Dogs that don't produce enough insulin because of a pancreatic condition, or whose insulin works poorly, can't utilise carbohydrates properly to provide energy to their cells. The diabetic dog's body operates as if it were starving. The liver begins to convert fat and protein into components that can be used to fuel the cells in the place of glucose converted from carbohydrates.
The process produces a byproduct called ketones. Ketones are often present in trace amounts in healthy animals that are exercising strenuously and require extra energy. But diabetic animals that produce ketones due to a deficiency in insulin can see higher levels. High levels of ketones acidify the blood and can lead to a condition called diabetic ketoacidosis, which can lead to damage, coma and death.
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If your dog is producing excessive ketones, her respiration rate will increase as she tries to shed the acidifying ketones through her breath. This pattern of breathing is called Kussmaul breathing and will likely be deep and rapid.
Diabetic dogs may produce "starvation ketones" if they are not eating and receiving insulin regularly. Dogs who are eating well but seem increasingly hungry, lethargic or confused may be entering ketoacidosis from low insulin levels.
Excess ketones are dangerous in the bloodstream. The body expels them through urine and respiration. Dogs producing ketones will often have a sweet, "fruity" breath. The smell is similar to that of acetone-based nail polish removers. Urine will also have an odour, although a dog with high blood sugar is also expelling sugar in the urine and that may mask the ketone smell.
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