by Tasha Phillips, M.S.
Welcome back to the fourth installment of “It’s an Emergency!”
Today, we’re diving into a somewhat complex condition called diabetic ketoacidosis (DKA). Diabetes mellitus (commonly just called diabetes) is a common condition in both dogs and cats that is typically managed with daily insulin injections and close diet and exercise monitoring.
This diagnosis can be scary! There are many pet parents that struggle to understand their diabetic pet's care. My hope is that some explanation will help you become more confident in your understanding of this DKA and its care.
We will talk about diabetes and the progression leading to DKA. We will also cover the symptoms to watch out for in your diabetic pet and what to do if you notice some of these symptoms popping up. Let’s jump in.
The Not-So-Sweet Side to Diabetic Pet Management
So, your pet has been diagnosed with diabetes. Maybe this is new for you, or maybe you’re a seasoned diabetes-fighting ninja. Either way, let’s quickly cover the nuts and bolts of the disease.
Diabetes mellitus is a medical condition in which the body doesn’t produce the vital peptide hormone insulin. Insulin, produced by the pancreas, acts as a cellular key. This key fits the locks of cells that require sugar for energy (which is pretty much every cell in the body).
When working properly, the pancreas produces insulin in response to rises in blood sugar after eating or during stress. Insulin binds to an insulin receptor on the cell’s surface, causing membrane channels to open and allow the glucose inside.
How Does Insulin Work? via the Diabetes and Wellness Clinic
In pets without diabetes, glucose is broken down through a process called glycolysis. Glycolysis produces a molecule called pyruvate. Pyruvate then travels to the mitochondria (the powerhouse of the cell) where it is further broken down into ATP - the body’s preferred energy source. This is nerd-speak for how the body creates cellular energy, which will be important later.
What Happens When the Key Doesn't Work?
When the insulin key is absent, or nonfunctional, the glucose has no way of entering the cell. This causes glucose in the bloodstream to climb higher. With nowhere to go, glucose can then begin “spilling over” into urine.
The kidneys are great organs for removing extra stuff that we don’t “need.” But in this case, it’s removing glucose that the pet does need but can’t utilize properly. Once the kidneys ramp up to remove that extra glucose, you may notice that they are increasingly thirsty and frequenting the water bowl.
Symptoms of Diabetes in Pets
Excessive Urination
The kidneys attempt to remove excessive glucose and ketones in the bloodstream through urination.
Excessive Thirst
When the kidneys are working hard to remove glucose that isn't being used, it takes a lot of water! This translates to a thirsty pet.
Excessive Appetite
A state of body starvation is caused by cells in the body not having enough energy (ATP) to continue normal function.
Weight Loss
The body begins to break down fat to get what little energy it can, resulting in weight loss.
Cataracts in eyes; image via the Royal Veterinary College at the University of London
Cataracts
In diabetic dogs, a cataract may rapidly develop in the eyes when high levels of glucose are present inside of the lens. The lens normally feeds on glucose in smaller amounts.
Excess glucose is converted to an additional sugar called sorbitol. This sugar is a “water attractant”. The extra water attracted by sorbitol enters the lens and disrupts the clarity which results in a diabetic cataract.
The Big Bad DKA: Diabetic Ketoacidosis
For diabetics that are not controlled through insulin administration or have an underlying disease, blood sugar can become dangerously high without the key (insulin) to enter cells. As cells in the body become starved for an energy source, they resort to breaking down body fat.
Once the body begins to breakdown body fat, a molecule called a ketone is produced. Ketones are considered an alternative form of energy and used by the body in times of stress when energy levels are low.
They are generally safe in healthy patients that only require a small number of ketones in times of need. However, in uncontrolled diabetic patients, the large amounts of ketones generated in fat metabolism can lead to some dangerous downstream effects.
One of those effects is an increase in blood acidity. Ketones are an acidic molecule, and in larger amounts, they can begin to affect the blood's pH level.
This acidity can lead to severe electrolyte imbalances which lead to secondary issues of ketoacidosis. This imbalance can also create dehydration, which also leads to more pH and electrolyte imbalance.
Symptoms of DKA
- Excessive thirst
- Excessive urination
- Lethargy
- Vomiting
- Weight loss
- Decreased appetite
- Diarrhea
- Sweet breath odor
- Increased respiratory rate
- Jaundice
- Enlarged liver
- Dehydration
Diagnostics: Blood Work and Urine Testing
Some of the first steps to diagnosing DKA in animals is blood work and urinalysis. Blood work can look at glucose values, electrolyte levels, organ function, and immune cell values.
Because DKA is sometimes triggered by an underlying illness that stresses the body, this can be a key insight into the diagnosis and treatment plan. Urinalysis is also important to look at potential glucose or ketone values spilling over into urine and urinary tract infections.
Treatment for Diabetic Ketoacidosis in Pets
The goal is to correct hyperglycemia (excess glucose in the bloodstream) and electrolyte and pH imbalances. This must be done gradually to change the body’s metabolism from a state of rapid fat breakdown and manage the underlying diabetes.
Round-the-clock care must be initiated to administer insulin, fluids, and monitor electrolytes and organ function. Here are a few things you can likely expect during treatment of your pet:
Hospitalization
Three to five days is typical; however, it may be longer depending on improvement.
Intravenous Fluids
Fluid therapy is the key to instigating DKA treatment. Correcting dehydration from high blood glucose levels, vomiting, diarrhea, and urination is critical.
Central Line Placement
In some instances where IV access is difficult or limited, a central venous catheter may be recommended. A central line gives access to the larger veins like the jugular vein. This also makes frequent blood draws easier and less stressful for patients. A central line can also be used to administer IV fluids, medications, or even blood products when needed.
Insulin
Circulating blood sugar must be controlled by insulin administration. This must be done slowly over several hours. Some hospitals may give injections; others may choose to give a continual slow infusion of insulin over several hours. This is typically called an insulin CRI.
Potassium Supplementation
While insulin is mandatory in managing DKA, it also can make the body’s potassium imbalance worse. Insulin facilitates the movement of both glucose and potassium inside cells, leaving serum potassium levels lower.
Potassium - a vital electrolyte - is often supplemented inside the IV fluids to help correct this imbalance. This is also why frequent blood work is important to monitor electrolyte levels throughout treatment.
Daily Blood Work
Daily bloodwork is often done to monitor progression of treatment and track those electrolytes over time. Your pet will most likely get blood glucose checks every few hours using a handheld glucometer and have full blood panels completed every 12-24 hours as needed - depending on budget, facility protocols, and veterinarian’s orders.
Conclusion
Having a pet diagnosed with diabetes can be scary and daunting in the beginning. It takes pet parents a while to get the hang of diabetic management.
Understanding the disease process and its effect on the body is the first step in really getting the hang of things. With that understanding comes the ability to recognize changes in your pet, new symptoms, and any alarming progressions.
Unmanaged diabetes can lead to even more life-threatening complications, including diabetic ketoacidosis. I always recommend that pet parents start a savings account when they first bring their new pet home, and I would strongly consider pet insurance.
This can really help offset the cost of diabetic management and potential emergencies that may arise as the pet ages. The best way to manage diabetic patients is to see your veterinarian as recommended. Monitoring diet, weight, and exercise are the foundation to managing blood glucose.
If your pet gains or loses weight, insulin dosage may need to be adjusted. This is also true for any change in diet. This is why it is not recommended to feed outside of the prescribed diet, including cookies and snacks. Everything your pet eats causes a change in blood glucose.
Glucose curves are often done at prescribed intervals to ensure the current insulin dose is effective at keeping blood sugar within normal levels for your pet. It is typical for pets to come in every 3-6 months after the initial management curve is done.
Once the pet remains stable, without clinical symptoms, they may be able to go longer in between glucose curves. Patients with other medical concerns may need to come in more frequently for monitoring.
Thanks for tuning in to learn more about diabetes in pets! I hope this helps you understand the internal workings of the diabetic pet and allows you to make educated decisions about their care!
Tasha Nelson Phillips is a veterinary assistant and researcher. She began her work in veterinary medicine in 2014 at a small practice in East Tennessee. She has a B.S. in Biology as well as a Master’s degree in Microbiology from East Tennessee State University. Her undergraduate and graduate research focused on Lavengel®, exploring its efficacy and mechanism of action against common bacterial species.
Tasha’s interests focus on natural antimicrobial options and exploring novel compounds to combat antibiotic resistance. She continues to work in small animal emergency and critical care medicine. She spends her free time with her husband and three furry babies in their East Tennessee home.