Diabetic Ketoacidosis in Cats: Symptoms, Treatment, and Survival Guide

What is Diabetic Ketoacidosis (DKA) in Cats?

Diabetic ketoacidosis (DKA) is a serious metabolic emergency. This condition arises when normal metabolism of glucose does not occur due to extreme deficiency of insulin or insulin resistance in the body.

If diabetes in cats is not treated timely and appropriately, glucose cannot reach cells due to insulin deficiency or insulin resistance. When an existing illness—such as infection, inflammation, or stress—increases the body’s metabolic rate, energy demand also rises. To meet this increased demand, the body produces stress hormones (e.g., cortisol, adrenaline), which further reduce insulin’s effectiveness.

In this situation:

• Cells cannot utilize glucose for energy.
• The body starts breaking down fat to produce ketone bodies.
• This increases ketone levels in blood and urine, termed ketonemia and ketonuria respectively.

"Diabetic Ketoacidosis in Cats: A Survival Guide"

"Diabetic Ketoacidosis in Cats: A Survival Guide"

Cat Diabetic Ketoacidosis Symptoms and Key Causes

Diabetic ketoacidosis (DKA) does not result from a single cause but develops due to a combination of factors. Key contributors include:

1. Hyperglycemia (High Blood Glucose)

• When insulin deficiency or insulin resistance occurs, glucose cannot enter cells. This abnormally elevates blood glucose levels.

2. Ketone Body Accumulation

Fat breakdown for energy produces three types of ketone bodies:

1. Beta-hydroxybutyrate (β-Hydroxybutyrate)
2. Acetoacetate
3. Acetone
4. Vinegar/rotten fruit-like odor in breath/urine (due to ketonemia/ketonuria).
5. Excessive levels disrupt the body’s acid-base balance, causing metabolic acidosis.

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3. Metabolic Acidosis

• The body’s pH decreases.
• Blood becomes more acidic.
• This affects nervous system functionality and organ performance.

4. Dehydration

• Hyperglycemia increases urine output (osmotic diuresis), leading to fluid and electrolyte loss.

5. Electrolyte Imbalance

• Excessive potassium (K⁺) and phosphate (PO₄³⁻) loss through urine.
• Levels drop rapidly during insulin therapy, severely impacting the heart, muscles, and nerves.

Summary: DKA is a multi-causal disease involving high blood sugar, ketone buildup, acidosis, dehydration, and electrolyte imbalance. Each factor exacerbates the others, worsening the condition.

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The Role of Hormones in DKA

Insulin and glucagon—both secreted by the endocrine pancreas (Islets of Langerhans)—perform opposing functions:

• Glucagon: Released by alpha (α) cells, increases blood glucose.
• Insulin: Released by beta (β) cells, decreases blood glucose.
  If insulin is deficient or ineffective (e.g., due to obesity), blood glucose rises, triggering diabetes symptoms.

Diabetic Ketoacidosis in Cats Treatment Approach

Effective DKA treatment requires addressing all underlying factors—not just one. Veterinarians must first identify root causes (e.g., infection, pancreatitis) that trigger or worsen DKA before initiating therapy.

DKA Cat Bloodwork and Core Treatment Components

1. Intravenous Fluid Therapy (IV Fluids)

• Replenishes dehydration and improves blood circulation.
• Crystalloids (e.g., 0.9% NaCl) are commonly used.

2. Insulin Therapy

• Short-acting insulin (e.g., Regular Insulin) controls blood glucose.
• Initial IV/IM administration; switched to subcutaneous (SC) once glucose stabilizes.

3. Electrolyte Supplementation

• Potassium (K⁺) and phosphorus (PO₄³⁻) levels must be maintained.
• Sodium, magnesium, and chloride levels should also be monitored.

4. Treating Underlying Causes

• Essential if triggered by infection, pancreatitis, cancer, or systemic diseases.

5. Continuous Monitoring and DKA Cat Bloodwork

Critical parameters to track during treatment:

• Blood glucose: Every 1–2 hours.
• Ketone levels: Via urine/blood tests.
• Acid-base balance (pH): Through blood gas analysis.
• Electrolytes: Especially potassium and phosphorus.

6. Diabetic Ketoacidosis in Cats Survival Rate and Prognosis

Successful DKA treatment extends beyond insulin administration. It is a holistic process involving:

• Fluid balance restoration
• Electrolyte stability
• Identification/treatment of root causes
• Rigorous monitoring

Conclusion: Timely, coordinated treatment reduces DKA severity in cats and can save lives.

Pathophysiology of Diabetic Ketoacidosis in Cats

Glucose is the primary source of carbohydrates. It is a monosaccharide sugar and an example of a hexose sugar. In non-ruminant animals, glucose is the final product of carbohydrate digestion.
Carbohydrates are stored as glycogen in animals. This is the body’s main energy source, enabling mitochondria within cells to produce energy molecules called Adenosine Triphosphate (ATP).
ATP is obtained through aerobic and anaerobic oxidation of glucose.

• One glucose molecule produces approximately 32 ATP under aerobic conditions.
• Only 2 ATP are produced under anaerobic conditions.

ATP Production Process (Aerobic Conditions):

1. Glycolysis (in cytoplasm):
   Glucose → 2 Pyruvic Acid + 2 ATP + 2 NADH
2. Link Reaction (in mitochondrial matrix):
   2 Pyruvic Acid → 2 Acetyl-CoA + 2 NADH
3. Krebs Cycle:
   2 Acetyl-CoA → CO₂ + H₂O + 2 ATP + 6 NADH + 2 FADH₂
4. Electron Transport System (ETS):
   • 1 NADH = 2.5 ATP
   • 1 FADH₂ = 1.5 ATP
     Total ATP Calculation: 32 ATP

In humans and pets, carbohydrates are stored as glycogen. During fasting, glycogen converts to glucose via glycogenolysis (primarily in the liver). Similarly, excess body fat is stored as Triacylglycerol (TAG). During starvation, TAG breaks down into fatty acids via lipolysis. These fatty acids convert to Acetyl-CoA:

• Some enter the Krebs Cycle to produce energy.
• Others form ketone bodies (acetoacetate, beta-hydroxybutyrate, acetone).

Excess Ketone Bodies Cause:

• Ketonemia (in blood)
• Ketonuria (in urine)
  Collectively termed Ketosis.

Insulin-Glucose Relationship

To produce ATP, cells require insulin (except brain cells) to transport glucose from blood. Inside cells, glucose either:

• Generates ATP, or
• Stores as glycogen (liver/muscles) or fat (triglycerides).
• Insulin also transports electrolytes (e.g., potassium) into cells and inhibits fat oxidation.

Diabetes Mellitus (DM) occurs due to:

• Insulin deficiency
• Impaired insulin receptor function
• Reduced receptor count
  In cats, DM typically results from beta-cell degeneration in the pancreas, linked to conditions affecting insulin receptor sensitivity:
• Pancreatitis
• Chronic inflammatory diseases
• Obesity
• Hormonal disorders

Consequences of Insulin Deficiency:

• Blood glucose rises (hyperglycemia)
• Cells experience glucose shortage
• Excess glucagon worsens imbalance Cells break down stored glycogen and fat (TAG) into glucose and fatty acids. Fatty acids undergo β-oxidation in mitochondria, forming Acetyl-CoA:
• Some enters the Krebs Cycle
• Some converts to ketone bodies (acetoacetate, beta-hydroxybutyrate, acetone)

Excess ketone bodies cause blood acidity (acidosis), disrupting acid-base balance—a condition termed ketoacidosis.

When blood glucose exceeds renal threshold:

• Excess glucose excreted in urine (glucosuria)
• Increased urine volume/density (polyuria)
• Elevated plasma osmolality and thirst (polydipsia)

Diagnosing Diabetic Ketoacidosis in Cats

Diagnostic Criteria for DKA

DKA is confirmed when all three conditions coexist:

1. Hyperglycemia: Elevated blood glucose
2. Ketones: Ketone bodies in blood/urine
3. Acidosis: Blood pH < 7.35 (normal pH: 7.4)Note: ~10% cases show normal glucose (“Euglycemic DKA”).

pH Measurement Protocol

• Sample Type: Venous blood is sufficient (minimal arterial-venous pH difference)
• Sampling Caution: Repeated draws risk anemia; use ear vein collection for minimal invasiveness

Glucometer Use for DKA Cat Bloodwork

AlphaTRAK 2 Glucometer (Zoetis):

• Species-specific calibration for cats/dogs
• Requires only 0.3 μL blood
• Technique: Light ear margin prick with 25G needle

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Ketone Testing in Cats

• Blood β-hydroxybutyrate levels indicate hospitalization needs.
• ⚠️ Degrades rapidly—test immediately after collection.

DKA Cat Bloodwork Essentials

DKA vs. HHS (Hyperosmolar Hyperglycemic State)

Summary:
DKA diagnosis requires:

• Hyperglycemia
• Blood/urine ketones
• Acidosis (↓ pH)
  Additionally, screen for:
• Infections
• Kidney function
• Electrolyte imbalances
  These factors dictate treatment plans and prognosis.