Diabetic ketoacidosis in cats

Diabetic ketoacidosis in cats is a life-threatening complication of diabetes. It can affect diabetic cats of any age or sex but is most common in older patients and Burmese cats.

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

Overview

What is diabetic ketoacidosis in cats?

Diabetic ketoacidosis is a life-threatening complication of diabetes. It happens when the body can’t get enough glucose for essential functions.

How does DKA happen?

Without insulin, glucose can’t get into cells
Glucose levels rise but cells can’t get at it
Vital organs need this glucose as 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 cats

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
Collapse
Coma and death

Take your cat 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

Risk factors for diabetic ketoacidosis in cats

Cats with undiagnosed or newly diagnosed diabetes are most at risk of DKA. But even treated cats develop DKA. This can develop very suddenly and under the following circumstances:

Increased requirements for insulin due to other illnesses

In around 90% of cases, DKA happens in cats who have other illnesses as well as diabetes:

Chronic kidney disease
Acute pancreatitis
Infections, such as urinary tract infections
Fatty liver (hepatic lipidosis)
Cancer

Not getting enough insulin

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

Interaction with other medicines

Such as corticosteroids

Diagnosis

Diagnosis of diabetic ketoacidosis in cats

DKA is an emergency and cats will usually be very sick. Your vet will 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

Vet treatment for diabetic ketoacidosis in cats

The priority for emergency treatment of DKA in cats is stabilising the sick patient. With prompt and intensive hospital treatment, about 70% of cats will survive DKA. Without treatment, it always causes death.

Emergency treatment of ketoacidotic diabetes includes:

Fluids given on a drip to treat dehydration and support vital organs. Potassium may be added as 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 cat’s own immune defences won’t be working
Monitoring blood sugar levels
Encouraging to eat or feeding by a special tube

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

DKA recurs in about 40% of cases

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

Home treatment

Home remedies for diabetic ketoacidosis in cats

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

Once your cat comes home, you can support them by:

Ensuring your cat eats regularly and consistently
Ideally, feed them a diabetic prescription diet, such as Hills Prescription Diet Diabetes Care w/d, to support a healthy weight, stable blood sugar levels and to provide all the nutrients needed by your diabetic cat.
Learning how to monitor your cat’s glucose levels at home. Simple kits are available and your vet team will show you what to do.

Prevention

Tips on how to prevent a diabetic ketoacidosis crisis in cats

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

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

When to worry