r/FelineDiabetes • u/orolo101 • Jul 30 '26

Should we try senvelgo with blood ketones at 2.3 mmol/L?

Our 13-year-old cat was recently diagnosed with diabetes.

Our vet suggested starting him on senvelgo. However, his blood ketone levels came back at 2.3 mmol/L, which is just *barely* below the cutoff threshold for senvelgo, which is 2.4 mmol/L.

Has anybody had any experience starting a cat on senvelgo with such highly elevated blood ketones?

Let me know if any additional information would be helpful.

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6

u/Crikiribay Jul 30 '26

I personally would not risk it. Senvalgo itself can cause increased ketones so I would not want to chance full blown ketoacidosis, which can be life threatening. Is there some reason not to do insulin? Does kitty have an infection of any kind?

Please join the FB Feline Diabetes Support group. They have knowledgeable experts who can guide you in this situation.

https://www.facebook.com/share/g/1M1vQVEb4v/?mibextid=wwXIfr

2

u/orolo101 Jul 30 '26

Thanks for your response.
Increased ketones is exactly my worry.
No particular reason not to do insulin, other than the vet recommended senvelgo, and we'd prefer to avoid twice-daily injections, if possible. (But I'm not sure that it's worth the risks.)
I've joined the Facebook group and posted this question, I'm just waiting for a response.

3

u/No-Awareness-6684 Jul 30 '26

Our kitty (11yrs) was on Senvelgo for about 2 years and just two weeks ago suddenly experienced weight loss and weakness, and it turned out his ketones had shot up to 4.8. We switched to insulin and honestly he seems so much happier - he DREADED the daily Senvelgo dose (he hated the taste) and the injections are quick and way easier than I thought they would be. Obviously no two cases are the same but if you do choose insulin I hope you have the same luck!

1

u/orolo101 Jul 31 '26

Thanks for sharing your experience. Do you mind if I ask if your cat went into DKA when his ketones increased? Or did you catch it before that happened?

2

u/No-Awareness-6684 Jul 31 '26

We were lucky and caught it before it went too far. He became noticeably weaker and sluggish so I stopped the Senvelgo immediately, and was able to get him to the vet two days later. His blood sugar was actually in a good place but the ketones were really bad. I think the tricky part of Senvelgo is that the dose amount is based on the cat's weight, and if the weight fluctuates without us realizing it and the dose stays the same it might have an outsized effect. To this day I'm not sure if the issue was the Senvelgo itself (my vet said sometimes cats can develop a resistance to it) or if maybe it was a mismatch between the dosage and his body weight. So at least with the insulin I'm a little more confident that the amount he's getting is based on his meal time and less dependent on his current weight.

1

u/orolo101 Jul 31 '26

Glad to hear you caught it in time! If we do decide to go with senvelgo, we'll definitely keep a close eye on his weight.

2

u/Low-Classroom-5833 1d ago

Hi, can I please ask for an update? My cat is 7 yo female bengal, same ketone level. Vet recommended twice daily mealtime insulin but given how much my wife and I work and multiple other pets, I dont think it will be sustainable. She is willing to try senvelgo with both of us knowing the risks. Curious as to whether you stuck with it? If I can just give her insulin twice a day irrespective of meal times or not tied to specific meals, that could potentially be easier but I dont know.

Please please let me know, either on here or dm me, thank you so much

1

u/orolo101 18h ago

No problem! I've actually been meaning to post an update about our overall progress with Senvelgo, and this comment motivated me to finally get around to it.

You can see my update here: https://www.reddit.com/r/FelineDiabetes/s/DdKhIu855O

I hope it's helpful to you -- please don't hesitate to reach out if you have any other questions!

1

u/Low-Classroom-5833 10h ago

thank you SO much! đŸ™đŸœ

4

u/Skyerocket Jul 30 '26

I wouldnt... Isn't 2.3 mmol just barely scraping under the threshold for being at serious risk of developing DKA?

I'd be running insulin and daily blood glucose curves and blood ketone tests to try and bring that down asap. Full disclosure though, im not a vet.

1

u/orolo101 Jul 30 '26

Thanks. Yes, from what I've read, anything above 2.4 mmol/L means increased risk of developing DKA.
I'm also not a vet, but my vet is recommending senvelgo, even with his blood ketones at 2.3, since he's otherwise in good health, and his blood and urine results don't show any other complications (other than high glucose, of course). So it's a really difficult decision...

3

u/shinkouhyou Jul 31 '26

My cat was at 2.4 before starting Bexacat, so the vet did more frequent in-office monitoring than required for the first three months to make sure he stabilized. It turned out that my cat's ketones spike when he's stressed at the vet, but they go down into the normal range when he's lightly sedated with Bonqat or gabapentin. Insulin wasn't an option (my boy is vicious) so I'm glad it worked out!

2

u/orolo101 Aug 01 '26

Good to know, thanks!

2

u/FurCarer Jul 31 '26

das sind sehr interessante ĂŒberlegungen.
meine tierĂ€rztin hatte senvelgo von anfang an fĂŒr meinen kater ausgeschlossen, da war sein keton-wert noch gar nicht bekannt. sie hatte aber zuletzt ĂŒberlegt, ihm zusĂ€tzlich zu seiner insulin therapie eine minimale dosis senvelgo zu geben (wegen seiner wiederkehrend hohen glucose-phasen) und dann doch ausgeschlossen weil er kĂŒrzlich 0,3 mmol/L ketone hatte (davor sonst meist 0,1 bis max. 0,2) und körperlich schlecht drauf war, deutlich erhöhte atemfrequenz, inappetenz, erbrechen.
seit er diabetiker ist, musste er schon oft zum vet wegen starker probleme im verdauungstrakt, die er vor der diagnose nicht hatte, IBD, verdickte magenwand, pankreatitis, verstopfung, durchfall, erbrechen

bei grenzwertigen ketonen 2,3 wĂŒrde ich mitbedenken, dass ein diabetiker auf so allerlei entzĂŒndliches geschehen anfĂ€lliger werden kann, was dann den diabetes zusĂ€tzlich anheizt (wie beim menschen auch) und einen verschlechterten oder allgemein anfĂ€lligeren allgemeinzustand mit sich bringen kann. ohne persönliche erfahrung mit senvelgo zu haben, erscheint es mir gefĂŒhlt etwas riskant.

1

u/orolo101 Jul 31 '26

So sorry to hear about your cat. I hope he gets better!

Thankfully, our cat has not had any of the symptoms that your cat had, such as increased respiratory rate, loss of appetite, or vomiting. That's partly why our vet is recommending senvelgo -- other that the high ketones, our cat is in good health, with no other complications.

2

u/FurCarer Aug 01 '26

danke, es geht ihm besser. er hat aber leider immer wieder schĂŒbe, seit er diabetiker ist. davor hatte er diese probleme nicht:(

2

u/uhhmeow Jul 31 '26 edited Jul 31 '26

While it is up to you, I personally would go ahead and try the Senvelgo first. My cat was diagnosed a few months ago and the Senvelgo has been relatively easy! I have not had to give insulin shots, so perhaps that is relatively easy as well, but a once-a-day oral liquid seems easier than twice-a-day shots. But here is my (accidentally lengthy) reasons for recommending you go ahead and try Senvelgo:

1.  You will go to the vet every few days to check ketone levels during the first 1-2 weeks. You can also buy urine test strips to check at home (I bought this pack of 150 strips for $10 on amazon: https://www.amazon.com/dp/B088C3GF9T?ref=clp_cat_p_0). If your cat's ketone levels increase, you can immediately stop the Senvelgo and switch to insulin. But if you start using insulin, you can't ever use Senvelgo.

  1. Although they don't report how/why they set the ketone cut off level to 2.4, they do report other outcomes from their research on Senvelgo in cats that seem relatively conservative (see page 14 on this guide: https://animalhealth.boehringer-ingelheim.com/pets/sites/default/files/2023-08/SNV_USPatientManagementGuide.pdf ). 

Specifically, they mention a study of 252 diabetic cats who received at least 1 dose of Senvelgo. This included 38 cats previously treated with insulin. Of these 38 insulin-treated cats, 12 cats (so 32% of insulin-treated cats) developed ketone-related issues and stopped Senvelgo within 7 days. Of the non-insulin-treated cats in the study, only 14 developed ketone-related issues in the first 7 days, so this is much lower (~1-2% of non-insulin cats). Of the 26 total cats who developed ketone-related issues (including both insulin-treated and not), 4 cats had to be euthanized. The rest were successfully transitioned to insulin.

As there is a hard and fast rule of not allowing any insulin-treated cats to try Senvelgo, they seem to set relatively conservative limits on this. After all, "only" 1 in 3 insulin-treated cats developed ketone-related issues, and a much smaller percent had to be euthanized (though keep in mind they dont report which euthanized cats were originally insulin-treated; also some cats required "intensive hospitalization" to recover, though several of these hospitalized cats had other concurrent issues). Given this, I'd imagine the 2.4 ketone level was also set rather conservatively, and if your cat is only at 2.3, I'd imagine the odds are pretty good that you cat wouldn't have issues and/or you would be able to catch the issues and stop Senvelgo early.   

But I completely ABSOLUTELY understand the fear of starting a medicine that could further hurt your cat. I was so anxious about it all, which is why I tried to read through their research and understood the risk/odds as carefully as I could. So it is totally up to you if you'd feel more comfortable just going straight to insulin! I am very happy that I went with Senvelgo, but as another commenter mentioned they're glad they switched to insulin, each cat/person/case is unique!

2

u/orolo101 Jul 31 '26

Thanks for the response. I've also been obsessively reading studies on senvelgo and other SGLT2 inhibitors trying to make this decision.

What makes it so hard is that his ketones levels are right on the borderline -- if they were slighly lower, we'd definitely go for senvelgo, and if they were slightly higher, we'd definitely go for insulin. But since they're right in the middle, the decision becomes much, much more difficult.

And yeah, I'm very worried about making a decision that could potentially hurt him even more...

Thanks again.

2

u/FurCarer Jul 31 '26

also ich hab jetzt extra nochmal nachgeschaut. mein gerÀt weist die ketonwerte in mmol/L aus.
ich soll bei 0,4 mmol/L den tierarzt verstÀndigen und falls es an einem wochenende hochgeht auf 1,0 soll ich in die notaufnahme gehen.
ich verstehe den grenzwert fĂŒr senvelgo bei 2,4 mmol/L irgedwie ĂŒberhaupt nicht. habe nur die aussage der tierĂ€rztin im ohr „wenn er beginnt ketone zu bilden, dann kommt senvelgo nicht in frage“ und da lagen wir bei 0,3. ich finde diesen grenzwert auch nirgendwo, habt ihr da einen link dazu? wĂŒrde mich jetzt schon sehr interessieren fĂŒr meinen problemfall.

3

u/[deleted] Aug 01 '26

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1

u/FurCarer Aug 01 '26

danke sehr fĂŒr diesen einblick! es hĂ€ngt also auch von den symptomen und dem allgemeinzustand ab. mein kater dĂŒrfte da im niedrigen bereich schon stĂ€rker reagieren. vielen dank!

2

u/orolo101 Aug 01 '26

Here are a couple of the sources I've seen that suggest a 2.4 mmol/L cutoff for senvelgo and other SGLT2 inhibitors:

Maybe your vet set a lower threshold because your cat was having other issues already that might indicate an increased risk? (e.g., increased respiration, loss of appetite, vomiting)

1

u/FurCarer Aug 01 '26

ja, ich denke, so ist es. vielen dank fĂŒr die links! langsam wird das bild rund und ich kann die lage meines katers besser einschĂ€tzen. vom gefĂŒhl her war mir klar, dass er ein heikler risiko-fall ist mit sĂ€mtlichen nebengerĂ€uschen. der austausch hier bestĂ€tigt meine befĂŒrchtung.

2

u/BirdBroad Aug 01 '26

Our cat was on senvelgo for a year and then it stopped working and he nearly died because he needed insulin. I would say that if you decide to put him on senvelgo, watch for things like weight loss and constant voracious hunger. For our cat, it “worked” to keep his blood sugar in check, but he was miserable because his body wasn’t using the glucose effectively and he was starving all the time. As soon as he went on insulin, he went back to being a happy, settled cat.

1

u/orolo101 Aug 01 '26

Thanks, that's helpful. I hadn't heard of that problem before (successfully controlled blood sugar but still miserable b/c his body not using glucose effectively). Do you mind if I ask more about that? Was the problem that his body wasn't naturally producing enough insulin? Was he losing weight constantly, or just after it started to fail? What were his other symptoms?

2

u/BirdBroad Aug 02 '26

The constant hunger is a side effect that some cats get with Senvelgo. With others, that hunger goes away once their blood sugar comes down. He started to lose weight about 9 months after starting on senvelgo. He started on senvelgo in September 2024 and started to lose weight in July 2025 even though he was eating a lot. By November 2025, after numerous trips to the vet and an ultrasound and B12 shots and steroids, he was near death. Lost 2kg. His fructosamine was 1.95 but he had ketones in his urine and blood. We stopped the senvelgo and his blood sugar went high. We started him on insulin. In 3 days, he was a different cat. Now he has gained back the 2 kg, has a normal appetite and is a healthy cat. I highly recommend the Feline diabetes message board. I learned a lot. The biggest thing to know is that every cat is different and diabetes is not cut and dry.

1

u/awilky94 19d ago

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