Giving a Pet Insulin Injection and Missing | Ask Dr. Joi

By |2018-03-06T13:46:29-05:00Updated: January 11th, 2018|Pet Care, Pet Diabetes, Pet Newsletter|38 Comments

I get some great questions from clients. They inspire me with article ideas and keep me in tune with diabetic pet owners. I enjoy interacting with our readers, and sometimes the questions are worthy of a newsletter. I bet if one person has this question and takes the time to write me, there are likely lots of folks with a similar question. Todays question is about grabbing too much skin during an pet insulin injection.

Dr. Joi, tonight I believe I grabbed too much skin when giving my dog his insulin injection and POSSIBLY gave an intramuscular injection instead of subcutaneous. It hurt him. He cried and snapped at me. I was having a difficult time pulling up skin in a different area is what I believe happened. Is this harmful to him? Will he still get the effects of the effects of the insulin or is it just lost?

When I teach folks to give insulin injections, I have them practice over the shoulder blades for the first month or so until they feel comfortable. Over the shoulder blades it is usually easy to pick up the “scruff” of a pet, and for some reason it doesn’t seem to bother pets much there. As you do it more and more you become an old pro. Once you have the hang of it you can start rotating injection sites. It is best to move injection sites around so you don’t cause scar tissue by poking the same area over and over again. Scarring could hinder insulin absorption.

Every now and then a poke may come near a nerve in the skin and hurt a bit. Or, as you experienced, a pet may wiggle and you might give it intramuscularly (IM). An IM injection could certainly affect that dose. It might be absorbed more quickly or not last as long as a subcutaneous injection (particularly if the insulin is one that is pH dependent), but don’t fret… It was just the one injection. You will be back on track the next injection.

Now, you know to rub the area before the injection, yes? Your mom probably told you when you were a kid to rub a boo-boo to make it feel better. That’s hard science! Really, when you massage the skin before an injection it stimulates nerve endings in the skin and it really does help the injection hurt less. When I give a pet an injection of any sort (insulin, medication, vaccine, whatever) I rub the skin for a couple seconds before the injection, during the injection and a couple seconds after the injection. It really helps decrease discomfort of the injection. Besides, this is your sweetie and you want to pet and hug your darling after the injection regardless for being a good pet. You want the injection to be perceived by the pet as an episode of love and cuddles rather than a poke, but in reality it is both!

Every now and then you will “miss”. Everyone does! Maybe you feel wet fur after the injection and wonder. Maybe you know right away that the needle came out. Rarely will you know that the pet got all or got none of the injection. If you are not certain, don’t give another injection. Really, a short period (well, 12 hours) of hyperglycemia for a missed shot is safer than a short period of hypoglycemia from being dosed twice. Just wait until the next injection time in 12 hours and start fresh rather than risk an episode of hypoglycemia.

Chin up. Soon you will be very proficient with insulin syringes and injections. Again, once you get the hang of it start moving the injection site around. Maybe go down one side of your pet one week then back up the next side the following week.

Have a question or comment? Then post below! I always enjoy hearing from my readers!


NOTE: Consult your veterinarian first to make sure my recommendations fit your pets special health needs.

About the Author:

Dr. Joi Sutton is a 1993 graduate from Oregon State University. She has practiced both in emergency medicine and general practice. Dr. Sutton has done extensive international volunteer work though Veterinary Ventures, a nonprofit organization that takes teams of veterinarians to undeveloped countries for humane medical care. She also runs a small animal practice in South Florida.

38 Comments

  1. Stacey January 18, 2018 at 12:24 pm - Reply

    Hello Dr. Joi,

    My Vet just reduced my cat’s U100 insulin dosage from 1 unit to 1/2 of 1 unit, but I cannot find syringes that start at half unit, even if I change gauge. It seems they all start at 1 unit, what can I do?

    Thank you.

    Stacey

    • Dr . Joi Sutton January 18, 2018 at 8:08 pm - Reply

      Stacy, they do make a 3/10 cc syringe with half 7 it markings. On our website they are item number sy5751509436. Or, you can out “half unit” into the search box on the adw website. They are made by UltiCare

  2. Stacey January 18, 2018 at 12:26 pm - Reply

    Hello Dr. Joi:

    The Vet just reduced my cat’s U100 insulin dosage from 1 unit to 1/2 of 1 unit, but I cannot seem to find any syringes that start at 1/2 of 1 unit, even if I get a different gauge, what do I do?

    Thank you

    • Dr . Joi Sutton January 24, 2018 at 6:17 am - Reply

      They do make half unit marking insulin syringes, but the first “half unit” may not be clearly marked due to space on the syringe. Search “half unit” in the adw website search box to see the options. In this case you may be doing what we vets have been doing for decades… estimating a half unit. I used to drive the vet techs nuts at the emergency hospital where I worked in the 1990s over this. I’d say, a smidge under or a smidge over or a half unit and they would be frustrated with me. I’m so thankful that there finally are half unit marking syringes these days. I wish a company would make a 1/10 cc syringe with half unit markings. That would be awesome. I’ve asked ulicare reps to consider this in the past but I’m guessing it isn’t a very difficult size to make. Do your best. 🙂 Joi

  3. Dennis January 19, 2018 at 10:25 am - Reply

    We all hate seeing our pets in pain. These injection tips are definitely a pet owner’s lifesaver. Moving the injection site sounds like a good way to make your pet dread the injection less. Thank you for sharing.

  4. Alma Cooper May 25, 2018 at 8:55 am - Reply

    Dr Joi,
    I appreciate your comments. I’m afraid I missed when I gave my dog a shot of insulin. I will wait until the next shot is due.

    I do have a question. My dachshund/chihuahua mix has gone from 19 to 13.8 lbs. The vet said give him 5 units (from 3) and canned dog food. He is losing so much weight. I had been giving him boiled chicken with broccoli and green beans and brown rice. She said I was giving him too many carbs and to change to the canned dog food. I’ve been weaning him out of the homemade food to the canned. It is grain free chicken.

    It seems to me with this minimal diet he will lose even more weight.

    I would like your thoughts on this and how I can help him gain some of his weight back. I’m finding it harder to grab the skin to inject.

    Thank you.

    • Dr . Joi Sutton May 25, 2018 at 4:46 pm - Reply

      The weight loss I sent most likely from unretulated diabetes, although it could be concurrent disease. Step one is to run a blood glucose curve!!! Blood glucose curves tell us if we should adjust the insulin dose up or down or leave it where it is. No matter how many calories you feed, if your pet isn’t unable to utilize those calories it can’t gain weight to achieve proper weight. Do you run blood glucose curves at home? Do you own a blood glucose meter? First let’s see how well the blood glucose is regulated.

      Next, if there hasn’t been a recent CBC and chemistry profile and urinalysis, have your vet run these tests! Also, ask your vet to evaluate the calories fed and likely increase portions fed.

      Keep me posted! You may also email me directly at joi.suttondvm@adwdiabetes.com.

  5. Connie June 15, 2018 at 9:32 am - Reply

    My dog has lost a ton of weight. She is down to 21 lbs from 33 a few years ago. Her diiabetes has been difficult to control. We have always done insulin shots in her belly (she hates the scruff!), but in the past year she has startes yelping with shots. I wonder if there is less wiggle room since she used to have significantly more abdominal fat. We tent. We rub. We warm the insulin. We have tried cold packs on her belly. Nothing is working. Is it just a consequence of too little belly fat?

    • Dr . Joi Sutton June 19, 2018 at 9:12 pm - Reply

      Connie, it is common practice for humans to give injections to themselves in the tummy, but I’ve never given a dog or cat an injection in the abdomen. Why don’t you try the scruff for a bit to give her a break.
      When I first teach folks to give injections to their pet I have them start in the scruff until they feel confident. Then I have them move the injection site around. I do typically have them inject the top side of the pet for ease. We rotate sites to decrease scar tissue at any one site. Scar tissue could affect absorption of the insulin.
      I do think the weight loss could make her more sensitive to the injections.
      Do chat with your vet about her glucose curves and run a blood panel, up and urine culture to see if you can find a cause for her weight loss. Hopefully when she isn’t so lean the injection she won’t hurt so much.
      Good luck!

  6. Matthew July 7, 2018 at 4:02 am - Reply

    I have a sibirian samoyed and for the past three months I’ve been giving her shots with insulin pen only at the abdomen and switching positions. She receives one shot in the morning at the right side and the evening at the opposite. She looks fine and her blood sugar is normal. However the thing that wories me is using the abdomen. That’s by my vet recommendation. I could not found antywhere on the internet using that site to give shots. Is it ok if I continue doing so or should go for the shoulders hips instead?

    • Dr . Joi Sutton July 8, 2018 at 12:15 am - Reply

      I’ve never given insulin injections to a pet in the belly. I typically stick to the topline of s pet, often massaging the pet with my non-dominant hand. Once folks get good at giving injections I have them change injection sites—go down one side of the pet and then back up the other. If you poke the same site each time pet pet could form scar tissue which could hinder insulin absorption.
      🙂 Joi

      • Matthew July 8, 2018 at 2:26 am - Reply

        Thank Joi, I’ll probably try doing that. You know Samoyedes and their thick coat and fur, I had to shave her stomach to manage to give the shots properly. If you are familiar and if it makes any difference I’m using a Levemir Insulin and Flex Touch Pen. Giving her 4 units with each shot. Her blood sugar dropped from 27 to 6.5 (in the morning one-hour post breakfast).

        • Dr . Joi Sutton July 9, 2018 at 1:16 am - Reply

          I like levemir quite well for dogs. 🙂

  7. Penguin Lopez July 23, 2018 at 5:22 pm - Reply

    I have a Mini dachshund has gone from 16 to 12.4 lbs. The vet said give him 2 units. I just did how soon should he be feeling ready to start eating? In reality he hasn’t eaten in 2 days.He wasn’t able to walk at one point or even lift his head he was dehydrated 8%. Hes drinking today and I started insulin just curious what to expect as far as appetite.Hes sleeping alot but seems peaceful should I force feed him? Is he ok as long as hes drinking?

    • Dr . Joi Sutton July 24, 2018 at 7:59 pm - Reply

      He does not sound stable. Please take him back to the vet clinic ASAP for evaluation.

  8. About Penguin July 24, 2018 at 8:52 am - Reply

    Update 1 st shot yesterday 6 pm 2nd shot this morning drinking well but not eating at all.any suggestions?

    • Dr . Joi Sutton July 24, 2018 at 8:00 pm - Reply

      A diabetic who is not eating for days should see a veterinarian promptly.

  9. Rose August 4, 2018 at 7:00 am - Reply

    To Connie

    My dog takes insulin and she don’t care for the scruff either. We give her her shot in her butt.her left side in the morning and right side at night.

    • Dr . Joi Sutton August 6, 2018 at 6:39 pm - Reply

      Once someone gets used to giving injections to a pet (usually in the scruff as it often hurts less there) I want rotation of injection sites. Repeat injections at any one site can lead to scar tissue and affect absorption of the insulin. I usually have folks go down one side then up the other. 🙂

  10. Cath November 6, 2019 at 2:14 pm - Reply

    My dog is not diabetic but someone has given her some insulin would it kill my dog

    • Dr . Joi Sutton November 9, 2019 at 3:32 pm - Reply

      Let’s hope this has not occurred!! Just as with humans, the effect of exogenous insulin (given as an injection rather than made by the body) depends on the dose.

  11. Keesha Bracamonte November 17, 2019 at 11:41 pm - Reply

    Hello Dr. Sutton,
    My 8 year old pitbull was recently diagnosed and we are having a real struggle getting blood glucose samples at home. Today was day 6 of insulin treatment and we planned to do the curve test. It was not successful. I did however test her urine for ketones throughout the day and took pics for my vet. There are no traces of ketones despite my Zola’s alarming 807 BG last Monday. We are desperate to get this right and my vet has told me that my dog may not be a good candidate for in vet curve testing because of her fear and strength. What can we do now? Thank you so much for your insight!

    • Dr . Joi Sutton December 14, 2019 at 4:23 pm - Reply

      Check out my article from a couple years ago about obtaining blood. In the search box for articles type: tips and tricks. Read that and persevere!
      Also, consider asking your vet or vet techs for lessons. Be sure to try the warm sock trick. 🙂

  12. Vernel Bryant November 20, 2019 at 10:45 am - Reply

    I have to be out of town for 3 days. I am my dog’s person. My husband says he will be able to give Petey his insulin(2-13 units a day). I have my doubts. I have researched pre-filled syringes and it looks like I’ll be able to do those. What if he can’t do the shots? I’ll be able to give his Friday morning shot and his Sunday night shot. So, 2 of the days he would get at least 1 dose. Saturday, maybe no dose at all. There is no one to ask to help, as anyone who could help will be with me. How will this affect Petey, if he misses the 4 shots in between?

    • Dr . Joi Sutton December 14, 2019 at 4:26 pm - Reply

      If he misses his insulin his blood glucose will be elevated and he will drink a lot and pee a lot, much like before your vet made the diagnosis. And he won’t feel very good for that time. Any chance you can convince one of the vet techs at your vet office to swing by to give the injections?
      If your husband is willing to try, let him!!! Not only will your pet feel better on this trip, it will free you to go on future trips.
      Best, Joi

  13. Sandy December 26, 2019 at 7:25 pm - Reply

    My Chihuahua gets three C’s insulin shot twice a day nobody told me that if you give a first shot that you don’t reload but I only gave her 1 Cs . Will this hurt

    • Sandy December 26, 2019 at 7:28 pm - Reply

      I meant to say I missed and they call it fur shot. She get 3 cs so I only gave her 1 c . I didn’t know your not supposed to do that is this going to hurt her

  14. Megan January 4, 2020 at 4:58 pm - Reply

    My Samoyed was just diagnosed and we are only two injections in so to say I’m still learning is an understatement. So far, the biggest hurtle is he doesn’t have very loose skin to pull up on to “tent”. That plus the amount of dense coat makes this super challenging, especially doing it by myself. Any advise on how to administer more effectively?

    • Dr . Joi Sutton January 5, 2020 at 10:04 am - Reply

      A Samoyed has a decent coat that you can use the fur to gently raise the skin. You may not be able to tent the skin in all animals. Gently raise the skin by pulling up on his fur coat and aim in that area. And of course rubbing the skin prior stimulates mechanoreceptors in the skin and makes the injection barely noticeable. Mom was right when she said rubbing it makes a boo boo feel better!

  15. Holly January 18, 2020 at 7:26 pm - Reply

    Just want to share With other diabetic pet parents. Ask your vet about using the style libre for your animal. It is a human sensor that can be prescribed at any local pharmacy. It can be attached to your animal and secured with skin glue. It will last for 14 days. You can either buy a reader at the pharmacy or use an app on your phone to scan the sensor and get immediate glucose readings. We are on our second style libre . It is amazing.

    Our senior pug has been having such trouble being regulated. Now anytime I’m concerned about his sugar being too high or too low I can simply scan him and I know immediately what his sugar is at. We have also compared the style libre to the Alpha track meter and it is the same. The style libre tops out at 500 MG so if your animal is over 500 the sensor will say hi. When this happens we test using the Alpha tracker and it is correct usually our pug is at 570 MG

    • Dr . Joi Sutton January 19, 2020 at 9:46 pm - Reply

      That’s great! I’m so glad you’ve had success with the freestyle Libre!

  16. Barbara McCord February 7, 2020 at 10:45 pm - Reply

    I just wanted to “second” the comment above about the Freestyle Libre! I have used it on two cats – the first cat had radiation therapy for Cushing’s disease and her blood sugar was all over the place until finally dropping to normal levels. The Libre kept us from giving too much insulin. For the second cat, he is not very cooperative (OK he is awful at the vet) and the Libre is allowing us to adjust his insulin dosage pretty quickly and without the high glucose levels often seen at the vet’s office. I will not be using it long term on either cat although the Cushing’s kitty had to have one for a couple of months. They really are very helpful!

    • Dr . Joi Sutton February 9, 2020 at 5:18 pm - Reply

      Anyone following this thread can look on YouTube for some great instructional videos on freestyle Libre for pets. They last 2 weeks and aren’t cheap but neither are Alphatrak test strips. I’m all for the freestyle Libre. Thank you for your comment! Dr Joi

  17. Carol Pooley February 27, 2020 at 7:23 am - Reply

    My cat is suppose to get her injections twice a day. I feel I have tried every which way, but I know she does not receive the insulin on a consistent basis. She has had two hospitalizations. Sometimes the needle bends, sometimes I smell or feel the insulin, sometimes I prick my finger. She is very thin. The only place it seems to work is holding the scruff & giving it on the right side near the shoulder blade. I will try as you suggested & continue to give it there for a month to make sure she gets the insulin. She is so thin often the needle comes out the other end before I realize it. I am so terribly frustrated & feel so responsible.

    • Dr . Joi Sutton March 6, 2020 at 8:34 pm - Reply

      It can be frustrating but you will soon be a champ! Heck, you are already a champ for trying so hard.

  18. Yvette April 16, 2020 at 9:00 am - Reply

    Hello I have a 11 pound Yorkie that gets 2 units of novolin n twice a day. After I gave him his insulin shot I saw a little blood in the syringe. Does this mean he didn’t get the dose? Also I am using 1/2 inch, should I go smaller inch since he’s a small dog?

    • Dr . Joi Sutton April 26, 2020 at 10:11 am - Reply

      Not to worry! He got the dose. It’s actually quite a rarity to hit a vein when you give a subcutaneous injection. When we give injections we will pull back on the plunger to make sure we haven’t hit a vessel if it is to go SQ. With the tiny little dose that is insulin, most folks just poke and push. And of cou she you should rub the skin as well to decrease any discomfort to the pet by stimulating mechanoreceptors in the skin. I prefer the 1/2 inch needle length to the 3/16. Most folks find the 1/2 inch length easier to use.

  19. Donna Marsala May 28, 2020 at 8:22 am - Reply

    Hi Dr. Joi…my corgi has had diabetes for over 2 yrs. We had his blood so on par that his levels were excellent. Then…at a vet appt for some mild stomach issues the vet decided to test him for Cushings though he had no symptoms of it. Since that test..we have not been able to regulate his blood. He has gone from 6 units in the AM and 61/2 PM to 71/2 both AM and PM. At first this seemed to be a blessing but now after a few days at this new number he had blood readings of 400+. He is on a strict diet..no treats…wake up every morning..365 days at 630 am and same routine at night…its getting so frustrating. We even changed vets and brought our insulin and needles to make sure we were doing the shots right. He gets Novlin N. Please give advice…we are thinking he isn’t getting the shot properly and all we want to do is make sure he is ok. Any advice?

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