Diabetic ketoacidosis (DKA) in dogs: the signs, why it can't be treated at home, and what happens next

What is diabetic ketoacidosis in dogs?

Diabetic ketoacidosis, usually called DKA, is the most serious emergency in a diabetic dog. It happens when there isn't enough insulin working in his body.

Without insulin, sugar can't get into his cells, so his body starts breaking down fat for fuel instead. That makes acids called ketones, and they build up in his blood. His sugar runs very high, he loses water and salts through all the extra peeing, and his blood turns too acidic.

It's a life-threatening complication of diabetes. It can't be waited out, and it can't be fixed with a missed meal or an extra shot.

It's different from an everyday high. A dog whose sugar runs high but who is bright, eating and himself needs a vet visit to adjust his plan. A dog who is high and sick needs the vet now. High blood sugar in dogs explains the difference.

Signs of DKA in a diabetic dog

The signs often build over a day or a few days, and they usually come together rather than one at a time:

Vomiting, and not wanting to eat. Being very tired, weak, low or not himself. Breathing that is fast, deep or looks like hard work. Breath that smells sweet or fruity, a bit like nail-polish remover. Drinking and peeing even more than usual. Diarrhoea, or getting dried out: signs of dehydration shows what to look for.

If it goes further, a dog can become wobbly, collapse or be hard to rouse. Don't wait for that. Why is my diabetic dog shaking? helps you tell a low, a seizure and a dream apart.

Sometimes DKA is how diabetes is first found. A dog who has been drinking and peeing a lot for weeks, then suddenly gets sick and stops eating, can already be in ketoacidosis when he reaches the vet.

Any of these signs in a dog with diabetes is a reason to call your vet now, day or night. The emergency page has what to tell them, and no emergency vet nearby helps if your clinic is closed.

Can you treat ketoacidosis in dogs at home?

No. There is no safe way to treat ketoacidosis at home, and time spent looking for home remedies is time he may not have.

In hospital, vets correct several things at once: they replace the water he has lost through a drip, give insulin in small, carefully timed amounts, put back salts such as potassium, and check his blood again and again as it all comes back into balance. A home meter can check his sugar, but it can't check his potassium or how acidic his blood is, and it can't replace a drip.

Insulin at home doesn't fix it. If he's vomiting or won't eat, phone your vet before his next shot: don't give an extra one, and don't decide about the usual one on your own. Insulin at the wrong time can drop his sugar or his potassium too fast, and both can be dangerous. If you're not sure whether he had his last shot, don't give another one to be safe: what if we might have given the insulin twice? covers that.

What you can do at home: call your vet, write down when the signs started and when he last ate and had insulin, keep fresh water out, and bring his insulin and your notes with you.

Ketones on a urine strip: what does it mean?

Some owners check their dog's urine with test strips that show sugar and ketones. Ketones on a strip are a warning sign, not a diagnosis: ketones in the urine are not the same thing as ketoacidosis.

A dog can have some ketones and still be bright and eating. That still needs a call to your vet the same day, because it means his diabetes isn't controlled and things can tip quickly. What if a urine strip shows ketones? goes through it.

A dog who is vomiting, not eating or weak needs the vet now, whatever the strip says. A strip that shows no ketones doesn't rule DKA out.

At the clinic, a vet can measure ketones in a drop of blood with a small meter, which can show trouble sooner than a urine strip.

What causes DKA in a diabetic dog?

DKA comes down to not enough insulin working. That can happen for two broad reasons.

Not enough insulin going in. A dog who has diabetes but hasn't been diagnosed yet, missed or skipped doses, insulin that has been damaged by heat or freezing, or a syringe that doesn't match the insulin. Storing insulin and the syringe check help with the last two.

Another illness making insulin work less well. A common trigger is another illness on top of the diabetes: pancreatitis, a urine or other infection, Cushing's disease, or kidney disease. In the largest study of dogs with DKA, most of them had another illness at the same time, and pancreatitis was the most common. Food after pancreatitis, diabetes and Cushing's and diabetes and kidney problems have more.

Some medicines, such as steroids, can push his sugar up too. Always tell any vet who treats him that he's diabetic: medicines and diabetes explains why.

In a female who isn't spayed, her season and a womb infection called pyometra can upset her diabetes too. If she's unwell after a season, tell your vet straight away.

What happens at the vet

Your vet will examine him and test his blood and urine: his sugar, ketones, salts, how acidic his blood is, and how his kidneys and liver are doing. They may also scan his belly or take X-rays to look for whatever set it off, such as pancreatitis or an infection.

Treatment usually means staying in hospital for several days. Your own clinic may send him to a hospital that can watch him overnight. He'll be on a drip to replace water and salts, and he'll get short-acting insulin in small amounts while his blood is checked often. The vet will also treat the illness that triggered it, and help with sickness, pain or appetite if he needs it.

Once he's eating and drinking again and his blood is back in balance, he moves back onto injections at home, on a plan your vet writes for him then.

Do dogs survive diabetic ketoacidosis?

Many do, when it's caught early and treated in hospital. Untreated, it is fatal.

The largest study, from a university animal hospital, followed dogs treated for DKA: 89 of the 121 dogs that were treated (70%) went home from the hospital. That figure comes from one specialist hospital, years ago, and it can't say how your own dog will do.

In that study, the dogs who didn't get home were already worse on their blood tests when they arrived. Calling early gives your vet the most time.

Your vet knows your dog and what set it off, so ask them what they expect for him. How long do diabetic dogs live? looks at the bigger picture.

Coming home after DKA

He comes home on the plan your vet writes that day, often twice-daily insulin with the amount worked out again, even if he has been diabetic for years. Follow that plan exactly, and don't go back to an old amount on your own.

Expect rechecks in the first weeks while his sugar settles, and keep notes of his meals, insulin, drinking, peeing and energy. Home testing, glucose curves and notes for your vet has a simple way to do it, and diabetes check-ups explains what the rechecks are for.

Watch for a low as well as a high while his dose is being adjusted. Low blood sugar in dogs has the signs and what to do.

Some dogs have DKA more than once, especially if the illness behind it comes back. Know the signs, and call early.

How to lower the risk of DKA

Keep his insulin and meals on time, and feed him before the shot unless your vet says otherwise: do I feed my diabetic dog before the insulin? explains why. The Insulin given? fridge card helps the whole family avoid a missed or doubled dose.

Store insulin the way the label says, check the syringe matches the insulin every time, and replace a bottle that has been frozen, overheated or is past its date.

Call your vet now, even at night, if he's vomiting or won't eat, and the same day if he's drinking and peeing more than usual. Diabetic dog vomiting and my diabetic dog won't eat cover those days.

Keep his rechecks, and get infections, sore ears, skin problems and tummy upsets looked at early, because other illnesses are a common trigger. When the day goes wrong has the other urgent problems in one place.