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Diabetes Mellitus and Diabetic Ketoacidosis (DKA) in Cats

  • June 30, 2015 12:17 PM EDT
    Diabetes melliitus (DM) is a condition commonly seen in the small animal patient. Although the disease can affect both cats and dogs, there are species-specific differences for certain known risk factors and for how the disease manifests. Some of these differences include:
     
    • Obesity is an important risk factor for DM in cats (but not for dogs)
    • Cats can experience diabetic remission, however this is uncommonly seen in dogs
    • Other endocrine disorders are often associated with the development of DM in cats (hyperadrenocorticism, hypersomatotropism)
    • Diabetic cataracts commonly develop in dogs but not in cats with DM
    • Neuropathy associated with diabetes is more commonly seen in cats than in dogs
       
    Both species can develop a severe form of diabetes mellitus - diabetic ketoacidosis (DKA) - in which there is an excessive accumulation of ketones in circulation. Ketones are derived from free fatty acids that are normally released from adipose tissue. These free fatty acids are taken up by the liver and can then be utilized in one of three ways. They can be metabolized by the liver, incorporated into triglycerides, or they can undergo oxidation which leads to their conversion into ketones. Normally, ketones are then utilized by tissues as an energy source in a period of glucose deprivation. However, in the patient with uncontrolled diabetes mellitus (a physiologic state of starvation), there is an excess production of ketone bodies which results in the development of ketosis and acidosis.

    Patients with DKA require emergent care to stabilize the life-threatening metabolic derangement which can be characterized by metabolic acidosis, severe electrolyte imbalances (hyponatremia, hypokalemia, hypochloremia), and the presence of ketonemia or ketonuria.

    Although there are previous reports describing the typical presentation and clinicopathologic findings in cats with DKA, the study populations have been small and have had other confounding factors limiting their conclusions and specific applications. Until recently, little has been known about the specific risk factors for the development of diabetic ketoacidosis in cats with diabetes mellitus and the predictors for outcome in affected patients. 

    In this week's Evidence Based Update - available for on demand viewing (running time 15 mins; Approved for CE credit in New York and by the NJVMA, pending approval for CE credit by AAVSB RACE) we learn:

    • Criteria for diagnosing DKA
    • Common signalment of cats with DKA
    • Cat breeds at a higher risk for developing diabetes mellitus and DKA
    • Common presenting signs of illness
    • Clinicopathologic findings and those associated with a poorer prognosis
    • Insulin regimens and influence on patient oucome
    • Prognosis for cats with DKA

    View this Evidence Based Update - paid registrations include a package of 3 textbook chapters published in 2015: 

    1) Feline Diabetes Mellitus - Canine and Feline Endocrinology (Fourth ed), 2015, Chap 7, pp 258-314. Author: Claudia E. Reusch

    2) Diabetic Ketoacidosis - Canine and Feline Endocrinology (Fourth ed), 2015, Chap 8, pp 315-347. Author: Richard W. Nelson

    3) Diabetic Ketoacidosis - Small Animal Critical Care Medicine (Second ed), 2015, Chap 64, pp 343-346. Author: Rebecka S. Hess

    • 342 posts
    June 30, 2015 6:26 PM EDT

    In our CE archives, Dr. Michael Schaer presented "Internal Medicine Case Rounds - Diabetes Mellitus" - available for On Demand viewing. View the entire Diabetes Rounds presentation for CE credit or have a look at this particular case (running time 18 mins):

     

    Trouble viewing this video? Click here

     

     

    Related: Correction Formula for Point-of-Care Glucometer Values in Dogs

     

  • July 9, 2015 9:35 AM EDT
  • August 4, 2015 8:37 AM EDT

    Here is an excerpt from our recent Evidence Based Update Roundtable Discussion on the topic of DKA in cats. Melissa Holahan, DVM, DACVECC summarizes the findings reported in this recent publication.