Call your vet immediately if your diabetic dog has the following warning signs:
DKA is life-threatening if not treated quickly.
Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes and, in many cases, it is the way diabetes is first diagnosed in dogs, particularly if the early warning signs of diabetes such as increased thirst, urination, weight loss, or appetite changes were missed.
DKA most often develops when an unregulated diabetic dog — meaning their insulin dosing isn’t keeping their blood sugar levels under control — experiences a sudden increase in energy demand, such as illness or stress. Common triggers include:
Missed or ineffective insulin doses
Infections (urinary tract, dental, skin, kidney)
Pancreatitis
Cushing’s disease (excess cortisol)
Certain cancers
Without enough insulin to help cells use glucose, the body switches to using fat as a back-up fuel. Normally, insulin also puts the brakes on this energy production process — but when insulin is missing, fat metabolism runs out of control, producing large amounts of acidic ketones that build up in the blood. You can think of it like burning dirty fuel for energy that makes the surrounding environment very toxic to live in. The combination of ketones, high blood sugar, and dehydration will leave your dog feeling extremely unwell.
Dogs with DKA are usually much sicker than dogs with uncomplicated diabetes. The condition can develop very quickly and always needs urgent veterinary care. Signs that should prompt an immediate vet visit include:
Vomiting or diarrhoea
Not eating or refusing food
Extreme lethargy or weakness
Dehydration (sunken eyes, dry gums, poor skin elasticity)
Rapid or laboured breathing
Collapse or loss of consciousness
In some cases, a sweet or “acetone-like” smell on the breath
If your diabetic dog shows any of these signs, treat it as an emergency and contact your vet straight away. At the clinic, your vet will run tests to confirm the diagnosis and assess how sick your dog is. These typically include checking blood glucose levels for dangerously high sugar, testing urine or blood for ketones, and running electrolyte and acid–base balance tests to assess hydration, pH, and key minerals such as potassium and phosphorus. Additional tests such as bloodwork, urinalysis, X-rays, or ultrasound may also be recommended to look for underlying problems like infection or pancreatitis that could have triggered the crisis.
| Item | What it Includes | Estimated Cost (NZD) |
|---|---|---|
| Initial consultation & exam | Emergency vet assessment, physical exam | $90–$180 |
| Basic bloodwork panel | Blood glucose, complete blood count (CBC), biochemistry | $180–$300 |
| Electrolyte & acid–base testing | Potassium, phosphorus, sodium, pH | $100–$180 |
| Urinalysis & ketone testing | Urine sample, dipstick or meter for ketones | $60–$120 |
| Imaging (if needed) | X-rays and/or ultrasound to check for pancreatitis, infection, or other triggers | $200–$500 |
| Estimated total (initial work-up) | — | $630–$1,280 |
*Costs vary by clinic, location, and how sick your dog is. Hospitalisation, IV fluids, insulin therapy, and intensive monitoring are additional and make up the bulk of the overall cost (see treatment section).
Most dogs with DKA need to stay in hospital for 3 to 7 days to get their bloodwork values back to baseline and to treat the underlying problem that triggered the crisis. Treatment usually involves:
IV fluids to correct dehydration, restore circulation, and provide additional glucose for energy
Insulin therapy (often IV infusion) to allow cells to use glucose and stop producing ketones
Electrolyte support (especially potassium and phosphorus), as levels can shift dangerously during treatment
Nutritional support once vomiting settles, sometimes with a feeding tube
Treatment of underlying conditions such as infection, pancreatitis, or hormonal disease
Dogs with DKA need very close monitoring while in hospital. The veterinary care team will regularly check vital signs, blood glucose, electrolytes (such as potassium and phosphorus), and acid–base balance to ensure treatment is working safely. These checks are often repeated every few hours at first because insulin and fluids can cause rapid shifts that may throw the body even further out of balance if they happen too quickly. Careful monitoring allows vets to make gradual adjustments and prevent complications that could make your dog more unwell. In some cases, your regular veterinarian may recommend referral to a 24-hour emergency or specialty hospital so your dog can receive round-the-clock care.
Treatment can usually be stepped down once your dog is rehydrated, their electrolytes are back to normal, blood glucose is under 250 mg/dL (14 mmol/L), ketones have reduced or disappeared, and they are able to eat and drink on their own without vomiting.
Depending on the severity of the case, treatment for DKA usually costs between NZD $3,000 and $7,000. The exact cost depends on how sick your dog is, how long they need to stay in hospital, and whether referral to a 24-hour specialty centre is required.
With appropriate care, it is possible to stabilise most dogs that develop DKA and then re-adjust their management plan to prevent future episodes. However, it is difficult to give exact statistics on survival rates because many dogs are euthanised at the time of diagnosis due to the high costs and intensity of treatment rather than the severity of their illness. For those that do receive care, outcomes are often positive once the crisis is stabilised and diabetes is brought under control.
The best way to prevent DKA is by keeping your dog’s diabetes well managed. This means giving insulin exactly as prescribed, following a consistent feeding routine, and scheduling regular check-ups to catch problems early. Prompt treatment of other illnesses, such as infections or pancreatitis, also reduces the risk of a crisis.
Because treatment for DKA is intensive and costly, it’s a good idea to think in advance about whether you would want to pursue full hospital care if your dog were to develop this complication. Making that decision ahead of time helps you feel prepared and avoids having to make a difficult choice in an emotionally charged, emergency situation.
Helping people understand animals and each other