This is essentially just like “regular” DKA except that the patient has a normal blood glucose level. This condition occurs almost exclusively in patients taking SGLT2 inhibitors. Bexagliflozin will normalize blood glucose levels, even in cats that have DKA. Cats taking Bexacat can develop DKA if their ability to produce insulin (endogenous insulin production) is insufficient to prevent DKA, which can often be due to concurrent illness.

eDKA is diagnosed essentially the same way you would diagnose “regular” DKA – look for serum and/or urine ketones even if the blood glucose level is normal or near-normal.

• A urine dipstick (nitroprusside test) will be positive in most cases, either with urine or serum. NOTE:  Ketonemia will occur before ketonuria, so if the urine test is negative, test plasma/serum ketones using a urine strip.
• Appropriate additional diagnostics, including CBC, Chemistry, and UA.
  • High anion gap
  • Metabolic acidosis
  • Dehydration
  • Note that hyperglycemia is NOT a finding with eDKA
• If you have a portable ketone meter available that is capable of measuring beta-hydroxybutyrate (BHBA), this is a great option as well, especially if DKA is suspected but urine strip testing (plasma or urine) is negative. 

• Discontinue Bexacat
• Treat appropriately for DKA noting that patients with eDKA must be promptly administered insulin, even though their blood glucose levels are normal. This is critical to stop the ketogenesis.
• Maintain dextrose infusion, as necessary, to allow for sustained insulin administration
• Correct electrolyte disturbances
• Correct acidemia
• Correct dehydration
• Promptly initiate appropriate nutritional support to prevent and/or treat hepatic lipidosis
• Call Elanco to report at 888-545-5973

No. eDKA and DKA are essentially the same complication of diabetes, and neither is more difficult to treat than the other. Rather, the most important thing is to be able to identify this condition promptly, and not be misled by a normal serum glucose level! Identifying underlying disease beyond diabetes (pancreatitis, etc.) is an important consideration.

Visit the Bexacat website, call Elanco Customer Service at 1-888-545-5973, or reach out to your local Elanco representative.

BHBA is the predominant ketone body formed in DKA and considered the most sensitive test for DKA¹. The fastest way to run this test is with a portable/handheld ketone monitor. Monitors that measure blood ketones often can test glucose as well, so make sure you have the proper ketone test strips!

There are a number of handheld ketone/glucose monitors available in the retail market. Only one handheld monitor in the US, the Abbott^© Precision Xtra™, has published data in a peer-reviewed journal as being validated in diabetic cats to measure BHBA². These various monitors are widely available from local retailers, drug stores, and online merchants. No prescription is required to purchase a monitor or their testing strips. Double check that you have the proper ketone monitoring strips for the monitor you purchase. Additionally, several reference laboratories, such as IDEXX, can run the BHBA test; however, turnaround time is typically 1-3 days and is therefore not an appropriate method of testing for sick cats taking Bexacat.

According to one study, it was found that cats with a BHBA >2.4 mmol/L showed 100% sensitivity and 87% specificity to diagnose DKA³. Another study in dogs and cats suggests that values of BHBA >3.5 mmol/L should prompt intensive treatment⁴.