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9 Warning Signs of Diabetic Ketoacidosis in Dogs

Did you know that dogs with diabetes are at risk of diabetic ketoacidosis? We would all be happier dog owners if they could just tell us what’s wrong. Since that isn’t about to happen, the best defence we have is informational articles, posts, and the invaluable advice of our veterinarians.

It’s important to understand just how serious diabetic ketoacidosis is. Your veterinarian should always be your first source of information and guidance.

Diabetic ketoacidosis in dogs occurs when there isn’t enough insulin to control glucose (sugar) levels in the body.

If your dog has been drinking and peeing more often, has fruity-smelling breath, and appears to be panting more often and more heavily, he/she may be experiencing a medical emergency.

Your dog could be experiencing ketoacidosis if he/she has diabetes mellitus. In some cases, underlying conditions (in addition to having diabetes) can trigger a stress response that activates ketoacidosis.

Unfortunately, you might not be aware of underlying disease until your dog shows serious signs of low insulin levels. This post will guide you through the 9 warnings signs of diabetic ketoacidosis in dogs. In addition, you’ll learn why it happens and how to catch it before it becomes severe.

Diabetic ketoacidosis can occur in dogs who were otherwise thought to be healthy.
Heavy panting, frequent urination, weakness, fatigue, and vomiting are signs of ketoacidosis.

What is Diabetic Ketoacidosis?

Ketoacidosis is, essentially, a complication of diabetes mellitus. Dogs, like people, can become either insulin dependent (Type 1) or insulin resistant (Type 2). In either case, lack of insulin in the body prevents the muscles and organs from being able to convert glucose into energy.

Without a job to do, glucose continues to build in the dog’s bloodstream. The glucose has to go somewhere, so it is eventually excreted through the urine. The buildup of glucose in the bloodstream creates a domino effect that looks like this:

  • Low glucose levels in the body mean that the brain isn’t getting the signal that the body has been fed.
  • The dog becomes super-hungry as a result.
  • Glucose disrupts the urine concentration which then leads to excessive urination.
  • The more your dog drinks, the more he/she pees.
  • Dehydration occurs.

As you can see, a vicious cycle begins whereby your dog’s body is eating and drinking as much as it can without any good result. The glucose in the blood totally disrupts the normal balance of electrolytes and this imbalances creates a harmful, acidic environment.

The body realizes it’s not drawing enough energy from the usual source and begins searching for another source. That secondary source of energy is drawn from the liver which converts fat into a hormone known as ketones.

Unfortunately, ketones are made up of an acidic chemical composition that throws everything off. An adequate release of insulin within the body would be able to restore the chemical balance. Diabetic dogs, however, either cannot produce enough insulin or are insulin resistant.

Ketoacidosis in dogs can be hard to manage
Is your dog diabetic?

Why Did My Dog Develop Diabetic Ketoacidosis?

Maintaining healthy insulin levels in a diabetic dog is tricky business. Unfortunately, even the best attempts can be offset by underlying conditions and other health problems. The problem is, you probably never knew there were any underlying health problems.

Diabetes is an insidious disease that can bring on a host of other problems including the following:

  • Heart disease
  • Nerve damage
  • Kidney damage
  • Diseases of the eye
  • Skin conditions
  • and more

So while you’re busy trying to maintain your dog’s insulin levels and keep him/her healthy, any of the problems above could be developing beneath the surface.

Suddenly, your dog’s body is trying to accommodate health problems it wasn’t ready for. This fight or flight response can lead to the release of stress hormones.

Stress Hormones That Can Trigger Diabetic Ketoacidosis in Dogs


A sudden surge of adrenaline is harmless to healthy dogs. Unfortunately, it raises the amount of glucose (sugar) in the blood. That sudden spike in sugar totally throws off the impact of insulin therapy.


Cortisol has a number of uses in the body including a sudden concentration of glucose, fatty acids and amino acids. Combine a shot of cortisol with adrenaline in a diabetic dog and you’ve got a dangerous chemical cocktail.


You may not have heard of this one before. This particular stress hormone has a number of functions, but the one most dangerous in dogs with diabetes is the alteration of water balance. People and dogs with diabetes require more water, not less.

Less water balance leads to increased glucose levels. This is where that vicious cycle mentioned earlier begins.


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The 9 Warning Signs of Diabetic Ketoacidosis in Dogs

If your dog already has diabetes, you’re probably well informed about treatment. Regular sugar testing, proper diet, and insulin are all vital in the management of this disease.

Consider yourself one of the lucky dog owners. Why? Regularly checked sugar levels mean that you will probably spot a problem before it becomes severe.

If you’re carefully monitoring your dog’s disease, you’ll know that something isn’t right when the sugar levels are consistently off. However, if you’re not aware that your dog is (or has) developed diabetes, the following warning signs are important to understand.

1. Excessive Thirst

Dogs get thirsty, especially on hot days or after intense exercise/play. Excessive thirst in dogs with ketoacidosis is much more pronounced.

2. Frequent Urination

Depending on your lifestyle, your dog may have a usual routine of going out to pee.

There are certain times of the day (during walk, first thing in the morning, and just before bed for example) that you can expect your dog to pee. If your dog is suddenly crying in the night to go out or frequently at the door for yet another pee, he/she could be experiencing signs of ketoacidosis.


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3. Nausea and Vomiting

It’s hard to tell when a dog is nauseated until he/she actually vomits.

Dogs do vomit from time to time and it’s not usually a cause for concern if it’s an occasional thing or you can pinpoint the problem (swallowing too much grass or eating too quickly, for example).

If your dog suddenly appears weak, is extremely thirsty, AND begins throwing up, it’s your cue that a veterinarian visit is urgent.

4. Abdominal Pain

Dogs have an uncanny ability to hide pain.

You may not notice this one unless your dog actually winces when touched, avoids being touched, whimpers, trembles, or hides.

5. Weakness

You know your dog better than anybody.

Signs of weakness could include things like exercise intolerance or a sudden disinterest in normal kinds of play (fetching a ball, for example).

6. Fatigue

This one is pretty self-explanatory. It might not even be immediately obvious until you realize your dog isn’t asking to go for walks anymore and not dropping a ball at your feet.

Fatigue and weakness tend to go hand in hand.

7. Rapid Breathing (heavy and quick panting)

Dogs pant, especially when excited, stressed, too hot, or after exercise. If that panting continues longer than it should, happens randomly without any cause, or seems quicker than a normal pant, it could be cause for concern.

8. Fruity-Smelling Breath

This phenomenon is caused by the production of ketones in the body.

Ketosis occurs when the liver begins converting fat into energy. This process involves the release of ketones and acetone from the liver.

What you’re actually smelling is acetone being released from the body.

9. Confusion

Your dog might actually be pretty good at covering up confusion. It might not be apparent right away or it may happen suddenly in such a way that it’s obvious.

Dogs experiencing confusion may have trouble finding their dish of food or suddenly can’t find the right door to go outside. He/she may react oddly to familiar people in the home.

A confused dog may suddenly not respond to common commands. In senior dogs, this can be a sign of cognitive dysfunction.

More Resources for Pet Parents

And also: Diabetes Insipidus in Dogs – 5 Critical Signs of Dehydration

The Cost of Treating Ketoacidosis in Dogs

Without pet insurance, costs can be high.

The majority of the expense comes from an extended hospital stay, blood tests (or other ordered tests), medication, follow-up visits, etc.

In severe cases, costs can range anywhere from $3000 to $5000 or more.

Immediate treatment, however, can be a matter of life or death. If the expense is a concern, discuss payment options with the veterinarian.

Let’s face it, many people don’t have that kind of money lying around.

Planning for dog health emergencies isn’t always a top priority when you have to pay the bills and put food on the table.

If you suddenly find yourself in a position of needing to treat your dog immediately, you won’t have time to discuss payment options. You’ll just want your dog treated.

In addition to the suggestions below, please check out Vet Bills: Should You Get a Personal Loan by Personal Loans, org. You will find useful advice and detailed help on how to afford the costs of pet care.

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This is an online payment plan that isn’t a credit card or line of credit. You don’t have to worry about your credit score to apply.

The only catch is that your veterinarian has to be registered with the company in order for you to apply.

The way this works is that Scratchpay pays the veterinarian up front and you, in turn, pay back the company.

It’s a little like CareCredit in that you won’t incur interest costs if you can pay the balance within a certain period of time.

Pet Insurance

Pet insurance is an obvious one and, unfortunately, you need to have this long before your pet becomes ill.

There are several pet insurance plans available and it’s important to shop around for the best option.

When looking for pet insurance plans, be sure to read the full list of what the insurance will cover and compare the monthly fees.

The Ultimate Reality of Ketoacidosis in Dogs

This is a serious, life-threatening condition if not treated.

If you are already managing diabetes in your dog, the signs and symptoms might become obvious to you faster than someone not in the know.

Having a sound understanding of the signs and symptoms of diabetic ketoacidosis is key.

The most important thing in the moment will be treating dehydration and getting your dog’s sugar levels back in balance. After your dog is stable, the veterinarian should be looking for the cause.

Treating the underlying condition will be vital to preventing the episode from happening again. Unfortunately, some dogs do experience ketoacidosis again. Talk to your veterinarian about that possibility.


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