SGLT2 inhibitor misconceptions: Addressing diabetic ketoacidosis and cost concerns in feline diabetes

Concerns about diabetic ketoacidosis (DKA), ketone monitoring, and cost can influence how veterinarians approach SGLT2 inhibitors in feline diabetes management, but the monitoring requirements and overall cost of care associated with these medications may differ from what some veterinarians expect. In an interview with dvm360 during the 2026 AVMA Convention in Anaheim, California, Ellen Behrend, VMD, PhD, MS, DACVIM (SAIM), discussed common misconceptions surrounding the use of these medications ahead of her July 11 session, “Sunrise Session: Improving patient outcomes and owner compliance in the changed landscape of feline diabetes mellitus - Part 1.” In this video, Behrend discusses misconceptions about blood ketone monitoring, the importance of considering the clinical picture when assessing patients, and how reduced monitoring requirements, including fewer glucose curves in many cases, may help lower overall costs for owners.

Below is the transcript, which has been lightly edited for clarity.

Ellen Behrend, VMD, PhD, MS, DACVIM (SAIM): One big misconception is about the fear of diabetic ketoacidosis, and blood ketones [having] to be monitored very carefully multiple times while the cat is on the drug. The licensing studies for Senvelgo in both Great Britain and the United States were done with urine monitoring only, not blood monitoring.

So, you don't have to do blood monitoring of ketones in order to use these drugs. And again, it's the clinical picture that really matters, so I think people need to focus less on DKA and be less afraid of using SGLT2 inhibitors.

The other thing is that I think a lot of people don't use these drugs because of the cost, and the cost of the drug itself compared to insulin is more expensive. However, there is so much less monitoring that you need to do with these drugs that that is where the clients are going to save money and they're going to save a lot of money. I don't do all the monitoring that is recommended on the label. I think you don't have to do that and still use these drugs very safely. We don't have to do glucose curves, unless it's an unusual situation, but that just makes use of these drugs so much easier and so much cheaper for the owners.