Diabetic Ketoacidosis (DKA) in Cats

Feline Diabetic Ketoacidosis

Diabetic ketoacidosis (DKA), the most severe form of Diabetes Mellitus, results in severe changes in blood chemicals including imbalances in small, simple chemicals known as electrolytes.

Diabetes mellitus (DM) is a chronic condition in which a deficiency of the hormone insulin impairs the body’s ability to metabolize sugar. It is one of the most common endocrine (hormonal) diseases of cats. DKA is a life-threatening condition caused by diabetes mellitus resulting from insulin deficiency that leads to excess production of ketoacids by the liver. Subsequent changes in the blood result that includes metabolic acidosis, electrolyte abnormalities producing severe signs of systemic illness.

DKA condition can occur in pets with new diabetes or in current diabetics that decompensate. Secondary diseases and/or infections can cause diabetics to decompensate and develop DKA.

What to Watch For

Signs associated with DKA depend on the individual cat and the length of time they have been ill. Signs may consist of the classic signs of diabetes including:

• Increased thirst
• Increased frequency of urination
• Weight loss despite a good appetite
• Sudden blindness

Additional signs of DKA include:

• Lethargy
• Vomiting
• Weakness
• Dehydration
• Some pets will have a strong smell of acetone from their breath

Diagnosis of Diabetic Ketoacidosis in Cats

Veterinary care should include diagnostic tests to determine level of blood sugar, the presence of ketones, and electrolyte concentrations to help guide subsequent treatment recommendations.

Some of these tests include:

• Complete medical history and thorough physical examination.
• Serum biochemical profile to determine the blood glucose concentration and to exclude other potential causes of the same symptoms. Elevated blood glucose is the hallmark of diabetes. In addition, these tests will allow some assessment of kidney and liver function and of the acidity (pH) of the blood.
• Analysis of the urine to check for glucose and ketones and for signs of urinary tract infection. Elevated glucose and ketones are hallmark signs of DKA.
• Urine culture may confirm the presence of a urinary bladder infection, prove what type of bacteria is causing the infection and tell the veterinarian which antibiotics should be effective in treating it (and which ones will not).
• Complete blood count (CBC) can discover anemia (too few oxygen-carrying red blood cells), abnormal platelet numbers (too few or too many blood clotting cells) and abnormal white blood cell counts (too few or too many infection-fighting cells). Infections are a common complication of DM and can be a contributing factor in development of DKA.

Additional tests may be recommended on an individual basis. These tests include:

• Abdominal radiographs (X-rays) may be requested to rule out changes in size of organs like the liver or kidneys or to look for evidence of abdominal tumors. Kidney disease, intestinal disease, or certain abdominal tumors may be present and have signs very similar to DM.
• Abdominal ultrasonography uses sound waves to evaluate the contents of the abdominal cavity. A specialist often performs the test in which the fur is shaved and a probe is held against the abdomen (this is the same test given to many pregnant women to visualize the fetus). This test can reveal many of the same things as abdominal radiographs, but provides a more detailed examination along with views of the inside of organs rather than just the shadow of the organ.

Treatment of Diabetic Ketoacidosis in Cats

Patients with uncomplicated diabetes are generally managed on an outpatient basis, but those experiencing complications such as diabetic ketoacidosis will require initial in-hospital stabilization.

In-hospital therapy generally includes insulin administration with frequent dose adjustment, intravenous fluids, administration of electrolytes (blood chemicals), treatment of secondary problems, and antibiotics.

Therapy may include the following:

• Cats will require frequent injections of a short acting insulin around the clock to slowly control the blood glucose. These injections are given through a continuous intravenous drip system, by injections in the muscle or in the subcutaneous tissue. The route and frequency of administration will be dependent upon the severity of the pet’s clinical signs. Many pets require 24 hour care and may need to be transferred to a 24 referral facility. Longer acting insulin is instituted once the ketones are resolved and the glucose levels have normalized.
• Fluid therapy is essential. Insulin is generally started after a few hours of fluid therapy. Fluids may be supplemented with electrolytes such as potassium, phosphorus, and/or magnesium. Eventually, dextrose administration (a form of glucose) is often administered after the glucose has normalized yet ketones are still present.
• Complications like urinary tract infections may require additional medications, but certain drugs, including steroids (such as prednisone), should be avoided in diabetic cats.
• Frequent monitoring of blood glucose, urine ketones, electrolytes, and urine output will help guide above therapy.

Home Care and Prevention

Long term management of diabetes will include insulin injections at home and possible antibiotics to treat infectious complications. Ovariohysterectomy (spaying) is indicated in female diabetic animals. When animals come into heat (estrus), the hormonal changes alter insulin and glucose metabolism.

Be prepared for frequent adjustments to therapy early in the course of treatment. Veterinarians prefer to start with a low dose of insulin initially and adjust upwards slowly to avoid overdose.

Prognosis for Diabetic Ketoacidosis in Cats

The prognosis depends upon the severity of the illness, the cat’s response to therapy, overall health of your cat, concurrent diseases, and secondary complications from diabetes. Once pets survive the life-threatening DKA portion of the disease and go on to become “routine” diabetics and do well after 6 months of treatment, many will have a good quality of life for more than 5 years.