My dog is diabetic. He has been doing pretty well overall, but recently he became really ill. He stopped eating well, started drinking a lot of water, and got really weak. His veterinarian said that he had a condition called ketoacidosis, and he had to spend several days in the hospital. What is ketoacidosis?
Diabetic ketoacidosis is a medical emergency that occurs when there is not enough insulin in the body to control blood sugar (glucose) levels. Insulin may also be prevented from working normally due to other hormones released as a result of certain diseases. The body cannot use glucose properly without insulin, so blood glucose levels get very high, and the body creates ketone bodies from fat as an emergency fuel source. While fine in an emergency, if glucose regulation is not restored, ketone levels increase resulting in a shift in the body's acid/base balance. The body becomes more acidic (acidosis), and it can't maintain appropriate fluid balance. The electrolyte (mineral) balance becomes disrupted which can lead to abnormal heart rhythms and abnormal muscle function. If left untreated, diabetic ketoacidosis is fatal.
How could this disorder have happened?
If a diabetic dog undergoes a stress event of some kind, the body secretes stress hormones that interfere with appropriate insulin activity. Examples of stress events that can lead to diabetic ketoacidosis include infection, inflammation, and heart disease.
What are the signs of diabetic ketoacidosis?
The signs of diabetic ketoacidosis include:
- excessive thirst/drinking
- increased urination
- lethargy
- weakness
- vomiting
- increased respiratory rate
- decreased appetite
- weight loss (unplanned) with muscle wasting
- dehydration
- unkempt haircoat
These same signs can occur with other medical conditions, so it is important for your veterinarian to perform appropriate diagnostic tests to determine if diabetic ketoacidosis is truly the issue at hand.
What treatments would my dog have received while he was in the hospital?
Generally, dogs diagnosed with ketoacidosis (if they are sick with symptoms) are hospitalized and placed on intravenous fluid therapy to reverse dehydration and ensure adequate fluids in the tissues. Short-acting insulin is given to bring the blood sugar level down quickly. Many patients with diabetic ketoacidosis also have very low levels of potassium, so potassium supplementation is provided.
Blood sugar levels, electrolyte levels, and the acid-base balance are measured frequently in hospitalized patients with diabetic ketoacidosis during treatment.
Are there any problems that can occur secondary to diabetic ketoacidosis?
Unfortunately, there are several potentially serious conditions that can occur in conjunction with, or secondary to, diabetic ketoacidosis including:
- persistently low potassium levels
- low blood sugar
- low phosphorus levels
- brain swelling
- fluid in the lungs
- heart failure
- kidney failure
These potentially life-threatening complications help to explain why hospitalization and aggressive treatment are so important.
How do I prevent diabetic ketoacidosis from happening again?
Diabetic ketoacidosis is life-threatening, so preventing it is important. The most important step in prevention is ensuring proper insulin dosing. The importance of home-monitoring of blood glucose levels cannot be overemphasized. If you are not yet performing home blood glucose monitoring, your veterinary healthcare team can help get you started. The necessary blood sample is tiny - just a tiny drop of blood - and the tiny needle that is used will not hurt your dog. Most dogs barely notice the pin-prick.
Your veterinarian will guide you on how often to take readings, when to report the results to the practice, and will explain how the 
"The importance of home-monitoring of blood glucose levels cannot be overemphasized."
If you are already doing home monitoring of your dog's blood glucose levels, your veterinarian will guide you as to how often to check glucose levels once your dog returns home. The key to preventing a recurrence of diabetic ketoacidosis is to be very aware of your dog's glucose levels both throughout the day, as well as the pattern of his blood glucose levels over the span of several days to several weeks. As you report the glucose levels, your veterinarian will be able to help you fine- tune your dog's insulin doses and set the stage to prevent this crisis from recurring.
