Timing is Everything

By Dr . Joi Sutton|2018-09-07T14:27:54-04:00Updated: August 22nd, 2018|Pet Care, Pet Diabetes, Pet Newsletter|480 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.

480 Comments

  1. Cathryn Davenport May 25, 2023 at 12:40 pm - Reply

    Very informative information. I have a question.. 11 yr old 90 lb male lab diabetic (with enlarged liver) on Vetsulin (started at 12 units, then 14 and now16 units) with 12 hr feedings. He is on a combination of Hills w/d wet and dry. Having a hard time regulating his BG as stays way too high. Month and a half since diabetes diagnosis and his reading went from like 550 to 460. If Vetsulin only lasts like half a day…assuming you mean it may not last until next feeding, if my dog is not taking in any other food when the Insulin wears off, and still hours until next feeding…what happens to their blood glucose levels? Vet supposed to check for adrenal function (Cushings disease?) today which after reading about, my dog seems to have so many of the symptoms so not sure why it took 6 weeks to suggest further testing. His health spiraled downhill so fast I didn’t see all this coming…but things have approved from outward appearances. He could barely use his hind legs and now we go for walks every other day and overall he seems much better. But just wasn’t sure what happens to blood glucose levels between meals if Vetsulin wears off.

    • Dr . Joi Sutton June 3, 2023 at 8:02 am - Reply

      Don’t be upset at your vet for not suggesting cushings testing for 6 weeks after starting diabetes treatment. Frankly, lots of newly diagnosed diabetic dogs and cats have increased liver values or large livers upon initial diagnosis. Yes, cushings disease could cause secondary diabetes due to insulin resistance, but the signs could easily have been just from the diabetes. Vetsulin is a great insulin for dogs. It’s actually a combination of 2 insulins. If it doesn’t last very long in your pet, you might consider trying a different insulin. My favorite insulin for big dogs is levemir which is a human insulin and lasts longer. You buy a pen and treat the pet as if it was a vial. Levemir is particularly potent in dogs, so we typically need to drop the dose by about 1/4 of what the vetsulin dose is. Levemir is also more affordable than vetsulin for a big dog. I’m glad his diabetic neuropathy is improving!! Be sure to start some ocu glo supplements to help prevent diabetic cataracts! I put all of my diabetic dogs on ocu glo, but it’s especially important is the blood glucose levels aren’t under control. We don’t want your sweetie to go blind from cataracts while you are sorting his blood glucose levels.

  2. Debby May 2, 2023 at 3:24 pm - Reply

    I try to give my dog her insulin 12 hrs apart. I feed her at 7 am (give her shot right after she eats) & 5 pm (give her her shot at 7 pm) Lately she doesn’t want to eat in the am so I wait until she finally eats to give her her shot. If she eats her am meal at 3 then her pm meal at 5 do I give her a shot after each meal?

    • Dr . Joi Sutton May 7, 2023 at 11:55 am - Reply

      Diabetes is a lot harder to manage when your sweetie is a finicky eater. Many diabetic pets act ravenous when mealtime comes around, so their humans can give the insulin injection when the pet dives head first into the chow bowl. When a pet doesn’t eat we wonder why… Does the pet have underlying pancreatitis? Many diabetic dogs and cats become diabetic secondarily to pancreatitis. Pancreatitis can cause nausea. My own personal 19 year old cat was voluptuous in her younger years and has battled chronic pancreatitis since 2016. Or, when a pet’s blood glucose is elevated it might feel a bit of nausea simply from the elevated blood glucose. Or, it could be something unrelated to the diabetes. There are some pets who just are not food motivated. Regardless, a trial of some anti-nausea meds might be worth a chat with your vet. And running a blood glucose curve at home to see how your pet’s blood glucose is doing is a good idea.

      Now for your question: I’d be hard pressed to give 2 insulin injections within a couple hours! That could land her in a state of hypoglycemia. Instead, you might check the blood glucose before each of her meals. If her blood glucose level is moderately or severely elevated, you might give the insulin even if she doesn’t eat. Then, 12 hours later when she is due for her next meal, check her blood glucose again and make an appropriate choice. What I don’t understand is why you would feed her at 5pm and give her insulin at 7pm. You should feed her 12 hours apart and give the insulin at the time of the meal. Make sense?

      Good luck and have a chat with your veterinarian. 🙂 Joi

  3. Maryann April 16, 2023 at 7:19 am - Reply

    I gave my dog his insulin shot 8 hrs apart at .4
    She is 10 lbs, she did eat before. I made a mistake! So is this dangerous? What should I do ? I can skip the next shot ? I will monitor her blood for 24 hrs .

    • Dr . Joi Sutton May 7, 2023 at 11:33 am - Reply

      Back in the 90s I worked ER and it wasn’t uncommon for pets to get double dosed when more than one person is giving injections. That is why when I have families who split the responsibility of the insulin injections I like there to be a calendar on the fridge for caretakers to check off that the dose was given.
      I’m glad you have a blood glucose meter to monitor the blood glucose level! Do that. And give extra food to prevent it from dipping so low that your pet has clinical signs of hypoglycemia. The most common clinical sign of hypoglycemia is nothing at all–They often just take a nap or get sleepy. Or, your pet might stagger or act drunk. If the blood glucose level gets down to 30 mg/dL or so your pet could have a seizure. Skipping the next dose is likely also wise.
      Best, Joi

  4. Anonymous March 21, 2023 at 4:08 pm - Reply

    Hi! I have two cats. One, Willow, became diabetic six months ago following an anal gland infection and pancreatitis. She spent a few days in the ER. Our wonderful Family Vet has gradually increased her insulin to 4,0 units morning and 3.5 units pm. The excessive thirst has now abated but Willow’s appetite has not.

    Is it okay to give Willow a small helping of her food, a main meal 1-2 hours later and her insulin shot just after her main meal? It seems to be the only way to keep the peace at home. Should I be putting snack and meal closer together?

    By way of explanation: My other cat, Jillian, non diabetic, is a very finicky grazer and it’s all I can do to get her to eat more than 1/4 can of Fancy Feast at a time most days, and it also involves moving the feeding place around and switching flavors a lot. Willow uses Jillian’s finickiness to try to steal her food at every opportunity. Taking the food up just means Jillian doesn’t eat enough. She isn’t getting into the habit of eating more at one time. Putting it on a couch or bed stops Willow from stealing it but sometimes Jillian eats the food and sometimes she just flips the bowl upside down with the food getting on fabric , and family disharmony ensues! So this is the best I’m able to do while running between home and work.

    I have been journaling both cats’s eating to make sure Willow is on schedule and Jillian eats *enough*! (And going quietly crazy in the process.) I should add our house is partly open concept and shutting either of them in a room to eat brings on panicked cats. (Both of them were humane society rescues so there may be trauma somewhere).

    thanks much!!
    Our vet is wonderful but they’ve been understaffed and hard to get cats in since the pandemic …both have appointments for annual checkups in April and will be asking them in detail then too.

    • Dr . Joi Sutton March 25, 2023 at 2:24 pm - Reply

      I feel your pain! It’s very difficult when you have such a situation going on. (I have lived a similar situation in my home.) I wish I had an answer for you, but you are doing very well sneaking food to the finicky eater and trying to prevent the hungry diabetic from stealing the finicky pet’s chow. 4 and 3.5 units are a bit high in regards to insulin doses for the typical diabetic cat. Many diabetic cats became diabetic because they are food motivated and end up chubby with pancreatitis which results in diabetes. However, make sure you aren’t overdosing the insulin (causing hypoglycemia) which makes the patient hungry. If you’ve not done a recent blood glucose curve, do another to make sure your cat isn’t hungry from hypoglycemia. Or, it may be that your cat requires more insulin than the average kitty. Have a chat with your vet. Blood glucose curves at home tend to be more accurate than curves run at the vet clinic because their blood glucose tends to be elevated at the clinic due to stress. Good job wrangling the cats!

  5. Laura March 14, 2023 at 8:31 am - Reply

    Thank you for the article Dr. Joi,

    Our 7 year old tom cat recently diagnosed is in his second week of insulin every 12 hours and we have switched foods to diabetic cat food, same amonut same time each day. With a special event coming up is it ok to shift the 12 hour time forward over a couple of days to accomodate not being able to give it on time on one day. So we usually do 7am and 7pm but could I go 6:30pm then 6:00am then 5pm just for 1.5 day? What do you suggest please?

    • Dr . Joi Sutton March 25, 2023 at 2:01 pm - Reply

      That’s exactly what you should do—adjust it over several days. Good job!
      Recall that cats do much better on canned food. Even the so called diabetic dry foods are still much higher in carbohydrates than canned food. Our goal with newly diagnosed diabetic cats is to get them into remission, and canned food only is the way to go.

  6. Ann February 11, 2023 at 8:08 pm - Reply

    This is all nice and tidy when you have a dog eats normally. My dog has had diabetes for the last 5 years. Recently she stopped having the hearty appetite she used to have which made it easier for me to regulate her sugar. Now, at 15, she refuses ALL food and treats at breakfast time. No matter what I give her, even her favorite human food-chicken, she does not want to eat. So I’m forced to test her and give her insulin according to the reading which sometimes is 5mmol and sometimes it’s 35. At night she generally eats. Not as much as before but at least eats some kibble or some soft food. I can’t even feed her the same food, she refuses and then I have to offer something new. It’s very frustrating trying to hand feed a dog who refuses food when you have to rely on her eating to administer insulin. As well it is a torture to have to prick her daily to get a blood sample plus prick her for the insulin needle. It’s just hard.

    • Dr . Joi Sutton February 19, 2023 at 3:52 pm - Reply

      This does sound very frustrating. There is likely an underlying issue causing the new inappetence. We all wish for the simple easily regulated diabetic pet, but that doesn’t always happen. It is hard. I am sorry for her and for you, but clearly you do it because you love her. She is lucky to have you!

  7. Tammy Metcalf February 2, 2023 at 11:10 pm - Reply

    Thank you for the information about a DIABETIC Cat. I have a booboo cat just got diagnosed and her numbers are high. I live on a disability check and I am widow. My baby loves to eat, I have had her on Fancy Feast 2.1 it she eats one in the am then dry threw out the day. My vet said it was ok to leave her on that food because it’s high in protein and low in carbs. She has always drank a lot of water, I also fed her these treats called temptations. I have been trying hard to start a set time on her shots, He had her on 3.1 Vetsulin shot twice a day, then he went up to 5.1 ml of insulin. When I give her this shot she drinks a lot of water then goes to bed, all day. She has always slept with me, and wake me up for her breakfast, now she does not do that. Her walking has changed her front legs wobble in the morning, but not in the evening. Please give me advice on what I need to do to save this cat. She has been supportive friend throughout my kids of family, she always knew when I would start having a panic attack, or when 6am in real bad pain, I have a lot of medical stuff. I’m a homebound woman, I never leave unless it’s a doc or groceries, I saved this baby 10 yrs ago, I found her in a sack floating down a river, I did over feed her she was close to 30 pounds, and you don’t have to say something, I know how bad that was and I am the reason she has this, she has lost 15 pounds. The vet said her kidneys and liver all that stuff was very good. Please tell me how to save my baby.

    • Dr . Joi Sutton February 5, 2023 at 11:49 am - Reply

      Hello, Tammy. Low carb is definitely in your favor–good job! I’d get rid of the dry temptations snacks. 5 units is an awfully high dose of insulin for the average kitty cat and if she is sleeping all day it may be from a low blood glucose level. I think you should invest in an Alphatrak starter kit. The Alphatrak is the easiest of the blood glucose monitors because it is not only simple, it only requires 0.3 microliter of blood to get a blood glucose reading. I wrote an article on this website years ago on “tips and tricks” to getting a blood glucose sample. You can type “tips and tricks” into the search box on the articles at the ADW website. Checking blood glucose at home will save you money and then you can chat with your vet about dosing. I will email you some of my favorite pet diabetes articles to the email address you provided. Vetsulin is approved for use in cats, but I prefer PZI or Lantus/glargine as they are longer acting for most cats than Vestulin. If you buy a human glargine pen (which now comes in generics that are affordable) you can spend less money on insulin. A 3 cc glargine pen in my town costs about $68 at the local human pharmacy. That can last the average diabetic cat 4 to 6 months. It needs to stay in the fridge and it is “extra-label” use to use the vial for more than a month for any insulin based on FDA usage. I use the pen as if it was a vial and use u-100 3/10 cc insulin syringes with 1/2 unit markings with the 3 cc glargine pen.
      I hope these tips help you save money on your fixed income. The weight loss and canned only pet food are a great start. Chin up and have a chat with the veterinarian who has examined your sweetie. Best, Joi

  8. Sara January 29, 2023 at 8:19 am - Reply

    My dog’s BG is 460 in morning 2:00 hours after his Insulin shot he is on vetsulin. The rest of the day he has been between 260 and 350 for the last few days. He was diagnosed on Dec.31, 2022 he weighs 14 pounds and is on 4 units of vetsulin twice a day.

    • Dr . Joi Sutton January 29, 2023 at 10:01 am - Reply

      Please chat with your veterinarian who has examined your sweetie about adjusting the insulin dosage. A blood glucose curve helps us adjust insulin by telling us where the blood glucose “bottoms out” (called the nadir) and how long a particular insulin lasts in a particular pet. (Pets absorb and metabolize various insulins differently.)
      A curve means checking the blood glucose right before you feed and administer the insulin. Then check the blood glucose every 2 hours until the next feeding/insulin dosage 12 hours later. If the blood glucose drops to below 150 mg/dL you should check it hourly until it starts to rise again. By giving equal insulin doses and equally portioned meals every 12 hours with consistency we hope to find the best dose for your pet. Another key point that folks often forget is to have consistent exercise patterns. Taking your pet for a walk after each meal will help blunt the blood glucose spike that inevitably follows a meal.
      Do a blood glucose curve and share the results with your veterinarian. 🙂

  9. Kristine Hyberts January 2, 2023 at 7:24 pm - Reply

    I have a diabetic cat which,I give her insulin(Lantus) shot every morning at 6 AM. I need to do a curve at 12 is she allowed to eat any dry or wet food before the curve. She likes to graze after her main meal. Please advise. Thank you

    • Dr . Joi Sutton January 8, 2023 at 3:35 pm - Reply

      If you are giving her the insulin at 6 am, you will feed her at 6 am as well. You will then check her blood glucose every 2 hours from the injection / feeding time until the next injection / meal. If the blood glucose drops to below 150, check hourly until it rises. We do a curve to see where it bottoms out. A curve means checking how low it goes after the injection / meal (her regular routine) until the next. We do curves to see how long a particular insulin will last in a particular pet. We use where it bottoms out to help us adjust the insulin dosage. So, yes, feed her when you give the insulin. Also get the first blood glucose level when you give the insulin /meal. Then share the curve results with your veterinarian to help you interpret!

  10. Zeljko Kojcic December 21, 2022 at 6:54 pm - Reply

    Hello doctor, thank you for writing a good and an informative article! I might have a question and doubt: my 10 year old Siamese male has been diagnosed with diabetes 6 months ago. Since then, we habe been trying to regulate him with Lantus, and lately switched to Levemir. He is eating only low carb food: I give him raw meat with EZ Complete, and diabetic pates, occasionally cooked fish. But his BG numbers don’t seem to improve at all, he is always around 20 mmol/l (in US values that would be around 350 or so). I am doing readings multiple times a day. He is currently on 2.5 units of Levemir and his numbers are higher, now at 23 or so. He doesn’t have any eating schedule, but usually has good appetite. The only few times his BG dropped significantly was during the daya his appetite was so poor that it made me worried actually (as soon as his appetite increases, numbers start being high again). Can you please share any advice with me, or point me if I am doing anything wrong? I am so desperate because I am not able to regulate him at all after months despite trying different insulins, high doses, low doses, long holds, always low carb food etc… Any advice would be greatly appreciated! Thank you!

  11. Jackie Wilson December 5, 2022 at 10:11 pm - Reply

    My 14 yr old cat who has been on insulin for about 4-5 years is having what appears to be hypoglycemic reactions but at a time that doesn’t make sense. He eats and get 2 u of insulin at about 6:30am and 1 1/2 u at 6 pm. This eve about 15 min before food and insulin while sitting in my lap he was shivering, acting like he was trying to keep his balance and then seemed confused. Last just a few seconds except the confusion was a few seconds longer. If insulin last 6-8 hours why a reaction that late after morning dose. This happened a few days ago too at same time.

  12. 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.

      • Crystal N Jarrard January 5, 2023 at 4:29 pm - Reply

        Is their any information you or anyone who happens to read this post can give me about acquiring a freestyle libre for free or at least at a large discount for my chocolate lab in which is a five year old female in tact. She has been put on 12 units twice daily. I have been having a very horrible time with measuring her glucose levels. The vet suggested that I do not use the blood monitor due to him believing she wouldn’t allow me to so he has me using the strips that I have to dip in a urin sample every morning first time potty. Yet I’m not feeling so great about it because every single test I’ve done which is a lot have all been horribly high . its darker than the darkest brown color for too high in the pictures and once in a while it will be a tad lighter but not enough to even go one down. So I really need to get her glucose monitored correctly please if any one may have any suggestions im in need of help and open to all. Thank you in advance.

  13. 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?

  14. 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.

  15. 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

  16. 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

  17. 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.

      • Madi kanga December 16, 2022 at 10:52 pm - Reply

        Hi dr. Sutton I have the following question for you : diabetic cat with glucose 420 mmol/l , after 4 hours of administration of 1iu Vetsulin it reads 200mmol/l, but when rechecked 12 hours after is still 423 mmol/l . Given the gig level , bathe cat was given 3/4 iu vetsulin ( not to give too much lethargy) and 12 hours later ( next morning that is ) the cat has still 413iu.
        Is that accettabile or do I have to read lower numbers ?
        I realize that insulin at 1iu rates tends to give some laziness to my cat , I wished to gie the very minimum to let her enjoy vivacity.
        Thanks for yr attention

  18. 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.

  19. 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”.

  20. 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.

      • Melissa January 2, 2023 at 7:50 am - Reply

        My Yorkie poo Bella, blood sugar is over 700. The meter says hi 30 mins after I give her 3 units of insulin it still is over 600. Vet told me to keep doing what I’m doing. The vet told me to feed after shot every 12 years. Ive called her vet to see if I need to up her insulin but I can’t get him to call and let me know nothing. It’s been over a week and she won’t eat much, she weak, pees on herself in her sleep. I feel helpless on this and can’t get the right help she needs.

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