An internal medicine specialist explains the answer to this question, in an interview with dvm360 

Should cats on SGLT-2 inhibitors go on a special diet?

Ellen Behrend, VMD, PhD, MS, DACVIM (SAIM), a consultant at Veterinary Information Network, answers a common question from caregivers of cats with diabetes: Should a cat receiving a sodium-glucose cotransporter 2 (SGLT2) inhibitor be placed on a specific diet? As Behrend explains, her recommendation is to follow the traditional diet for a cat with diabetes, which is high in fats and protein and low in carbohydrates. In the video, she delves into the reason behind this.

Below is the interview transcript, which has been lightly edited for improved clarity:

Ellen Behrend, VMD, PhD, MS, DACVIM (SAIM): 

A really common question is about diet in combination with an SGLT2 inhibitor: Do you put a cat on a specific diet, and when?

I still recommend the typical diabetic cat diet: high fat, high protein, [and] low carbohydrate in combination with an SGLT2 inhibitor. There's some evidence in people that such a diet could increase the risk of [diabetic ketoacidosis]. We don't know in cats. Cats handle carbohydrates hugely [differently] than people do, so until we know better or differently, I'm going to use a high-fat, high-protein, [and] low-carbohydrate diabetic diet because it can really help with putting a cat into remission, at least when the cat is on insulin.

I typically don't change the diet for 2 weeks after starting the SGLT2 inhibitor or until I think the cat is settled and doing well. I don't want to do 2 things that can cause vomiting and softening of the stool at the same time—change the diet and start the drug—because then you're not going to know what the problem is. So, I start the SGLT2 inhibitor first, and then after 2 weeks, when the cat's doing fine—or whenever that is, typically around 2 weeks—then I'm going to start the diabetic diet.

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An internal medicine specialist explains the answer to this question in an interview with dvm360.

Should cats on an SGLT2 inhibitor go on a special diet?

Pet poison prevention tips with Renee Schmid

5 Tips to help prevent poisonings

Veterinary professionals play a key role in safeguarding companion animals against inadvertent exposures to toxic substances. Equipping clients with precise, evidence‑based recommendations can help reinforce preventive care and reduce the incidence of emergency poisonings. Below are 5 guidelines from Pet Poison Helpline’s Renee Schmid, DVM, DABT, DABVT, that clinicians can readily integrate into client education to enhance in‑home safety.

 medications—yours or your pet’s—up high in a closed‑door cabinet. Even better: install a lock on the cabinet to prevent curious paws or noses from getting inside.

Designate 2 different storage areas—one for human prescriptions/OTCs, one for veterinary formulations—to avoid dangerous mix‑ups when dosing.

Common “people foods” that can be deadly to pets include:

Onions & garlic
Store these safely out of reach (and out of temptation).

Before bringing any new plant into the home, confirm it’s non‑toxic to pets. Highly dangerous species include:

 (true lilies)
Either skip these entirely or keep them completely inaccessible to your animals.

5. Secure rodenticides in approved bait stations

Pets can squeeze into the tiniest nooks and sniff out poisons. Always use tamper‑resistant bait stations specifically designed for rodenticides, and place them where only rodents can reach.

Don’t wait for an emergency. Here are 5 straightforward tips from Pet Poison Helpline’s Renee Schmid, DVM, DABT, DABVT

Five tips to help keep your pets safe from poisonings

 today announced the winners of its prestigious 2025 Hospital Design360 Competition, which honors veterinary hospitals that exemplify excellence in design, innovation and functionality.

Each year, the Hospital Design360 Competition celebrates practices that are reimagining veterinary care. These winners demonstrate how thoughtful design can transform the way veterinary teams work, how clients experience care and how pets heal and thrive. Their achievements herald a future where veterinary spaces are created with intention, compassion and innovation.

The Fauna Veterinary Collective lobby (Image courtesy of Sydney Pokard, DVM) 

In the category of less than 3,500 square feet, 

, located in Lake Forest, California, earned the top honor for its warm, innovative and purpose-driven design. Merit recognition in this category went to Ivy Veterinary Care and Treeline Veterinary Cancer Care for their thoughtful, efficient and client-centered facilities.

“Winning this hospital design contest is such an incredible honor,” said Sydney Pokard, DVM, founder of Fauna Veterinary Collective. “Fauna was born from a very personal vision. I wanted to create a space that not only provides the highest standard of care for all animals but also reflects warmth, innovation and purpose in every detail. From the layout and lighting to the materials and flow, everything was intentionally designed to reduce stress for our patients and their owners, while also supporting our staff in the work they do every day.”

In the category of 3,500 to 8,000 square feet, 

, Sherwood, Oregon, won for its inspiring design that balances functionality with community impact. Merit awards in this category went to The Eye Vets, The Animal Neurology Center, and Windsong Veterinary Hospital for their innovative and efficient designs.

Exterior of Sherwood Family Pet Clinic (Image courtesty of Sherwood Family Pet Clinic) 

“We are incredibly honored to have our hospital recognized by dvm360,” said Robert Merrill, DVM, owner of Sherwood Family Pet Clinic. “Designing this building was a true labor of love. We poured our hearts into creating a space that would support our team, care for more pets, and serve our growing community for years to come. Being part of the contest that inspired us is an amazing full-circle moment.”

In the category of greater than 8,000 square feet, 

, in Queen Creek, Arizona, won for its expansive, innovative and compassionate facility. Merit awards in this category went to BluePearl Pet Hospital— Grand Rapids, Stitches Veterinary Surgery and Veterinary Healthcare Associates for their impressive designs that prioritize advanced care delivery and team well-being. 

“This award is a reflection of the heart, vision, and relentless dedication of the entire ARISE team,” said Melissa Burns, director of hospital operations, ARISE Veterinary Center. “I’m incredibly proud of the culture we’ve built — one grounded in compassion, innovation and a passion for leading the future of veterinary medicine. It’s an honor to be recognized for the work we love doing every day.”

Exterior of ARISE Veterinary Center (Image courtesy of ARISE Veterinary Center)

The Hospital Design360 Competition recognizes newly built and renovated practices that raise the bar for veterinary spaces. By spotlighting hospitals that improve client experience, staff efficiency and overall care delivery, dvm360 continues to inspire the profession to create facilities that reflect the very best of modern veterinary medicine.

“At dvm360, we believe that hospital design is more than aesthetics — it’s about creating spaces that empower veterinary teams and support the emotional and physical well-being of pets and their owners,” said Adam Christman, DVM, MBA, chief veterinary officer of dvm360. “These winners are raising the bar for what veterinary medicine can look like when thoughtful design meets innovation. They inspire all of us to reimagine what’s possible in our profession."

“These practices aren’t just beautiful — they’re strategic, sustainable and deeply intentional in how they serve patients, clients and staff,” said John Hydrusko, vice president of sales at MJH Life Sciences

, the parent company of dvm360. “As the veterinary profession evolves, dvm360 is proud to lead the way in highlighting hospitals that integrate technology, prioritize wellness and ultimately create better outcomes for animals and the people who care for them.”

journal and honored at the Fetch dvm360 conferences, where veterinary professionals connect to learn about the latest advancements in medicine, practice management and hospital design.

Articles

As the leading authority on veterinary practice design, dvm360 sets the standard for hospitals that elevate care, efficiency and wellness.

dvm360® Announces Winners of the 2025 Hospital Design360 Competition 

Recently, a membership-first veterinary care provider opened a new location in New York, New York. Meanwhile, a veterinarian-founded startup is rapidly expanding its network across the United States, and a privately owned veterinary group headquartered in Washington State has partnered with a hospital in Florida and acquired 3 other hospitals.

Continue reading to learn more about those new or upcoming updates.

Small Door Veterinary Park Slope. (Image courtesy of Small Door Veterinary)

Earlier this week, Small Door Veterinary opened its 6th location in New York City.

 The newest practice is Small Door’s second location in Brooklyn and can be found in the borough’s Park Slope neighborhood. The facility will offer a variety of services, including preventive care, 24/7 telemedicine, spaying and neutering, urgent care and emergencies, nutrition, dentistry, allergies and dermatology, diagnostic testing, euthanasia, surgical procedures, behavioral consultations, puppy and kitten care, and more.

“...[W]e’re excited to expand our modern, member-first approach with this new Park Slope location,” Florent Peyre, co-founder and CEO of Small Door, said in an organizational release.

 “We’re committed to serving members where they are, providing next-generation veterinary care—including after-hours telemedicine support—to ensure pets receive the care they deserve.”

Small Door was one of the first veterinary care companies to receive B Corp certification

—a designation given to businesses that achieve high social and environmental standards, public transparency, and legal accountability. The veterinary care provider is also American Animal Hospital Association (AAHA)-accredited and has pursued AAHA accreditation for all of its practices.

The startup CodaPet—a network of veterinarians specializing in at-home euthanasia services—recently announced a milestone for its organization. What began as a small operation in only one city in California has grown into a network of more than 160 veterinarians in over 100 cities across the US in just over 2 years. These cities include rural and metropolitan areas, including Hawaii, Maine, Seattle, and Fort Lauderdale.

“We've grown faster than we imagined because the need is real," said Bethany Hsia, DVM, CodaPet cofounder, in a company release.

 "More pet families are choosing to say goodbye at home, and more veterinarians are embracing the opportunity to make that experience peaceful and personal."

Lakefield Veterinary Group has partnered with the 5300 sq ft Emergency Pet Hospital of Collier County in Naples, Florida. In the near future, through the collaboration with the emergency pet hospital staff, Lakefield plans to expand the hospital’s services to include emergency and critical care 24/7.

Lakefield also recently acquired Catlett Animal Hospital in Catlett, Virginia; Compassion Animal Hospital in Bealeton, Virginia; and Northwest Georgia Veterinary Emergency Center in Rome, Georgia.

“We are excited and honored to partner with such great hospitals and passionate teams who care so much for the pets in their communities,” Chad Quick, chief development officer, said in a news release.

 “We will continue to invest in these hospitals to ensure these teams have the technology and resources they need to provide exceptional care to all pets who come to these hospitals.”

Small Door Veterinary expands NYC footprint with Park Slope location. News release. Small Door Veterinary. July 21, 2025.

CodaPet expands to 100 cities, offering veterinarians career flexibility and pet owners peaceful goodbyes at home. News release. CodaPet. July 8, 2025.

Lakefield Veterinary Group expands to Florida, strengthens East Coast Presence. News release. July 15, 2025. Accessed July 23, 2025. https://www.businesswire.com/news/home/20250715271646/en/Lakefield-Veterinary-Group-Expands-to-Florida-Strengthens-East-Coast-Presence

Clinic center: From New York to Hawaii, veterinary organizations grow across the US

, James Bascharon, DVM, joins our host Adam Christman, DVM, MBA, to talk about the importance of proactive pet care in veterinary medicine, specifically with anal glands and osteoarthritis. Throughout the episode, Christman and Bascharon discuss different products, the importance of early intervention and multimodal treatments for osteoarthritis, and the need for innovation within the veterinary medicine industry.

Below is a partial transcript, edited lightly for clarity.

I think we've been conditioned a little bit as vets. Sometimes we just go right to the treatment, and particularly in this instance, it's easy enough to do an anal gland expression. [However], overly manipulating the glands further exacerbates the problem, reduces the tone of the glands, and can create some microtrauma to the ducts and further irritation. So, I do think it's worthwhile to...pause and say, "OK, this pet has [a] recurrent [anal gland issues].... What do we need to be thinking about?" Are there underlying allergic issues that we're not recognizing? Is there an underlying digestive health issue, whether [an] imbalance of bacteria, a parasitic issue, or something else? Or [maybe] a diet change [is] needed. 

On that note of diet, it is interesting that, as we've gotten to higher-quality, more expensive, [and] fancier dog foods—one trying to outcompete the next—have we done too much and removed a bit too much of the fillers and fibers that are necessary to form bulky, firm stool? There was this whole movement around grain-free—as we all know—and there are repercussions to it. Some of those elements [are required] in the digestive tract and in the diet to produce formed, healthy, and bulky stools necessary to empty the glands. It's one of the theories that we have on why anal gland issues are increasing. And just so all the viewers can hear this: They are technically called anal sacs. We do know that we go by anal glands, because I think sometimes it's a little easier for people to understand what you're talking about, but the correct [terms are] anal sac and anal sacculitis.

Thank you for sharing. That is true because there is a disconnect. Pet owners may not seem to recognize anal sac vs anal gland...people get to recognize that more and assimilate to that.

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Discover insights on proactive pet care, anal gland issues, and innovative treatments in veterinary medicine.

Proactive solutions for patient wellness

Health officials in the US are sharing that medetomidine and vatinoxan hydrochlorides injection (Zenalpha), a medication approved for dogs for sedation and analgesia, and can be used under extralabel drug use regulations for cats, pocket-pets, exotics, zoo, and wildlife species for restraint and sedation, has emerged as a dangerous adulterant in the illegal drug supply. Medetomidine, which received approval from the FDA in March 2022, is now often being mixed with other illicit drugs such as heroin and fentanyl.

Illicit medetomidine was first identified in Maryland in 2022 and has now spread to California, Colorado, Illinois, Missouri, and Pennsylvania, with overdose clusters present in Chicago, Illinois; Philadelphia, Pennsylvania; and Pittsburgh, Pennsylvania in early 2025. Medetomidine, which is a racemic mixture of dexmedetomidine and levomedetomidine, is not a controlled substance and was not approved for use in humans. Despite this, dexmedetomidine enantiomer is considered the pharmacologically active component that is responsible for the sedative and analgesic effects of the drug. Dexmedetomidine, which has separate approvals from the FDA for use in animals and humans, is often used for sedation in humans in the intensive care unit (ICU). 

From May 11-17, 2024, Chicago reported 181 suspected opioid overdoses in 3 hospitals, with 12 of them confirmed illicit medetomidine-involved cases. Most patients exhibited slow heart rate, altered mental state, and a poor response to naloxone.

Philadelphia reported 165 people hospitalized with a previously unseen withdrawal syndrome that is now linked to illicit medetomidine between September 2024 and January 2025. Of the patients who were hospitalized, most required an ICU visit, and almost a quarter of them were intubated. For these patients, traditional treatments for opioid withdrawal failed, and dexmedetomidine was an effective way to control the patients' symptoms due to the drug’s similar pharmacological properties to medetomidine.

In Pittsburgh, almost 24 patients were evaluated between October 2024 and March 2025, with 10 confirmed to have illicit medetomidine exposure. Most of the patients "deteriorated rapidly" before arriving at the hospital with symptoms including extreme autonomic hyperactivity, including agitation, hypertension, and tachycardia.

 Of those 10 patients, 9 required ICU admission, and all responded to dexmedetomidine when other medications did not work.

“This cluster of confirmed medetomidine-involved overdoses is the largest yet reported, and the landscape of adulterants in the illegal drug supply is ever-changing and expanding. The recent addition of xylazine has led to a concerning trend in deaths potentially resulting from adulteration in the fentanyl supply, and the emergence of medetomidine further complicates the opioid overdose crisis,” the CDC’s 

stated. “Clinicians and persons who use illegal drugs should be aware that medetomidine can be present in the drug supply. Although medetomidine effects cannot be reversed with naloxone, if a person might be overdosing, the use of naloxone or any other opioid overdose reversal medication is recommended. In addition, connecting persons at risk for overdose to evidence-based treatment, services, and support can save lives.”

Health officials finding different illicit veterinary sedative in US drug supply. News release. American Veterinary Medical Association. June 23, 2025. Accessed July 1, 2025. 

https://www.avma.org/news/health-officials-finding-different-illicit-veterinary-sedative-us-drug-supply

Nham A, Le JN, Thomas SA, et al. Overdoses involving medetomidine mixed with opioids — Chicago, Illinois, May 2024. 

. 2025;74(15):258-265. doi:10.15585/mmwr.mm7415a1

Huo S, London K, Murphy L, et al. Notes from the field: suspected medetomidine withdrawal syndrome among fentanyl-exposed patients — Philadelphia, Pennsylvania, September 2024-January 2025. 

. 2025;74(15):266-268. doi:10.15585/mmwr.mm7415a2

Ostrowski SJ, Tamama K, Trautman WJ, Stratton DL, Lynch MJ. Notes from the field: severe medetomidine withdrawal syndrome in patients using illegally manufactured opioids — Pittsburgh, Pennsylvania, October 2024-March 2025. 

. 2025;74(15):269-271. doi:10.15585/mmwr.mm7415a3

Health officials are finding medetomidine is now emerging as a dangerous adulterant in the illegal drug supply and is often mixed with other illicit drugs.