Timing is Everything

By Dr . Joi Sutton|2018-09-07T14:27:54-04:00Updated: August 22nd, 2018|Pet Care, Pet Diabetes, Pet Newsletter|362 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.

362 Comments

  1. andrea booth November 13, 2021 at 1:24 pm - Reply

    Hello Doctor, My 16 year-old cat became diabetic @ five years ago following a course of steroid for a UTI. The vet admitted the dose was wrong, too-high a dose, and acknowledged that this had resulted in the cat becoming diabetic as well as losing her hearing. She hoped the diabetes would reverse but nothing could be done for the hearing. Anyway, after some trials of dietary and insulin regimes, the cat has been well-maintained for more than three years on twice-daily lantus 3 units at 8am and 8pm, and Fancy Feast low-carb canned food 3-4 cans a day. There is no sign of remission. She is thin, 4-5 pounds, is usually ravenously hungry and doesn’t gain weight. She is also thirsty and drinks a lot of water and voids a lot to the litter box. By “well-maintained” I mean her glucose is reliably between 8-13, has been as high as 22 rarely (sorry, Canadian units). That’s all background. The last two days she has started seizing, some quite violent seizures where she is stiff with legs splayed out to the sides, others with violent jerking motions. At times she is completely limp and unable to stand. Her “normal” now is constant small jerking motion to the head, and she is hallucinating, vigorously chasing small things that are not there and pawing at them (she is not a cat who usually wants to play or chase). She can still see normally and makes her way to the litterbox and threads her way through chair legs easily. She is excited, and panting loudly with her tongue hanging out like a dog. The lowest her BGlucose has been throughout is 4.5 (I spoonfed her small amounts because she was limp). The highest glucose that I have caught through all this was 12. Can this seizing and hallucinating result from a diabetic crisis? She does not seem afraid or in pain. Could it be a brain tumour? Her poor ears are sore from all the skin pricks.

    • Dr . Joi Sutton November 13, 2021 at 7:23 pm - Reply

      Your poor darling.
      A blood glucose of 4.5 (which is American units is 81 mg/dL) is not a level that would cause seizures. That’s usually when the blood glucose is down to the 20 to 40 mg/dL range. There are numerous causes for seizures, including brain tumors. Have you checked her blood glucose when she is seizing to make sure that she isn’t hypoglycemic at that time? It is important to know if that is the cause. If ever a diabetic is looking neurological but can still eat, put food in front of the pet right away. I think you should chat with your vet and also consult a veterinary neurologist.
      Best wishes.

  2. Paul October 17, 2021 at 8:07 am - Reply

    Good morning,we have a 9 yr old choc,lab that’s on novolin 1 and we have her on a pretty good schedule of every 12 hours after she eats but sometimes when a storm is coming she freaks out and will not eat last night would not eat she usually eats about 530pm so I left the food down and we went to bed and got up and the food was gone And I have no clue when she ate the food my question is do I still give her her same amount of insulin injection she gets 19 units every 12 hours thanks

    • Dr . Joi Sutton October 17, 2021 at 1:04 pm - Reply

      This is a good reason to have a blood glucose monitor. Knowing your pet’s glucose level will help you adjust insulin dosing when things aren’t going as per usual. I’d check a glucose and chat with her veterinarian.

  3. Cassie Rutherford October 15, 2021 at 1:25 pm - Reply

    Good Morning. I have. 8 lb peekapoo who has been dx with diabetes for 7 years. He has always been on vetsulin, but since around may we have seen poor control. Blood sugars above the 500’s and symptomatic all day we switched him to Novolin, his blood sugar curve became upside down. With high sugars during the day and frequent urination. In the evenings before dinner his blood sugar would drastically drop to 50’s. We started him back on his vetsulin 1.5 BID 3 days ago. After the first dose we finally saw a drop in his blood sugar during the day, mimicking a perfect bell curve. But today he was 540 with breakfast 1.5 units given 2 hours post his blood sugar was 688, 4 hrs post 336. I’m not sure if we need to increase his insulin. He use to be very brittle with vetsulin, he would have hypoglycemic events during the day and seem to have a symogi effect of climbing right back up in the evening. I can’t wrap my head around what is going on.

    • Dr . Joi Sutton October 17, 2021 at 1:02 pm - Reply

      You need to go over the results with your veterinarian who has examined your pet. 🙂

  4. Linda Hughes September 27, 2021 at 8:16 pm - Reply

    Lucky for me my kitty grazes and eats canned cat food throughout the day, so don’t have to worry about him eating preshot. He is on Humulin N 1 unit twice a day, I give him the shot 7 a.m. & 7 p.m. However just got a new job and have to be to work by 8 a.m. so is it ok to give him the shot half hour early at 6:30 a.m. so the next shot would be at 6:30 p.m. And then wean him down to 6 a.m. for shots to be given? As if I wait until 7 a.m. to give shot, I will be late to work, Job is a hour away!

    • Dr . Joi Sutton October 3, 2021 at 10:46 pm - Reply

      This is a question you should ask your veterinarian who has examined your cat. I’m very glad you are using canned food only as there is less of a blood glucose spike compared to eating dry kibble.
      Humilin N isn’t a typical insulin choice for kittens. More often bets use a longer acting insulin on kitties such as Lantus or pzi.
      The best way to know how your schedule adjustments have impacted the blood glucose is to do home glucose testing
      Do chat with your veterinarian. 🙂

  5. Jen September 22, 2021 at 9:40 am - Reply

    Hi Dr. Joi-thank you so much for this article. Our cat is 16 and has been on Lantus insulin since March. I inject him religiously every 12 hours, usually within 15 minutes after his meal. He has been getting breakfast, snacks, lunch, dinner daily for a very long time. Breakfast is almost always 5:30a.m. Snacks 11;30a.m., Lunch 2:00pm, dinner 5pm. He eats prescription Hills KD canned food.
    Question: we want to go on a 10 day trip and can’t kennel him. For convenience of neighbor, Is it safe to immediately delay breakfast until 7a.m., inject while eating, eliminate snacks and lunch and then give dinner at 7pm and inject while eating.

    • Dr . Joi Sutton September 26, 2021 at 10:02 pm - Reply

      Jen, I would.ove for you to feedhimtwicea day and give the insulin at mealtime. That is preferable to giving snacks and midday meal.
      Before you leave, alter his schedule to this new plan and watch his glucose. Doot a week or 2 prior to your trip.
      Do you have a blood glucose meter? It’s always good to check a curve 5 to 7 days after altering anything in a diabetic schedule (or amount fed or insulin dose). Have a chat with your vet. And be sure to have your petsitter over for dinner and a Diabetes lesson! Make sure your petsitter can always reach you. And let your vet know that your petsitter is authorized to bring him in for whatever issue needed in your absence.
      Happy travels.

  6. JD September 17, 2021 at 7:13 pm - Reply

    My 14 year old cat has diabetes not due to obesity. The likey cause is years of prednisolone for IBD. I’ve switched him to diabetes-friendly food. My vet had me start with 1 unit of Lantus once a day. After three weeks, there was no change in his glucose blood tests. I’m now doing 2 units for four weeks. I already had some concerns about my vet’s expertise with cats. Have you ever had a case for which once-a-day dosing was appropriate? Thank you!

    • Dr . Joi Sutton September 19, 2021 at 10:11 pm - Reply

      I have never seen a dog nor cat successfully treated (emulated blood glucose) on ONCE DAILY insulin injections. Lantus is typically given twice daily. Lantus is my favorite insulin for cats. I put diabetic cats on canned only food, preferably a diabetic canned food. You might want to read the 2018 AAHA dibetic Guidelines. Have a chat with you veterinarian.

      • JD October 3, 2021 at 7:12 pm - Reply

        Many thanks. I’ve made arrangements for a second opinion consultation with another vet who specializes in caring for cats.

        • Dr . Joi Sutton October 3, 2021 at 10:52 pm - Reply

          🙂

      • Sharron Coulson October 29, 2021 at 3:46 pm - Reply

        Hi I have given my dog is insulin too early will he be ok

        • Dr . Joi Sutton October 31, 2021 at 10:23 am - Reply

          Well, this depends on how early and what his glucose regulation has been. This is a good reason to have a home blood glucose monitor—-to help you make educated choices. Chat with your veterinarian for guidance.

  7. Crissi Hill September 4, 2021 at 3:39 pm - Reply

    My mother has a diabetic toy poodle who she does a fantastic job of keeping on a routine with her diet and insulin shots. Occasionally though, she needs me to watch her baby for a week or weekend when she goes out of town and I live a life much less routine than that of my mom. She of course leaves me very specific directions which I try so hard to follow but, because of my lifestyle it’s quite difficult to follow the instructions to a tee. Also, when my mom is gone, Porschea (her dog), tends to not eat much because she misses her. Now she’s my mamas everything, she got her when my daddy, her husband of 32 years died, and so she’s her very special companion. Whenever she’s gone and i am in charge of her dog, I have to get my boyfriend to help me give her the shots because she squirms relentlessly and makes it’s almost impossible, I don’t even know how my mom manages to do it twice a day every day by herself but like i said, Porschea is her everything and she’ll do anything in the world for her, which is wonderful because she’s an amazing dog, wonderfully behaved even without training she was never one to get into any trouble she’s just a lover and that’s great for my mom just the kind of dog she needed after my daddy’s passing. Anyways, when I’m responsible for her during these occasional trips, I struggle to give her the shots at the right times of day especially in the morning because sometimes I can’t get my boyfriend up to help me and I can’t do it by myself . Also it’s almost impossible to get her to eat in the mornings, usually at night I can get her to eat but morning time I rarely can. I want to know if this is very dangerous for her dog, because most of the times she’s on a strict routine and diet, except for the occasional times my mom is away. I try my hardest but sometimes it’s just out of my hands, I can’t do it because of my boyfriend, or because we live almost an hour from my moms house and his job requires him to randomly have to go to the area we live, at all times of day or night sometimes. I try taking her food or insulin with us if I can, but I can’t always keep it cold or don’t always get to do it at the right time. I want to know if this is detrimental to her health, even though it’s only occasionally, I don’t want to be the cause of anything happening to her because my mom needs this sweet dog. I would like your advice or opinion on my situation if there’s anything you can tell me to help or let me know if it is really going to effect her badly because like I said I don’t w an t to be the reason anything happens to her and I love her so much and my mom too, and would like the medical advice and opinion on this situation if that is at all possible. Please and thank you for taking the time to read this and hopefully getting back to me about this. Thank you so much.

    • Dr . Joi Sutton September 5, 2021 at 10:56 pm - Reply

      If you need to drive an hour to give the injections, perhaps everyone might be happier if her doggie was staying with you in your home when your mom is away.
      As far as a game plan for when she doesn’t eat breakfast, I think that would be a good question for her veterinarian who has examined her and knows her medical history. Some diabetic pets are well regulated whereas others are fragile diabetics. Home glucose testing can help you know if you need to adjust the insulin dose when a pet isn’t eating well. Chat with your mom and also with her veterinarian for suggestions.

    • Phyllis October 9, 2021 at 1:12 pm - Reply

      I have a diabetic cat..
      Was put on Novolin twice a day twelve hours apart…took him back to the vet and his glucose was over 500…I have an older cat so have been letting them graze on dry cat food, treats twice a day and the wet cat food before the shots…should I take the treats and dry away from my diabetic..wont be able to let the other cat graze..what do ido?

      • Dr . Joi Sutton October 9, 2021 at 4:58 pm - Reply

        Canned food only for diabetic cats typically results in much better blood glucose regulation than when a diabetic cat is given dry food. It can be difficult feeding 2 cats in one home different diets. I myself feed my cats different foods and it means I have to feed them in separate rooms. It’s tricky.
        Novolin isn’t a common choice for diabetic cats. Cats tend to do better with longer acting insulins such as Lantus or PZI.
        Chat with your veterinarian who has examined your kitties for guidance.

  8. Thomas Lee Garner August 21, 2021 at 4:16 pm - Reply

    Hello, I have a CHIHUAHUA Min Pin mix sho is 9 years old. Two years ago she got pancreatitis which turned into her being a diabetic. She was put on vetsulin two times a day and her sugar levels remained 800 plus throughout the day. I have used the Libre to monitor her sugar levels and the vetsulin didn’t work. The doctor at the vet school went to a seminar about diabetic dogs and talked to the speaker and the expert on diabetic dogs told the doctor to put my dog on Trujeo Human Insulin. My dog was the first dog ever to be put on it at the vet school. We did the libre 3 separate times and we settled on 12 unit’s once a day which I give at 630 PM everynight. I cannot do 2 shots a day as I don’t have help. At 12 units her levels were perfect. So I went yesterday and had her teeth cleaned and had a blood test done as well as a fructalose test and 2 months ago it was 405 last month it was at 450 now yesterday it was 545. I have been feeding her Royal Canine S/O moderate calorie. Today i went and bought 10 cans of the Hills Science Diet WD and Royal Canine Gloucester Canned dog food. The doctor wants to go back with the libre for 14 days which I’m going to do in 2 weeks I just don’t know if I am feeding her the correct food? I have read good reviews on the Royal Canine they have for diabetic dogs and the Hills Science Diet W/D. I’m going to try the new food if my dog will eat it. Do you have any suggestions on any type of canned dog food I need to be feeding her and how concerned should I be about the fructalose number that keeps going up? Again. She weighs 13 pounds and takes 12 units of Trujeo once a day as there is no way I can give her two shots a day because I have no help. So I have been feeding her the Royal Canine S/O moderate calorie I don’t think has been helping her. I would like your suggestion on what canned dog food I need to feed her. Also, how much exercise should she be getting a day. How many minutes a day should I walk her? I normally walk her 3 or 4 times a day but not for long due to the heat. She went blind and had cataract surgery and I have spent close to 120 yes 120 Thousand Dollars on her with visits food being in ICU the cataract surgery and I have no Insurance on my dog so the price of the food does not matter. I do not want to cook any food I prefer canned dog food. Any advice will be greatly appreciated. Also have you heard of any dogs taking Trujeo? Like I said my dog was the very first at the vet school to take it and it has not been approved for animals however it has WORKED so good. I don’t understand why her fructalose is rising because she is not drinking more water or not urinating in excess. So again I desperately need your opinion on what canned food I need to buy. I can buy a variety I just need to know what you recommend. Also , the Trujeo comes in a pen and I give it to her in her back muscle and she doesn’t even know she has gotten the shot. Will be waiting for your response. If you can email me I would greatly appreciate it because I think if I can find the correct food her sugar levels may come down and again be almost perfect. Oh one last thing, being I give her one shot every 24 hours and I am not home all day should I leave the food out for her to eat as she pleases? She is not overweight by any means but if the food is there she can eat when she gets hungry. My dog currently takes Denamarin twice a day for her liver and a capsule called Ursodiol 30 mg twice a day what do you think of those two pills? lI still feed her around 6PM before she gets her shot at 630 PM. Again looking forward to your response. I just need help finding out what canned food I need as it has to be low in fat. When she first went to the emergency room, the doctor said it was the worse case of pancreatitis he has ever seen and her blood was so thick they had to call a specialist in because at that time she wouldn’t eat the prescribed diabetic dog food. I feel if I don’t get her levels straightened out, she may suffer down the road. I have no kids so money is not the issue when it comes to my dog. Also, I will occasionally give her mirtazpine when she doesn’t eat or Entyce. Entyce seems to work much better. So after we put the libre on her we should know if 12 unit’s is sufficient or if we need to up it. Again, I need your help on what Low Fat canned dog food I need to feed her and how many minutes a day I need to walk her and how many times a day as I know exercise is important. Again I appreciate all of your help and looking forward to your response on the canned dog food , medications, and hoe much exercise times a day and how often. Thank You!!! Can you please email me at [email protected] . Thanks Again.

    • Dr . Joi Sutton August 22, 2021 at 12:16 pm - Reply

      Your pet is clearly a complicated diabetic. I’ve not used that insulin. And yet, once a day rarely is effective. You’ve spent so darned much money it might be best to hire a dog walker or pet sitter to pop by once a day on the days you work to give a 2nd injection. Or a neighbor perhaps?
      You might consider feeding the same canned food as the dry food. You mentioned Royal Canin. Royal Canin Glyconalamce and Royal Canin GI low fat are indeed good foods, but you must ask the vets who have examined her what diet is the best.
      Clearly she has liver disease if she is on denamarin and ursodiol. They are effective medications. I’ve never seen a side effect from either. Entice is extremely effective for appetite stimulation. Mirtazapine is very effective in some pets and not in others. It’s hard to gauge. Irtazapine also comes in a transdermal.
      These are questions you should be asking her team of doctors. Nonetheless, I think it would be worth hiring someone to help give the injections if you’ve spent 120k. Surely a petsittercouldnt be that much. Perhaps a vet tech at your vet’s office might want a side gig?
      Good luck!

  9. Dina Gordon August 16, 2021 at 7:02 am - Reply

    Hi Dr Sutton,
    My precious fur baby DJ was recently diagnosed with diabetes. He seems to be suffering from neuropathy in his hind legs. I read that this can reverse itself once we get his blood glucose levels under control. I’m assuming this will be a gradual process and can take some time. I also read that B12 can help with the process. What’s your thoughts?

    • Dr . Joi Sutton August 22, 2021 at 12:01 pm - Reply

      When I have a dog or cat with diabetic neuropathy I do give weekly b vitamin injections, but I don’t know that there is any definitive proof that’s it helps. Diabetic neuropathy takes a whi.e to present and takes a while (and patience) to resolve. Good glucose regulation, which means home monitoring of the blood glucose, is critical to resolution of diabetic neuropathy. When I diagnose a diabetic I encourage the humans to read up on diabetes. There are numerous current articles on pet diabetes on veterinarypartner.com and you just ant beat the 2018 AAHA Diabetes Guidelines. These are free online.

  10. Lisa Black August 13, 2021 at 9:53 am - Reply

    My schnauzer was newly diagnosed with diabetes and the vet started him on prozinc once a day and she seems to be a fan of the once a day injections and everyone else I know who has diabetic animals and everything I read they are on 12 hr injections. Would his blood sugar be better controlled with 12 hr injections?

    • Dr . Joi Sutton August 15, 2021 at 1:38 pm - Reply

      I have never seen a well controlled diabetic pet on once daily insulin. The odds of successful diabetes control is greatly increased with insulin injections every 12 hours. You might read the 2018 AAHA diabetes guidelines which are free online. It is an exhaustive review of pet diabetes.

  11. Carolyn Joyce August 8, 2021 at 11:07 am - Reply

    My little 11yr old dachshund is diabetic. She was spayed a month ago but it hasn’t made any difference to her insulin dose.
    Aside from trying to keep her glucose levels below 12 is there anything else I can do to prevent blindness? Her levels don’t seem to want to stay below 13. We feed exact portions, stick to the exact same insulin times (2 X per day, 12hrs apart, 30 mins after her meal. Considering this article Should we give it immediately after her meal ?)

    • Dr . Joi Sutton August 8, 2021 at 2:29 pm - Reply

      Good blood glucose regulation and a small amount of alpha lipoic acid (found in ocuGlo) can help lower the risk of diabetic cataracts in dogs.
      For most pets (good eaters) I recommend giving the insulin at the same time as the meal.

      • Barbara A Coulter August 12, 2021 at 6:34 pm - Reply

        Hi. I feed my Chihuahua a half portion of her food at 9am. I give her her insulin shot right before she eats.
        She gets her full portion of food around 4pm.
        Then at 6pm she gets her injection followed by her half portion of food.
        She is 14 lbs.
        I feed her Cesar dog food.
        My vet said not to change her schedule.
        Is this alright?

        • Dr . Joi Sutton August 15, 2021 at 1:34 pm - Reply

          Giving food at times other than when she is getting insulin is not likely to achieve good glucose regulation. Typically it is best for diabetic pet owners feed equal portions of food twice daily, 12 hours apart. And then you would also give equal doses of insulin at the time of the meals, again, that is 12 hours apart. This is of course provided everything else is normal.

  12. June Hirsh July 31, 2021 at 11:39 am - Reply

    Hi Dr. Sutton,
    We e been in contact before. Rosie is my 13year old diabetic cat. She receives 2and 1/2 units of lantus twice a day. I inject her as she begins to eat. She eats a can of Royal Canin or Hills venison with each injection. She begins begging for food a couple of hours before the 12 hours. During the day, I can leave my studio apt. at 2pm and return at 4pm and feed her. However, at nite she begins to scream for food two hours early (2-3am) and I have no place to go. I either have to hear her and have her jump on me for 2 hours or give her the food and injection within in 10 hours instead of 12. Sometimes I feed her within the 10 hours and give her the evening feeding 12hours later. So the time in the evening varies. She also wants me to be with her when she eats-so I stay up and hour. I can probably train her to eat without me.

    The big question is giving her the injection 10 hours later in the early am instead of waiting it out. Is this ok? It’s hard to endure her crying and diving on my for two hours.
    Thanks,
    June

    • Dr . Joi Sutton August 1, 2021 at 2:47 pm - Reply

      Hmmmm… Nobody wants sleep deprivation. Have you considered altering the feeding times to right before you go to bed (and then 12 hours later)?
      If your kitty is on a very low carb canned food diet then there will be fewer blood glucose spikes than if your cat gets canned food. You might consider giving a little piece of deli meat during the day when she is asking for food early. Do chat with your veterinarian who has examined her. Best wishes!

  13. Janet Longley July 29, 2021 at 5:39 am - Reply

    we are new to this our cavie (charlie) has just been diagnosed with diabetes and is on insulin x2 aday first day i was very scared i would hurt her but im on 3rd day now and its becoming easier i feed her then insulin straight after it makes sense she has to eat first , she is going for a glucose curve next week at the vet for the day the hardest for us is not treats if she has any i give her fresh chicken its hard as we meet alot of people every morning who give treats so i have to be strict and they understand ,our other dog has also been cut down on his treats which wont hurt him/ both have always been abit overweight so it may help them both to lose some, is it my imagination after only 3 days she does seem to have more energy i hope so hang on in there everyone we love our pets and even though i have to get up at 6am every morning i dont mind.

    • Dr . Joi Sutton August 1, 2021 at 2:51 pm - Reply

      It’s only your 3rd day and you seems to be adjusting well. Excellent.
      I’d love for you do get a glucose meter and do the testing at home. It’s more accurate as there won’t be stress hyperglycemia from being at the vet Clinic all day. And if there are issues such as inappetence or nausea you will have a meter to check the glucose and guide you what do do. My favorite meter is the Alphatrak simply for its ease of use. It also takes such a tiny droplet of blood that most folks can easily check their pet’s blood glucose. Home curves typically save you money as well.
      Consider reading the 2018 AAHA Diabetes Guidelines which can readily be found online for free.

  14. Laurie Powell July 20, 2021 at 10:47 am - Reply

    Dear Dr. Sutton, Thank you for this educational and inspirational article!

    Prior to one of my cats receiving a diabetes diagnosis, I would feed all of them wet food 3x a day. So far, I have not been successful with feeding my diabetic cat just 2x a day, especially when all of them show up and cry for that middle meal. What are your thoughts on feeding (and giving insulin) to my diabetic cat every 8 hours? I feel like it would work better for him.

    He currently receives 3 units 2x a day, so I would switch to 2 units 3x a day.

    • Dr . Joi Sutton July 25, 2021 at 2:48 pm - Reply

      I’d be afraid to give insulin 3 times per day to a dog or cat. The insulin injections could overlap and predispose your pet to hypoglycemia. Occasionally I’ll hear about someone giving insulin every 8 hours and it scares me. I’m glad you are feeding a low carb diet. Canned food is much lower in carbohydrates than kibble. If you are using Lantus (aka glargine) or pzi and a low carb canned diet, you could likely sneak in a tiny low carb snack such as a piece of meat or tablespoon of low carb canned food mid day (knowing it could spike the blood glucose a bit), but I’d strongly prefer you just fed more per meal and fed twice a day and gave insulin twice a day.
      Mid meal/insulin snacks spike the blood glucose. A low carb snack will spike the insulin less than kibble which is high in carbs. Make sense?
      If people do opt to give insulin every 8 hours I’d insist they checked the blood glucose before every insulin injection to make sure they won’t send the pet into hypoglycemia.

      • P. Reid August 11, 2021 at 2:00 am - Reply

        Dr. Sutton, our Yorkshire Havanese was recently diagnosed as a diabetic with a severe case of pancreatitis. His insulin dosage has been increased and we now give him 4 units twice daily…and have a Freestyle Libre affixed to help gauge his glucose levels. We have been very deliberate on the 12-hour schedule. However, he is a finicky and eater and sometimes that dictates our ability to give the insulin injections. At times, he has shown a lack of eating and/or will go to sleep. We feed him Fresh Pet foods and purchased some diabetic food from the vet to offer a healthy option. Any other suggestion?

        • Dr . Joi Sutton August 15, 2021 at 1:29 pm - Reply

          If he has pancreatitis he may have nausea. These are medications that can ease nausea such as ondansetron and cerenia. These can be given by mouth at home.
          If he is finicky and doesn’t eat well, you might chat with your vet about a sliding scale for the dose of insulin depending on the blood glucose level and amount of food eaten. Chat with your vet who has examined him about this.

        • Ingrid stulb September 5, 2021 at 10:19 pm - Reply

          Dr joi Sutton , After coming home from watching my grandchildren , my husband said her took our dog to our vet. We knew she was a diabetic but our vet said there wasn’t any place in Augusta Ga to take 24 watch over her. We found out from the Columbia SC hospital that she has diabetic ketatosis ! She has been there three days and nights ! I don’t want her to suffer and I hear I can check her sugar level at home. She is a picky eater ! I will do whatever to make her life worth living well ! So I hope all doctors understand that animals are part of a family We love her and glad we adopted her. Hope to hear from you!

          • Dr . Joi Sutton September 5, 2021 at 11:00 pm

            Diabetic ketoacidosis treatable but also life threatening and can take days to resolve. Unless there is another underlying issue, many pets successfully pull through a DKA crisis. I hope she does well. My heart goes out to you. Joi

  15. Hayley July 19, 2021 at 3:50 pm - Reply

    Hello,

    So, my little Amber a few months back was drinking so much, urinating more due to the water and lost nearly a kilo. After a trip to the vets, they confirmed that my precious Amber has diabetes.

    First off, trying to inject the insulin of caninsulin (2.0units) I’d chase her round the house and we both got stressed! Plan B came along, as usual she has her food at 6:45 am and 6:45pm. I shut her in the kitchen whilst she eats and once she’s eaten she is injected at 7am and 7pm. I find by shutting her in the kitchen I can go back in and get the insulin and inject her. She can’t run away, and neither of us are stressed. Amber isn’t bothered at all by her insulin injection anymore, it certainly helps having her shut in the kitchen.

    The vets first instructed me to inject 2units of Caninsulin twice per day. After a month, I did her blood curve every two hours and submitted them to the vets who then advised me to increase Ambers insulin to 2.5units, and after two weeks do the blood curves again so I have done that today and they are very much similar to the readings a few weeks ago, see below readings – very high first thing in the morning before food and then drops a little then a few hours later the reading is very very low and then throughout the afternoon creeps back up high again as her insulin wears off – I will submit them to the vets tomorrow and see what they say. The vets just came back and keep doing the same thing and do the curves again in a week. Poor ambers ears it breaks my heart pricking them.

    Amber would have biscuits in morning and throughout the day which is leave down whilst I went to work and in the evening she would half a wet food pouch, and probably a small few biscuits before bed time.

    I asked the vet should Amber have a change in diet, He said not, which I was quite surprised by, however I listened to them and I didn’t change the diet. The vet did suggest to change to senior food and wet food only, feeding only twice per day. Therefore now she only has senior wet food, one pouch in the Morning and another in the evening.

    she does appear to be still hungry, however I am so determined and she doesn’t get the treats like she used too.

    anyone have any thoughts, tips etc on diet and if I’m doing everything correct? I don’t really understand the readings below if someone could help me.

    The vet did say she could go into remission but I have idea on how long that would, I want to as much as I can for her.
    I used the alphatrak2 to do the readings.

    she is my world, and I will do everything I can to help my little Amber.

    Thanks

    6.50am – 20.02mmol/L
    7.00AM – Food x1 wet pouch
    7.15AM – Insulin 2.5units
    9AM – 13.1mmol/L
    11AM – 2.6mmol/L
    1.00PM – 2.7mmol/L
    3.00PM – 8.2mmol/L
    5.00PM – 17.9mmol/L
    7.00PM – 29.8mmol/L
    7.05PM – FOOD x1 wet pouch
    7.15PM – Insulin 2.5units

    • Jamie August 5, 2021 at 12:33 am - Reply

      My vet told me that my cat needed 240-260/kcal a day. That equals 1 and a half of the big cans (5.5oz). I don’t know how man kcal are in each pouch but your cat may very well be hungry. I’d definitely ask the vet to make sure you’re giving enough food. Good luck.

    • Tubs August 5, 2021 at 3:43 am - Reply

      Your cat is going too low!!! That’s hypo , hope you have spoken to the vet again , lowered dose etc

      • Dr . Joi Sutton August 8, 2021 at 2:26 pm - Reply

        I believe she was saying 12 mmol which in mg/dL would be a blood glucose of 216. The conversion is multiplying mmol by 18 to get mg/dL.

  16. aaron July 18, 2021 at 2:02 am - Reply

    My dog gets insulin twice a day (10am and 10pm due to my schedule), but eats twice in-between injections. I’ve noticed that about 6pm or so she starts to become lethargic, I test her blood sugar and it’s really high (28 – 32). What can I give her between injections to help lower her blood sugar?

    • Dr . Joi Sutton July 18, 2021 at 10:46 pm - Reply

      Please chat with your veterinarian who treats your pet. Why are you routinely giving meals between the insulin injections? It would be best for her to eat at the same time that she receives the insulin. It’s not a surprise that a feeding at a time other than when she gets an insulin injection will cause the blood glucose to spike. Do chat with your veterinarian regarding making the alterations to her routine. 🙂

  17. Linda Wilson July 17, 2021 at 5:19 pm - Reply

    My two mini schnauzers have diabetes. The female has had it for 3 years and male just diagnossed. I feed both dogs at 7 30 am followed by injcetion. However come 5pm both are looking for their dinner as this is how they have always been fed. I have been giving Ruby her insulin at aoout 7 pm so 2 to 2 1/1 hours after she has eaten. I have not had any problem with this for the past 2 1/2 years. If they are doing fine with this regime Is it okay to continue now that they both have diaetes

    • Dr . Joi Sutton July 18, 2021 at 10:49 pm - Reply

      You will have better blood glucose control if they are fed when they get their insulin. Better glucose control means better quality of life, less immunosuppression from diabetes, less risk of diabetic induced cataracts and blindness, fewer urinary tract infections, etc. why not strive for the best blood glucose control by feeding them when they get their insulin doses?

  18. Rachel Lane July 17, 2021 at 6:19 am - Reply

    Hi, my parents give our 12 year old diabetic labrador 3 doses of insulin a day – 8 on the syringe with a full can of chappie dog food each time. 9am. 3pm and 9pm.

    Origionally vets said twice a day 9am and 9pm but my parents felt our dog (Maddy) needed more in between as she was lethargic and hungry.

    Is this safe for them to do? I’ve raised concerns but they shrug me off. Too much insulin too soon?

    Any advice would be appreciated,
    Thanks,

    Rachel

    • Dr . Joi Sutton July 18, 2021 at 10:54 pm - Reply

      I’ve never been a fan of 3 injections per day as it can set the pet up for a hypoglycemic episode. I have never advised 3 insulin injections per day. I would first try a longer lasting insulin such as levemir before resorting to 3 injections per day. I don’t know which insulin the pet is taking nor do I know the details of her history. This is a question the sho7ld ask their veterinarian. If they continue to give injections 3 times per day I think at the very least they should check her blood glucose before each injection. Thank you for writing on your “sister’s” behalf.

      • Rebecca Melquist July 26, 2021 at 5:41 am - Reply

        I’m just a couple of days into this diabetes with my kitty baby…
        My vet has insisted that I only feed her the food he sells… she doesn’t like it, and hence she is always hungry and howling at me…
        I found a product that is a high protein cat food with reduced starch… she was eating it before she was diagnosed and went from a cat that I was sure was going to die, to an active cat with shiny fur and sparkley eyes…
        With the hills/Purina food she has even stopped peeing…
        I really think that just because he’s so adamant about only his food that I’m going to change vets… I’m going into his office tomorrow to get more of his food per his direction, I’m going to take a label from this other food and tell him that at least she will eat it, and eat enough to carry her for the 12 hrs…
        Do you think that I’m wrong to do this??? I know how I feel but I guess that I need someone to tell me just what I know is right…

        • Dr . Joi Sutton August 1, 2021 at 2:56 pm - Reply

          If your cat refuses the food, there are clearly lots of other options. I’m guessing your vet was suggesting the Hill diabetic diet, m/d. Purina and royal canin also make diabetic diets.
          Kitties with diabetes tend to do much better on canned diets as canned food is much lower in carbohydrates than kibble. (Of course each of the diets mentioned also come in a dry but those dry food are higher in carbs than their canned version.)
          There is a list of commercial cat foods online that lists carb, protein and fat contents. I typically start kitty diabetics on canned DM which is only 4% carbs. If your cat refuses the prescription diets, find a low carb canned food that she likes. Do chat with your vet. My guess is that he didn’t realize she is refusing the diet. Cats get a vote in what they will or won’t eat. They can be rather stubborn.

  19. Kevin Duke June 20, 2021 at 11:31 am - Reply

    How long after my dog eats is it ok to give the insulin dose. Should the dose be scaled down as time goes by? My dog is fighting the shot especially when one on one but does well when distracted by my wife’s touch. The problem is it is not always possible for both of us to give him his dose.

    • Dr . Joi Sutton June 21, 2021 at 6:28 am - Reply

      This is a good question to ask your vet who has examined your pet and your blood glucose curves. If your pet is a really good eater and is overall well controlled, I’d suggest giving the injection when the pet dives into the meal—-food is a good distraction for food motivated pets. Again, chat with his veterinarian. 🙂

  20. John Ortez June 16, 2021 at 3:56 pm - Reply

    hello! my 13 year old baby boy was diagnosed yesterday (June 15,2021) with diabetes. we are very new to this and would appreciate ANY tips for us in what we can do to manage this. My dog has always been a picky eater but he did eat this morning and we waited 30 minutes after he ate to give him his 5 units of Vetsulin. I am noticing today that he is hungry and i have NO idea what to give him as a treat in between his feedings. i do not want to give him something that will elevate his blood sugar levels. I ordered a trial of The Farmers Dog food that contains no grains or carbs. It is chicken and beef based with veggies & sweet potatoes. Could that possibly be a good option for him?

    • Dr . Joi Sutton June 21, 2021 at 6:33 am - Reply

      With a new diagnosis of diabetes, I like pet owners to read upon diabetes. In 2018 AAHA wrote a consensus statement for current thoughts in diabetes in pets. You can find it online for free if you search 2018 AAHA diabetes guidelines. Veterinarypartner.com also has numerous fabulous current diabetes educational articles for pet diabetes. There re many good pet foods for diabetic dogs and I’m a fan of the prescription diabetes diets such as royal canin glycobalance for dogs. A good mid meal reward could be a low carb veggie like green beans which dogs typically love.

  21. Debbie June 16, 2021 at 11:49 am - Reply

    Thank you for writing this article on diabetes. I have a 14 year old kitty, that I bottle fed with her 2 littermates, which had diabetes when she was born. After being on insulin for a while did get better and had been off for many years. I have been having problems with her eating (being fussy trying many different flavors) for a while. My original vet (which I loved) had left the area and I had tried several since. One actually diagnosed her with pancreatitis once telling me that it had nothing to do with diabetes (as I was concerned that she would get it back as she had been on prednisolone for asthma for years). She advised me that pancreatitis had nothing to do with diabetes, since the pancreas had 2 purposes. That was the last time I saw her. About a year and a half ago my newest vet diagnosed her with triaditis and gave me prednisone and b12 shots. After several visits over the past year and a half I was given no further advice on how to fix her eating problem, losing weight and vomiting. Two weeks ago I decided to give him one more chance to help with this problem. He did blood work and told me that her liver counts were so high that I had 2 choices to wait about 2 weeks to get an ultrasound done (they use an outside mobile person) or wait for her quality of life to get worse. Again I decided to find another vet I had used in previous places and found again.

    As soon as I went to him he advised to leave her for hospitalization. As I was desperate and felt she could be helped, I was grateful for his expectations were he could help. After going through all the history I had for her, as well as the fact she was diabetic prior, he did an ultrasound and came to the conclusion she was in diabetic ketoacidosis. He kept her for the week and saw much improvement. He has her on Prozinc as well as several other meds to treat her liver problems. She is eating only twice a day with the insulin shots right after her meals and also the other meds. She is very hungry so making her wait 12 hours is tough, but I understand is necessary. I would also like to mention, my new vet said that the reason the diabetes was not caught earlier was because the other vets sent out the blood tests to labs, which he said will cause the levels to not read correctly after waiting the time to get to the labs.

    I am relearning about diabetes again and I think your article and advice has helped me a lot and explains many of the problems I have been having with her through the years. I know we still have a ways to get her better, but thank you again for sharing your knowledge, it has been very helpful. Also I am extremely grateful for my new vet who has given me back my special fur baby. Sorry for the long post, I just wanted to share my story and thank you again.

    • Dr . Joi Sutton June 21, 2021 at 6:40 am - Reply

      I am so glad that you persisted and found a vet who is helping you!! Best wishes to you and your sweetie.

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