Diabetes - sudden onset or ketoacidotic diabetes

 There are times when diabetes occurs secondary to another problem, particularly immune mediated disorders and other hormonal illnesses. Genetic factors, obesity, some medications such as progesterones and chronic pancreatitis have also been associated with diabetes. Diabetes can be a really insidious disease. The weight loss would be a good hint here. Diabetic dogs do reasonably well until they lose most of their ability to utilize sugar. Once this happens, they burn body fat for energy almost exclusively. Fat accumulates in the liver leading to liver problems. By products of fat metabolism include ketone acids which cause acidification of the blood and severe metabolic problems. This part of the process does happen very rapidly - often within a few days. If the initial signs of diabetes are masked or missed the onset of severe diabetes can seem to be extremely sudden. We have also seen sudden onset of diabetes after severe attacks of acute pancreatitis in our practice and vomiting does occur in this case.

It can be very expensive to treat ketoacidotic diabetes. Even with intensive care there is a possibility of death. I am very reluctant to give up on these patients but sometimes wish that I had after losing one. These dogs are so sick and seem so miserable that I really regret attempting to treat them when they do die. . This is not a situation in which you are making a choice to return a pet to full health. They are still diabetic even if the treatment for the ketoacidosis is successful. In many instances it is not possible for people to care properly for a diabetic dog and that has to be considered in the initial decision to treat or not treat the ketoacidosis. Secondary damage that is already present also has to be considered.