Diabetic Ketoacidosis Is A Dire Diagnosis
Michelle Gerhard Jasny, V.M.D. has been practicing veterinary medicine on the Vineyard since 1982 and writing the Visiting Vet column for more than 25 years. She lives and works in West Tisbury. She can be reached at [email protected]. Yves had always been a cat who liked to eat. A seasonal resident, I saw him every summer. When he was four years old, I suggested reducing the amount he was being fed. At six, I advised a prescription weight loss diet. It was a difficult regimen for his owners to maintain. Yves lived strictly indoors and didn’t get much exercise, and the other cat in the household had different health problems, requiring different food. By 11 years old, Yves was tipping the scale at 21 pounds. “He’s at risk for all kinds of diseases, especially diabetes,” I said, not unsympathetically, considering how many years I have struggled with my own battle of the bulge. His family committed again to helping him lose weight and last winter we sent them off with more diet food, recommending monthly weigh-ins with their winter veterinarian. Spring arrived. Seasonal folks began returning. Memorial Day weekend, Yves’s mother called. “We’ve been here two weeks,” she said. Yves had been fine until yesterday. “I am worried he might have some kind of blockage. He’s been vomiting and crying and he’s not eating.” “He’s still an indoor cat?” I asked. Cats who go out have greater risk of ingesting things that may upset their tummies, anything from mice to antifreeze, but Yves never ventured to the great outdoors. “Any flowers like lilies in the house?” I asked. Ingestion of houseplants is a common cause of gastroenteritis for indoor cats and lilies in particular are extremely toxic to cats, leading to potentially fatal kidney failure. “No, Continue reading >>
Diabetic Ketoacidosis In Dogs
My dog is diabetic. He has been doing pretty well overall, but recently he became really ill. He stopped eating well, started drinking lots of water, and got really weak. His veterinarian said that he had a condition called “ketoacidosis,” and he had to spend several days in the hospital. I’m not sure I understand this disorder. Diabetic ketoacidosis is a medical emergency that occurs when there is not enough insulin in the body to control blood sugar (glucose) levels. The body can’t use glucose properly without insulin, so blood glucose levels get very high, and the body creates ketone bodies as an emergency fuel source. When these are broken down, it creates byproducts that cause the body’s acid/base balance to shift, and the body becomes more acidic (acidosis), and it can’t maintain 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. How could this disorder have happened? If a diabetic dog undergoes a stress event of some kind, the body secretes stress hormones that interfere with appropriate insulin activity. Examples of stress events that can lead to diabetic ketoacidosis include infection, inflammation, and heart disease. What are the signs of diabetic ketoacidosis? The signs of diabetic ketoacidosis include: Excessive thirst/drinking Increased urination Lethargy Weakness Vomiting Increased respiratory rate Decreased appetite Weight loss (unplanned) with muscle wasting Dehydration Unkempt haircoat These same clinical signs can occur with other medical conditions, so it is important for your veterinarian to perform appropriate diagnostic tests to determine if diabetic ketoacidosis in truly the issue at hand Continue reading >>
Understanding And Treating Diabetic Ketoacidosis
Diabetic ketoacidosis (DKA) is a serious metabolic disorder that can occur in animals with diabetes mellitus (DM).1,2 Veterinary technicians play an integral role in managing and treating patients with this life-threatening condition. In addition to recognizing the clinical signs of this disorder and evaluating the patient's response to therapy, technicians should understand how this disorder occurs. DM is caused by a relative or absolute lack of insulin production by the pancreatic b-cells or by inactivity or loss of insulin receptors, which are usually found on membranes of skeletal muscle, fat, and liver cells.1,3 In dogs and cats, DM is classified as either insulin-dependent (the body is unable to produce sufficient insulin) or non-insulin-dependent (the body produces insulin, but the tissues in the body are resistant to the insulin).4 Most dogs and cats that develop DKA have an insulin deficiency. Insulin has many functions, including the enhancement of glucose uptake by the cells for energy.1 Without insulin, the cells cannot access glucose, thereby causing them to undergo starvation.2 The unused glucose remains in the circulation, resulting in hyperglycemia. To provide cells with an alternative energy source, the body breaks down adipocytes, releasing free fatty acids (FFAs) into the bloodstream. The liver subsequently converts FFAs to triglycerides and ketone bodies. These ketone bodies (i.e., acetone, acetoacetic acid, b-hydroxybutyric acid) can be used as energy by the tissues when there is a lack of glucose or nutritional intake.1,2 The breakdown of fat, combined with the body's inability to use glucose, causes many pets with diabetes to present with weight loss, despite having a ravenous appetite. If diabetes is undiagnosed or uncontrolled, a series of metab Continue reading >>
Feline Diabetes Mellitus
4 0 Diabetes Mellitus is a metabolic disease caused by a failure of the pancreas to produce enough insulin. Insulin allows cells in the body to absorb glucose (sugar) from the blood. Glucose is the cells’ main energy source and is critical to cellular function. Without insulin, the cells do not get the energy they need to function, and glucose levels in the blood rise. The body can use fats as an energy source; however this can occasionally lead to a life threatening condition called diabetic ketoacidosis which requires emergency treatment. Symptoms of diabetes include the following: 1. Weight loss – as fats are mobilized for energy instead of glucose 2. Increased appetite – as the body tries to increase its energy supplies 3. Increased drinking and urination – the glucose in the blood overwhelms the kidneys and spills into the urine drawing excessive amounts of water with it 4. Untreated diabetics can develop diabetic ketoacidosis. If this happens, the cat will show signs of severe illness including loss of appetite, lethargy and vomiting. Diagnosing diabetes is generally straightforward. Most diabetic patients have significantly elevated glucose levels in their blood as well as in their urine. In many cats we recommend a fructosamine test to confirm the diagnosis and make sure the elevated glucose was not due to stress. Most diabetic cats do very well with treatment and can live for many years with the disease. In addition to treating the diabetes, it is important to closely monitor all aspects of your cat’s health, since diabetes can make cats more susceptible to other problems such as infections. Dental health is especially important! Treating diabetes involves several steps: 1. Diet – Recent studies have shown that decreasing the intake of carbohydrates Continue reading >>
Diabetic Ketoacidosis
Diabetic ketoacidosis (DKA) is an emergency. DKA develops due to: Long standing undiagnosed diabetes mellitus Insufficient insulin dose in treated diabetics Reduced insulin action - caused by obesity , concurrent illness or drugs. This is the cause of more than two-thirds of cases of DKA. What causes DKA? Due to a lack of insulin , glucose cannot be used by the body cells as an energy source. Instead fat is broken down to provide energy. When fat is used as an energy source, acids known as ketones are produced. Ketones circulating in the blood cause signs of DKA - anorexia, nausea and lethargy. Diagnosis The diagnosis of DKA is based on detecting ketones in the urine and sometimes in the blood along with signs of illness. See Urine Monitoring for more information. Treatment DKA is an emergency and treatment must be started as soon as possible. Your veterinary surgeon will administer intravenous fluids and insulin and correct any underlying disorders to stabilise your cat. Once your cat is stabilised it will be started on long term insulin therapy again. Continue reading >>
My Cat Has Diabetes :: Treatment
Living with a diabetic cat Each diabetic cat responds differently to different therapies. Some cats are easier to regulate; others require more complex types of treatment. Some cats can be treated successfully through changes in diet and with oral medications. In cats with more severe diabetes, insulin injections may be required for the remainder of their lives. In general, treatment for diabetes falls into three categories: Insulin injections Oral hypoglycemic medications Diet Home monitoring & testing Ongoing and frequent home monitoring of your cat's glucose level is important both for ensuring that diabetes is under control and the long-term health maintenance of your pet. Home monitoring usually results in less stress on the cat and allows for closer, more precise control of blood glucose levels on a regular basis, which helps avoid the risk of hypoglycemic episodes. Home testing of glucose levels can be done with a similar type of blood glucose monitor used by humans. This method requires a small sample of blood that is taken from the cat for testing and generally provides an immediate reading of your cat's blood glucose level. In addition to monitoring glucose levels through the blood, caretakers can use urine glucose monitoring. However, urine glucose monitoring is generally not as accurate due to the lag time for glucose to go from the blood to the urine in the cat's body. It is recommended to consult with your veterinarian on the best way to monitor your cat's glucose. They can also provide valuable advice on which type(s) of monitors work best in cats, as well as train you on how to use and interpret the test results. When at home, you also should continually be aware of your cat's appetite, water consumption and urine output to determine what is normal behav Continue reading >>
How I Treat Electrolyte Disturbances In Diabetic Ketoacidosis
Proceeding of the NAVC North American Veterinary Conference Reprinted in the IVIS website with the permission of the NAVC Close window to return to IVIS Small Animal – Critical Care Nishi Dhupa, BVM, DACVIM, DACVECC College of Veterinary Medicine Cornell University, Ithaca, NY INTRODUCTION Diabetic ketoacidosis (DKA) results from an absolute or relative insulin deficiency in conjunction with glucagon and stress hormone excess. It is crucial to identify underlying disease factors contributing to stress in these patients. Stress factors include changes in environment, dehydration and concomitant disease. Commonly associated diseases include renal disease, urinary tract and other infection, and pancreatitis; in cats, hepatic lipidosis is also commonly seen. DKA is characterized by hyperglycemia, dehydration, ketonemia, metabolic acidosis and multiple electrolyte abnormalities. Treatment must be intensive and directed towards the correction of fluid, electrolyte and acid-base abnormalities as well as the correction of abnormal carbohydrate metabolism. The treatment itself (particularly the correction of acid-base imbalance with sodium bicarbonate therapy and the use of insulin therapy) may exacerbate the electrolyte abnormalities, and careful monitoring and aggressive treatment of these abnormalities is critical. Without treatment, DKA is fatal and it should be considered a medical emergency. The mortality rate for DKA is 25-30 %, even with aggressive treatment. CLINICAL SIGNS Clinical signs seen in dogs and cats with ketoacidosis include polyuria, polydipsia, weight loss, anorexia, vomiting, diarrhea, lethargy, weakness, dehydration, obtundation and hyper- or hypoventilation. These clinical signs may develop in various combinations and are usually severe in the keto Continue reading >>
Diabetes Complications In Dogs And Cats: Diabetes Ketoacidosis (dka)
Unfortunately, we veterinarians 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.). So, 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 Mellitus (Sugar Diabetes) in Dogs Once you have a basic understanding of diabetes mellitus (or if you already had one), this article will teach you about life-threatening complications that can occur as a result of the disease; specifically, I discuss 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 when it is 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 to complete anorexia Large urinary clumps in the litter box (my guideline? If it’s bigger than a tennis ball, it’s abnormal) Weight loss (most commonly over the back), despite an overweight body condition Excessively dry or oily skin coat Abnormal breath (typically a sweet “ketotic” odor) In severe cases DKA can also result in more significant signs: Abnormal breathing pattern Jaundice Ab Continue reading >>
Diabetes With Ketone Bodies In Cats
Diabetic ketoacidosis is an extreme medical emergency that requires immediate veterinary attention. The condition can result in an accumulation of fluid in the brain and lungs, renal failure or heart failure. Affected animals that are not treated are likely to die. With timely intervention and proper treatment, it is likely that an affected cat can recover with little to no side effects. Diabetes mellitus occurs when the pancreas fails to produce sufficient insulin, creating an inability to efficiently process the sugars, fats, and proteins needed for energy. The resulting build-up of sugar causes extreme thirst and frequent urination. Since sugar levels help to control appetite, affected animals may experience a spike in hunger and lose weight at the same time due to the inability to properly process nutrients. In extreme cases, diabetes may be accompanied by a condition known as ketoacidosis. This is a serious ailment that causes energy crisis and abnormal blood-acid levels in affected pets. Cats affected with diabetic ketoacidosis are likely to present with one or more of the following symptoms: Vomiting Weakness Lethargy Depression Excessive Thirst Refusal to drink water Refusal to eat Sudden weight loss Loss of muscle tone Increased urination Dehydration Rough coat Dandruff Rapid breathing Sweet-smelling breath Jaundice The exact cause of diabetes in cats is unknown, but it is often accompanied by obesity, chronic pancreatitis, hormonal disease, or the use of corticosteroids like Prednisone. Ketoacidosis, the buildup of ketone waste products in the blood that occurs when the body burns fat and protein for energy instead of using glucose, is caused by insulin-dependent diabetes. Diabetic ketoacidosis is commonly preceded by other conditions including: Stress Surgery Continue reading >>
Diabetic Ketoacidosis In The Cat: Recognition And Essential Treatment
Review Article Diabetic ketoacidosis (DKA) is a not uncommon emergency in both newly diagnosed and poorly regulated diabetic cats. When there is a heightened metabolic rate and energy requirement due to concurrent illness, an increase in the release of glucose counter-regulatory hormones causes insulin receptor resistance, lipolysis, free fatty acid release and ketogenesis. This necessitates not only treatment to eliminate the ketosis and control blood glucose, but also investigation of concurrent illnesses. Continue reading >>
Diabetic Ketoacidosis In Cats
Diabetic ketoacidosis requires urgent veterinary treatment. With ketoacidosis, the lack of insulin causes the body to burn fat and muscle creating ketones. The kidneys are unable to filter all of the ketones from the blood. As a result, these ketones build up in the bloodstream, turning the blood extremely acidic. This is a dangerous stage of diabetes that causes blood chemical and blood sugar imbalances, and also impairs brain function. Left untreated, diabetic ketoacidosis can lead to diabetic coma and death. Understanding Diabetes Mellitus Diabetes mellitus is more commonly referred to as diabetes. With this disease, the feline's pancreas fails to properly regulate the flow of insulin within the body. Without the proper levels of insulin, the cat eats more, but fats and protein break down into energy, so the cat loses weight. Sugar levels within the blood skyrocket and are released in the urine. Cats often require insulin injections to maintain healthy blood sugar levels. With non-insulin dependent diabetes, diet, weight loss and exercise may be enough to keep blood sugar levels down. If a cat's blood sugar levels are properly monitored, a cat with diabetes is unlikely to face any serious health issues. If diabetic ketoacidosis does occur, call your vet immediately. Signs of Diabetic Ketoacidosis The most common signs of ketoacidosis in cats are excessive thirst and frequent urination. However, you should also watch for: Breath smells of nail polish remover/acetone Excessive appetite Vision changes/blindness Vomiting Weakness Weight loss Ketoacidosis can occur with an infection or illness. It can also happen if the insulin amounts need altering. Your vet will find a cause and create a new treatment plan you will follow at home. Diagnosis and Treatment When you bring Continue reading >>
Diabetes In Cats Part 2 – Things You Should Know About Diagnosis & Treatment
3 53 Remember Stephen? Stephen is having a cat nap. So I guess it’s up to me to tell you all a little bit more about diabetes in cats. In my previous article – What Does a Cat With Diabetes Look Like? I talked about what diabetes mellitus actually is, what I think about people who taste urine to check for its sweetness, and gave some pointers on signs to watch out for that might indicate your cat has this disease. Now it’s time to have a quick look at how diabetes in cats is diagnosed and most importantly, what the heck we can do about it. How Can My Veterinarian Tell if My Cat has Diabetes? There are two main test results required for a vet to be able to diagnose diabetes in a symptomatic cat: A high fasting blood glucose (i.e. loads of glucose floating around in their blood even when they haven’t eaten recently) Testing these parameters is a piece of cake! See what I did there? But here’s where it gets tricky. Cats can get enormously stressed out by a visit to the vet (kind of like I feel about sitting in the dentist’s chair), and a really important effect of this stress can be a transient elevation in their blood glucose, which can even be significant enough to see glucose spilling over into the urine. What this means is that cats who do not have diabetes may have a high blood glucose reading, and even occasionally glucose in their urine. These tests aren’t always diagnostic on their own. It is best to run a full blood profile rather than just checking the glucose alone. This assists us with detecting any other illnesses that may either be the sole cause of your cat’s problems or could just be lurking around complicating the situation. If there is any doubt about the diagnosis of diabetes, a good test to do next is a plasma fructosamine level. This te Continue reading >>
Feline Chronic Kidney Disease
ON THIS PAGE: Risk Factors Home > Related Diseases > Diabetes It is not uncommon for a CKD cat to also have or develop diabetes. The dietary needs of a diabetic cat may seem incompatible with the needs of a CKD cat but the diabetes must take precedence. What is Diabetes Mellitus? Insulin is a hormone which enables the body to process food and to produce energy from it. Diabetes mellitus is a disease in which: not enough insulin is produced by the pancreas; or the cat’s body cells do not properly process insulin which the pancreas has produced. As a result, the cat develops high blood sugar levels (hyperglycaemia), which eventually lead to high sugar levels in the urine (glucosuria). Diabetes may present as: uncomplicated; or diabetes with ketoacidosis (DKA) Cats with the former may only have mild symptoms, at least in the early stages, but cats with ketoacidosis are usually very ill, and may die if not treated promptly. There is another, much rarer form of diabetes called diabetes insipidus which is beyond the scope of this website. Cornell University College of Veterinary Medicine has a good general overview of diabetes in cats. Feline diabetes mellitus: from diagnosis to therapy (2009) is a helpful article by Dr DL Zoran. Feline Diabetes provides detailed answers to frequently asked questions. Risk Factors Increasing age is a factor (as it is for CKD cats). Steroid-induced diabetes in cats (2013) Peterson ME Veterinary Endocrinology says "The average age at diagnosis for feline diabetes is 10 years, with a peak incidence between 9 and 13 years." Obesity in cats, as in humans, is a strong predisposing factor for diabetes. For some reason, male cats and neutered cats are more at risk of diabetes. Burmese cats in the UK and Australasia (but not the USA) appear to be mo Continue reading >>
When And How To Check For Them
Information provided about specific medical procedures or conditions is for educational purposes to allow for educated, on-going discussion with your vet and is not intended to replace veterinary advice. Diabetic Cat Care Ketones Many of us have heard of ketogenic diets; used often by bodybuilders, or to help with weight loss. The science is that by keeping the body in a ketone producing state, fat stores will be used by the body, weight will drop off much more quickly. That may be fine for humans, but producing ketones is the last state we want our diabetic cats to be in. Ketones occur when the body cannot access blood glucose for energy. Left untreated, ketones build up in the system and can lead to a life threatening situation called Diabetic Ketoacidosis, also known as DKA. While development of ketones is not an "immediate emergency", the progression of excessive ketones which develop into diabetic ketoacidosis IS a very real emergency situation requiring immediate veterinary care and very aggressive treatment. Catching ketones at low levels, before they get out of control, and then taking immediate and appropriate action can save your cat’s life. Ketones are a direct result of hyperglycemia (high BG). Ketones can develop because of not enough insulin, illness, infection, and/or anorexia. In humans, ketones can be produced when the body burns too much fat storage for energy. While practicing TR it is very rare for a cat to produce ketones once the BG is well regulated. That said, at the start of TR, right after diagnosis, if your cat is sick, or when making an insulin switch, its strongly recommended as a precaution to test for ketones if your cat is over renal threshold (225/12.5) for longer than a day. For those cats prone to quick ketone production, checking fo Continue reading >>
The Signs, Diagnosis & Types Of Diabetes Mellitus In Cats
There are certain signs or symptoms which are commonly seen in cats with diabetes mellitus. Unfortunately, these signs also occur in other diseases and conditions. Therefore, laboratory tests are necessary to diagnose diabetes mellitus in cats. The following article includes a discussion of how this diagnosis is made and the types of diabetes found in cats. What are the signs of diabetes mellitus in cats and why do they occur? Depending on how severely insulin production is impaired, there may be few signs of disease, or the signs may be severe. Dogs with diabetes often develop cataracts; cats do not. The most common signs of diabetes are: Increased thirst (polydipsia) and urination (polyuria) Change in appetite Weight loss Change in gait (walking) Decreased activity, weakness, depression Vomiting Increased Thirst and Urination: Because the glucose cannot enter the cells, the glucose levels in the blood become abnormally high (hyperglycemia). The glucose is filtered out by the kidneys and is found in the urine (glucosuria). When it is filtered out, it carries water with it. The animal, then, is losing more water through the urine than normal and has to make up for it by drinking more. Inappropriate Elimination: The increased urination may result in the cat not always urinating in the litter box. This inappropriate urination may be one of the first signs of diabetes in cats. In addition, cats with diabetes can often develop urinary tract infections, which may also result in inappropriate elimination. Change in Appetite: Some diabetic cats eat less, because frankly, they do not feel well. Other cats may have voracious appetites and eat a lot (polyphagia) because their hypothalamus keeps telling them they are hungry. Weight Loss: Because the cat cannot use the calories he Continue reading >>
