Timing is Everything

By Dr . Joi Sutton|2018-09-07T14:27:54-04:00Updated: August 22nd, 2018|Pet Care, Pet Diabetes, Pet Newsletter|460 Comments
  • Cats and dog eating food

A friend recently told me that she always comes up with the perfect comeback. Her problem is that she thinks of it 20 minutes too late. Yep, sometimes timing is everything, especially the timing of Insulin Injections in pets.

When it comes to diabetes care of our pets, timing can make the difference between a well regulated diabetic pet and a “mostly” regulated diabetic pet. Routines may not be exciting, but routines make for a well-regulated diabetic pet! After two plus decades practicing veterinary medicine, I sometimes think I have heard it all. Then a client comes along and proves me wrong. Recently one of my own veterinary clients told me he routinely gave his cat the insulin then waited an hour before feeding his pet. I don’t know where this client got this notion as I had told him what I tell all my clients, to feed and give insulin at the same time every 12 hours.

I also hear from diabetic pet owners all the time about what they do. I often hear that they want to feed a variety of foods so the pet doesn’t get bored with the food. I sometimes hear that a client gives the food and then some period of time before (or sometimes after) will give the insulin. Sometimes folks give the insulin injections at times other than 12 hours apart. I am sometimes surprised at what folks do.

So let’s chat about my preferred order of events for diabetic pets and why:

French Bull Dog with OwnerEvery diabetic pet is a unique experience. And yet, in general it is best to give equally portioned meals and equally portioned insulin injection every 12 hour as the norm. That is the ideal. Diabetic cats on tight diabetic control or pets who are tough to regulate may be a different story, but for the majority of diabetic pets, this is my preference. There is less potential for errors when there is a routine!

Humans usually ponder what they are going to eat, check their blood glucose, then give themselves a dose of insulin based on their blood glucose level and the type and quantity of food they are about to ingest. Diabetic humans are in control of their actions. And they know how they will likely react to a particular food. Clearly low carb foods will affect the glucose less than a high carb food. They know if they feel hungry before they inject themselves. We hope they make good food choices, but they can and will alter their insulin dose based on those food choices. Humans like variety in their food choices. They are in control of their actions and know if they will eat. They have an opposable digit and give themselves insulin injections. Pets can’t do this.

If we wish to minimize the variability of how much insulin to give, we must give the same diet in the same portion repeatedly to pets. Until pets can figure out how to inject themselves, please don’t change your diabetic pet’s diet on a day to day basis. Yes, pets do like treats and variety, but they would prefer to “feel good” by having good glucose regulation over a variety of foods.

Now, whether one waits to see if Fluffy is eating before giving the injection is another story. For folks who have a pet with a hearty appetite that couldn’t imagine missing a meal, they may give the injection as the pet dives into dinner. A feeding frenzy is definitely a distraction to the quick poke of an insulin needle. For folks who have a finicky eater, they might watch to make sure the pet truly eats before giving the injection. Nonetheless, I would feed the pet essentially at the same time as the injection rather than waiting any length of time. The insulin needs something to work with. If food is not given with the insulin the pet could become hypoglycemic.

How about the timing of meals?

The timing of insulin injection with cats and dogDoes it matter if a pet eats in between insulin injections? Yes. Just as giving insulin without food can cause a low blood glucose reading, giving food without insulin will cause an elevated blood glucose test result. If you give a snack in the middle of the day, the blood glucose will likely rise due to the snack.

Different Eating Habits Of Diabetic Pet

  • Pets can dive into their chow with such gusto you are lucky to get your hand away before setting down the food bowl.
  • Some diabetic pets are more finicky about if and how much they will eat.
  • A pet can have erratic blood glucose numbers and are more difficult to regulate.
  • Hard to manage pets are so difficult that their humans are forced to check a blood glucose every time they fed the pet and adjust the insulin dose based on the appetite.
  • The easiest to manage pets are very regular and predictable regarding blood glucose.
  • No two diabetic pets are the same.

If I had my way, diabetic dogs and cats would be fed twice a day with their insulin injections. That sounds all very good on paper, but the truth of the matter is that our pets may have a different opinions. Cats especially are notorious for nibbling throughout the day. I joke that in my home pets get the same authority as humans – that it is a “democracy” in the Sutton household. In all honesty, however, the truth is that the cats wear the pants in my family. I have never had a dog boss me around so much as my cats do. If I were to feed my cats a mere two times daily, there would be no end to them telling me about it. My particularly food-motivated cat sometimes looks at the empty food bowl and then looks at me. I’m certain she is thinking, “Human, are you daft?”

My compromise for diabetic pets who think they are constantly starving is to try to get them to eat the majority of their calories at the same time as the insulin injection. For dogs who insist on a mid-day treat, I encourage a low-calorie veggie such as green beans as the snack. For cats, it is the same low-carbohydrate food as they receive as a meal, but hopefully the majority of food is given with the insulin. This stubborn food-nibbling preference of cats is likely why we tend to have greater success with longer-acting insulin for putty tats (i.e. glargine, PZI and demetir). Glargine has a relatively steady action over its duration and has been referred to as a “peak-less” insulin. Most dogs readily accept “meal” feeding twice daily, so we tend to go with intermediate-acting insulin as our first choice, such as Vetsulin and NPH.

If you have a diabetic with a healthy appetite you are lucky! It is a blessing to have a food-motivated diabetic pet compared to a finicky diabetic pet. It makes it much easier to treat the diabetes. It’s easier to predict how much insulin to give. We evaluate the insulin dosage based on periodic blood glucose curves. You probably don’t need to check a glucose before each and every injection once your pet is regulated IF you give equal portions and equal doses of insulin every 12 hours and IF your pet’s glucose is predictable. Of course, you must always use common sense.

Speaking of finicky diabetics, why might a diabetic pet not want to eat?

The Timing of Insulin Injections

  1. Hyperglycemia can cause nausea. If a pet isn’t well regulated, the pet may not be hungry due to nausea. Yes, diabetics are often hungry, but they can be hungry and nauseous at the same time. If I have a diabetic pet patient who isn’t eating well I often send a prescription of Zofran or Cerenia to see if it helps the appetite. Regularity of appetite makes it so much easier to treat a diabetic pet.
  2. Additionally, pancreatitis is a common cause of diabetes in pets. The pancreas is, afterall, the organ that makes insulin. Pancreatitis causes nausea and abdominal pain. Many diabetic pets have chronic smoldering pancreatitis.
  3. Diabetic pets are often immunosuppressed. A high blood sugar can affect the function of white blood cells, so infections such as kidney or bladder infections could cause a poor appetite.

The above are discussion points with your vet if your diabetic pet is a finicky eater.

Timing of Insulin Injections: Before or After Meal?

Now, do you give the insulin injection before or after the meal? I typically wait to see if a pet will eat before giving the insulin injection. Again, diabetic humans usually give themselves the insulin a few minutes before they eat. The reason we wait until the diabetic pet is eating before we give insulin is actually pretty obvious: we wish to see if the pet will eat. If we give a pet an insulin injection and then the pet doesn’t eat, hypoglycemia may ensue. For good eaters who are well controlled, I will give the injection as the pet dives into the food bowl. For finicky pets, I’ll check the blood glucose and then decide how much insulin to give, taking into account how much the pet eats.

Life sometimes get is the way of our plans, but do your best to give the injections every 12 hours. Occasionally I hear of clients giving insulin injections 10 and 14 hours apart or 11 and 13 hours apart due to their family’s work and sleep schedule. Strive for 12 hours apart. Consistency is key to diabetes regulation. I encourage consistency of timing of injections and consistency of portions fed. Every family has individual quirks and schedules, but we all do our best for the love of Fluffy.

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

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.

460 Comments

  1. Gillian Nash December 2, 2022 at 7:12 pm - Reply

    Really interesting and useful article, and I am going to adapt my routine to incorporate the tips given.
    My cat is approximately 13 years old, and diagnosed with diabetes around 2 months ago, 6 weeks after I noticed she was losing weight. She has gone from being a finicky eater to asking for food constantly. I have occasionally given her two pouches instead of one at one sitting (in the past, she grazed on dry food during the day, and had one pouch of wet food at night), but will now stick to set amounts. I will inject while she is eating in future. Noted that dry food is not advised (vet mentioned this due to lack of water content). I am having difficulty with the 12 hourly schedule. I try to inject around 10.00/10.30am, & 12 hours later, but have forgotten a couple of times due to other things happening (work-related).
    I have food-related questions; should I buy diabetic food (can’t get locally), or is Felix (Panda’s preference) OK? Should it be 50:50 as a compromise? Is one pouch morning and evening enough? Regarding the timing of the injection, I will endeavour to keep it to 12 hourly intervals. On the odd occasion where this isn’t possible, is it OK to inject Panda up to an hour earlier or later while feeding?
    Thanks again.

    • Dr . Joi Sutton December 4, 2022 at 4:21 pm - Reply

      Do chat with your veterinarian who has examined Panda regarding portions. The prescription diabetic foods are great, but if your kitty has a strong preference for a different food, 50:50 is fine. It is important for kitties to eat a low carb diet which means canned food. (Dry food is much higher in carbohydrate content than canned food.) There are “cat food composition charts” available for free on the internet that will tell you the carbohydrate content for all commercial cat foods. Ideally the carb content should be less than 7 to 10%. Purina DM canned has a mere 4% carbohydrates and most cats find it very tasty. That is my “go to” when I first diagnose a diabetic cat, but of course there are other great cat foods. Life is not perfect… 12 hours is ideal, but so few of us can get home exactly every 12 hours so an hour either way is usually okay.

  2. Gabrielle November 29, 2022 at 6:59 pm - Reply

    Hi 12 yr Cairn terrier Dx 7 years ago.
    You mentioned why to inject q12h but I didn’t see why or risks injecting 2-3 hours later.
    Can you elaborate please.
    Thank you

    • Dr . Joi Sutton December 4, 2022 at 4:13 pm - Reply

      If you give the insulin 2 to 3 hours after the meal there will be a 2 to 3 hour period of high blood glucose. High blood glucose affects the quality of life in that it makes the pet thirsty and pee more often and prone to urinary tract infection and immunosuppression and so forth. We want the blood glucose as close to the normal range for the majority of the day. If you give the insulin when the pet eats the meal (typically every 12 hours for meals) the insulin acts upon the energy in the food. The pet feels better when the blood glucose is well regulated. Of course you’ll need to monitor the blood glucose with periodic blood glucose curves either with a blood glucose meter or a continuous blood glucose monitor. Make sense?

  3. Brenda November 2, 2022 at 5:13 am - Reply

    Very informative thank you.
    I have a 10 year old silky Yorker who was diagnosed in April of this year. He eats twice a day and gets a small “meal” in between of 1/8 c. Boiled skinless chicken and a chicken jerky treat, no sugars in it. My problem is I cannot get his BG to maintain some sort of consistency. He is all over, usually high then around 150’s
    His nose is showing signs of severe dryness again like when he was first diagnosed. I do not change his food and he gets the same amount every meal. Now he is dropping fast after insulin and going very low so I give him some food to stop him going hypo then he goes hyper until the next day. I’m scared and stressed, what am I doing wrong? Please help.

    • Dr . Joi Sutton November 6, 2022 at 12:54 pm - Reply

      First of all, you should chat with your veterinarian about this! Your vet will surely want a blood glucose curve OR even better (since you say he “dropping fast after insulin and going very low”) perhaps asking your vet to apply a freestyle libre sensor. He might have what is called Somogyi swing where the insulin dose is too high for his needs, causing hypoglycemia and then his liver responds by making blood glucose. He might need you to back off on the insulin. The only way to know is to either run a blood glucose curve or use a sensor. Dr Patty Lathan is a veterinary internist/endocrinologist and she even has a video posted on YouTube how to apply it. Again, chat with your veterinarian. 🙂

  4. Pat Mitchell October 26, 2022 at 10:26 am - Reply

    Very informative. Would like to know what would cause my healthy 5 yo female Corgi/ Lab cross to get diabetes & is it possible for her to go into remission.

    • Dr . Joi Sutton October 27, 2022 at 3:11 pm - Reply

      It’s rare for diabetic dogs to go into remission unless they are intact females and having pregnancy or pseudopregnancy and are under the influence of progesterone. In those cases spaying the pet can result in the diabetes going away.
      Kitties are another story. Tubby cats can get what is called glucose toxicity. Cats are true carnivores and in nature they don’t typically eat many carbs. Dry kibble is high carbohydrate. If a cat is on a high carb diet, especially if also overweight, they can become diabetic. The high blood glucose can inhibit the insulin producing cells in the pancreas. Going on a low carb diet (low carb canned food only) and insulin if the blood glucose is high enough to warrant can help reverse the glucose toxicity and result in diabetic remission.
      I think the most common causes of diabetes in dogs are obesity and pancreatitis. Keeping your pets thin (whether dog or cat) can decrease the risk of diabetes.
      best,
      Joi

  5. Mirjana October 10, 2022 at 1:24 pm - Reply

    I love this article. I have a chocolate labrador mix (mixed with a certain type of hunting breed, so naturally slimmer than labradors).

    She is 6 and a newly diagnosed diabetic.
    She eats well and we inject her 12 hours apart, usually before food as she eats without issues. I will switch to injecting during food, as it does make more sense.

    I work in healthcare, so I was thinking about the amount of insulin.
    Her blood levels vary throughout the day. She receives same amount of food twice a day, but despite this, her levels are very different and never the same.

    Usually she ranges between 4 and 16 (I am in Europe, so not sure what measures you use), so naturally we give her more or less insulin depending on how high the sugar levels are.

    My question is…should we give her always the same amount of insulin, regardless of her sugar levels? Or, should we always adjust ? I am asking because my friend has a diabetic dog and she always gives her the same amount, regardless of how high her levels are.

    Any additional advice is helpful.

    Thank you!

    • Dr . Joi Sutton October 17, 2022 at 3:16 pm - Reply

      Great question!
      If your doggie’s blood glucose varies a lot, you may be one of the diabetic pet owners who gets to adjust the insulin dosage with each feeding. Some pets are easy to manage and some are difficult. I think a lot of pets are unfortunately unregulated. The most common sign of hypoglycemia is nothing at all… It needs to be down around 30 mg/dL for a pet to seizure. I wish more folks would measure their pet’s blood glucose at home!
      Factors such as temperature (say, Florida summertime versus Alaska wintertime) can affect the absorption of the insulin. For insulins that require mixing, if the person doesn’t mix it adequately it could have different amounts of insulin in the volume. The pet’s appetite may vary from meal to meal. And then there is physical activity! Just as exercise before or after a meal affects blood glucose in people, the same is true for pets.
      I do prefer owners stick to feeding approximately every 12 hours and avoid snacks, but sometimes life gets in the way.
      As a new diabetic pet owner, you might check out my Back to Basics articles I wrote a few years ago on this website. The 2018 AAHA Diabetes Guidelines are also great. And veterinarypartner.com has some great articles for newly diagnosed diabetic pets.
      Best,
      Joi

  6. Cheryl D October 2, 2022 at 10:21 am - Reply

    I’m one month into my kitty’s diagnosis. She’s a 10yo calico and a very healthy eater. The only way for me to hit the 12 hr insulin schedule is to give her a couple spoonfuls of her wet food while giving her the PM injection. #1, is that acceptable? 2nd question, she’s always telling me she’s starving, I can’t get her food down fast enough. Is this typical of diabetic cats? I don’t test at home because my vet told me it’s difficult to do. BTW, your article helped a lot.

    • Dr . Joi Sutton October 9, 2022 at 7:07 pm - Reply

      My cats have been telling me they are starving for decades. That might just show who wears the pants in my family.
      I’m glad you are feeding canned food. I hope you are only feeding canned food. Dry kibble is much higher in carbs than canned food and can cause your cat’s blood glucose to spike. We have a much better chance of getting into remission if a cat is on canned only food.
      It is NOT difficult to do home glucose testing. I have an article on this website about “tips and tricks” for home testing. Type “tips and tricks” into the pet article search box. I also have 4 “back to basics” articles that may help you.
      Good job! I think giving the insulin as your pet dives into a meal is great.

  7. Suzanne Dunaway September 22, 2022 at 12:49 pm - Reply

    We have a diabetic tuxie who did not wish to eat unti we discovered Mirataz, which works wonders. She still lies by her water bowl very often but her kidneys and interior have been tested and she has no ketones or problems with organs. I just wish we could monitor her glucose more easily than attatching a “capteur”(in French, we live in France) and using an iPhone to watch her levels. If you have any other ideas about that and, peeting outside the box (!), I would love to hear them. Thank you for a great article, which helped us realize that our schedule of 12 hours is a good one and we will stick to it, even with a meowing kitty who wants her Animonda….

    • Dr . Joi Sutton September 25, 2022 at 11:03 pm - Reply

      I’ve not heard of that brand but I imagine you are speaking of a continuous blood glucose monitor. CGMs are actually way easier than blood glucose monitors using a droplet of blood.
      So your vet checked a urine culture to rule out a urinary tract infection?
      VeterinaryPartner.com and http://www.vet.cornell.edu
      Both have good articles on house soiling and inappropriate urination.

  8. Emily September 19, 2022 at 8:18 pm - Reply

    My 10 yo mini Aussie just diagnosed as type 1 diabetic. I received the instructions on when injecting the insulin, but when should I check the glucose levels to keep track for my vet? I have the Alphatrak 2. Do I check before food/insulin and then again after? How long of a gap should be between feeding and checking the glucose? Thank you.

    • Dr . Joi Sutton September 25, 2022 at 10:52 pm - Reply

      We typically wait 5 to 7 days after starting insulinto run a blood glucose curve. We are looking to see how long the insulin lasts in that pet. And we are seeing how low the blood glucose level goes. We check the glucose every 2 hours from one injection of insulin until the next. And if the glucose drops below 150 mg/dl we check hourly until it rises so we don’t miss where it “bottoms out”.

  9. Peter September 18, 2022 at 6:43 pm - Reply

    I was nodding my head through this whole article. Agree, agree, agree.

    I’d appreciate your advice on something…

    I’ve slowly switched up my diabetic cat’s diet:
    – low-carb diet
    – wet food
    – twice a day meals
    – injections at meal time (3ml each time)

    I’m hoping to ween him off the insulin through a carefully controlled diet.

    Do you think that’s achievable? What would be a reasonable (safe) speed to reduce insulin?

    Thanks a ton for any help.

    • Dr . Joi Sutton September 18, 2022 at 6:57 pm - Reply

      Thank you.
      Are you testing your kitty’s blood glucose at home? That is critical to knowing when your cat is improving and hopefully going into remission. My favorite blood glucose meter for pets is the Alphatrak meter as it takes such a tiny droplet of blood to get a reading and because it is so easy to use.
      Typically we check a blood glucose curve 5 to 7 days after starting insulin and canned food. I’ve seen cats go into remission in 2 weeks. And yet, some cats never reach remission. The canned food is key for kitties to achieve remission. 🙂

      • Peter September 28, 2022 at 1:43 am - Reply

        Yes, I’m testing at home.

        At the moment, kitty has a FreeStyle Libre so I can just beep him for readings.

        My wife is the mommy of these cats, but I’ve been encouraging her to start improving their diet with better food. Although kitty’s blood sugar is still high, we’ve started to make their eating time twice a day with no snacks.

        I’ll keep on measuring and adjust as necessary.

        Thanks so much again for your reply to my comment.

      • Kiki November 30, 2022 at 8:08 pm - Reply

        Due to a job change I have to adjust the twelve hour span two hours down from 4:30 am to 6:00am morning and afternoon. How will that impact my dog? And what can I do to help her stay safe on her glucose levels? Thank you.

        • Dr . Joi Sutton December 4, 2022 at 4:15 pm - Reply

          She should accommodate well to a new schedule. When changing to a new schedule, you might change the dosage a smidge one day at a time. If you are cutting the time to be a bit shorter than the usual 12 hours you might cut that dosage of insulin a bit to slightly less insulin for that dosage. Chat with your veterinarian who has examined your pet for guidance.

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