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.
My cat ran out of insulin on the 24th, however I placed an order to have it delivered to me before then but somehow it got lost in shipping. Fast forward 7 days later and a new shipment being sent it is finally being delivered. But my question is can I give my pet the 4 units of insulin he was administered per vet instructions or should I start slow?
4 units is a rather high dose for the average kitty, but if that is the amount of insulin you and your veterinarian sorted to be the best dose for your cat, then you should be able to restart at that same dosage. Just to be sure, in a week or 2 you might want to run a “blood glucose curve”. We have several articles regarding blood glucose curves in our articles for pets.
My dog is small 11 lbs and get 4 u of insulin twice a day and his meals are split into 3 times per day. This morning when I gave him his insulin he moved and I felt the insulin on my finger. Should I skip his afternoon meal?
Yes, it is safer to skip a dose and have a brief period of hyperglycemia than repeat when you don’t know how much went into your pet on the first attempt and repeat and end up with an episode of hypoglycemia.
The bigger question is this: Why is he getting fed 3 times per day when he gets insulin twice a day? Most veterinarians (including me) advocate feeding a pet twice daily and giving the insulin twice daily—meals and insulin paired so that the insulin has energy to put into the cell. Chat with your vet about this odd pairing of 3 meals but 2 injections each day. Sort how to get your pet to 2 meals per day with your veterinarian who has examined your sweetie! 🙂
I have a 10 year old chocolate lab . Her dosage is 23 units. I wasn’t able to give her her injection until four hours past her usual time. When do I give her the next dosage? How can I adjust back to her regular time?
It helps if you have a blood glucose meter to guide your insulin dosing choices. Nonetheless, if you are 4 hours late you might just give half her normal dose if you aren’t able to check her glucose. Then check her glucose again before her next regularly scheduled dose.
If it is hours late you might just wait til the next regularly scheduled dose. Or, if you have a blood glucose meter you could give half a dose and check the blood glucose before the next regularly scheduled insulin dose. You can use the blood glucose to help determine the dose. Have a chat with your vet who has examined her. It’s ideal to have a glucose meter to help in situations such as this. 🙂
Why does my pet only get feed twice a day I feed a little three or four times because has not much appetite,, my small dog lick Volvo and potty’s little spots every once in a while is this normal for diabetes to do I have something else going on
Typically for diabetic pets we feed the pet twice a day and give insulin at those feedings. We strive to make this every 12 hours.
If your pet is licking her vulva and having urinary accidents, you should have her evaluated for a urinary tract infection! Diabetics are prone to urinary tract infections due to the sugar in the pet’s urine. Bacteria thrive in a nice warm sugary spot like the urinary bladder. Please take your pet to your veterinarian for evaluation.
My 13-year-old Italian Greyhound/Chihuahua mix has been on insulin for two years. Recently she’s been very sleepy. She had a rabies shot two weeks ago but got over three-day post sleepiness. I skipped a couple of insulin shots then. Should I skip her shot now?
Skipping shots because your pet is sleepy could be dangerous. It would be best to check the blood glucose with a blood glucose meter to guide the insulin dosing. Chat with your vet about home glucose testing. I wrote an article on this website years ago titled Tips and Tricks. It’s much easier than you might expect.
Taking care of my neighbor’s cats. I give 5 units of Vetsulin porcine insulin zinc suspension 4 AM after eating and 4 PM after eating. This AM the fur was wet. First time so I am assuming the injection did not get into the cat. I gave a second shot but a little less than 5 units. How soon will hypoglycemia set in if it occurs?
The timing of potential hypoglycemia depends on the patient. It could be quickly or in a few hours. Stay with the cat so you can give more food if you see anything suspect. Ideally check a blood glucose a few times today as well. In the future, if you miss and part or all of the injection goes onto the fur, please resist the temptation to give more until the next regularly scheduled insulin dose.
5 units is a pretty high dose of insulin for a cat. When the pet owner gets home she might want to chat with her vet about this. Hopefully they are doing regular blood glucose curves. If the cat is eating dry food 5 units is not unheard of, but of the cat is on a canned only diet the insulin dose is more typically or 2 units. Each patient is different.
Hello there, I came across your website after researching more on how to give a dog insulin shots. My relatives have a 12 yrs old Bichon, very skinny now and not much fat to have a good grip/pinch on some “scruff”. Eventually I need to start giving the insulin shots as they go on vacation.
They tried teaching me how they do it but I just can’t seem to grasp how fast and how much force I need to put in order to penetrate the skin. I’ve only gotten as far as “poking” the skin before their dog would slightly flinch from it, causing me to withdraw in hesitation and fear that I’m hurting him. The skin also caves in that the needle doesn’t penetrate. Could it be because I’m not pulling the skin (creating that triangular shape) with enough tension?
Do you have any advise? Tips? on what I should try doing next time? Or maybe how I can practice (I read and was told to try an orange).
Thank you for taking the time to read this.
The orange idea is a good one, but you can’t “tent” an orange. You don’t need to form a true tent on the pet either… just pull up the skin a smidge. Rubbing the site where you will inject is really helpfully it decreases the sensation of the poke. (Rubbing the skin stimulates nerve receptors in the skin… like your mama told you: Rubbing a boo boo does indeed make it feel better!). Before the family goes on vacation, go practice with them! The pet is likely sensing your fear. You can do this!
I usually give my cat a shot at 10 am and 10 pm. I’m not a morning person. I woke up at 12 pm gave him the shot . Should I try for 11 pm then back to 10 am schedule tomorrow?
A gradual change is great. Good job!
This morning I may have hit muscle and maybe shot didn’t go all the way in. But I can’t tell if fur is wet!
He only gets 2units insulin once in AM and ate a good breakfast. I’ll let him nibble before his night portion of prescription diet so he keeps some food in stomach. Nervous and feeling guilty. Ugh
This happens and you should not feel guilty. Don’t add more as you could then accidentally overdose your pet. Wait til the next regularly scheduled dose and give it then. The blood glucose will just ride a little high for the next 12 hours.
My dog was diagnosed with diabetes in February. We are still trying to get it regulated. She is 60-63 pounds and at 20 units. This morning she had a hypoglycemic event , lost her footing & appeared shaky. I gave her some pure maple syrup & after she appeared stable I fed her but DID Not give her her insulin. She wears a freestyle libra that she just got put in on the 22nd a few hours later she showed around 432. I can not get into a local vet & mine is out of town & closed one the weekend. I can not get her in until Monday @ 8am. Instead of risking her becoming hypoglycemic again can I reduce insulin until Monday or not give it at all (which seems to be the safe thing to do) . Shortly after the incident she was back to her normal self, ready to walk and bark at invisible things.
My Chihuahua has diabetes and I give him 4 mL twice a day today I gave him a shot and some of it came out the other and should I repeat the shot
I think you mean “unit” rather than “ml”. If you miss and give some into the fur, it is best to wait until the next regularly scheduled injection time and give the full amount of the next dose at the next meal. If you give too much (if you guessed how much you squirted out and guessed wrong) you could cause hypoglycemia. A short period of hyperglycemia is safer than a short period of hypoglycemia.
Hello my dog typically get 4units at 7am & 5pm. The dog sitter forgot to give him his insulin this morning. Should she give him the full dose as scheduled with his feeding at 5pm?
Yes, a full dose would be the logical thing to do after missing a dose.
Why is your pet getting insulin at 7 am and 5pm? Could you give. The insulin 12 hours apart? Either 7 am and 7pm or 5 am and 5 pm or 6 am and 6pm. Pets typically do best when the feedings and isn’t using are 12 hours apart. Have a chat with your veterinarian who has examined your sweetie.
This site is the absolute best I’ve come across. Every single question and answers were the exact fears I had. This site is excellent. ThankYou for posting it. I can’t say enough good about it!
Hello,
I am injecting .25 ml into my cat who has diabetes. Once I inject the needle, I don’t need to push down to insert the insulin. It appears that it’s already gone. What has happened ?
Perhaps you are accidentally pushing the plunger in as you push the needle into your pet? Hold onto the barrel of the syringe without touching the plunger when you insert the needle into your kitty. Perhaps you might give an injection in front of your veterinarian or vet nurses? Or, maybe take a video or you giving an injection and show it to your vet.
my 11 year old bichon was diagnosed 1 yr ago 1 was just told my dog h as diebetes and requires two shots a day 12 hrs apart I have tried every thing to give her shots but she just jerks her body steady it is just hit and miss and lands all over her fur I do have to give more and can only tell by using diastix if I got it in. She has not been back to the vet so I do the best I can she eats good no weigt loss there have been several time she starts to drink excess amounts of water and gets me up 2 or 3 times a night but the worry not knowing if i got it in is so stress full .
She also became blind after the first couple of weeks of her diagnoses she has no problems with her blindness she is such a loving dog I hate to part with her but I just can’t seem to get the inslulin in. It breaks my heartthinking of putting her down.
I think you need to go back to your vet for another injection lesson. And perhaps bring a friend who can help. Do you have a neighbor or family member who can help calm your pet (and you) as you get the hang of giving an insulin injection? I’m sure you will master this! Hug and praise your pet before the injection to Luther at ease. Then rub/pet/massage the spot to decrease the sensation when the tiny insulin needle enters and rub /massage the site afterwards as welll.
The blindness may be cataracts which happen with uncontrolled diabetes. Talk to your vet about ocu Glo and alpha lipoic acid and go see a local eye doc. (Most large cities have vet ophthalmologists.)
Please don’t give up! There is a learning curve to pet diabetes. There are great articles online. Perhaps the best is the 2018 AAHA diabetes guidelines which are readily googled.veterinarypart er.com has some great diabetes guidelines as well. My oldie but goodie on our website can be found if you type in “back to basics” in our pet articles search box. (It’s beena few years since I wrote these articles.)
Don’t give up. Get a friend or neighbor to help. And chat with your vet.
My Yorkie was diagnosed with diabetes a month ago with glucose 535 the first week and liver enzymes 1600. Weekly checks haven’t gone down. He lost 2.5 pounds in the first few weeks but steady 16 lbs the past 2 weeks. Very worried though that at week 4 the other day his glucose check was 634 an hour and half after his morning 4 UI dose. His meals have been chicken and rice (not too much rice) all month since he was having diarrhea. They boosted him to 6ui twice a day but said if still that high next week they would talk about insulin resistance. Should I take him for a second opinion?
When you take him into the clinic are they doing a blood glucose curve or just a spot check. Veterinarians use blood glucose “curves to help us evaluate how a pet is responding to a particular insulin and where it bottoms out to adjust the dosage of insulin. I like clients doing these curves at home so that stress doesn’t affect the blood glucose level (as being in a vet clinic can stress a pet). I’m not able to answer your question regarding a 2nd opinion based on this little bit of information. Certainly a blood glucose of 635 isn’t good. I think you need to chat with your vet who has seen your doggie. Chicken and rice is fine for recovery of a brief bout of diarrhea, but it’s not very high in fiber. High fiber diets are a good long term choice for diabetic dogs. As far as a 2nd opinion: It’s never bad to look for a 2nd opinion. If you do choose to have a second opinion, you might ask for a referral to a vet internist. Most large cities have a specialty hospital with a vet internist. Do chat with your veterinarian and tell him/her your concerns.
Dr. Join,
I got the insulin shot into the fur from my cat this morning. I have to wait until this evening for the next shot. Is it okay if I give her food now because she is hungry, the doctor had prescribed a appetite stimulate
Yes, feed the cat. Otherwise you might have an uprising! Good job not potentially overdosing her and having the patience to not give more insulin til the next planned dose. A short period of a high blood glucose is safer than overdosing your cat and having hypoglycemia. Good job.
Was preparing to give my dog the insulin shot—she moved poked my hand.
but continue to give her the shot. Will she be ok?
If you mean you are worried about injecting her after the needle was in you…. It would have been better if you had gotten a fresh needle and drawn up a new dose of insulin, but she is likely going to be just fine.
My dog is new at Being diabetic coma he doesn’t want me to be near him, I do massage before but he knows that that’s what I’m going to do and I’m afraid he’s going to bite me
You can get a soft nylon muzzle from your veterinarian to place on your dog before the injections. Chat with your vet as we never want you to be injured.
Giving an injection is a learned art. If you rob the area before, during and after with your opposite hand t will stimulate nerve endings in the skin and your pet may not notice the poke.
Again, chat with your vet for some help as he or she knows your pet.
Dr. Joi,
Thank you for this article! My 12 year old Yorkie has been diagnosed with diabetes and on insulin for a little over a month. Your article really helped to relieve my anxiety. I have 10+ years of experience working in the Veterinary field and many of those years specifically included routine sub q injections. I want other owners reading to know that EVERYONE misses now and again! I did! just this morning! and even though I knew not to double dose my dog, I didnt /don’t know enough about canine diabetes to stop my own anxieties from over taking me after feeling a wet spot when rubbing out the injection site. Which is why I panicked and ended up searching and thankfully found this article! Thank you for easing my mind and reiterating that not only does EVERYONE miss at times, but that it’s OK.
Thank you for your kind words. Yep, we are all human and make mistakes. 🙂
Hello, injected my cat this morning, he swatted at my other cat walking by and the small needle broke off. I can’t find it.
Well, if you don’t find it you could ask your vet to snap an X-ray to see if it is still in your kitty. I’m guessing the needle would be inert, but nobody would want a needle under the skin. Ouch! Search high and low before paying for an X-ray and chat with your vet. Good luck!
How long does it typically take of insulin regulation. We are on week 3 or shots at 6 units and the diasticks are still over 2++. My dog does also have cancer from what we were told. Do you think it’s insulin’s resistance or it takes time?
Occasionally we can sort the insulin dose in a few weeks time, but it may take months. We used to use urine glucose sticks decades ago, but now the norm is to check the blood glucose. Urine glucose strips have limited use. The blood glucose threshold your vet in dog kidneys for urine to spill into the kidneys is somewhere around 250 to 300 mg/dL. For cats it is somewhere around 200 mg/dL. You can see then how inaccurate urine glucose testing is if we wish to manage their diabetes. Chat with about home testing. I wrote a article a few years ago on this site to help folks do home testing. Look under “Tips and tricks”.
If the needle bends is my cat getting the insulin
Very likely your cat did indeed get the insulin.
Found out my 11 yr old poodle has diabetes back in April.Been trying to give 1 shot in morning 7 am or there about and 1in evening. He’s getting harder and harder to feed that early in morning. He was never used to eating that early before. I have used everything to try to coax him to eat. This morning he just wouldn’t eat anything. But in evenings I have no problem. Today he had to miss his morning dose because of not eating. It looks like this is an every day thing now. Not sure how to handle the situation. My vet told me that as long as I could get him to eat a bite of anything I could give him insulin. Then usually I could get him to eat around one in afternoon. But then it got
harder to get him to eat in evening. I am so frustrated that I can’t give him insulin on schedule. Do you have any advice for me. My poodle is my world and I feel like I am letting him down.
It sounds like he was a once a day eater even before he had diabetes. Have yo7 tried feeding him less at meal sothatheis hungry when the next injection time (12 hours later) he is hungry? That would be my first step. And of course if he isn’t eating an you wish to give him insulin you should check his blood glucose. That can help you and your vet how much insul8n to give in such situations.
It’s also possible that he may be nauseous. Diabetic dogs not uncommonly also have a smouldering pancreatitis which causes nausea. High blood glucose can also cause nausea. Ask your vet about a prescription of an anti-nausea medication to see if that helps his appetite. Cerenia and zofran (ondansetron) are both excellent anti-nausea medications. Zofran is now generic and quite affordable if you do a couple week trial.
Chat again with your vet. And if you aren’t check8ng the blood glucose at home already, I suggest yo7 gets Alphatrak meter. It’s the easiest pet glucose meter to use as it’s so simple and it requires such a tiny droplet of blood for a blood glucose reading.
I gave my r Rottweiler is insulin dose 2 hours late. Will he be okay?
It’s ideal if we can give the injections every 12 hours with equally portioned meals and equal activity after the meal, but… LIFE DOESN’T ALWAYS WORK THAT WAY!
Giving the dose a couple hours late is fine. If you find yourself in the situation where you might need to give the injection early then you could potentially find your pet in a hypoglycemic event, so you’d best check the blood glucose first and likely lower the dose IF you opt to give it.
No 2 diabetic pets are the same. Some diabetic pets are super easy to regulate. I’ve met them. And others are truly a nightmare to get regulated. Talk to your vet (who has examined your sweetie) and get his or her input if your schedule changes often.
I’m concerned that because I don’t pinch the skin on my dogs scruff that the insulin isn’t being absorbed correctly ?
I don’t think pinching the skin affects the absorption. Certainly some things can affect absorption such as cold weather versus hot weather.
It’s always a good idea to rub the injection site before you poke your pet as it stimulates nerve endings and decreases the pain felt by your pet. And rubbing the site after the injection for a couple seconds also helps decrease pain. (You love your pet and rubbing the injection site pre and post injection will be soothing emotionally for your pet in addition to decreasing pain sensation from the poke.
My 11 year old Bichon a treat (hard small) dog cracker each time with both insulin shots. While she is eating it I then inject her. She never moves and it works awesome. I wanted to give that tip to anyone else having trouble injecting.
I am concerned though. I have not been doing the exactly every 12 hours the past month. It will be at 8 or 9am then at 5 -530 pm.
I have not checked level (never have I just taje her in) but now she started drinking lots n lots of water and while in bed with me at night (she is also blind) and can not jump off bed, she peed in the bed.
Could her levels be off and does this affect her kidney’s? I feel horrible. I will start doing 6am n 6 pm each day.
I am planning to get her level check. I do not know the normal range nor know how to properly adjust the insulin so I go in with her and they test it.
Thank you so very much. You are so great to help us all.
If she is now blind and is peeing the bed, she is probably not regulated.
Home glucose testing with an Alphatrak meter will help you achieve regulation.
If she is going blind from diabetic cataracts, that is also a sign that her glucose is not regulated. See your vet promptly. I always start diabetic dogs on Ocu Glo just as soon as I diagnose diabetes as cataracts are such an issue for diabetic dogs. It’s the alpha lipoic acid that helps prevent cataracts in diabetic dogs. At this point I’d suggest you see a vet ophthalmologists see if there is any treatment to salvage eyesight.
Home testing is critical to a well regulated diabetic pet. We have lots of articles on this site including “tips and tricks” to collecting a blood sample.
Do chat with your vet pronto.
My dachshunds is 13 years old almost 14 actually and she normally gets 6 units of insulin every 12 hours the last two days she started getting a little more lethargic and really like more week almost like hypoglycemic I believe but I just want to make sure I did you give her some food she finally ate a whole plate of food today and she did eat actually last night but she didn’t eat much this morning but now she’s eating a full plate so my question is should I give her the whole 6-unit if she’s acting still lethargic but a little better and just reduce the dose my vet is not open today we have an appointment Tuesday
Sorry I was voice texting all of that stuff so it didn’t come out as crisp but I think you can all get the gist of this thank you for any support
I understood your question!
Here is a link to helping you check glucose at home. https://www.adwdiabetes.com/articles/tips-tricks-blood-sample-pet
Without knowing the blood glucose it’s a guess. Situations like this are why having a blood glucose meter at home is a good idea. (Additionally, you can do your glucose curves at home for greater accuracy than at a vet clinic where stress hyperglycemia is common.).
My cairn has been sick and diarrhea and is off food can I give her insulin with out food
When you say she’s is sick does that mean she is vomiting? I hope you have a blood glucose monitor. Without knowing her blood glucose you don’t know if she can take her insulin dosage. Contact your veterinarian immediately. And check her blood glucose so you can make educated choices. I have an article on the ADW website titled Tips and Tricks for obtaining blood for a pets blood glucose test that you might read.
We missed our 1st dose of insulin this morning. Should I give the afternoon injection like normal. We just found out Minnie (6 yr old; 15 #) was diabetic yesterday so I had to get the insulin today. The vet sent me home with 1 filled syringe . This whole process is stressing me out!
In general if you miss a dose you should likely wait til the next regularly scheduled dose. As you are new to diabetes care, look for the “back to basics” articles I wrote on our ADW website a couple years ago. Plan on getting an Alphatrak blood glucose monitor (as it is the easiest to use of the pet blood glucose monitors and takes the smallest droplet of blood to get a reading). Google 2018 AAHA Diabetes Guidelines which is a wealth of information about pet diabetes. And check out veterinarypartner.com which has some great education articles for pet owners about diabetes. Education is key to a well controlled diabetic pet. I’m not sure if Minnie is a dog or a cat. Know that feline diabetics have better glucose regulation on low carbohydrate diets.
Hello, Dr … Do you have any advice for giving insulin shots to a troublesome terrier? We have been giving our Cairn twice-daily shots (5 units) and at first it was relatively easy… we would give it to him while he was eating or otherwise distracted… Few problems… But over time he has grown to dread the shot; It’s less about the pain than the process. He fights like a proverbial mad dog. We have had to use a muzzle more often than not in recent weeks. It occasionally can be a 20-30 minute stressful struggle. He arches and twitches his body such that it’s impossible to keep a pinch still enough to inject. Help! Any tips welcome!
Do you rub the site before giving the injection? With any injection it I should best to rub and massage the pet before giving the injection and also after the injection. It stimulates the nerve endings in the skin and just as your mama said when you were little and had a boo boo, rubbing it does indeed mKe it feel better. You might pet him in such a manner at times when you aren’t following the rub with an injection as well. Pets can send your anxiety so relax and be calm.
Have you tried other injection sites just in case it’s a tender area for him? Most often I have clients start with injections over the scruff as that area tends to hurt less for a poke. Then as folks get less she’ll shocked with the idea of poking their sweetie I have them go down one side of the pet then up another side.
I’m glad you have a soft muzzle for him as terriers can be headstrong. If there is more than one person in the home, one can distract the pet and the other can give the injection.
A favorite treat such a a small piece of chicken can be given at the time of the poke as well.
Chat with your veterinarian for any ideas from the doctor who has examined him.
Best, Joi