Diabetes with Ketone Bodies in Cats

Diabetic ketoacidosis is an extreme medical emergency that requires immediate veterinary attention. The condition can result in an accumulation of fluid in the brain and lungs, renal failure or heart failure. Affected animals that are not treated are likely to die. With timely intervention and proper treatment, it is likely that an affected cat can recover with little to no side effects.

Diabetes mellitus occurs when the pancreas fails to produce sufficient insulin, creating an inability to efficiently process the sugars, fats, and proteins needed for energy. The resulting build-up of sugar causes extreme thirst and frequent urination. Since sugar levels help to control appetite, affected animals may experience a spike in hunger and lose weight at the same time due to the inability to properly process nutrients. In extreme cases, diabetes may be accompanied by a condition known as ketoacidosis. This is a serious ailment that causes energy crisis and abnormal blood-acid levels in affected pets. 

Cats affected with diabetic ketoacidosis are likely to present with one or more of the following symptoms:

• Vomiting
• Weakness
• Lethargy
• Depression
• Excessive Thirst
• Refusal to drink water
• Refusal to eat
• Sudden weight loss
• Loss of muscle tone
• Increased urination
• Dehydration
• Rough coat
• Dandruff
• Rapid breathing
• Sweet-smelling breath
• Jaundice

The exact cause of diabetes in cats is unknown, but it is often accompanied by obesity, chronic pancreatitis, hormonal disease, or the use of corticosteroids like Prednisone.

Ketoacidosis, the buildup of ketone waste products in the blood that occurs when the body burns fat and protein for energy instead of using glucose, is caused by insulin-dependent diabetes. Diabetic ketoacidosis is commonly preceded by other conditions including:

• Stress
• Surgery
• Infections (skin, respiratory, urinary tract)
• Heart disease
• Kidney failure
• Asthma
• Cancer

If diabetic ketoacidosis is suspected, a veterinary consultation is in order. Proper diagnosis will require a thorough medical history and details regarding the onset and severity of symptoms. A physical examination will be completed and lab tests including complete blood count (CBC) and biochemistry will be ordered. The vet will be checking for elevated glucose levels, high white blood cell count, elevated liver enzymes, high blood cholesterol, and low sodium levels. Tests will also be performed to check for levels of potassium, phosphorous, and the accumulation of urea in the blood. Urine tests will be needed to measure glucose and ketone levels. 

Treatment recommendations will depend on the severity of the symptoms and the overall health of the cat.

Hospitalization

When a cat is exhibiting signs of sickness including vomiting and lethargy, it is likely that it will need to be hospitalized. An I.V. will often be administered to restore fluids and electrolytes, and a feeding tube may be inserted. It is likely that the cat will need insulin injections and therapy to reduce ketone bodies and acid levels in the blood. Low potassium levels can potentially be life-threatening and will need to be treated with supplementation. Glucose levels will need to be tested every one to three hours to determine the effectiveness of the treatments, and close monitoring will be required. Intensive in-patient care and ongoing testing will likely be required for up to five days. 

Home Treatment

If the affected cat is not displaying signs of sickness, at-home treatment may be sufficient. Insulin supplementation, careful feeding and constant access to water will be required. Owners and veterinarians will need to work closely together to monitor the cat’s overall health. For overweight cats, diet changes, and an exercise program may be recommended to encourage weight loss.

Once a cat has been examined by the veterinarian and released to home care, owners will likely need to administer insulin shots regularly. Dosage and timing instructions must be carefully adhered to, and treatment should never be stopped without veterinary approval. Insulin requirements change over time, so glucose levels will need to be carefully monitored. If the vet approves, at-home glucose testing may be a viable option. It should be noted that inaccurate results may occur if testing strips are not handled correctly, so extra care will be needed. Owners should carefully observe the cat and contact the vet immediately if there are signs of relapse including weight loss, changes in thirst, appetite, or urination frequency, vomiting, or jaundice.

While there is no cure for diabetes, it is possible that insulin-dependency can be reduced or even eliminated. This is especially likely in circumstances where obesity was the primary cause and significant weight loss has occurred. Even when symptoms do not resolve themselves, they can be managed. With proper treatment and home care affected cats can live a long and healthy life.