What is the Best Food For a Dog With Diabetes?

Hill’s Metabolic vs. Royal Canin Glycobalance vs. Ketona Dog Food

Diabetes is a metabolic disorder has become increasingly common among dogs in the United States over the past decade. It’s a serious disease that can have disastrous consequences (including death) if not managed appropriately by dog parents. And, unfortunately, management is usually both time-intensive and costly. 

Because dog food has such a direct impact on metabolism, nutrition is the cornerstone of managing diabetes in dogs. Which, of course, raises the question “what is the best diabetic dog food?”

We think there’s a very clear answer to this question. And to show you why we’re going to break down the costs and benefits of three of the most popular diabetic dog foods. Each has some unique selling points, but when all is said and done we think you’ll agree that one dog food clearly rises above the others.

If you need a general introduction to canine diabetes, check out our popular overview article here. The material that follows here assumes that you’re already familiar with basic concepts such as blood glucose and insulin.

Let’s get started by looking at how we are going to evaluate the options.

How to Evaluate Which Diabetic Dog Food is Best

So what makes one dog food product better or worse than another?

That depends on individual consumer priorities. Don’t kid yourself by thinking that any one dog food is going to be the tastiest, healthiest, least expensive, and best for the environment—all in one place. That’s not realistic. And if anyone is telling you that their product wins in all of those categories and considers themselves to be the "Best Dog Food Ever!" then you should probably make sure your wallet hasn’t recently disappeared.

So what do consumers tend to prioritize in this particular case? For parents of diabetic dogs, four qualities tend to be the highest priorities in selecting a dog food:

1. Impact the Dog Food Has on Blood Glucose and Insulin Usage – This is usually the foremost priority. Diabetic dogs can’t process blood glucose effectively because their bodies can’t produce enough insulin. So a food product’s impact on blood glucose (and, consequently, on exogenous insulin needs) tends to be the single most important factor for parents of a diabetic dogs.

1. Cost of the Dog Food – This is, of course, an important consideration in any buying decision.

1. Convenience and Ease of Use of the Dog Food – Ditto.

1. Overall Healthfulness of the Dog Food Outside of Diabetes Care – Nutrition is a broad concept that encompasses all manner of different health-related issues. And, just as no single pet food is likely to stand out as having the lowest price, the smallest carbon footprint, and the best nutritional content, it’s unlikely that any one product is going to win the day on any and all relevant nutritional issues either. So, in addition to considering the impact of a dog food on blood glucose and insulin in diabetic dogs, it’s important to also consider other important nutritional qualities, such as a product’s protein content.

The Top Competitors in the Diabetic Dog Food Space

Now that we’ve narrowed down our evaluative framework a bit, let’s meet our competitors. To our knowledge, the three most popular food choices for diabetic dogs are as follows:

Hill’s Prescription Diet Metabolic

Royal Canin Glycobalance

Ketona by KetoNatural Pet Foods (our product)

All of these products are available in a few different varieties (canned wet dog food, dry kibble, etc.). So, to make sure we’re comparing apples to apples, we’re going to be looking at the heaviest available bag of the chicken recipe of the dry/kibble dog food version of each of the three products. Let’s get it on!

Criterion One: Cost of Your Diabetic Dog Food

The sticker prices of the three competitors follow immediately below. These are the advertised prices from Chewy.com as of early July of 2023.

Royal Canin Glycobalance: $95.99

Hill’s Metabolic: $118.99

Ketona: $124.99

So if we go by sticker prices, Glycobalance is cheapest, Hill’s is second, and Ketona is third. But sticker prices don’t tell the whole story, for two reasons.

First of all, the three products have different weights. A large bag of Hill’s contains 27.5 pounds of food while a large bag of Glycobalance only contains 17.7 pounds. So we also need to do a price/pound comparison in order to determine value. Here’s how they stack up when we look at things that way:

Hill’s Metabolic: $4.33/pound

Ketona: $5.17/pound

Royal Canin Glycobalance: $5.46/pound

This relatively small change alters the rankings pretty materially. If we think about things on a price/pound basis (instead of a sticker price basis), then Hill’s is cheapest, followed by Ketona, and then Glycobalance.

But that’s also not the best way to compare costs. Because, since the three products contain different amounts of caloric energy, the same dog would have to eat different amounts of each product in order to get the same number of calories. Said somewhat differently, the same dog would take a different amount of time to work through the same amount of each of the three products.

As such, the best way to compare prices is to evaluate them on a price/day basis. This requires a little bit more math, but it’s not rocket science. Here’s what it costs each day to feed each of the three competitors to a 60-pound dog that isn’t trying to lose weight:

Ketona: $3.85/day

Hill’s Metabolic: $4.11/day

Royal Canin Glycobalance: $4.70/day

And that’s a true apples-to-apples comparison and the final answer on price. Ketona is the least expensive, at about $3.85/day for a 60-pound adult dog. Hill’s Metabolic costs about 7% more than Ketona whereas Glycobalance costs another 14% more than that.

Criterion Two: Convenience of Your Diabetic Dog Food 

This one is pretty simple because there’s only one material difference between the three dog food products.

All three of them are extruded kibbles (“dry foods”). Which means that none of them require any freezing or refrigeration (like so-called “fresh” dog food diets do). None of them require elaborate sanitation measures (like raw diets do). They’re all available for home delivery via Chewy and they’re all absurdly simple to prepare: just scoop it and serve.

There’s just one key difference. Both Hill’s Metabolic and Royal Canin Glycobalance are prescription-only dog foods, meaning they are only available with a veterinarian’s prescription.

If you try to buy them from Chewy without a vet’s blessing, you won’t be allowed to complete the transaction.

Ketona isn’t like that. It’s available for all dogs, regardless of whether your vet has written you a prescription for it. So while it’s not a huge deal, it’s fair to say that Ketona is also the most convenient of the three competitors.

Criterion Three: Impact on Blood Sugar and Exogenous Insulin Needs

This is where things start getting interesting. 

For most diabetic dog owners, this is the single most important issue. The differences in price and convenience are minor enough that most pet parents are willing to overlook them if they result in a product that actually “works” better.

What makes diabetic dogs different from healthy dogs is diabetics are unable to naturally produce enough insulin to manage high blood sugar concentrations. So you can think about whether or not a diabetic dog food “works” in two different ways: (1) to what extent does it minimize postprandial blood sugar levels (“postprandial” just means “immediately after eating,” when levels tend to be highest) and/or (2) to what extent does it reduce the amount of exogenous insulin that needs to be administered in order to bring those postprandial blood sugar levels under control?

These two different concepts are really just two sides of the same coin (because lower blood sugar levels in dogs require smaller exogenous insulin doses). Scientists and clinicians often use a single term to encapsulate both of them: “glycemic control.” A diabetic dog food can be said to “work” if it provides a diabetic dog with better glycemic control—meaning lower postprandial blood sugar levels and a reduced demand for insulin injections.

As we write these words, no studies comparing these products against one another have yet been published in any peer-reviewed journals. (Although researchers at the University of Guelph are presently working on one, with data expected by 2024.) So we have to dig a little deeper if we want a good answer.

More particularly, we need to understand how the three competitors work. The nutritional makeup of these three diets are actually quite different from one another, meaning that they help with glycemic control in somewhat different ways. 

Recall that the primary driver of canine blood sugar levels is the amount of digestible carbohydrate in the dog's diet. As we explained in detail here, all digestible carbohydrates get converted to glucose during digestion. So, while other factors can influence blood glucose levels, none can do some with as much vigor and potency as dietary carbohydrate intake.

For this reason, minimizing digestible carbohydrate intake has been shown to be by far the most potent nutritional strategy for reducing postprandial blood glucose in dogs. (Take a look at this study to see just how huge the impact tends to be. After evaluating the glycemic impact of fifteen different nutritional profiles, here’s what they concluded: “the starch [digestible carbohydrate] content of the diets is the primary determinant of postprandial glucose.”) So, naturally, choosing a low- or zero-carb pet food tends to be the best way to keep blood glucose levels (and insulin needs) low. 

Our three competitors feature markedly different amounts of digestible carbohydrate. By weight, Ketona is only about 5% digestible carbs. That’s way lower than the other two options. At a bit more than 30% digestible carbohydrate, Royal Canin Glycobalance contains more than six times as much digestible carbohydrate as Ketona. And Hill’s Metabolic is even worse! At more than 35% digestible carbohydrate, it contains seven times as much dietary carbohydrate as Ketona! 

Those are some pretty massive differences. In the one nutritional factor that matters most to diabetic pet parents Ketona is so far ahead of the two prescription-only diabetic dog foods that the products really aren’t even in the same ballpark.

In fact, the differences are so significant that you might be asking yourself why on Earth are Glycobalance and Hill’s Metabolic commonly used with diabetic dogs in the first place. It’s a good question! Part of the answer is that, amazingly, the other dog foods sold by Hill’s and Royal Canin contain even more than 30-35% carbohydrate. So, relatively-speaking, Glycobalance and Hill’s Metabolic really are better options for diabetic dogs than the other products sold by those companies.

But there’s something else. There is also a second nutritional quality that has been shown to help reduce postprandial blood sugar levels in dogs (though not nearly as strongly as carbohydrate restriction), and it is also a part of this discussion.

That second nutritional quality is fiber content. Technically, dietary fiber is actually a kind of carbohydrate molecule too. But unlike digestible carbs it doesn’t get broken down into glucose during digestion. Instead, it passes through your dog's body without being digested into caloric energy, meaning that it never becomes glucose and doesn’t flood your dog’s system with a torrent of sugar after each meal.

To the contrary, there’s evidence that fiber tends to slow the rate at which digestible carbs are broken down and absorbed into the bloodstream. As such, all else being equal, higher-fiber diets are thought to produce somewhat less pronounced blood sugar spikes than lower-fiber ones. (The evidence supporting this idea, however, isn’t particularly strong. In the study mentioned above the researchers found that the fiber content of the diet had no impact on postprandial blood sugar.) The impact is not nearly as profound as the impact of minimizing carbohydrate intake, but all else being equal it’s certainly better than nothing.

At 10% and 11% fiber, respectively, both Royal Canin Glycobalance and Hill’s Metabolic contain somewhat more fiber than many mainstream dog foods. But, at 11%, so does Ketona. So all three of these formulations use elevated fiber levels to help slow the absorption of glucose—but in the case of Ketona there’s far less glucose to be absorbed in the first place.

And that’s what makes Ketona such a clear winner on this issue. Because Ketona contains roughly the same amount of fiber as the other two competitors but only a tiny fraction of the digestible carbohydrate, it wins this aspect of the competition by a landslide. It works better, period.

Criterion Four: Other Nutritional Considerations

The fourth and final criterion in our analysis is the extent to which each of our three competitors provides diabetic dogs with health-related benefits other than improved glycemic control. To break this one down, we need to compare the complete nutritional profiles of the three products.

We’ve already highlighted two important things about those profiles: (1) all three diets contain about the same (relatively high) fiber levels and (2) Glycobalance and Hill’s Metabolic contain around six and seven times as much digestible carbohydrate as Ketona, respectively. 

Let’s pause there. In addition to its positive impact on blood sugar and insulin levels, carbohydrate restriction has also been shown to offer dogs other health benefits. The most important of which is it helps dogs shed unhealthy body fat. As we discussed in this article, obesity is the single greatest health problem faced by dogs in America today. The disease impacts more than half of the dogs in the country and it is deadlier for a dog than a lifetime of smoking is for a person.

Studies have consistently shown that dietary carbohydrates are more fattening for dogs than other nutrients, calorie-for-calorie. This means that reducing its carbohydrate intake is likely to make your dog leaner (and thus healthier), even if you don’t increase its exercise or reduce its overall caloric intake. That’s another huge benefit of Ketona.

There’s also a limited body of evidence suggesting that carbohydrate restriction may help reduce cancer incidence and/or improve cancer outcomes. This evidence is far less persuasive than the iron-clad evidence showing that limiting carbs promotes leanness and improves glycemic control in dogs. But, given cancer is so deadly and prevalent among dogs, it can’t be completely ignored. Read more here.

In addition to its lower digestible carbohydrate content, Ketona’s nutritional profile differs from the Glycobalance and Hill’s Metabolic profiles in another important way—it contains much more protein. Hill’s Metabolic is shockingly low in protein content (only 24%), whereas Glycobalance is only somewhat better (35%).

Ketona, on the other hand, contains about as much protein as any pet food presently being sold in the United States (at least 46%). That’s much more than Glycobalance and nearly twice as much as Hill’s Metabolic.

Not only is the protein content of Ketona much closer to the average daily consumption by a wild grey wolf than either Glycobalance or Hill’s, there is also abundant experimental evidence showing that it provides dogs with comparative health benefits too. The most important of these is the growth and maintenance of skeletal muscles and other lean tissues. Strong, healthy muscles are synonymous with good health for a reason: they’re a sign of good health! Not only do muscles enable dogs to do all manner of enjoyable physical activities, but they play vital roles in healthy metabolism too. And dietary protein is a necessary ingredient for building lean muscle mass (and staving off age-related muscle deterioration). All else being equal, diets with only limited contents damage canine health by denying the animal with the raw materials its body needs to build strong, healthy muscles.

Conclusion

Look, we get it. We have a very clear incentive to promote the healthfulness of Ketona. After all, it’s our product and we’re very proud of it.

But facts are facts. Dietary carbohydrates are horrible for dogs with diabetes because they increase postprandial blood sugar and exogenous insulin requirements more than any other nutritional factor, period. And dogs fed Glycobalance and Hill’s Metabolic will consume about as much carbohydrate every single day as dogs fed Ketona will in an entire week.

Similarly, dietary protein really is good for dogs. It’s necessary for building and maintaining strong muscles, which are the very definition of good health. And dogs fed Ketona will consume far more protein every day than those fed Glycobalance or Hill’s Metabolic.

Plus, Ketona is both less expensive and more convenient than Glycobalance and Hill’s Metabolic. At the end of the day, this competition is hardly a competition at all. In every way that matters, Ketona is simply the best diabetic dog food. So it’s no coincidence that it is also the fastest-growing diabetic dog food brand in the United States.