Diabetic Cat Care DKA (Diabetic Ketoacidosis)101

A DKA is a life-threatening situation that requires IMMEDIATE vet care.

What is DKA?

A DKA is the result of ketones developing from high blood glucose levels, dehydration, and the inability of cells to access energy from glucose; leading to the breakdown of fat and muscle cells for fuel and the by-product of acid ketones.

When DKA occurs, several things happen:

-Blood glucose is not being used, so builds up and is dumped into the urine
-Ketones build up, resulting in ketosis (ketones present in the urine)
-Severe dehydration occurs as the body tries to rid itself of excess glucose and ketones
-Acids build up in the blood, leading to metabolic acidosis
-The level of ketones in the urine pulls in electrolytes to neutralize the acids
-Depletion of potassium levels in particular, but also other electrolytes such as phosphorous become severely diminished.


The result of a DKA can be a severe electrolyte balance and     dehydration which can lead to coma and death if not treated immediately.

Dora/Justin, an Advanced Member at DCC (who is herself diabetic) shares her personal experience with DKA;

Back in May 2008, I had a gastro intestinal bug that spiked my blood sugars so high and kept them high (I'm diabetic) that I went into a diabetic crisis (DKA) Diabetic Ketoacidosis, a condition I know many of our cats have been through. This was my first time. The doctors told me had I waited one more day to go to the hospital, I would have gone into a coma.

It started with stomach flu symptoms – no appetite, couldn't keep anything down including water, severe nausea, vomiting, diarrhea, weight loss and a weakness I have never felt before. I could barely get out of bed. At this point, my blood sugars were rising and not coming down. In my weakened state, I didn't even think to check for ketones and that was a BIG mistake on my part. Always check for ketones when you see these signs are present. Had I checked this early on, I would have gone to emergency sooner. Same advice I would like to give for your cats as well.

When I arrived at the hospital, my blood sugar was 30.0 (540). I was in the hospital for 4 days and it was pure hell as I was so weakened by it all and so very ill. My body was starting to shut down. I was immediately put on IV Fluids, to get all my levels back to normal, as my blood became acidic as well. There were times I didn't know how I was going to make it through the next hour, much less the 4 days I had spent in the hospital.

I slowly did start to recover. I started taking in clear fluids and worked my way up to solid foods. It takes weeks to recover from something like this and you need the patience to see it all through. There is no rushing this kind of recovery.

The main thing that was stressed to me by the medical staff regarding recovery is to drink plenty of fluids and remain hydrated. Eventually, I fully recovered and I haven’t had a DKA episode since that time. I am always on the lookout for those signs and check my ketone levels when I even suspect something is not quite right.

 

Treatment for DKA

There are three main issues that need to be dealt with or a DKA requiring immediate veterinary assistance;
1. -It is essential to get blood glucose levels down
2. -Re-hydration via fluid therapy is required
3. -Electrolyte imbalances need to be corrected


1. Blood Glucose levels

BG levels will usually require a very fast acting insulin. Common insulin used:
· Ultra rapid R insulin such as Nova Rapid – or other ultra rapid insulin commonly used by people as a booster insulin before eating
· Faster acting insulin such as NPH (Humulin N – North America or Humulin I – Europe) or Caninsulin may also be used

Vet protocols for using these ultra rapid or faster acting insulin types are usually very conservative. If your cat requires need of these after leaving the vet, please post on Talking TR for assistance with dosing. In certain cases, with the assistance of experienced advisors, aggressive use of these faster acting insulin types may be possible to help reduce BG levels when ketones present to avoid an episode of DKA. Advice from those with the knowledge and experience is needed to attempt this method at home.

2. Re-hydration therapy

Cats going through a DKA are usually severally dehydrated. Your vet will set your cat up on an IV to rehydrate. There are a number of different fluids used, but most used to deal with DKA contain electrolytes.

3. Electrolyte Imbalances

The electrolyte imbalances will be addressed by your vet by adding and adjusting via the IV. Imbalances are difficult to redress. Your vet will need to be doing ongoing testing to adjust these levels - bringing up one electrolyte value can result in an imbalance with another.

It is essential that your vet has in-house lab capabilities (or access to a lab close by) in order to very closely monitor and deal with electrolyte imbalances.

Potassium is the most commonly depleted with a DKA – low potassium levels can lead to muscle weakness and heart problems.

Phosphorous is also often depleted – which can lead to weakness, anemia and even seizures.

Low magnesium levels can also occur – aggravating low potassium levels and leading to cardiac problems.

Your vet will need to monitor and adjust these levels as well as others.


 

Once your cat is back home after a DKA….

Your cat may still need fluids once home back with you. SubQ fluids are not difficult to administer at home, anyone able to give a shot of insulin is able to once they have been shown How to Give SubQ fluids.

The essential things to do for your cat after a DKA are to keep him well hydrated (extra water in his food is a good idea whether you need to give SubQ fluids or not) and above all to get and keep the BG below 8.3/150. Experienced advisors will help you use your cat's normal insulin, and/or fast-acting insulin depending on your cat's situation. You should not attempt to use faster acting insulin alone without veterinary/advisor advice.

It is important to keep checking for ketones until your cat recovers from DKA, in order to avoid another life-threatening episode.


For more information about diabetic ketoacidosis:

Diabetic Ketoacidosis: Treatment Recommendations

Ketoacidosis - PetWikia

Remission of diabetes mellitus in cats with diabetic ketoacidosis.

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