Relatively healthy dogs with DKA can be treated with potent but regular short-acting crystalline insulin injections to help get the serum glucose levels back under control. It may take a few days for serum glucose and urine ketone levels to fall, but aggressive treatment may not be needed as long as the dog's condition is basically stable.
Treatment of sick diabetic dogs needs to be more aggressive. Paramount to the treatment of DKA is the gradual replacement of fluid deficits, as well as the maintenance of normal fluid balance. Many dogs will seem substantially better after being treated by intravenous fluids alone. Phosphate supplementation may also be needed, since serum phosphorus concentrations can drop to dangerously low levels during the treatment of DKA leading to serious complications such as a red blood cell breakdown that results in anemia. Bicarbonate is given to help correct acid-base disturbances. Insulin also is vital in the treatment of DKA. In some situations, fluids need to be replaced quickly, while the glucose levels will need gradual adjustment.
Until safer serum glucose concentrations are obtained, most dogs with DKA are treated first with regular crystalline insulin, the most potent and shortest acting form of insulin, which may be given intravenously or on an hourly basis in the muscle. If the dog is not eating on its own, dextrose may be added to the fluids to keep the serum glucose level from dropping too low after insulin is started.
Concurrent illnesses must be identified and treated specifically where possible. Pancreatitis is extremely common in DKA, but there is no specific treatment for this disorder. Bacterial infections need to be identified and treated in a timely manner. Antibiotics usually are given even if a bacterial infection has not been confirmed, due to the problems that infections cause in DKA. Acute kidney failure may also accompany DKA, and needs to be treated aggressively with fluids. Drugs may be needed to stimulate urine production if it appears inadequate.
Complications during treatment of DKA that occur most frequently include the development of hypoglycemia, central nervous system signs, electrolyte abnormalities, and anemia. The best way to prevent these side effects is to aim for gradual correction of the multiple abnormalities associated with DKA. Excessively rapid correction of glucose concentrations and electrolyte abnormalities often leads to brain cell swelling and neurological signs. Electrolyte concentrations need to be monitored very carefully during the treatment of DKA, as frequent adjustments of fluid type and rate, and the amount of potassium supplementation, are often needed. Also, close attention must be paid to the serum phosphorus concentration, as supplementation with phosphorus is often needed to prevent the development of severely low serum phosphorus concentrations and the anemia that can result from this.
Once the dog is stabilized and eating and drinking on its own, longer-acting insulin types can be initiated. In addition, the supportive measures, such as fluid therapy and medications, can be tapered, as long as no other complicating issues surface and improvement continues. Eventually, the animal should be able to go home with an insulin regime designed for at home use, as well as any other treatments necessary to address additional disorders that might be present.
