Diabetic ketoacidosis (DKA) is a relatively common complication of diabetes mellitus in dogs and cats. In the face of insulin deficiency or resistance, the liver produces ketones to provide an alternative energy source from glucose. However, excessive ketone production can lead to high anion gap metabolic acidosis and other negative effects. Besides restoration of intravascular and interstitial fluid deficits as well as electrolyte derangements such as hypokalemia, insulin administration is necessary to stop production of ketones, reduce lipolysis and enhance cellular uptake of glucose.
Several insulin protocols have been described in veterinary medicine to treat DKA patients during the first 24-72 hours of hospitalization until the patient becomes stable and regains appetite. One of the most commonly utilized protocols in clinical practice is an intravenous variable-rate insulin infusion protocol when a short-acting insulin is infused IV and the rate is altered based on blood glucose concentration (Figure 1).
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