What diet should cats receive with SGLT2 inhibitors? An expert weighs in

Diet recommendations for cats receiving sodium-glucose transport 2 (SGLT2) inhibitors remain an area of ongoing discussion among veterinary professionals. In this video interview from the 2026 AVMA Convention in Anaheim, California, Ellen Behrend, VMD, PhD, MS, DACVIM (SAIM), discusses what is known about dietary considerations with SGLT2 inhibitors, why recommendations from human medicine may not directly translate to cats, and why timing diet changes after starting therapy may help avoid confusion when monitoring for adverse effects.

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

Ellen Behrend, VMD, PhD, MS, DACVIM (SAIM): At this point, we don't know what diets to recommend with the use of an SGLT2 inhibitor. In people, use of a high-fat, high-protein diet with an SGLT2 inhibitor actually increases the chance of diabetic ketoacidosis (DKA). I still recommend, and I think a lot of people still recommend, what we consider the typical cat diabetic diet with high fat and high protein in combination with an SGLT2 inhibitor. Cats are not small people. Cats handle carbohydrates totally differently than people do, and those diets are so beneficial for cats that are diabetic that I'm still recommending their use in combination with an SGLT2 inhibitor until someone proves that it's not a good idea. I do recommend not changing the diet until about 2 weeks after starting the SGLT2 inhibitor, because SGLT2 inhibitors can cause vomiting and diarrhea without going into DKA. Vomiting and diarrhea are adverse effects of the drug. Changing a diet can cause vomiting and diarrhea, so that complicates the picture, and I don't want to do the 2 together. I recommend the SGLT2 inhibitor first, and then once the cat is stable on the drug after a couple of weeks or so, then try a diet change.