What do I need to know about using Senvelgo® & ketoacidosis?
Senvelgo® manages diabetes in a different way to insulin treatment: by causing urinary excretion of excess glucose to reduce hyperglycaemia. This reduces glucose toxicity, improving endogenous insulin production whilst also increasing peripheral insulin sensitivity.
It is important to remember, however, that not all diabetic cats are able to produce enough endogenous insulin to prevent catabolic processes and suppress ketogenesis (especially in the early stages of treatment). A small proportion of diabetic cats are therefore at risk of developing ketoacidosis despite treatment with Senvelgo® since they are not receiving exogenous insulin. If a cat does develop DKA they will usually present with eDKA (euglycaemic diabetic ketoacidosis), and therefore have normal glucose levels.
This is why it is important to monitor for ketones, especially in the first two weeks of treatment before glucose toxicity is controlled and endogenous insulin secretion and sensitivity increases. By monitoring regularly the goal is to identify these cats at the ketotic stage, before they become unwell.
What is euglycaemic ketoacidosis (eDKA)?
All diabetic cats can be prone to ketogenesis, ketosis, and ultimately ketoacidosis, both before and during treatment irrespective of treatment type. Monitoring for ketone production, by checking for ketone bodies in the urine or blood prior to use, is always important, but especially for cats on SGLT-2 inhibitors. They can also develop a specific condition called euglycaemic ketoacidosis (eDKA). It is therefore important to understand these conditions, why they happen, and what to do about them.
Understanding ketosis, DKA and eDKA:
Ketosis
Ketosis refers to the presence of circulating ketones, but not at a level to cause metabolic acidosis. Most ketotic cats appear healthy, are eating and not sick, but require treatment for their diabetes before they become ketoacidotic.
The presence of ketones in the urine is called ketonuria, while ketones in the blood are called ketonaemia.
Diabetic ketoacidosis (DKA)
Diabetic ketoacidosis (DKA) is a serious metabolic disorder which is normally characterised by marked hyperglycaemia, circulating ketones, metabolic acidosis and clinical signs such as dehydration, lethargy, anorexia, vomiting and weight loss. It is usually associated with untreated diabetes and/or concurrent disease in a treated diabetic. It is an emergency condition requiring urgent treatment with soluble insulin, intravenous fluids and dextrose supplementation.
Euglycaemic diabetic ketoacidosis (eDKA)
Euglycaemic diabetic ketoacidosis (eDKA) is a form of DKA which can be seen with SGLT-2 inhibition, with blood glucose controlled despite insulin deficiency. Cats with eDKA show typical signs of DKA but with blood glucose <14 mmol/l. They still, however, need to be treated in the same way as a standard DKA cat (including administration of soluble insulin) despite normal glucose levels.
If ketonuria is detected or if the cat becomes unwell at any time, then Senvelgo® treatment should be suspended, the cause of ketosis/DKA/eDKA investigated and managed, and standard treatment protocols followed.
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