Diabetic ketoacidosis (DKA)

Diabetic ketoacidosis (DKA) is a life-threatening disease affecting diabetic cats. Patients may go downhill very quickly, and rapid intervention is needed. It can be a very alarming condition for owners as your pet may become ill very suddenly. When you seek veterinary help there is an urgency to admitting a patient and starting treatment that can mean your decision-making feels rushed and you may feel you don’t really know what is happening.

Diabetic ketoacidosis (DKA) is most often seen in cats that have not yet had their diabetes recognized but can also occur in cats receiving insulin treatment if the dose of insulin is too low or the insulin is not working properly. In almost all cases there is another disease or condition in addition to the diabetes that triggers the DKA to develop. In normal animals, blood sugar levels rise after eating. Insulin is released and this helps the tissues to take up the sugar from blood to use as an energy source. In diabetic animals the insulin is not present, or not working effectively, and the cells cannot use the sugars. Tissues are starved of fuel and so they switch to using fats instead of sugar. The rapid breakdown of fat to use as an energy supply, results in the production of ‘ketones’ which can be toxic to the body.

DKA usually occurs in middle-aged to older cats (which are the cats most likely to develop diabetes). Cats that develop DKA have usually previously had signs of diabetes, such as excessive drinking and weight-loss despite a big appetite. Over a short period of time, they may then become unwell with vomiting and depression. There may also be signs of another underlying condition, such as a urinary tract infection or liver disease with yellowing of skin and gums (jaundice), or kidney disease. The signs of DKA usually develop within a few days and your pet may go downhill very rapidly.

Cats with DKA may have changes to their breathing pattern and you may notice an unusual, sweet smell on their breath (similar to nail polish remover). If untreated, cats can develop hypothermia and will feel very cold and slip into a coma.

An underlying disorder is recognized in more than 7 out 10 cats with DKA. These conditions are often infections, eg urinary tract infection, or diseases causing inflammation such as gum disease, tumors or pancreatitis. Some hormones also prevent insulin from working properly and DKA can occur if thyroid hormones are too high. In cats that are already receiving insulin treatment for diabetes there may be a problem with the insulin itself, ie it is out of date or has been stored incorrectly, or the dose or frequency of injection is wrong. Some drugs such as steroids can also affect the action of insulin, so great care is needed if these are given to a diabetic cat.

If your cat has already been diagnosed with diabetes and becomes unwell your veterinarian will immediately be checking to make sure they don’t develop DKA. If you take your cat to see your veterinarian because it is unwell, your veterinarian will most likely collect a urine sample straight away.

A diagnosis of DKA is usually made on the basis of a history of signs of diabetes (excessive drinking, weight loss) followed by a period of illness and then rapid deterioration. Your veterinarian will check a urine sample and an immediate diagnosis can be made if there are sugars and ketones in the sample. Your veterinarian may also be able to smell the ketones on your cat’s breath. Blood samples will also be needed to look for the ketones in the blood and to measure blood sugar levels. However, in addition to making the diagnosis of DKA, your veterinarian must identify if there is another underlying disease as this must be treated to bring the DKA under control. It can be difficult to separate the changes in the blood caused by the DKA from changes that caused the DKA in the first place.

X-rays and ultrasound may also be needed to look for underlying problems.

There are a number of important parts to the treatment, but these all have to be addressed at the same time. Your veterinarian needs to provide supportive care to keep your pet alive whilst using insulin therapy to get the tissues using glucose again. In addition, your veterinarian will need to identify and treat the underlying cause of the problems. Your pet will be admitted to a hospital and immediately placed on an intravenous drip. This will help correct any fluid loss and any imbalances in the blood. A special kind of insulin has to be given in DKA and this can be given in the drip. It is likely that antibiotics will be needed as the DKA may have been triggered by an infection, but in any case, cats with DKA are likely to be immunosuppressed and vulnerable to developing an infection during treatment.

Regular monitoring of your pet’s condition will be needed, and changes made to treatment on a minute by minute basis. Once the crisis has been stabilized your veterinarian may need to place a feeding tube to give nutrition.

DKA is a very serious condition and only two-thirds of cats will survive despite intensive care. Those with a severe underlying condition may be less likely to recover. Those cats that do improve usually have to remain in hospital for up to a week and will need constant monitoring to control their diabetes as well as treat the underlying conditions. Once discharged from hospital your cat will still have diabetes and will require ongoing treatment and monitoring. In addition, depending on the underlying cause of the DKA they may have a second condition that will require ongoing treatment. Four out of 10 cats that develop DKA will develop it again at a later date.

DKA is a severe and life-threatening condition for which urgent treatment is needed to give your pet the best chance of survival. Under those conditions it can be hard to think clearly and make the best decisions for you and your pet. The length of time that your pet will need to be in hospital, together with the urgent treatment and blood tests that will be needed, means that the first few days of treatment will be expensive. Many pets do not survive this period even with intensive care and, if they do, they will face ongoing treatment for diabetes. It is important that you consider all the options at the start, including whether you have the time and money to manage your pet’s diabetes. If you are concerned about any aspect of your pet’s care or about the cost of treatment always raise this with your veterinarian as soon as you can.