Diabetes Ketoacidosis (DKA) - A Complication of Diabetes in Cats and Dogs

Unfortunately, as veterinarians, we 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.). You're probably wondering 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 in Cats

• Diabetes in Dogs

This article will teach you about life-threatening complications that can occur as a result of the disease; specifically, 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 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 or complete anorexia

• Vomiting

• Excessive thirst and urination (clear, dilute urine)

• Large urinary clumps in the litter box (anything bigger than a tennis ball is abnormal)

• Weight loss (most commonly over the back), despite an overweight body condition

• Obesity

• Flaky skin coat

• Excessively dry or oily skin coat

• Abnormal breath (typically a sweet “ketotic” odor)

• Diarrhea
  

In severe cases DKA can also result in more significant signs:

• Abnormal breathing pattern

• Jaundice

• Abdominal pain (sometimes due to the secondary problem of pancreatitis)

• Tremors or seizures

• Coma

• Death

What can cause DKA?

When DKA occurs, it’s often triggered by an underlying medical problem such as an infection or metabolic (organ) problem. Some common problems that we see with DKA include the following:

• Pancreatitis

• Urinary tract infection

• Chronic kidney failure

• Endocrine diseases (e.g., hyperadrenocorticism [when the body makes too much steroid], or hyperthyroidism [an overactive thyroid gland])

• Lung disease (such as pneumonia)

• Heart disease (such as congestive heart failure)

• Liver disease (such as fatty changes to the liver)

• Cancer

Diagnosing DKA

While diagnosing DKA is simple, by looking at the blood sugar levels of dogs and cats and by measuring the presence of these fat breakdown products in the urine or blood, treatment can be costly (running between $3-5000). A battery of tests and diagnostics need to be performed, to look for underlying problems listed above, and treatment typically requires aggressive therapy and 24/7 hospitalization.

Treatment of DKA

Treatment, typically, is required for 3-7 days, and includes the following:

• A special intravenous catheter called a “central line” (placed to aid in frequent blood draws)

• Aggressive intravenous fluids

• Electrolyte supplementation and monitoring

• Blood sugar monitoring

• A fast acting or ultra fast acting insulin, regular or Lispro, typically given intravenously or in the muscle

• Blood pressure monitoring

• Nutritional support (often in the form of a temporary feeding tube)

• Anti-vomiting or anti-nausea medication

• Antibiotics

• Long-term blood sugar monitoring and a transition to a longer-acting insulin

Thankfully, with aggressive supportive care, many patients with DKA do well as long as pet parents are prepared for the long-term commitment (including twice-a-day insulin, frequent veterinary visits to monitor the blood sugar, and the ongoing costs of insulin, syringes, etc.).

Preventing DKA

By following your veterinarian’s guidelines and recommendations you can help regulate and control your pet’s diabetic state better and monitor your pet carefully for clinical signs. For example, if your pet is still excessively thirsty or urinating frequently despite insulin therapy, they are likely poorly controlled and need an adjustment of their insulin dose (of course, never adjust your pet’s insulin or medications without consulting your veterinarian).

When in doubt remember that the sooner you detect a problem in your dog or cat, the less expensive that problem is to treat. If you notice any clinical signs of diabetes mellitus or DKA, seek immediate veterinary attention. Most importantly, blood glucose curves (when a veterinarian measures your pet’s response to their insulin level) often need to be done multiple times per year (especially in the beginning stages of diabetes mellitus).

If you have any questions or concerns, you should always visit or call your veterinarian.

Related reading:

• Diabetes in Cats

• Diabetes in Dogs

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Food Allergies in Dogs: Symptoms and Treatment

Dogs, like people, can have allergies to certain foods. In fact, food allergies are one of the most common allergic reactions known to affect our canine friends. When your dog is allergic to a particular food, their immune system responds to the food as it might respond to an infection or bee sting, producing antibodies that in turn cause the symptoms associated with the allergic response.

We all know dogs are “garbage guts” and will eat, well, a wide range of stuff. Sometimes it’s hard to distinguish a little upset stomach from an allergic reaction to food. When symptoms such as diarrhea persist, allergies may be the cause. These symptoms usually take time to develop, since your dog’s immune response takes time to produce the antibodies that cause the allergic response.

Symptoms of Food Allergies in Dogs

The most common symptoms of a food allergy are:

• Itching

• Hair loss

• Skin infection

Less common symptoms include:

• Vomiting

• Diarrhea

• Weight loss

• Lethargy

• Hyperactivity

Sometimes, dogs show more aggression because of their discomfort.

The most common foods that cause canine food allergies are proteins such as lamb, beef, chicken, and eggs. In addition, some dogs can be allergic to soy or gluten, which is found in wheat and similar grains. Some dogs may be allergic to preservatives or other food additives, as well.

When a dog eats a food they are allergic to, a vicious cycle occurs: they eat, their body produces an allergic reaction, and they become symptomatic, i.e., they itch, has diarrhea, or may vomit—which is why it is so important to identify the food for which they are having the reaction to. Frustrating, right?

Diagnosing Food Allergies in Dogs

If your veterinarian suspects your dog of having a food allergy, they will perform a thorough physical exam and take a detailed history of your dog’s food intake and activities. In addition, your veterinarian may recommend routine diagnostics to rule out other causes of your dog’s symptoms.

Your veterinarian will likely recommend a strict hypoallergenic diet trial for at least 2–3 months to see if it alleviates your dog’s symptoms. The suggested diet cannot contain any ingredients your dog has been recently eating; there are several specifically designed diets to help prevent food allergies. During the food trial, it is critical that your dog does not get any treats or supplements unless approved by your veterinarian.

Treatment for Dogs With Food Allergies

The best treatment for food allergies is avoidance. Once you’ve identified the food your four-legged friend is allergic to, you will be able to avoid it in the future and help your dog live an allergy-free life. Unfortunately, there is no way to prevent your dog from developing food allergies.

If you have questions about canine food allergies, please talk with your veterinarian—the best resource when it comes to the health and well-being of your best friend.

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Frequent Vomiting in Cats: Signs, Causes, and Treatment

It's abnormal for a cat to vomit daily or even several times a month. If your cat is vomiting frequently, it could be from a simple issue such as hairballs. It could indicate your cat has eaten a toxic substance or has a serious illness. Whatever reason you suspect, see your vet as soon as possible. A thorough exam can give an accurate diagnosis and provide treatment options.

WARNING

If you suspect that your cat (or any pet) has eaten something poisonous, call your vet or the Pet Poison Helpline immediately.

Many conditions and circumstances cause cats to vomit repeatedly. It could be a passing thing or a sign of a serious health concern. The key to correcting the issue is to identify the cause.

Eating Too Fast

One possible benign cause for frequent vomiting is that your cat eats too much food, too fast. This can happen to any healthy cat. You will notice your cat vomits barely digested or undigested food immediately after eating.

Food Allergies

The most common food allergens in cats are beef, fish, and chicken. Other ingredients can lead to allergies as well. Cats with food allergies are treated with special diets containing ingredients they haven't been exposed to before.

Poisoning

Sudden vomiting can also be caused by poisoning, which is an emergency. There are several sources of toxins in the average home:

• Antifreeze: Ethylene glycol is a poisonous ingredient in antifreeze. It is attractive to cats and dogs because its tastes sweet. Signs of poisoning include nausea and vomiting. Choose antifreeze with propylene glycol, which the U.S. Food and Drug Administration has labeled as non-toxic.

• Other home and yard toxins: Human medications, toxic cleaners, insect sprays, and yard and garden sprays to control weeds and pests all have the potential to poison your pets.

• Recalled cat food and treats: When news of a pet food recall breaks, take notice. Some recalls are because the food contains dangerous toxins. Read about the affected brands of food, then check to ensure that you don't have any in your home. If you do, follow the recall instructions and dispose of it immediately.

Feline Inflammatory Bowel Disease

Feline inflammatory bowel disease is another cause of vomiting. It is usually accompanied by diarrhea and weight loss. This disease can occur anywhere in a cat's intestinal tract, including the stomach (gastritis), the small intestine (enteritis), or the large intestine (colitis).

Pancreatitis

Pancreatitis is inflammation of the pancreas, which is part of the endocrine and digestive systems. Cats with pancreatitis show vomiting, lethargy, diarrhea, fever, and an unwillingness to drink water or eat.

Chronic Kidney Disease

Chronic kidney disease (CKD) is common in older cats. Kidneys filter waste from the blood. They balance nutrients and play a role in controlling blood pressure. Signs of CKD include vomiting, lethargy, diarrhea, weight loss, and increased water consumption. While CKD is a progressive disease, earlier intervention can lead to better outcomes.

Feline Diabetes

Diabetes is another endocrine disease. As with pancreatitis, vomiting is a common and often one of the first signs something is wrong. Other signs include increased thirst, hunger, and urination as well as weight loss and muscle weakness.

Hyperthyroidism

Frequent vomiting along with increased appetite and weight loss are also indicators of hyperthyroidism or an overactive thyroid gland, which is part of the endocrine system. You can also look for signs such as irritability, diarrhea, weakness, and excessive thirst. Additionally, your cat's fur may appear as if it's not being groomed as normal.

Hepatic Lipidosis

Hepatic lipidosis is also known as 'fatty liver disease'. While not a primary cause of vomiting, persistent vomiting can lead to hepatic lipidosis. This disease can be fatal. However, it's often reversible, provided it's quickly diagnosed and treated.

Hairballs

Although hairballs are common in cats, they're no laughing matter. Hairballs that are not vomited up can cause a bowel obstruction. Surgery is required to remove the obstruction.

Treatment

If your cat vomits for two days in a row, call your veterinarian. They will determine if your cat should be examined. You may be able to treat your cat at home.

The treatment for your cat's vomiting depends on the underlying cause. For instance, treatment for feline inflammatory bowel disease includes medication. If your cat also has food allergies, they need a limited-ingredient diet. If your cat has kidney disease your vet may recommend blood pressure medication and increasing fluid intake. Hyperthyroidism can be treated with surgery, medication, or radioactive iodine.

Your vet will guide you through the options and help you make an informed decision based on your cat's specific needs.

How to Prevent Vomiting

You can also take action to help prevent or decrease the frequency of vomiting in your cat:

• 
  If your cat eats too quickly, try to slow things down. Feed frequent small meals. Offer food on a paper plate rather than a bowl. Automatic feeders dispense a specific amount of food at a time.

• If your cat still vomits after eating too fast, put an inedible object (e.g. a golf ball) in their bowl. This forces your cat to eat around the object to pick out the food. The object must be clean and large enough so your cat can't swallow it.

• If you suspect food allergies, a diet change is in order. Talk with your veterinarian about different options. Be sure to read the ingredient list carefully.

• Routine veterinary exams are excellent preventative measures against health problems. Your vet can diagnose medical conditions in the early stages. This gives your cat the best prognosis.

• To prevent the possibility of poisoning, keep toxic chemicals, medications, and other potentially hazardous away from your pet. Remember, cats are curious and can get into or jump on things you might not suspect. Make sure there are no antifreeze spills on your garage floor or driveway. Keep your cat out of the garage. Pet-proof your home regularly.

• To prevent hairballs, brush your cat and prevent it from over-grooming. Frequent use of a high-quality cat brush or de-shedding tool can go a long way toward preventing a veterinary emergency. You can also try hairball-reducing food that includes more fiber. Mild hairball laxatives are available as well. These are designed to help any hairballs move more smoothly through the digestive tract.

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