Diabetic Ketoacidosis (DKA) in Cats

What is Diabetic Ketoacidosis in Cats?

Diabetic ketoacidosis (DKA) is a medical emergency caused by severe complications of diabetes mellitus. 

Diabetes mellitus is caused by a decrease of insulin resulting in the inability of glucose in the bloodstream to move into the cells and tissues of the body. Without glucose, the cells and tissues essentially starve since they have no energy or food source. Although there is a large amount of glucose circulating in the bloodstream, it cannot be utilized without insulin. This is why diabetic patients will show high blood-sugar levels on a glucometer (a measure of high glucose circulating in the bloodstream) because glucose cannot enter the cells where it is needed.   

DKA occurs when a diabetic patient develops a secondary medical condition that places additional stress on the cells and the body. The most common secondary medical conditions include:

• Pancreatitis

• Any infection (most commonly urinary tract infection)

• Fatty liver (hepatic lipidosis)

• Kidney disease

• Cancer

These conditions increase the body’s energy needs, which causes a spike in glucose demand. At this point, the body becomes desperate for energy and will start breaking down fat to acquire an energy source. 

This process leads to the conversion of fat to ketone bodies, which the cells and tissues can use as an alternative energy source. However, they create pH and electrolyte imbalances that result in acidosis (too much acid in the blood) and dehydration. 

Unless the normal fuel process is quickly restored (insulin providing glucose to the cells instead of ketones), the body will spiral into a metabolic turmoil that can quickly become life threatening.   

Because diabetes often goes undiagnosed in cats, the symptoms of DKA are often the first indication of this underlying condition. A pet can be diabetic (diagnosed or undiagnosed) and not show any symptoms of DKA until a secondary stressor or additional illness develops.

Symptoms of Diabetic Ketoacidosis in Cats

If a known diabetic cat is sick with acute vomiting and/or anorexia, the pet parent should have the cat evaluated by their veterinarian. Clinical signs of diabetic ketoacidosis in cats may include:

• Anorexia  

• Nausea/vomiting  

• Lethargy/depression/weakness 

• Increased drinking/increased urinating  

• Increased respiratory rate which can progress to slow, deep breathing (from acidosis)  

• Weight loss  

• Dehydration  

• Unkempt coat/lack of grooming

• Sweet smell to the cat’s breath  

Causes of Diabetic Ketoacidosis in Cats

DKA occurs when a diabetic patient develops a secondary medical condition that places additional stress on the cells and body. This increases the energy needs of the cell and tissues, which results in the body turning to ketones as an energy source.  Some of the common causes include:  

• Unregulated diabetes mellitus (not getting enough insulin) 

• Pancreatitis

• Any infection (most commonly urinary tract infection)  

• Fatty liver (hepatic lipidosis)  

• Kidney disease  

• Neoplasia/Cancer  

• Any other secondary medical condition that increases metabolic needs or stresses the body  

How Veterinarians Diagnose Diabetic Ketoacidosis in Cats

Diagnosing diabetic ketoacidosis will begin with a physical examination by your veterinarian. If the pet is a known diabetic, the veterinarian may already be suspicious of DKA. The ketones may also cause a sweet smell to the pet’s breath.   

The veterinarian will want to run bloodwork, including a serum chemistry and complete blood count to assess blood sugar and electrolytes. Urinalysis will be useful to determine if there are signs of glucose and ketones in the urine and to rule out urinary tract infection. Ketones may also be found in the blood serum.   

Once the pet is determined to be diabetic and their blood shows the presence of ketones, the focus moves to determining what disease could be occurring in addition to the diabetes that led to the DKA.  

At this point, the pet will likely be transferred to a 24-hour specialty/emergency hospital for advanced diagnostics and possible hospitalization. The veterinary staff will likely perform an abdominal ultrasound to assess the pancreas for signs of inflammation (pancreatitis), assess the liver, kidneys and other organ systems of signs of disease or tumors.  

Chest X-rays may also be considered to rule out any evidence of pneumonia (source of infection) or metastasis (evidence of cancer). Finally, a blood-gas analysis may be performed to determine the severity of the acidosis.   

Treatment of Diabetic Ketoacidosis in Cats

There are three main goals in treatment of DKA:

• Restore hydration through fluids

• Restore glucose as the main energy source through insulin therapy

• Stop ketone production, and correct electrolyte abnormalities

To accomplish these goals, most cats will require hospitalization for at least a few days but might be hospitalized longer.

Hospitalization of DKA in Cats

An IV catheter will be used to provide IV fluid therapy for rehydration as well as electrolyte replacement. Initially, the patient will receive short-acting insulin and transitioned back to their normal long-acting insulin for discharge and at-home management. Blood sugar and electrolyte levels will be checked frequently during your cat’s hospital stay. Other medications for nausea, vomiting, pain or infection (antibiotics) may also be administered.  

Nutrition for DKA in Cats

One important aspect of DKA management is nutrition. For a diabetic pet to be successful at home they need to eat without vomiting to receive insulin and prevent DKA from recurring.  

In the hospital, blood-sugar levels will be closely monitored and insulin can be adjusted frequently. But at home, cats will need to eat twice per day and receive long-acting insulin.

Since cats often refuse to eat during a hospital stay, it is important a cat eats when transitioning back home to ensure they get their insulin. In some cases, cats with DKA will need a temporary feeding tube to provide nutritional support to help with the transition. Your veterinarian will help you in understanding the type of feeding tube needed, and how to successfully use at home, should your cat need one.

If your cat has previously been free fed, you will want to work with your veterinarian to transition them to meal feedings. If your cat does not eat, please contact your veterinarian immediately to discuss how to proceed with their insulin administration. Giving insulin, if a pet has not eaten without instructions from your veterinarian, can result in low blood sugar (hypoglycemia) and seizures.    

Recovery and Management of Diabetic Ketoacidosis in Cats

Early diagnosis and treatment of DKA are important for best possible outcome and minimal complications; however, most cats will need to remain hospitalized anywhere from two to seven days and placed on IV fluids, anti-nausea medications, electrolyte supplements, IV insulin therapy and other supportive care.

Cats are typically discharged once they are eating on their own with no vomiting and can receive long-acting insulin at home.

Once the immediate concerns and risks associated with DKA have been corrected (including stopping dehydration, electrolyte abnormalities and eliminating ketones) the focus shifts to regulating and managing the diabetes mellitus and any concurrent illness.

Long-Term Management of Diabetes in Cats

There is no cure for feline diabetes mellitus, but the prognosis is positive for quality of life. For most cats, this will mean twice daily long-acting insulin administration for life. This is much more likely for cats that do not go into diabetic remission (meaning they are able to maintain normal blood sugar levels without insulin injections).

Long-term diabetes management is individualized for each cat by the veterinarian but it will likely include periodic glucose curves or fructosamine blood tests to ensure that the diabetes is properly regulated.   

Avoiding future DKA involves careful monitoring of your cat at home. If a known diabetic cat is sick with acute vomiting and/or anorexia, take it to a veterinarian immediately.