Diabetes In Dogs

Diabetes in Dogs: Treatment Options, Palliative Care, and How to Know When It’s Time for Euthanasia

Most diabetic dogs live well with insulin and routine. It may be time to consider euthanasia when there are more bad days than good, recurrent DKA or severe hypoglycemia, persistent inappetence/weight loss, uncontrolled distress (constant thirst/urination, painful sores), or complications that can’t be managed—especially despite close veterinary care and dose adjustments.

Diabetes mellitus (DM) is a common endocrine disease in dogs. It happens when the pancreas doesn’t make enough insulin (most dogs) or the body becomes resistant to insulin, leaving too much sugar (glucose) in the bloodstream. Typical signs include increased thirst and urination, weight loss despite a good appetite, and sometimes cloudy eyes from cataracts. With the right care, many dogs live happily for years; others decline more quickly depending on age, other illnesses, and how well blood sugar can be controlled.

As a hospice and palliative care doctor, my goal is always this: regardless of the path you choose, to make sure your dog’s remaining time here on Earth is full of love and happiness. If your options are confusing, or you aren’t sure how to know when it’s time for euthanasia, don’t hesitate to schedule a quality-of-life teleconsult with one of our doctors.

What Is Diabetes in Dogs?

In dogs, diabetes is most often an insulin-deficiency disease (similar to type 1 in people). Without enough insulin, glucose can’t enter cells to be used for energy. Blood sugar rises, the kidneys spill sugar into urine, and dogs drink and urinate more to try to flush it out. Over time, dogs lose weight and energy. Some dogs develop cataracts and vision loss. In severe, uncontrolled cases, dogs can develop diabetic ketoacidosis (DKA), a life‑threatening emergency.

Treatment Options for Diabetes in Dogs

1) Insulin Therapy (cornerstone of treatment)

Diabetic dogs need insulin injections every day—often twice daily—given with or right after meals. Insulin is not optional and dogs with diabetes will eventually die without insulin. Your veterinarian will choose an insulin type and starting plan for your dog and teach you how to give very small injections at home. Common tools for success:

• Consistent timing of meals and insulin each day.
  

• Home monitoring as directed (watching appetite, thirst/urination; monitoring glucose with home glucose monitor  if recommended).
  

• Regular rechecks with your vet for dose adjustments (often using glucose curves or fructosamine levels).

Pros: Dogs with diabetes cannot survive long term without insulin. Many dogs go on to lead long, relatively healthy lives once on insulin.

Challenges: Requires daily injections at the same time, requires fairly frequent monitoring, risk of low blood sugar (hypoglycemia) if too much insulin is given or a meal is missed. 

Best for: Dogs whose families can commit to a daily routine and follow‑up with their veterinarian.

2) Nutrition & Feeding Schedule

Nutrition alone NEVER controls diabetes in dogs, but can be a useful adjunct. Dogs with diabetes generally do best with a consistent diet and feeding schedule. Many vets recommend high‑fiber, moderate‑carbohydrate diets for dogs; weight management is crucial if a dog is overweight. Dogs with a history of pancreatitis may benefit from lower‑fat diets. What matters most is that your dog eats reliably at insulin time—your veterinary team can help you choose a diet your dog will actually enjoy.

Tips:

• Feed at the same times every day and pair meals with insulin as directed by your vet.
  

• Avoid frequent high‑sugar treats between meals. If you use treats for injections, keep them small and consistent.
  

3) Addressing Underlying/Concurrent Diseases

Some conditions make diabetes harder to control (“insulin resistance”), such as Cushing’s disease, infections (especially urinary), obesity, or being in heat. Spaying an intact female is often recommended. Treating these issues can dramatically improve regulation.

4) Cataracts & Vision

Most diabetic dogs develop cataracts and eventually, blindness. They often adapt well to vision loss and some are good candidates for cataract surgery with a veterinary ophthalmologist. If surgery isn’t pursued, you can help your dog navigate safely at home (keep furniture layouts consistent, use baby gates near stairs, add night lights, and use scent cues).

5) What About Oral Medications?

In dogs, oral diabetes drugs are rarely helpful. Insulin is the primary therapy. (Some oral medications used for cats are not appropriate for dogs.)

Could euthanasia ever be a compassionate option?

While the majority of dogs do well on insulin and experience good control of their diabetes, a percentage of dogs can be very difficult to regulate – leading to complications resulting in frequent hospitalizations, for example, despite the most diligent care from pet parents. In addition, there may be dogs that do not tolerate daily injections because they bite, and families for whom to cost of managing diabetes especially when it becomes complicates becomes too much – and there is no shame in that. 

Signs that euthanasia may be the kindest option:

• Persistent loss of appetite and weight loss despite supportive care. 

• Recurrent emergencies (e.g., DKA) or severe hypoglycemia that cannot be prevented.

• Infections or complications (e.g., repeated UTIs, painful sores, severe weakness) that are not responding to treatment.

• Distress that can’t be relieved: constant thirst/urination soaking the home despite management, or incontinence leading to skin wounds.

• Lack of interest in life: no longer engaging with family or favorite activities; mostly withdrawn or uncomfortable.

• Inability to treat: If for whatever reason you are unable to give insulin to your dog, euthanasia may be the kindest option.

It is much easier to make these decisions when you are in a calmer frame of mind, not in an emergency. Keep a simple daily journal—smiley face for a good day, frown for a bad day—to see the pattern. When there are more bad days than good days, it’s often time to give your dog a peaceful goodbye at home.

Final Thoughts

Key takeaways

• Insulin + routine are the cornerstone; diet consistency matters.
• Track trends with our Quality of Life Scale; aim for more good days than bad over time.
• Choose home euthanasia when suffering persists despite reasonable treatment.

A diabetes diagnosis can feel overwhelming at first, but many dogs live comfortably with treatment—and when that’s no longer possible, a peaceful home euthanasia can prevent needless suffering. Whatever path you choose, the goal is to make the time your dog has left full of love and good moments.

If you’d like our help reviewing records, discussing options, and creating an end‑of‑life plan tailored to your family, schedule a comprehensive teleconsult with a compassionate veterinarian.

And if you do have to say goodbye, Paws at Peace offers in‑home euthanasia in all five boroughs of NYC to help your dog pass peacefully at home, surrounded by family. 

Tools & Resources

• Paws at Peace Quality of Life Scale
• How Will I Know When It’s Time to Say Goodbye?
• Pet loss grief support

FAQs: Diabetes in Dogs & Euthanasia