Final Stages of Dog Diabetes: A Guide for the Dog Owner

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This article was updated on January 21st, 2024

Diabetes mellitus can be a challenging condition for owners to manage. The need for daily insulin injections and special diets is not only time consuming but also leaves a lot of room for error. To make matters worse, diabetes is a condition that will generally worsen over time. The need to monitor for changes in clinical symptoms is essential in case insulin doses need to be adjusted. In this post, we are going to dive deeper into the final stages of dog diabetes.

Insulin Treatments Can Become Less Effective Over Time

Diabetic dogs are typically treated with insulin injections and a carefully managed diet to regulate their blood sugar levels. However, insulin treatment may become less effective over time due to factors like insulin resistance, changes in the dog’s metabolism, or fluctuations in hormone levels. This can lead to the need for increased insulin doses to maintain proper blood sugar control.

Diabetes can also be influenced by any other disease that your dog may have that can alter how effective the insulin is at treating diabetes. Many other diseases will lead to insulin resistance, including hormonal conditions, infections, renal disease, and cancer.

This means that the dose of insulin that may have once kept your dogs’ diabetes under control can suddenly not be sufficient.

In extreme cases insulin resistance may be so bad that diabetes becomes uncontrollable, and the best decision might be to put your dog to sleep.

When Diabetes Gets Worse: The Final Stages

All the factors listed earlier can result in a failure to sufficiently treat diabetes mellitus. Therefore, the disease may advance to more extreme stages and symptoms may worsen. The end stage of diabetes is known as diabetic ketoacidosis (DKA) – this is fatal if not treated soon enough.

Signs that your Dog is in the Final Stages

Below are signs that your dog has an advanced condition or in the final stages of diabetes:

  • Excessive thirst and urination
  • Weakness and/or lethargy
  • Vomiting
  • Increased respiratory rate
  • Reduced appetite
  • Sweet smelling breath
  • Sudden impaired vision

Owners will have to pay particular attention to the appearance of any of these symptoms, some of which can be quantified by measuring how much water your dog is drinking or the number of breaths they are taking per minute; others are a bit harder to keep track of.

A dog in ketoacidosis will go downhill very quickly and it will often be obvious when they have entered the final stages of diabetes – they may be vomiting, depressed, lethargic and not themselves at all.

Dr. Crow shares a few tips:

“The goal is the pickup on subtle changes before the disease can progress to DKA as the earlier treatment is started, the better the prognosis. It’s a good habit to get into measuring how much water your dog is drinking as this can provide vital information for your vet. Record this every day and you can even plot the results on a graph. If the trend is gradually moving upwards, then it’s likely that your dog’s diabetes isn’t sufficiently under control.”

Dr. Alex Crow

Veterinarian at

It is also very important to take your dog to the vets for regular checkups and blood tests. Your vet can perform a blood glucose curve which measures how your dog’s blood glucose levels change over the course of the day. This allows them to ensure your dog is on the right dosing of insulin. They can also test a blood marker known as fructosamine, this tells the vet how high blood glucose levels have been over longer periods of time.

What is Diabetic Ketoacidosis? (End Stage of Diabetes)              

Diabetic ketoacidosis, or DKA, is the end stage of diabetes mellitus and occurs when your dog’s body cells and organs are no longer responding to insulin. This may be due to an insufficient dose of insulin or other concurrent diseases that are causing insulin resistance.

Insulin is an important hormone in allowing the body to utilize glucose (carbohydrates) and turn it into energy. With a lack of insulin, or insulin resistance, your dog’s body will rely on fats instead for this source of energy. Fats are broken down in large quantities to supply the body with energy, however the release of these fats also results in the accumulation of compounds known as ketone bodies.

Ketone bodies act as an emergency fuel source and when they are broken down to release energy, they cause the pH of the blood to shift and become more acidic. This change in pH has dire consequences on the body as it interferes with many other important metabolic reactions; your dog will display many of the symptoms listed above and the body gradually shuts down.

The Main Cause of Diabetic Ketoacidosis is Insulin Resistance

Insulin resistance is the inability of the body to respond to insulin and therefore the inability to utilize glucose. But what causes this insulin resistance?

  • Essentially any other concurrent illness or disease can result in insulin resistance through the release of stress hormone and inflammatory mediators. Therefore, it is important to rule out these other diseases in a dog who is no longer responding to their insulin medication.
  • Older dogs or female dogs that are not spayed are also more likely to become insulin resistant.

Some of the main causes of insulin resistance include:

  • Urinary tract infections,
  • Skin infections,
  • Respiratory infections,
  • Long term steroid use,
  • Addison’s disease,
  • Cushing’s disease,
  • Pancreatitis, and
  • cancer.

The treatment for DKA requires intensive hospitalization and care, including fluid therapy and intravenous insulin.

How do I Know if my Diabetic Dog is in Final Stages?

“If your dog’s diabetes has no longer become manageable and you have noticed a clear change in their demeanor and/or they are displaying any of the symptoms listed above, then they are likely dying of diabetes. A dog that is depressed and lethargic all day is not a happy dog, especially if they are vomiting and losing weight.”

Dr. Alex Crow

Veterinarian at

Dogs whose diabetes is not adequately under control may slowly deteriorate or they may sudden pass into DKA. Take your dog to your local vet if you believe either to be the case; treatment may be possible.

When is it Time to Put a Diabetic Dog to Sleep?

There is never a ‘right’ time to put an animal to sleep, most diseases are slowly progressing and so the decision is often not so clear cut. However, in the case of diabetes, the decision can be left too late. Learn more about the right time to euthanize a diabetic dog.

How Long do Dogs Live after Being Diagnosed with Diabetes?

The life expectancy of a dog with diabetes will vary on how well the condition can be controlled and if there are any other concurrent illnesses that complicate matters.

A dog that is receiving its daily dosing of insulin consistently, is on an appropriate diet and who has no other co-morbidities can live a long and happy life.

Stick to a routine and be sure to have regular checkups with your vet. It’s likely that your dog’s insulin doses will need to change over time so being proactive with this will improve the long-term prognosis.

However, if you are unable to give your dog their required daily insulin dose or if you skip doses, they will go downhill quickly.

Similarly, it’s very important to investigate any other unusual symptoms your dog displays, even if you don’t think they are related to diabetes. As we have mentioned, many other illnesses can contribute to insulin resistance, thus making diabetes harder to manage; the sooner these signs are investigated, the better the outcome.

If a dog is left untreated then their life expectancy may only be a few months depending on the progression of the disease.

Diabetes can be a challenging disease, both for owners and vets. If you are a dedicated owner and go for regular checkups then your dog has a real chance at continuing to live a normal life.

Learn More About Dog Diabetes:

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  • Dr Alex Crow, Veterinary Surgeon

    Alex Crow, VetMed MRCVS, is an RCVS accredited Veterinary surgeon with special interests in neurology and soft tissue surgery. Dr Crow is currently practicing at Buttercross Veterinary Center in England. He earned his degree in veterinary medicine in 2019 from the Royal Veterinary College (one of the top 3 vet schools in the world) and has more than three years of experience practicing as a small animal veterinarian (dogs and cats).

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Disclaimer: This website's content is not a substitute for veterinary care. Always consult with your veterinarian for healthcare decisions. Read More.

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