A guide to monitoring feline patients on SGLT2 inhibitors

Monitoring feline patients with diabetes on SGLT2 inhibitors requires a different approach than monitoring those on insulin. Ellen Behrend, VMD, PhD, MS, DACVIM (SAIM), a consultant at Veterinary Information Network, outlines what to monitor in feline patients on SGLT2 inhibitors, including when each parameter should be checked.

She also discusses a distinct form of diabetic ketoacidosis (DKA) seen in patients on SGLT2 inhibitors: euglycemic DKA. In the video, Behrend stresses that when treating this form of DKA, veterinarians must begin with administering insulin, even when blood glucose levels are low.

Below is a partial transcript:

Ellen Behrend, VMD, PhD, MS, DACVIM (SAIM): Monitoring is going to be somewhat different for SGLT2 inhibitors versus insulin. The SGLT2 inhibitors, if you compare the cost of an SGLT2 inhibitor to insulin directly, the SGLT2 inhibitors tend to be a little bit more expensive.

It does, of course, depend on the kind of insulin you're using because those costs vary hugely. Where the clients are going to save money is in the monitoring, and they're going to save a huge amount of money. If a client's never had a diabetic cat before, they might not know how good they have it with an SGLT2 inhibitor, but that's where the big difference is.

So, I recommend checking them at day...3, you're only checking for ketones. I prefer that you check beta hydroxybutyrate in blood, but if that's not possible, you can also check urine.

The only recommended in-house meter right now for checking ketones is the precision Xtra, spelled Xtra, and that's the only one that's been validated for cats. You can pick it up on Amazon. I checked the price last week, it was $35 to $40, it's just like a handheld glucometer that we're all used to using, this just measures ketones instead. So this is not a big piece of equipment that you're investing in...