabetic cat develops another condition, chemical changes can occur in response to the condition that interfere with appropriate insulin activity. Other conditions that can lead to diabetic ketoacidosis include infection, inflammation, and heart disease.
What are the signs of diabetic ketoacidosis?
The signs of DKA include:
- excessive thirst/drinking and increased urination
- lethargy, weakness
- vomiting
- increased respiratory rate
- decreased appetite
- weight loss (unplanned) with muscle wasting
- dehydration
- unkempt haircoat
- abnormal gait (plantigrade – hocks sink closer to the ground or even contact the ground)
How is diabetic ketoacidosis diagnosed?
The signs noted above can occur with other medical conditions, so it is important for your veterinarian to perform appropriate diagnostic tests to determine if diabetic ketoacidosis is truly the issue, including a complete blood count (CBC), biochemistry profile, and urinalysis.
High levels of sugar in the blood and urine can indicate diabetes mellitus. If there are also electrolyte abnormalities and ketones in the urine, clinical signs, and exam findings consistent with DKA, then your veterinarian can diagnose DKA.
Historically, DKA has always been associated with high blood sugar (glucose). However, when diabetic cats are receiving newer oral medications (Bexacat®, Senvelgo®), their blood glucose is often normal despite having DKA, which can make diagnosis more difficult, especially if the diagnosing veterinarian is not aware that a cat is taking one of these medications. Blood ketone testing may be recommended to diagnose DKA. A cat that develops DKA on these medications needs to be switched to insulin treatment for management of diabetes mellitus.
Your veterinarian may recommend additional testing to find other conditions that may have triggered the development of DKA. These additional tests can include:
- a urine culture to check for a urinary tract or kidney infection,
- abdominal ultrasound, and/or
- specific pancreatic inflammation testing (fPL, PSL) to screen for pancreatitis, liver disease or intestinal disease.
If your veterinarian suspects other conditions, they will recommend other testing specific to the condition of concern.
What treatments does a cat receive while in hospital?
Generally, cats diagnosed with DKA, and sick with symptoms, are hospitalized and placed on intravenous fluid therapy to reverse dehydration and ensure adequate fluids in the tissues. Short-acting insulin is given to bring the blood sugar level down quickly and reduce the body’s need for ketone production. Many patients with DKA also have very low levels of potassium, so potassium supplementation is provided. Blood sugar levels, electrolyte levels, and the acid-base balance are measured frequently during treatment in hospitalized patients with DKA.
Are there any problems that can occur secondary to diabetic ketoacidosis?
There are several potentially serious conditions that can occur in conjunction with, or secondary to, DKA, including:
- persistently low potassium levels
- low blood sugar
- low phosphorus levels
- brain swelling
- fluid in the lungs
- heart failure
- kidney failure
These potentially life-threatening complications help to explain why hospitalization and aggressive treatment are so important.
How do I prevent diabetic ketoacidosis from happening again?
Diabetic ketoacidosis is life-threatening, so preventing it is important. Proper diabetes treatment is the most important step in prevention. The importance of monitoring blood glucose levels and/or ketones at home and regular checkups and communication with your cat’s veterinarian cannot be overemphasized.
"Proper diabetes treatment is the most important step in prevention."
If you are not yet performing home blood glucose monitoring, your veterinary healthcare team can help get you started. Just a tiny drop of blood is needed for a sample, and the tiny needle will cause minimal discomfort. Most cats barely notice the pin-prick. An implantable, continuous glucose monitor is another way to ensure glucose levels aren’t getting too high. Ask your veterinarian what they recommend for your cat.
Your veterinarian will guide you on how often to take readings, when to report the results to the practice, and will explain how the values are interpreted to make decisions about modifying your cat's insulin dose.
If you are already monitoring your cat's blood glucose levels at home, your veterinarian will guide you on how often to check glucose levels once your cat returns home. The key to preventing a recurrence of diabetic ketoacidosis is to be very aware of your cat's glucose levels throughout the day, as well as the pattern of their blood glucose levels over the span of several days to several weeks. As you report the glucose levels, your veterinarian can help you fine tune your cat's insulin doses and help prevent this crisis from recurring.
Diet can also play an important role in managing glucose levels and maintaining a healthy body condition. Follow your veterinarian’s recommendation on diet selection and appropriate feeding amounts.
