Timing is Everything

By Dr . Joi Sutton|2018-09-07T14:27:54-04:00Updated: August 22nd, 2018|Pet Care, Pet Diabetes, Pet Newsletter|403 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.

403 Comments

  1. Gynn Infusini June 26, 2022 at 5:58 am - Reply

    Good morning is it ok to give my dog his insulin 3 hours earlier then the time. I usually give him his insulin 4am – 3pm bc it works with our schedule Every day at the same time for 5 years now. But today I have somewhere to be so I was wondering if I should skip the insulin? Or give it to him at 1pm please help

  2. Joyce Srok June 16, 2022 at 3:54 pm - Reply

    I have a 13 yr old miniature poodle first told bladder infection then disfunction liver and thyroid. Turned into pancreatitis and then to diabetic. I am trying to do the curve at home. She is 9 Lbs. She was in hospital for 9 days and now home for last two weeks. Still has pancreatitis and is hard to feed. I cannot get her to eat the prescription diet food so I am doing boiled chicken breast adding in peas and carrots and green beans. I tested her first and she was in normal range of 221. I feed her a small amount this morning but she really does not want to eat. Gave her the insulin at same time as every day. I am testing every two hours and my tests are saying 88 then 79 then 92. I am concerned about the numbers being so low.
    If she is in normal range in the morning should I wait to give her insulin? She is on a pretty much no carb diet trying to heal the pancreatitis, which she seems to be feeling pretty good today. No vomiting or diarrhea in some time now

    • Dr . Joi Sutton June 19, 2022 at 6:53 pm - Reply

      Joyce, 221 is not normal, but is a good first morning (pre-insulin) number! The 88, 79 and 92 are normal numbers. If she isn’t eating you could cause hypoglycemia if you give insulin. Years ago I wrote a series of articles on this site called “back to basics”. You might want to read those 4 articles. I also wrote one on hypoglycemia.
      You might also chat with your vet about some anti-nausea meds like cerenia and zofran to help her get through her pancreatitis. They come in injectable form for vets and oral pills for pet owners.
      Chat with your vet first thing in the morning. If the glucose is normal your vet may skip the dose. I can’t advise you as I’ve not examined your pet, but your concerns are accurate.

      • Joyce Srok June 21, 2022 at 6:43 am - Reply

        I was told that she is good between numbers of 100-250. What is the normal range for a dog?

        • Joyce Srok June 21, 2022 at 1:17 pm - Reply

          Could you please tell me where the numbers should be? What is the normal range is it 60-111 for all dogs even if they have diabetes? Is that where you need to shoot for?
          What is the range I found that says 100-250 for the majority of the day? I am so confused on what range I should be trying to keep her in!

          • Dr . Joi Sutton June 26, 2022 at 6:12 pm

            I wrote n article on just this back in 2014. The link is
            https://www.adwdiabetes.com/articles/what-is-normal-blood-glucose-range-pets

          • Dr . Joi Sutton June 26, 2022 at 6:16 pm

            If most of her numbers are below 200 to 250 for a dog (or below 250 to 300 for a cat, the pet will likely have no clinical signs of the diabetes (excessive thirst and urination). Those are the estimated glucose thresholds in their kidneys when sugar spills into the pee and causes excessive thirst and urination.
            Make sense?

  3. Darlene Clogston June 10, 2022 at 12:39 pm - Reply

    I just started fostering a 7 year old diabetic Male cat
    I’ve been giving him his insulin every 12 hours
    He always wants food in his dish so it’s easy to do the injection , my question is , Is it normal for him to be drinking Lots of water all day ?

    • Dr . Joi Sutton June 12, 2022 at 9:06 pm - Reply

      If your diabetic kitty is alway thirsty, the odds are the diabetes is not yet regulated. Have you spoken with your vet about home glucose monitoring? That is the best way to check blood glucose. I have an article from a few years ago on this website called “Tip’s and Tricks” for getting a glucose sample. My favorite option is the Alphatrak meter for pets, or you could have your vet place a freestyle libre sensor.
      We rarely get the insulin dose right on the first try. We need to test glucose curves and adjust the dose. It’s also very important for diabetic cats to be on low carb food—-ideally canned only and less than 10% carbs. That will help control the blood glucose significantly.

  4. Kim May 26, 2022 at 5:42 am - Reply

    I’m wanting to change my dogs feeding and insulin schedule. She has been at 345 in the morning and 345 in the afternoon. I’ve done that cause that’s what fit our Schedule. We are now able to do 830 in the morning and 830 at night. Is that ok to change?

    • Dr . Joi Sutton May 30, 2022 at 5:57 am - Reply

      Absolutely you can change. If you can adjust it over a few days that would be best, but if you need to change it abruptly due to a work schedule change, let the insulin ride high for a few hours rather than giving it shorter than the 12 hour span for the dose when you change schedule.

  5. Kirsi and Mango May 23, 2022 at 12:05 am - Reply

    Hi , if my cat threw up close to the insulin dose time , of course you worry he may do it again after eating for the shot . How long after an injection is it safe for a cat to throw up , so that you don’t have to worry about rubbing honey on their gums ?
    My cat likes to eat grass , he’s not one to throw up after like my other cat ,it but just in case .
    Even if a hairball causes him to randomly to throw up after a shot , when are we clear with the insulin ?
    Thanks

    • Dr . Joi Sutton May 30, 2022 at 5:29 am - Reply

      There are so many different scenarios here that I couldn’t even begin to tell you when you can give insulin again. If your cat is acting fine and only vomits once you might just skip the dose of insulin and pick up at the next feeding. Cats do occasionally vomit. If there is an underlying issue then your cat may vomit repeatedly. Nobody has a crystal ball. If you are not already checking blood glucose levels at home, you really should start. There’s no way of looking at a cat and knowing what the blood glucose level is. You need to test. Knowing the blood glucose level may help you to know if you might give a partial dose or skip a dose in situations like this. Further, you can do more accurate blood glucose curves at home than at the vet clinic where a cat will no doubt get stress hyperglycemia from sitting in a kennel all day. Chat with your veterinarian who has examined your sweetie for a plan.

  6. KC Warren May 19, 2022 at 6:09 pm - Reply

    Dr. Sutton: I have a shy diabetic cat who nibbles dry food throughout the day, and receives a bit of canned when I give him his twice-daily insulin. However, I’m planning a vaca and my cat care person has said he won’t eat in front of her. She can, however, give him his injections. Is it ok to assume he’ll eat when she leaves a nice plate of canned food and is gone? I’m thinking that would be ok. Thanks (go Beavs! I’m in Corvallis). 🙂

    • Dr . Joi Sutton May 22, 2022 at 5:44 pm - Reply

      If only I had a crystal ball to give you a guarantee! If your kitty is well regulated then you are likely ok. Cats can do weird things when their humans leave. If your kitty isn’t prone to an emotional hunger strike when you leave, you will likely be fine if your cat is currently well controlled. (That’s a question for your vet!) Do check with your veterinarian who has examined your kitty.
      Yes, go Beavers! Enjoy your trip. 🙂

  7. Steve Chiang May 10, 2022 at 9:56 am - Reply

    As one of the guardians of a recently diagnosed diabetic 7 years old Giant Schnauzer, I have poured thru everything I can find online about canine diabetic. This is the best article by far. Thank you.

    • Dr . Joi Sutton May 22, 2022 at 5:39 pm - Reply

      Thank you!

  8. Victo April 27, 2022 at 8:29 pm - Reply

    Thank you so much for this information. I have a diabetic cat and this has been very helpful!

  9. John Yanik April 26, 2022 at 9:16 am - Reply

    My dog is very thin Miniature Schnauzer and the injections seem to be hurting him. He is pulling away when I inject him and is now starting to even pull away anytime I reach for his back! He has only been getting injections for two weeks, how can this continue?

    • Dr . Joi Sutton May 1, 2022 at 3:31 pm - Reply

      Are you massaging his skin before and during and after the injection? Massaging the area stimulates nerve sensors in the skin and minimizes the discomfort.
      Initially you’ll start by giving injections in your pet’s scruff where injections tend to cause less sensation. Then as you get good you’ll wat to travel down the back and up the other side for injection sites. Be sure to rub/massage/stimulate the skin before/during/after the injections.

      Ask your vet for a lesson! Watch how your vet or on of his vet team gives injections. 🙂

  10. Schuyler March 27, 2022 at 8:55 am - Reply

    I have been working with my vet for two years to regulate my 12 year old dog. He was doing well until about 2 weeks ago. We are now doubling his insulin and he is still sluggish. He also has Cushings disease which I know is not helping. I regularly give his insulin at 8AM and PM but he eats at 7:30 am and 4:30pm. Could that be hurting his progress

  11. Kristin March 18, 2022 at 5:29 pm - Reply

    Hi Dr., my cat became diabetic in the past 4 months, he is 13 and 17lbs. He always eats around the same time daily 9am/6pm. I do make sure he has eaten before a shot but he doesn’t eat 12 hours apart, it is usually around 9am and 6pm. I give insulin 12 hours apart, after eating but not right when he eats except in AM which is same time (after food). My question is if it will cause big problem if he eats at night at 6ish and his shot is at 9pm, shots always are 9pm/9pm. But never if he doesn’t eat, he’s fat- he loves to eat.
    Thank you, Dewey’s Mom

    • Dr . Joi Sutton March 18, 2022 at 6:19 pm - Reply

      It would clearly help his glucose regulation if you fed him and gave the insulin at the same time, every 12 hours. If you are feeding a low carb canned diet there won’t be as much fluctuation in his glucose values compared to feeding dry food. (Dry food is higher in carbs. I recommend canned food only for diabetic kitties.) I hope you adjust his feeding times to every 12 hours!

  12. Janet Thatcher March 12, 2022 at 10:33 pm - Reply

    My dog gets his shot 7am & 7 pm. But the time changes tonight. Spring forward one hour. What do I do?? Sorry so late

    • Dr . Joi Sutton March 18, 2022 at 6:15 pm - Reply

      When changing the timing of insulinit is nice if you can adjust it over a couple days, but if you are springing forward know that the glucose may be a bit higher when you give the injection the next morning. If you are falling back it may be a bit lower. Checking the glucose may help you adjust the insulin dosage if needed.

  13. Charlie Kabath March 8, 2022 at 6:00 am - Reply

    My cat is very emotional. If there are any loud continuous sounds outside or someone entering my apartment she becomes very nervous. On the occasional visit to the veterinarian her being she will skyrocket. Trying to do a BG curve at the vet never works. I have broken up the testing times on different days to try and get a proper curve and it seems to work.
    I am needing to schedule a visit soon for dental work but she is currently in remission. Any advice on how to prepare her for this visit?

    • Dr . Joi Sutton March 12, 2022 at 4:00 pm - Reply

      Indeed I do have a suggestion! At my clinic when I have a skittish kitty coming for a visit I will send home a dose or 2 of gabapentin for the owner to give before the exam. For the typical cat it is 100 mg 2 to 3 hours prior to the vet visit. A capsule can be sprinkled into a bit of canned food as it doesn’t have much taste. (Be sure to skip breakfast as we want your kitty to be hungry to actually eat the canned food laced with gabapentin.) gabapentin decreases anxiety in addition to being an analgesic. It may also cause mild sedation. It’s inexpensive. And if your sweetie is really anxious you can give a dose the night before in addition to the dose prior to the exam. At my clinic I call this a “previsit pharmaceuticaal” and give them out for free. It is less stress for the kitty and safer for my vet staff who is working with an anxious kitty during the visit.
      I also spray my scrubs with feliway whenever I work with kitties. It’s a pheromone. Feliway comes in a spray and wipes. In our cat exam room we have a Feliway plug in.
      Also, you might ask your vet office when might be a slower time of day so that there aren’t barking dogs and a lot of hub bub in the office when you take her in.

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