A diabetic dog has two emergencies. One is too much insulin for the food in the dog, which happens at home and fast, and which the 2026 AAHA guideline wants every owner taught on the day of diagnosis. The other is too little insulin for too long, ketoacidosis, which is more often seen in dogs nobody knew were diabetic and which can come back in a treated dog when something else goes wrong. This page is both, in the guideline's words. The disease, the insulins and the routine are on the main diabetes page.
This is the emergency you prepare for on the day of diagnosis, because it happens at home, it happens quickly, and what you do in the first minutes matters. The guideline's list of signs is "lethargy, sleepiness, strange behavior, abnormal gait, weakness, tremors, collapse, and seizures." The Vetsulin owner sheet lists "Weakness, Depression, Behavioral changes, Muscle twitching, Anxiety, Seizures, Coma, Death." A diabetic dog that is suddenly wobbly, glassy, or oddly quiet is low until proven otherwise.
Keep a bottle of corn syrup and a few cotton swabs where the insulin is, and make sure everyone in the house who might be alone with the dog knows where they are. The emergency page has the signs that mean tonight for everything else.
A low is information, not a failure. The guideline has the vet get a curve or a sensor on the dog "after the next dose to identify whether hypoglycemia recurs", and if it does, "continue to decrease the dose and obtain a BGC until hypoglycemia is resolved." A dog that has had one low is not a dog that needs watching harder; it is a dog whose dose was too high for its life that week. Tell the vet what was different that day, if anything was: a meal left, a vomit, a long hike, a second person who may also have given the injection.
The rules on the main page exist for this. Insulin goes in after the meal, not before, and a dog that eats less than half gets half the dose: "If less than 50% of the meal is eaten, one-half of their normal insulin dose should be administered". No dose is ever repeated because you are not sure it went in, and no dose is ever raised at home: owners "should never increase the dose or frequency of insulin administration without clear instructions from their veterinarian." If missed meals are a pattern, the once-a-day insulins are worth asking about, because "Basal insulins do not have to be timed with feeding and are less likely to induce hypoglycemia when meals are missed."
Ketoacidosis is what untreated diabetes turns into, and the guideline calls it "a life-threatening complication of DM." It is more often seen in dogs nobody knew were diabetic, but it happens to treated dogs too, usually with something else going on: "Concurrent diseases (e.g., pancreatitis, urinary tract or other infections, hypercortisolism, and renal disease) often precipitate DKA." The signs are a diabetic dog that is sick rather than merely thirsty: lethargy, weakness, not eating, vomiting, and sometimes that sweet smell on the breath. A home urine strip showing ketones in a dog that is unwell is a same-day visit, and the guideline's own protocol sends the worst cases straight to a 24-hour hospital: a dog that is weak or cannot stand, badly dehydrated, vomiting or not eating on top of the thirst and weight loss, or collapsing. Treatment is intravenous fluids, potassium, and small insulin doses every hour or two until the ketones clear, and the guideline is firm that "only insulin eliminates ketosis so attempts should be made to start insulin within 4-6 hr of hospital admission in most cases." It also sets the expectation for the end of that stay: "Glycemic regulation before discharge is not a goal of DKA management and should not be expected." The dog comes home alive and eating, and the fine-tuning starts afterward, on the routine described on the monitoring page.
Several days in a hospital is the expensive part of this disease, and it is the kind of bill that insurance taken out before the diagnosis is for. The vet costs page has the emergency and hospitalization figures.
This only applies to an animal that is unresponsive and not breathing. An animal that is breathing does not need this, and chest compressions on one that does not need them can injure it.
One person drives to the nearest open vet. The other works on the animal on the way. Call the practice while you are moving so they are ready when you arrive.
Those are the numbers trained rescuers work to. Doing this well takes a course, and reading three numbers is not the same as being taught it. The RECOVER Initiative runs a paid course for owners if you want to learn it properly before you ever need it.
Numbers from the 2024 CPR Algorithm for Dogs and Cats, published by the RECOVER Initiative, which is supported by the American College of Veterinary Emergency and Critical Care. Find a board certified emergency vet near you.
Bitten by a raccoon, a skunk, a fox or a bat, or a bat loose in the house: what the rabies rules do next depends on the vaccine date. The rabies page has the three outcomes and what to do tonight.