Diabetic ketoacidosis in dogs

Diabetic ketoacidosis in dogs is a life-threatening complication of diabetes. It can affect diabetic dogs of any age or sex, but it’s most likely in older dogs with other illnesses as well.

Diabetic ketoacidosis in dogs is a complication of untreated or uncontrolled diabetes. It can develop very suddenly and is considered a veterinary emergency. With prompt treatment, around 70% of dogs will survive a diabetic ketoacidosis crisis. Without treatment it causes death.

Overview

What is diabetic ketoacidosis in dogs?

Diabetic ketoacidosis (DKA) happens when the body can’t get enough glucose for essential functions.

How does DKA happen?

Without enough insulin, glucose stays in the blood.
Glucose levels rise but remain out of reach for cells that need it for fuel.
Vital organs need this fuel to work.
The body breaks down its own muscle and fat for fuel instead.
The fuel formed is called ketones.
Ketones are a poor substitute for glucose. They accumulate in the blood because they can’t get into cells either.
High levels of ketones are very harmful.
Many organs and body functions are ‘poisoned’ by high ketone levels and start to fail.
Untreated DKA progresses quickly and will result in death.

Symptoms

Symptoms of diabetic ketoacidosis in dogs

Symptoms can come on suddenly and worsen very rapidly:

Vomiting and diarrhoea
Eating less or not at all
Sweet-smelling breath and/or urine: smells like ‘pear drops’
Weakness and tiredness
Breathing quickly
Becoming wobbly on legs: appearing drunk and vacant
Seizures and collapse
Coma and death

: Weakness and tiredness can be signs of DKA

Take your dog into practice to see a vet immediately if they are collapsed, having fits, or if you think they are having a diabetic ketoacidosis crisis.

Risk

What increases the risk of diabetic ketoacidosis in dogs?

Dogs with undiagnosed or newly diagnosed diabetes are most at risk of DKA. But even dogs receiving regular insulin may develop DKA under the following circumstances:

Not getting enough insulin:

Changing insulin requirements over time
Missed insulin treatments
Vomiting up food or not eating
Incorrectly stored or injected insulin

Increased requirements for insulin:

Extreme or unaccustomed exercise
Other illnesses: The added stress resulting from other illnesses increases the need for insulin as cells burn up more energy to cope. These illnesses include pancreatitis, Cushing’s disease, urinary tract infections, heart disease, cancer, pneumonia, and pyometra (unneutered females)

Interaction with other medicines:

Corticosteroids
Steroid hormone treatments

Diagnosis

How will vets diagnose diabetic ketoacidosis in dogs?

DKA is an emergency and dogs will usually be very sick. Your vet will diagnose it and start treatment for DKA based on the following:

History
Physical examination
Blood tests: Checking glucose, electrolytes (salts), general organ function and health
Urine sample: glucose and ketones will be raised
More advanced test options include blood gases and blood ketones to confirm DKA

Further investigation if other disease processes are also suspected:

X-rays and ultrasound exam of chest and abdomen
CT scan

Vet treatment

How vets treat diabetic ketoacidosis in dogs

The priority for emergency treatment of DKA is stabilising a sick patient with lots of fluids, insulin and replacing essential electrolytes, such as potassium.

Emergency treatment of ketoacidotic diabetes includes:

Fluids given on a drip to treat dehydration and support vital organs. Potassium may be added as it’s likely to be low and it’s vital for heart and nerve function
Insulin injections to control blood sugar levels
Anti-sickness medication if they are vomiting
Anti-seizure medication if they’re fitting
Antibiotics to treat or prevent infection as your dog’s own immune defences won’t be working
Monitoring blood sugar levels
Encouraging to eat or feeding by a special tube

Once your dog is safely stabilised, the vet will investigate and treat the underlying cause of the DKA.

Treatment for DKA is intensive and worrying for pet parents. But it will also be very expensive.

Home treatment

Home remedies for dogs with diabetic ketoacidosis

DKA in dogs is a life-threatening emergency. Your dog needs urgent and intensive veterinary care.

Once your dog comes home, you can support them in the following ways:

Ensure your dog eats regularly and consistently
Ideally, feed your dog a diabetic prescription diet, such as Hills Prescription Diet Diabetes Care w/d. This will support healthy weight, stable blood sugar levels, and provide all the nutrients they need.
If you haven’t started already, learn how to monitor your dog’s glucose levels at home. Simple kits are available and your vet team will show you what to do

Prevention

Tips for preventing a diabetic ketoacidosis crisis in your dog

The best way to prevent DKA is to understand why it happens. And to be aware of how your dog’s blood glucose changes through the day and over time.

Do urine tests often to detect ketones early on
Test blood sugar regularly when starting or changing insulin doses. Testing over 24 hours will provide a glucose curve for you and your vet to check how things change over the day.
Ensure your diabetic dog is eating
Keep mealtimes regular
Store insulin as directed
Try to be aware of anything that may change how much insulin your dog needs, including lifestyle or other illnesses.