Timing is Everything

By |2018-09-07T14:27:54-04:00Updated: August 22nd, 2018|Pet Care, Pet Diabetes, Pet Newsletter|261 Comments

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 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.


  1. Patti Maxfield November 3, 2016 at 10:00 pm - Reply

    Dr. Sutton my dog is a diabetic and blind. I am taking her to a kennel which they said they would give her her shots. I usually give her injection at noon and at midnight. I forgot do go down to an earlier time. What should I do?

    • Suzie Peck February 9, 2017 at 3:04 am - Reply

      No reply? 🙁 Good question, my dog is newly diagnosed and this is kind of overwhelming with the every 12 hours! I’d love to know if the timing can vary 30 to 40 minutes either way? I have a hair sytlist that only works at night and when I go, i won’t be at home to do my pet’s shot. Now obviously you don’t get your hair done every day but every 6 weeks it will be a problem. I live alone and friends don’t want to get involved and I am ok with that as to be honest, if I were them, and they asked me, I wouldn’t either. I keep 3rd shift hours he gets it around 8’ish in the am and pm. But I have varied it by 20 minutes.I wonder if that is ok?

      • Dr Joi February 11, 2017 at 9:07 am - Reply

        Sorry for the delay! I didn’t see your post.
        Of course a little leeway is okay. As I said, life is not perfect. We do what we can with our busy schedules in a busy world. 🙂

        • Suzie Peck February 18, 2017 at 8:57 am - Reply

          Thank you for your reply. I always try to get some food in him first, never on empty stomach, you hate to give too many treats but if I had to, to get insulin in him, I would resort to perhaps one or 2 no no treats but not make a habit of it. So far so good though in getting something healthy in him, even if I have to feed him I do. He is finicky and the most I vary in injections is 15 minutes. It’s now been 2 weeks, still a bit nerve racking and hope I calm down one day!

          • Dr Joi February 20, 2017 at 7:54 pm

            Good job, Suzie!

          • Suzie Peck February 20, 2017 at 8:06 pm

            Thank you! Dr. Joi, as I am sure you know some dogs get finicky! My Oreo does too. I can’t promise he will want or like what he ate this morning, tomorrow morning. Then inside I panic! Knowing he needs his insulin at 8am, so only then do I resort to a treat after I have exhausted all other possibilities in the dog food line. I’m assuming while not ideal all the time, it is ok so he has something in him for that insulin? Thank you in advance for your reply!

          • Dr Joi February 22, 2017 at 7:59 pm

            Suzie, if he is a newly diagnosed diabetic he may have some pancreatitis affecting his appetite. Pancreatitis is a common cause of diabetes in pets. Has he always been so finicky or is this a new issue? Your vet might prescribe an anti nausea medication (such as cerenia) or an acid blocker (such as Prilosec). Has he been checked for pancreatitis? Most diabetic dogs have a healthy appetite. Of course we prefer equal meals every 12 hours, it’s good to have at least some food in him before giving the insulin. Since most diabetic pets are food motivated I usually advise folks to give the insulin as the pet dives into the chow. If his appetite is dodgy, your vet may have you check the blood glucose before each meal and adjust the amount given based on his glucose level and how much he eats. 🙂 Chat with your vet who has examined him!

        • Jessica August 22, 2018 at 4:10 pm - Reply

          Dr. Sutton, I have a recently diagnosed diabetic 10.5yr 11lb maltipom. We are on week 3 and it’s been a roller coaster. We finally have eating and insulin down every 12 hours but now trying to get the glucose regulated….we have been to the vet for weekly readings and they have been all over the place. My vet has mentioned what high anxiety he has when in the office so I asked about testing at home. They okayd and made sure I got the same reader they have. Well today I took him to get 3rd reading…..he was horrible in the office so I tried getting a reading at home a few hours later…..again horrible. What are tips for getting home readings? This is all so new and overwhelming. Current diet is 1/4 rice/chicken mix 1/4 cup merrick gammys pot pie. Per serving a day and may get snack after potty of very very small portion of strawberry or apple. Is this a bad diabetic diet.

          • Dr . Joi Sutton August 25, 2018 at 1:56 pm

            Jessica, I wrote an article exactly on this topic a while back… I do indeed have tips and tricks. See here: Tips & Tricks For Collecting The Perfect Blood Sample From Your Pet“. Read the article and let me know if you need more help.

            I’d prefer a snack of a green veggie or little piece of meat over fruit as a reward for being a good girl. I hope the rice is brown rice rather than white rice.

            Chat with your vet. And ask for a lesson again if you are struggling. Be sure to use my sock of uncooked rice or beans when getting a blood sample. Warming it in the microwave and putting it over the blood collection site to improve circulation and vasodilation prior to blood collection works so well for our small pets.

            Keep me posted! 🙂

          • Jessica August 30, 2018 at 2:06 pm

            Thank you Dr. Sutton. My dog had another weekly reading at the vet yesterday and we were all pleased with the result. We’re set up for one more reading to make sure it stays regular and then I’m hoping to try your tips for the at home reading. I did try again to test on the ear rather than the toes he does seem to tolerate that much better. Thank you for your help and articles.

    • Gin Hunt June 11, 2018 at 12:24 am - Reply

      My vet told me to slowly change the time by 15 minutesonly every couple of days.day-so first day you might give shots at 11:45 am &pm. I repeat the next day at the previous day’s time so that 11:45 time. Depending on what time you’re shooting for, it might take a couple or more weeks. I was also told that the longer i stretched out the time changes the better is for my dog.

      • Dr . Joi Sutton June 11, 2018 at 6:24 am - Reply

        If you are changing the injection time and are able to change it 15 min per day that’s clearly better/safer than changing it by an hour per day. 🙂

    • Anonymous November 13, 2020 at 8:33 pm - Reply

      Thanks so much was very informative and helpful

    • Anonymous November 13, 2020 at 8:37 pm - Reply

      If you have time try to go back an hour or two on till you’re where you want to be

  2. Vasso October 11, 2017 at 11:26 pm - Reply

    What should the feeding pattern be for healthy cats? I had one diabetic, another one old and diabetic now, but also three young ones that I wish they do not develop diabetes. Should I feed them 2x or 3x a day? I am gradually switching to only can food (to reduce carbohydrates) but they act hungry now that I decreased from 3x to 2x/day (of course I increased the amount…but they still complain about missing their middle of the day meal). I read somewhere that 2x/day is better to prevent frequent “spikes” in insulin; sounds interesting and surprising considering that humans are supposed to eat many small meals per day to avoid large increases in insulin (keep the levels more steady). Thank you!

    • Michael April 20, 2018 at 12:55 pm - Reply

      This is my exact concern. Can the doctor respond?

      • Dr . Joi Sutton April 22, 2018 at 5:29 pm - Reply

        My apologizes for not seeing your question. It’s is the busy season in South Florida and in addition to consulting for ADW I own and run a hospital. I’m a busy lady. As this winter season draws to an end (snowbirds flee to the cooler north come April and May) I can catch up on life.

        As far as how to feed a healthy cat…

        I think in general folks should feed kittens a canned food and maybe dry food if they wish. We want kittens to recognize canned food as food. If folks choose to feed dry food they should monitor portions and be sure not to over feed—it’s much easier for cats to get tubby on dry food. Some cats (such as my recently passed, much beloved male cat) prefer dry food and refuse canned food. He didn’t think canned food was food. I fed him dry (because he wouldn’t touch canned food), but I fed him a lower carb dry food. Know that dry food is higher in carbs in general than canned food. Dry food is easier on their teeth, but canned food is preferable for keeping cats lean and thereby lowering the risk of diabetes. You can google “cat food composition chart” on the Internet to see how foods compare.

        Regardless, you should make a concerted effort to keep your cats lean to avoid the risk of diabetes. I have a very food motivated non-diabetic cat and I feed her canned food only.

        If a cat is not diabetic, I have no issue with feeding 3 times a day. Most cats prefer to nibble Here and there rather than meal feed. It’s the nature of the beast. Diabetic cats (and dogs) do better when they obtain the majority of their calories with the insulin injections. By using a longer acting insulin such as glargine or PZI AND feeding low carb canned food we improve the odds of getting a cat into diabetes remission.

        If a cat is lean and not eating high carb food, the risk of diabetes is low. If a lean cat wishes to nibble over the course of the day, I think 3 meals per day is fine. Unfortunately, many cat owners don’t recognize when their cat is getting tubby.

        There’s my 2 cents.

    • Deanna August 10, 2018 at 11:23 pm - Reply

      Hi- I’m the proud owner of a diabet cat now. My cat would let me know he was hungry and I’d alway give him small amounts of wet food (theory was to keep it as fresh as possible). So that made him a free grazer. I switched to a 3oz can am & pm. He got thinner and looked to be more unsteady and always hungry and looked dehydrated. After 2 weeks of that, I had had enough and went back to my 3x a day feed 6am, 3ish pm, 10pm – with the 2 larger meals being the morning and nigh. 2u insulin 6 am/ 1u Insulin 3ish/ 2u 10 pm. I do NOT think this schedule caused a Somogyi effect. He has some teeth that need to come out and infection of any kind will affect the BS numbers. I’ll reasses with testing after his 2 lower K9s get extracted and go from there. But, he will still be a 3 meal a day cat and insulin 3x a day, but might be scaling that down to 1.5u insulin am/pm. With a small booster shot around 3pm (his smaller meal). I wrote all this to encourage you to 1) take the advice from a Vet you trust & 2) question it if your cat doesn’t look right. YOU live with the cat, not the vet. I also recommend getting on a few diabetes message boards.
      Also, every cat is unique. I feel there is no cookie cutter answer as to: “which insulin should I use”, “how much insulin do I give” (although it can vary, one should have a good grasp on how much is too much) “should I test” the answer is always YES, at least until you know your cat is stable and have a good system down and consistent numbers. Then test can be done less frequently,

      • Dr . Joi Sutton August 12, 2018 at 7:11 pm - Reply

        I agree, home testing is very important. If you use a long acting acting insulin such as glargine or determir or PZI, a snack mid day won’t make as much of an effect as if you were using a shorter acting insulin (such as vetsulin), but the majority of calories should be at insulin time. Giving 3 injections per day of a long acting insulin could be dangerous as they could overlap. You will need to be on the alert for hypoglycemia. 🙂

        • Deanna August 13, 2018 at 11:35 am - Reply

          I “personally” don’t find Lantus to be as long lasting as I keep hearing about. I think it’s true, following the recommended dose is important, but also important to make sure what you’re doing is effective. It could be that this insulin isn’t the right one for my Cody. But, feeding and dosing every 8 hours works better than 2x a day. I switched from his 3x a day (per the VET’S recommendation) and did the 2u twice a day at meal time. In 10 days he had lost weight, looked dehydrated, and was unsteady with his hind legs. I went back to the 3 meals and 1.4ish units and he’s slowly gaining weight again and the BS is coming down.
          SO IMPORTANT!!!

          • Dr . Joi Sutton August 14, 2018 at 1:28 am

            Every diabetic pet is a different experience!

  3. Lois November 19, 2017 at 2:20 am - Reply

    My dog has been on insulin for two days. I give him the shots when he is eating at 8 AM and 8 PM. He gets SO hungry before 8 PM. Can I give him a coupe of small bowls of green bens in between meals?, He is a Pug.

    • Dr . Joi Sutton November 19, 2017 at 3:35 am - Reply

      Yes, green beans would be an acceptable snack as they are so low in calories. And they are delicious!


  4. Lisa November 26, 2017 at 9:04 am - Reply

    My westie is diabetic. Her glucose is very low in the morning (70) so the vet instructed us to feed her and wait 2 hours before giving her insulin. We did that and then took her to vet for a Glucose reading. It was up to 600. Now the vet wants us to check her blood before we administer the insulin and wait until the glucose is 300 and then give her insulin. This is all so confusing. We give her Humilin N. We tried Vetsulin but it did not work. Also she takes Furosemide for fluid build up because she has congenital heart failure. Could this be interfering with the insulin? This little dog also has a PK deficiency but is now 7 years old. We are trying our best. Can you comment on waiting two hous to administer the insulin.
    Thank you.

    • Dr . Joi Sutton November 29, 2017 at 4:25 pm - Reply

      Hello, Lisa!

      There may be a small relationship between insulin secretion and furosemide. Unfortunately, pets who need a diuretic often are given furosemide! Perhaps an internist or cardiologist might adjust the dosage or change to a different diuretic, but in general, when medications affect the blood glucose we may have to adjust our diabetic management rather than stop an important medication. Heart disease may trump the diabetes control.

      I don’t typically wait to give insulin. In general I want the ins7lin to be given with the meal. I th8nk checking the blood glucose before each injection/meal would be prudent with the wide range of numbers your mentioned. I would adjust the dosage based on the blood glucose level if needed. When was the last blood glucose curve run? A blood glucose curve sounds in order!

      I think a trip to the local veterinary internist is my best recommendation for you. Internists tend to be very good at both heart disease and diabetes. This sounds like a tricky situation.

      Best, Joi

    • Linda G Lewis May 15, 2020 at 10:30 am - Reply

      Dr. Joi , my 11 yr old Shitzu was diagnosed with diabetes and enlarged heart last Friday. She was placed on vitsulin , lasix and 2 other meds for her heart. I’ve been very off schedule the whole week as I also care for a disabled Mom and sister. This keeps me off key and I’m trying so hard. Well last night it was 11:30 pm before I could give her insulin. How do I get back to 7-7 or 8- 8 times. Please advise. Thank you.

      • Dr . Joi Sutton May 26, 2020 at 5:31 pm - Reply

        If you check her glucose at home, you can either underdose once if there is a shorter interval, or you can move it by an hour each day.
        Bless you for looking after so many!

  5. Shelly December 28, 2017 at 6:58 am - Reply

    Our furbaby has been diagnosed with diabetes about 3 weeks ago. I keep seeing the twice a day shot, ours is only once a day. He has lost a lot of weight, his appetite seems to be coming back. We are so overwhelmed and so afraid we are doing something wrong. Is a once a day shot unusal?

    • Dr . Joi Sutton December 31, 2017 at 7:58 am - Reply

      It would be fantastic if we could give insulin once a day to a pet, but in reality that is an extreme rarity. Insulin just doesn’t last that long in the body. I can’t recall even one pet on once daily insulin that is well regulated. Knowing this, I always start pets on twice daily injections. Years ago I had a client who refused to give insulin twice daily. The pet wasn’t regulated at once a day. Now, some insulins may last longer than others. NPH and Vetsulin last a shorter period in general than glargine/lantus, pzi or levemir. We tend to choose one of the longer lasting insulins for cats along with a low carb canned diet for cats. The only way to know for sure how long the insulin lasts in a particular pet is to run a blood glucose curve. I hope you are doing home testing. Chat with your veterinarian. We have 6+ years of diabetes pet articles on our site, and education is key to a well regulated pet. Happy new year! Joi

  6. Rob December 30, 2017 at 3:24 am - Reply

    I run a cats-only boarding facility and currently have seven clients with diabetes. I have found each cat to be a bit different in how their routines are laid out for me. One of the cats is 18 years old and is on quite the regimen. Each morning I crush a pill in her foot, give her the shot, then for evenings, it’s the shot plus a pain med that gets rubbed in one ear lobe. Once a week she gets half a prednizone. Anyway, she actually does polish off most of her wet foot as I give her the jab. Then she has a glucose control dry food she can nibble at all day. I have to say, the first time she came in (last Spring), she walked on her ankles and wasn’t too mobile. In the last couple visits, she has been MUCH more mobile and spritely. In fact you can SEE a kitten behind those slightly hazy eyes. She’s extremely loving and more mobile than she was 7 months ago! I can see why they are keeping her going.. She’s awesome.

    • Dr . Joi Sutton December 31, 2017 at 8:09 am - Reply

      I’ve long said, “Age is not a disease!” That’s awesomeness that she is doing so well. I do wonder why she is on the pred… Pred, even if just once a week, will cause insulin resistance. If she is on it for arthritis (as she is 18 years old), perhaps the family might instead consider onsior or gabapentin or tramadol. I’m guessing the ear smear med is an arthritis med? And the dry food available in between her meals is not a bad idea when a pet is boarding as boarding can be stressful and affect appetites, but in general even the low carb dry foods are too high in carbs for a diabetic cat. I hope they are not giving her dry food on an every day basis at home. She sounds happy and spry, so overall they are doing well. Perhaps they could do a smidge better? They are lucky to have you. Leaving a diabetic pet in good hands is a relief for pet owners. Happy new year! Joi

  7. Rob December 30, 2017 at 3:27 am - Reply

    *crush a pill in her FOOD (silly typo)

  8. Kristy January 5, 2018 at 12:03 am - Reply

    Hello – I am inquiring about my 9yr old Cairn, Tucker. Diagnosed Dec 15th and vet said to give one shot in the morning (5mg – Vetsulin) only if he eats.
    Well, he was doing pretty good then on Christmas day – didn’t touch his food (Hill’s W/D) Googled and saw where someone puts a Tbsp of plain canned pumpkin in with kibble. That’s worked good since Christmas day.
    Vet wanted a curve after the holidays – I did that today. Seems 5mg hasn’t “touched” Tucker’s issue at all. Vet wants another curve in 14 days, but die to cost, I said, no – I want to test at home. She said if I was “up to it” to be able to test at home, that was fine, just to share the readings with her. At his curve today, Tucker stayed around 300 in all 6 readings, so she upped his (mornings only) dosage to 7mg.
    I’ve order a monitor and extra strips/lancets to do home readings and the next curve in 14 days. I’m on a website that says once a day insulin won’t work and they are encouraging me to give twice daily shots – they and I don’t even know what the dosage would be.
    Are once a day shots not going to work?
    thank you, ks

    • Dr . Joi Sutton January 6, 2018 at 6:31 pm - Reply

      Hi, Kristy! It is unlikely that once a day will work with any insulin. Vetsulin is fda approved for once or twice a day, but never have I seen it last long enough when given once a day. Sometimes it doesn’t last long enough when given twice a day. I’m so glad you are going to do home testing! It’s more accurate because you take out the stress hyperglycemia component and also more affordable. Good job! Joi

  9. FRANCES MUNSCHAUER January 7, 2018 at 10:56 pm - Reply

    Suzie (12 lb chihuahua) is on trial of Lantus. Many DVM’s have no experience with this insulin except on cats. There are few extensive studies or protocols for non-DVM’s and NPH stops working, causing spikes in BG. Due to the increase number of Type 1 DM dogs, I would expect more info available. If DVM’s have access to Glargine protocols ,expectations, and actions, but are unwilling to move out of their NPH comfort zone to learn more, then I surely wish I could get access myself…in case I need a guide in case of irregularity. There are great protocols for cats.. As of 2018..surely, we have moved past the “NPH for dogs” years??? Any info would be greatly appreciated.

    • Dr . Joi Sutton January 13, 2018 at 11:14 pm - Reply

      Frances, I hope lantus does the trick for your doggie!

      It’s not like we veterinarians are “holding out” regarding protocols for lantus in dogs. It’s just that vets haven’t had great success with glargine in dogs. Knowing this, I’ve never personally tried glargine in dogs, even though it is my “go to” insulin for cats. This being said, I sincerely hope the lantus works well for your pet. I’d recommend giving it twice daily, much like you did with the NPH.

      My favorite insulin for dogs is levemir. It lasts longer than NPH or Vetsulin. For really small dogs it may not be feasible as it cannot be diluted and as it is very potent in dogs. Levemir is about 4 times more potent than most insulins in dogs, so it may not be feasible to give a tiny dog such a small volume. For example, if a small dog takes 1 unit of NPH, we’d guess the dose of levemir to be 1/4 unit, which is not a practical volume to administer.

      Good luck and keep us posted!
      🙂 Joi

  10. Chris January 27, 2018 at 10:45 am - Reply

    Good morning – wondering when the ideal time is for our walk. Before diabetes, Emma (puggle – 9 years old) and I walked before she had breakfast. We took about an hour walk (more like a stroll) and then I would feed her. SO that brought us up to 9:30 AM. Too late for her first insulin injection.

    So my question is- is it OK to walk her regular walk AFTER she has her breakfast and insulin?

    I am trying so hard to get her regulated.


    • Dr . Joi Sutton January 28, 2018 at 7:31 am - Reply

      Yes, it’s just fine to walk her after the meal. Regarding regulation, consistency is fantastic for regulation. Good work, Joi

  11. cherrie January 27, 2018 at 12:59 pm - Reply

    My dog has diabetes just 2 weeks in he also had pancreatitis which he is on meds for and was only eating chicken well now he will not eat his food. what do I do ? he gets 8 units of vetsulin and what dog food and treats or snacks should he have. he is a yorkie and Pomeranianmix and will be 10 in march

    • Dr . Joi Sutton January 28, 2018 at 7:36 am - Reply

      If he is not eating he may yet be experiencing nausea from the recent episode of pancreatitis. Ask your vet for some Cerenia and some ondansetron (both are anti-nausea medications) and perhaps an acid blocker such as Prilosec or Pepcid. Additionally, there is a very new product on the market for dogs called Entyce which is a grhelin analog—it is an appetite stimulant. I’ve had great success on the couple which pets I’ve used it recently. Call your veterinarian and have a chat. 🙂 Joi

  12. Lynn Coleman January 30, 2018 at 12:24 am - Reply

    I have a newly diagnosed 10-year-old diabetic dog. I read your blog and would like to give the insulin every twelve hours But my dog is, not only a chow hound but also a creature of habit. She gets fed at 7:30 AM and 5 PM. I can adjust the AM feeding a little but I fear that she will cry and bother us for two hours if we change the 5 PM (She is very smart, we have videos of her bringing her metal bowl and throwing it at our feet, lol) I was wondering if we could feed her and then medicate her later I have had no problems getting her blood sugar from her elbow pad when I need to.

    • Dr . Joi Sutton February 9, 2018 at 6:22 pm - Reply

      Let’s make the new habit every 12 hours. That will make for a better regulated diabetic pet and therefore a happier pet! 🙂 Joi

  13. Susan kachmar February 11, 2018 at 12:24 pm - Reply


    My Savannah cat was diagnosed with diabetes at the end of December. He is taking 1 unit twice daily. I am using Lantus. I have been checking urine using test strips every week. Today his glucose levels spiked. Previously the readings have been negative for glucose. My insulin is now about 45 days old sitting in the refrigerator. My vet said the 30 day expiration should be ignored as it can stay potent much longer. The insulin looks clear, nothing floating. The other negative is that he is still thin. He eats about 9 oz daily of only wet cat food high in protein. He weighs about 12 lbs. Since being diagnosed, he has never resumed the energy he had which was a lot previously. He is 8 yrs old. He is a picky eater. Why is he staying so thin? Why the spike? Could the insulin be less potent now? Thank you in advance.

    • Dr . Joi Sutton February 18, 2018 at 8:02 am - Reply

      Hi, Susan!
      The blood glucose threshold in the kidneys of dogs and cats is somewhere between 250-300 mg/dl. Surprisingly high, huh! So if below that they won’t spill glucose into their pee. Urine testing is crude compared to blood glucose testing. Many years ago it was how we monitored pet diabetes, but now it is simply an ancillary test. We rely these days in blood glucose tests, preferably at home.
      Tuning a blood glucose curve tells us how long an insulin lasts for your particular pet and also how low the blood glucose gets. We check glucose every 2 hours from one injection until the next, 12 hours later. If it drops below 150 mg/dl, I want you to check hourly until it starts to rise again–this way we don’t miss where it bottoms out. We want it to bottom out somewhere around 100.
      Great job feeding wet food and using lantus. Great choices.
      We do indeed use lantus for several months due to cost savings. Any insulin is only labeled for one month from the FDA. If you have kept it in the fridge and it looks clear, I think it is less likely that the insulin has gone bad. First check a curve. In the future, but a lantus pen. We throw less away when using a 3 cc pen than a 10 cc vial. It hurts the pocket book less!
      We want him at a normal body weight, but be sure to not let him get pudgy as obesity causes insulin resistance. If he is still very thin, he is not in diabetic regulation. Do run a curve and chat with your vet once you do. Do you have a pet glucose meter? That’s your next step if you don’t.
      Good luck!

  14. DenisE February 18, 2018 at 12:59 am - Reply

    I have an 11-year-old Yorkie who weighs 13 lbs. yes, he’s a large Yorkie but not overweight. He barely survived pancreatitis and immediately developed diabetes. We’re working on glucose curves now because he needs cataract surgery. He is still running high with some of his numbers and I have a problem getting him to stick to eating every 12 hours, but we stick to it. What do you advise pet parents to do when their diabetic dogs only eat about about 1/3 of their meal? He’s on Humulin N, 5 units every 12 hours. Should I lessen his dose when he doesn’t eat his whole meal? Tonight he ate about 1/3 of his meal and I was afraid to give him 5 units, so I gave him 3.5. Did I do the right thing? I know the highs don’t kill in the short run, but the lows do. My daughter was diagnosed > 20 years ago with T1d. I wish dogs had insulin pumps – this is such a difficult method to regulate BG with insulin. Tearing my hair out,

    • Dr . Joi Sutton February 18, 2018 at 8:06 am - Reply

      Your thought process is spot on! Yea, if he doesn’t eat you likely will give him less insulin for that feeding. Chat with your vet who has examined him to sort guidelines.
      Now, as far as the inappetance goes, was he always finicky? If not, he may yet have some nausea from the recent pancreatitis. You might ask your vet for some anti nausea meds such as Zofran or Cerenia. That may help.
      Great job!

  15. Kathy Wayne February 25, 2018 at 5:20 pm - Reply

    Help! My pup is a 9 1/2 yr old Poodle Mix, the sweetest little girl on the planet! When she was approximately 4 1/2, we became aware that she had a very small liver, most likely a liver shunt. We successfully medically managed her with diet, lactolose and antibiotics. About 1 1/2 years ago she was diagnosed with inflammatory bowel disease and put on prednisone as well as a slew of other meds. A year later came the diagnosis of diabetes. She is on vetsulin twice a day, as well as prednisone, Zoloft, Cerenia, Prilosec, metronidizole and gets a B-12 shot once a week. My issue is that she absolutely refuses to eat a full meal in the morning. Because of her liver shunt, she was never an early eater, preferring to eat several small meals later in the day. She will usually take in around 75 calories which is half of what the vet would like her to have. I have done a curve and her BG levels are high, too high, which may be a result of a few other issues we are working on (such as UTI) This is causing great stress because I know she needs that morning me. I have tried everything I can think of: switching foods, an appetite stimulant (mirtazapine), absolutely nothing works! What she refuses at 8 AM, she is more than happy to eat at noon. Is there ever a situation where morning insulin dose can be split between morning and afternoon??

    • Dr . Joi Sutton February 25, 2018 at 8:26 pm - Reply

      Wow, you are doing a great job.
      First of all, there is a new appetite stimulant on the market. It is a ghrelin analog. That’s the hormone that makes us hungry. It’s called Entyce. I’ve had great success with it thus far.
      Now, as far as splitting a dose, I would not. And yet, even though I strongly prefer equal meals and equal insulin dosages every 12 hours, you might just need to give less insulin for the morning meal if she continues to eat less in the morning.
      Now that she is diabetic it would be great to chat with an internist about changing to a different immunosuppressant for her IBD. The pred will make the diabetes difficult to regulate.
      Do try the Entyce!
      🙂 Joi

  16. FRANCES February 28, 2018 at 2:24 am - Reply

    Vetsulin does not last 12 hours..From NPH–Lantus and now Vetsulin. Vetsuin reps claim the “U” curve with 12 hour BG = >350 id “IDEALl” The DVM is supportive but has no great expectations? Is the goal to and expectation that 8 hours during each day, the BG can be on the rise to >300? Is there no “real” regulation of dogs? Our cat did well on Lantus and went into remission. I understand that dogs rarely if ever suffer Type 2 but id there no real expectation to get decent BG’s throughout the 24 hours? Now, you mention Levemir? I do notice no articles that discuss the difficulties in regulating Canine D.M…Is it okaY with Dvm’S to accept that “u” CURVE presented on Vetsulin as the “Ideal” (Google Vetsulin curve-It shows up under images) Thanks for your interest.

    • Dr . Joi Sutton March 4, 2018 at 11:47 am - Reply

      I love lantus for kitties. I’ve not tried it for dogs simply because it has a reputation of not working for dogs. This doesn’t mean it can’t work for dogs. I usually reach for levemir as my go to for dogs when I diagnose diabetes. Unfortunately for little dogs (your dog is only 11.5 lb you say) it may be hard to give a tiny dose. So for really tiny dogs I usually reach for NPH. With 3/10 cc volume syringes you could likely use levemir, but levemir is usually about 4 times more potent than other insulins for dogs. Levemir is long acting in dogs. NPH and vetsulin tend to last half the day for dogs. It’s my frustration with NPH and Vetsulin.

      I want the curve to bottom out somewhere around 100 mg/dL. If most of the numbers are below 250 to 300 mg/dL the pet wont be drinking and peeing excessively and the quality of life will likely be pretty good from the diabetes standpoint. Obviously the pet will be better if the blood glucose numbers are near the normal range all the time, but that’s hard to achieve. (The kidney threshold for blood glucose for dogs and cats is somewhere between 250 and 300.)

      Have a chat with your veterinarian. :). Joi

  17. FRANCES February 28, 2018 at 2:28 am - Reply

    Suzie is the 11.5 lb chihuaha written about on your site previously..Thanks..Fran Munschauer

    • Lynne November 7, 2019 at 11:19 pm - Reply

      Loved your article! Most things/ the way you think , I do! I’m very into routine! And yes… green beans are the treat for my boy !
      I hear you re 12 hours apart 👍🏻 But I give mm his 10 hours apart , as 8am & 6pm work for our household and I heard there’s a 2 hour window period on each side?
      MURPHY has been a diabetic for 3 years and is generally good & healthy 🙏🏻 Now and then ‘he’s thrown… as in a midnight wanting wee and drink water… not often though. On those days .. can I up his insulin ‘slightly’ ?
      I don’t test daily … my gut tells me when .. and like I said he’s a ball of fun, eats well, happy boy 🐕💙

      • Dr . Joi Sutton November 9, 2019 at 3:30 pm - Reply

        If you give the same sized meals and the same dosage of insulin, then every 12 hours is best. I understand that life and schedules can be challenging for a diabetic pet.

  18. CARMEN March 15, 2018 at 9:08 pm - Reply

    hello, i have a 10.5 yrs old pekineeseh shitzu mix female> end of jan she end up in the hospital she was extremely sleepy and refusing food, peeing alot. We were told she has DKA diabetes and was gravel ill; she stayed in emerge for 2 weeks. Before all these events, she was super playful<LOVE FOOD & SNACK< active, love outside.. Since we brought her home Fb 8 she was on feeding tube , which came out feb 15, she was well and though we have everything under control, then she started to vomit and poo with blood. She end up back in hospital 48h …. they said it may be pancreatitis – but her pancreas test results shows Normal.
    Now she sleeps most of the time, super quite and shy, eating has changed drastically, super finicky. i tried to feed her Hill I/D 2 times a day @ 6am and 6pm . We give her 5units of caninsulin ( we are in toronto). She is also on Vetoryl 30mg AM ans 10mgPM for cushings disease.
    i am desperate – i spent 12k in hospital and vet bills since jan 27- love her like my own kid, but she wont eat… i started her on pepcid ac 10mg half a pill with every meal. I don't know how to help her. i love her but im going broke and im scared im going to lose her. PLEASE PLEASE HELP ME with any suggestions to make her eat, i will cook her anything, as long as i know she will eat it and it is good for her.

    • Dr . Joi Sutton March 18, 2018 at 10:19 pm - Reply

      Pancreatitis and Cushings disease are unpleasant and expensive diseases for sure. Kudos to you for persevering!
      Do continue to see your vet as I can’t diagnose your pet over the Internet.
      Do know that there is a new appetite stimulant on the market for dogs called Entyce. And if your pet isn’t eating it may be from nausea. Check with your vet about adding some cerenia and/or zofran. Good luck!

  19. NATALIE REYNEKE April 6, 2018 at 5:14 pm - Reply

    Can I give my 10 year old cockerpoo, who is diabetic, a small diabetic chicken biscuit before his supper at 6.30 pm. Can I give it to him at 5.30 his dinner at 6.20 and his injection at 6.30 pm. He really get so hungry after 5 pm.

    • Dr . Joi Sutton April 8, 2018 at 7:01 pm - Reply

      I’d prefer if you waited for dinner at 6:30… I do understand how persistent (and convincing) a diabetic pet can be! I assume you give food and insulin at 6:30 am as well? We do want the injections to be 12 hours apart unless your schedule forces otherwise. Is there anything else that you can do at 5:30 to take his mind off food? Perhaps a walk? Or a toy? If you feel you must give a treat, stick to a low carb treat, perhaps some green beans or a bit of real chicken… Something lower in carbs. 🙂 Joi

  20. Kathy April 23, 2018 at 10:04 pm - Reply

    Thank you so much for this information. My cat is so sweet he comes and sits down for his insulin shot. He loves his prescription dry food and is not really interested in his old diet. I usually hit between the 11th and 12th hour and I give his Vetsulin at the same time as food. I’m learning to do daily blood tests but don’t know the range he should fall in so the numbers mean nothing to me. He still has problems (weak) in his back legs. He gets up and walks, sometimes ok and other times not so good. What can I do for that condition? It breaks my heart he is such a sweet, no problem, tuxedo kitty I’ve had since he was born and is 10 now.

    • Dr . Joi Sutton April 24, 2018 at 2:10 pm - Reply

      Weakness in a diabetic cat’s rear end usually is a diabetic neuropathy. The best way to resolve this is with good blood glucose control. I usually also give cats with diabetic neuropathy weekly injections of vitamin B12 as well. It can take months for the neuropathy to resolve.

      Hmmmm. Vetsulin isn’t my preferred insulin for diabetic kitties. It doesn’t often last long enough for diabetic cats. You’d likely have better success with glargine insulin or pzi insulin for a cat. Glargine is usually the most affordable (especially if you buy a 3 glargine pen) of all the 3 just mentioned.

      Do please get your cat off the dry food if at all possible. It is very difficult to regulate a diabetic cat who is eating kibble, even one of the lower carb kibbles. Our goal with newly diagnosed diabetic cats is to get them into remission. I feel your best chance at remission is low carb canned food and glargine insulin.
      Thanks for writing!

      🙂 Joi

  21. Kelly June 3, 2018 at 2:57 pm - Reply

    My sweet, 17 year old, Buddy, was diagnosed with diabetes back in April. I had recently moved to a new town and had to take him to a new vet. She started him on Vetsulin, 2 units, 2/day. Two weeks later, his numbers were still near 400 so she increased the dose to 3 units. She was not forthcoming with information or guidance so I decided to make the 40 minute drive and return to my old vet. My previous vet prefers Lantus but did not want to switch him because we were having such a hard time regulating him AND he had the most horrific diarrhea. (He is also hyperthyroid and has been medicated for that for years). She suspected he had food sensitivity and switched him to Royal Canin PR. His diarrhea is now gone but he is still not regulated despite being on 5 units 2/day. They have performed two glucose curves and his curve bottoms really quickly – about 3 to 4 hours after his injection.

    He did weigh about 15 pounds and is now down to about 9. He gets 1/2 can of food am/pm with his injection and kibble in between (per vet’s recommendation because she feels he will eat if blood sugar starts to drop). We are going to switch to Lantus but, after reading your comments above, I am now torn about getting rid of the kibble, He eats SO much of it that I can’t imagine how many cans I would have to feed him but I can’t stand the thought of him not having food when he is a skeleton. He will not eat more than half a can with his injection and sometimes it’s hard to even get him to eat that.

    Other than the unregulated diabetes (weight loss and PEEING EVERYWHERE), his bloodwork looks great and he seems himself for the most part. He goes back to the vet on Thursday for another curve and we will likely switch to Lantus. Any other thoughts about my food situation?

  22. Sharon July 7, 2018 at 9:39 pm - Reply

    My 6 yr old Maltese was diagnosed with diabetes 3 weeks ago. I have gotten used to giving the shots but he isn’t always calm. Tonight after his dinner I gave him his treat of a cut carrots while I gave his shot…the minute I touched him he started growling and snapping…,after getting my husband to help hold him…he bit my husband. After about 20 minuets I finally got his shot in. What can I do to make this easier?

    • Dr . Joi Sutton July 8, 2018 at 12:01 am - Reply

      I’m sorry this is causing you and him distress.
      Do you rub the area prior to giving the injection? Rubbing the skin stimulates nerve endings and makes the actual poke with the needle less painful. You may have just happened to get a sensitive area. When I give any subcutaneous injection I rub the skin before, during and after the injection.
      I’m glad you know the trick of giving the injection when you are giving a treat.
      Hopefully you just happened upon a sensitive spot and he doesn’t get grouchy again.

  23. Sherry Fischer July 9, 2018 at 10:35 pm - Reply

    My 15 year old Siamese cat, Sapphire, has IBD along with Diabetes. He was diagnosed with Diabetes in January of this year. I believe that the onset of Diabetes was caused by the Prednisilone he’s been on and off over the past 2 years. I tried Chlorambucil but that didn’t work – it caused another set of issues that we had to overcome. Sapphire is on Lantus right now at 2 1/2 units twice a day along with Prednisilone tabs 5mg twice a day. Would love to get him off the Pred but haven’t found anything else that works for the IBD.

    Any thoughts on alternate meds for the Pred? Every time I try to get him down on the Pred, the IBD flares up. My internal medicine specialist doesn’t think I can get him off the Pred.

    • Dr . Joi Sutton July 13, 2018 at 10:13 am - Reply

      Oh my. That’s a tough one. I would suggest you consult an internal medicine specialist, but you already have one! I assume you’ve already tried a hydrolyzed protein diet. And I’d sick to canned for as it is lower carb than dry food. I’d recommend you ask your internist for yet another chemo drug… anything to get your kitty off pred. I’m not versed in chemo drugs for IBD to give you an educated answer. Best wishes….

    • LJH September 11, 2018 at 5:00 pm - Reply

      Hi, Ms. Fisher and Dr. Sutton.

      My cat, MK, was diagnosed with small-cell lymphoma and IBD last December. With the help of an excellent oncologist located in Houston, she is doing fairly well. However, I found this page because, as a result of Prednisilone, MK has unfortunately developed diabetes, with a diagnosis last week, and I’m looking for any help I can get.

      At any rate, MK seemed to quickly go into remission with her lymphoma; yet, we struggled to control her diarrhea issue, most likely related to IBD, for many months.

      After exhausting a lengthy list of approaches, an internist who works with our oncologist suggested trying RX Clay as an alternative therapy. It’s a very fine, tasteless powdered clay that you sprinkle on their food. It immediately did the trick – and we all were shocked. I actually give a much lower dose than suggested. She’s had a flareup here and there and I just up the amount for a bit and she gets right on track. (Too much will, of course, have the adverse effect).

      Maybe you could talk with your vet/internists to see if this is an option for your cat. I ordered the RX Clay online – I’d caution against any warehouse-type sellers, though.

      Dr. Sutton, thank you for sharing your knowledge on such an important subject. I am feeling quite stressed about ensuring I manage MK’s diabetes correctly, but your guidance has been very helpful. (P.S. I’m also in Florida and glad to see the off-season breather arrive!)

  24. Amanda July 27, 2018 at 9:59 am - Reply


    My cat was diagnosed with diabetes last week. I was testing his blood glucose each time before I give him his insulin. He went from 22.8 to 16.1 mmol/L in the morning in 3 days.

    My vet says I don’t need to test before each insulin shot and I was wondering if that is a good idea or if I should continue testing each time.


    • Deanna August 9, 2018 at 4:25 pm - Reply

      I’ve heard of some cats going into remission, although it’s only a small number, I think it’s good to test!!
      Wishing you all the best!

  25. Deanna August 9, 2018 at 10:15 am - Reply

    I have a cat (11 yrs) diabetic for the last 4 months. Started out with 1u 2x daily. (Lantus) His BS was still reading between 400-500 hours befor next meal. Did 2u 2x daily and I saw 350 -425 ish.
    He prefers to eat when hungry, all wet food diet. Also has some kidney issues (stage 2) so he’s been getting turkey breast and high human grade protein.
    I switched to 1.5u 3x daily and he put the weight back on, had better energy – I thought he was doing well and he was. Dental vet said to feed him 3oz can 2x daily and do 2u twice daily suspecting a Somogyi effect for his high BS.

    Now my cat is thinner-looks more dehydrated and is unsteady on his feet. Not looking good like before. It’s been almost 2 weeks and I’m not convinced this was the correct plan. Cat was 10lbs -a good weigh and now I think he’s lost weight.

    I think I’m going to go back to feeding 3 times a day and 3x 1.5u of Lantus. I’ll do a curve tomorrow to see what his number are throughout the day, but visually his diabetes doesn’t look managed.

  26. Linda August 12, 2018 at 9:15 am - Reply

    Squidly, my 9 yr old Lhasa Apso just diagnosed diabetic. I am ok with it and giving him his shots twice a day. My vet has him on vetsulin. Food she said only Hills digestive weight glucose management. I will do what I can for him, but I am on SS and the food is expensive. Any suggestions or is this it? Thank you

    • Dr . Joi Sutton August 14, 2018 at 1:30 am - Reply

      Typically for diabetic dogs we feed a low fat diet as diabetic dogs are often pudgy and may have become that way secondary to pancreatitis. Carbs should be complex carbs, high fiber. If you are on a budget do please chat with your vet if he has other suggestions for you. 🙂

  27. ZB August 18, 2018 at 7:56 pm - Reply

    My cat was diagnosed six weeks ago and is still not regulated. She has urine crystals; these got quite bad even though she was on prescription food that had previously worked. (will need surgery when glucose regulated). We have left her on the urinary pH food due to Royal Canin recommendation, but 2x per day feeding with insulin dose at feeding time. She is up to 4 units vetsulin 40 insulin 2x a day (she weighs about 8 lb and is not overweight). Still has glucose about 400-450 every time checked; check performed sometimes 9 hrs after injection, once right before next injection. When diagnosed, glucose was 550. However, when the blood glucose curve done, she was free feeding same food, had 2 units and responded pretty well (glucose to 140 after 9 hrs). Being at the clinic, she ate hardly at all during the time the curve was done. Is the lack of food vs her eating at injection time why the insulin is having so little effect? Obviously she cannot fast constantly, but I am bothered by her responding well with the study and now not, even with double the insulin. Any comments?

    • Dr . Joi Sutton August 19, 2018 at 8:43 pm - Reply

      Do you mean she has urinalysis stones that need to be surgically removed? If she has a concurrent urinalysis tract infection she may have insulin resistance.
      I think you need to do home blood glucose testing and run curves.
      I’m not a fan of Vetsulin in cats. I prefer glargine (usually cc pen rather than a 10 cc vial).
      Is she on canned diet? Or dry? The dry will be very high in carbs.
      Why don’t you email me at joi.suttondvm@adwdiabetes.com so we can discuss this in more detail…

  28. Ella Frank August 22, 2018 at 12:16 pm - Reply

    One thing, I always allow for feeding around mid-point between insulin injections because occasionally her blood sugar will drop below acceptable levels. If so, she will need food and will eat hungrily.

    • Dr . Joi Sutton August 25, 2018 at 1:50 pm - Reply

      Depending on how often this happens, you may need to lower her insulin dose. Chat with our veterinarian about this.

  29. Martha August 23, 2018 at 5:54 pm - Reply

    Dr. Joi, My diabetic cat is in the early stages of kidney disease – the kidney diets all have high carb loads and sometimes they seem to be using plant proteins like soy instead of meat? Maybe you have already addressed the issue of managing kidney disease and diabetes and if you have can you provide a link to the article?

    • Dr . Joi Sutton August 25, 2018 at 2:01 pm - Reply

      Martha, when I have a cat with both diabetes AND kidney disease, I typically encourage a canned (not dry) kidney diet. Of course, kidney patients often have a finicky appetite and acidy stomach, so it can be tricky to manage the 2 diseases for sure! Of course, if the cat won’t eat the kidney diet it is more important that he or she eat than eat the “right” food. Do chat with our vet about the various renal options. Royal canin seems to have the best variety of flavors and smells for their renal diet selections over science diet and Purina but they are all good choices.

  30. Martha August 23, 2018 at 5:57 pm - Reply

    An ultrasound revealed thickening in my cat’s intestines – we decided not to do a sampling at the time so we don’t know if he has IBD or small cell lymphoma. Can you address how this might influence the treatment of a cats diabetes?

    • Dr . Joi Sutton August 25, 2018 at 2:03 pm - Reply

      Oh no!
      I am so sorry…
      I don’t know of a causative link between neoplasia and IBD, but certainly both often are treated with steroids. And of course steroids will result in insulin resistance that makes treating the diabetes more difficult.
      Much love to your kitty…

  31. Jeanne E. Barker August 25, 2018 at 7:13 pm - Reply

    Hello dear Dr. Joi, It’s been a little while since I sent you an email. LacyAnne is hanging in there. She has some diabetic neuro.pathy and weakening in her hind quarters. She responds well to B-Complex injections. The local vet said 1.5 units every 21-30 days?????? I disregarded his opinion, as I usually do, since waiting that long is harmful for LacyAnne. I waited a full 2 weeks and she was so weak that I gave her 2 units and she improved somewhat. Now I plan to inject her weekly and would appreciate knowing the maximum I can give her, without harm. There is a lot of diversity of thought about dosage to help her nerves remain healthier? Funny, this vet’s office tech had said bring her to office weekly for injection. Too stressful for LacyAnne, causing her glucose to go way above 250-300 levels. Since her kidneys are also affected by pancreatitis and Type I diabetes, I bought B Complex and inject her at home. She is definitely weakening in her hind quarters and needs the B Complex. Is giving too much very harmful to a dog? She now weights 16.4lbs and I’m giving her Levemir 1.5-2.0 units twice/day. I test and depending on her food intake, I will very the dosage, as needed. I appears that the Levemir does not always work. I went from using the pens to a vial for this reason and you don’t know if the insulin has been injected? Then the BG numbers are high and you know for sure. The vial Levemir seems to behave the same, even though you know with the syringe injection, that the med was injected. Some times it works and other times it doesn’t???? drug manufacturer refunded my $$ with the (4) unused pens I returned. Thinking of switching to Lantos. Like that it is long-lasting med. Drug viability is approximately 42 days. With the vial, two-thirds or more of the vial is wasted each time and cost is prohibitive. I see that you like the 3 pen Lantos script. Does it sound good for my LacyAnne? Also, is the Thiamine in the B Complex the component that helps her nerves deal with the diabetes? Can’t find just that part of the complex. Is the B-12 fat soluable and the one to be careful with, so as not to do harm? As always, I appreciate your sage advice. Thanks so much. Cordially, Jeanne Barker

    • Dr . Joi Sutton August 26, 2018 at 8:48 am - Reply

      “ I disregarded his opinion, as I usually do.” WHAT???? Please do not disregard the opinion of your veterinarian. If your history is such that you aren’t communicating well, either fix the situation or find another doctor who you feel you can work with. That comment scares me.

      Now, onto your questions…

      B12 (methylcobalamin) may or may not help diabetic cats. When I have a cat with diabetic neuropathy I use weekly B12 injections, but I can’t honestly say if it is helping. It takes a while (months) to get diabetic neuropathy and a while (months) for it to resolve. The true key to improving the neuropathy is good blood glucose control. For some cats that is easier than others. It’s not like we would just give B12 shots without striving the get glucose control, so there aren’t any studies proving B12 helps. We want good glucose regulation! B12 is water soluble.

      As far as using pens. I like them very much for veterinary patients as we waste so much less insulin with a 3 cc pen than with a 10 cc vial! I rarely have owners use the little twist on needles. Instead, I have them use the pen as if it was a vial and continue using insulin syringes just as they would for a vial.

      Levemir and lantus are both good insulin choices for a cat. Good job checking her blood glucose before each injection as she is clearly not under control if she has neuropathy. Is she eating a low carb canned food diet only? Low carb makes a difference. Since you mention renal disease I’d recommend the canned version of a renal diet.

      Do have a chat with your veterinarian. And don’t forget that most large cities have a veterinary internist. Internists go through an extra 4 years of training beyond the 8 it takes for us to call ourselves veterinarians. They are super smart and thrive on difficult to manage patients.

      Best, Joi

  32. Jeanne E. Barker September 1, 2018 at 4:45 am - Reply

    Dr. Joi, Do you prefer one drug over the other with Levemir or Lantus, for my dog LacyAnne? She has Somogyi, you mentioned, or the Levemir vial I’m now using is as unreliable as the pens were. The 3 pen Lantus script must be cheaper than the 5 pen Levemir @ $458 approximately. I would appreciate your thoughts regarding these two diabetic drugs for use in dogs. Thank you for your advice. Jeanne Barker

    • Dr . Joi Sutton September 1, 2018 at 2:05 pm - Reply

      The great thing about pens is that you are only buying 3 cc instead of 10 cc. That goes for whatever kind of insulin we are discussing. Our veterinary patients are usually so small that a 10cc vial mostly goes to waste. When I use a pen I have owners use the pen as if it were a vial, using an insulin syringe to pull the insulin from the pen and then injecting the insulin into the pet with the syringe.
      Now, I’ve never used lantus in a dog. It has a reputation of not working very well in dogs, so I’ve never tried it for dogs. Lantus is my fave insulin for CATS.
      Levemir is my fave insulin for dogs, but it can’t be used in really small dogs as it is so potent we can’t accurately dose it for really small dogs. I like it because it lasts longer than NPH or Vetsulin. However, I did have one dog who did horribly on levemir and so we changed insulin type and we finally got her regulated on Vetsulin.

  33. Gayle Joell September 1, 2018 at 11:22 pm - Reply

    Hi. My 16 year old bichon has been on insulin for 18mos. He gets two shots of vetsulin 4 units 12 hours apart. He gets very hungry late afternoon. One vet said best he doesn’t eat between but another suggested dividing food into three meals but only give insulin morning and night. I started giving a small portion about one fourth of each of the two meals midday. But everything you advocate seems to go against this feeding pattern. Would I be better off just giving some green beans midday?

  34. Jeanne E. Barker September 2, 2018 at 3:35 pm - Reply

    Dr. Joi, Thank you for your comments. LacyAnne, my dog, does good with her bg numbers one week and then terrible the next. Can she ever be well controlled or does this somogyi condition doom her too failure? If not Lantus as our new insulin, then maybe your mentioned vetsulin. I did however, read some negative reviews about this product when I first looked into it’s use. Did I gather correctly that if LacyAnne has Somogyi, she will likely not regulate on any insulin and all this stuff is due to her having pancreatitis too? Jeanne Barker

    • Dr . Joi Sutton September 13, 2018 at 8:39 pm - Reply

      Again, Jeane, please chat with your veterinarian who has examined her.

  35. Holly ramos October 3, 2018 at 11:17 am - Reply

    my corgi seems to be well regulated..but I’m curious to know your thoughts on his/our routine..I give him breakfast (3/4 heaped cup of kindle)..then a 14 oz can of string beans for lunch around 12-1:00…..then around 5-6:00 I give him either a handful of baby carrots or a small can of mixed peas and carrots WITH his evening insulin shot…..on any given day..he may get aan extra few carrot pieces as treats….very seldom now do we give him any carbs/fatty type foods as treats…as were trying to keep his weight under control…
    So..I’d like your opinion of his feeding schedule and WHAT he’s eating as well….thanks 🙂

    • Dr . Joi Sutton October 17, 2018 at 8:39 pm - Reply

      String beans are filling and low in carbohydrate. Green beans are your friend. Peas and carrots are fine as well, though they have more sugar than green beans. I didn’t catch when the breakfast is fed. In general, feed equal portions of the kibble every 12 hours, when the insulin is given.

  36. Kirk Welch October 14, 2018 at 1:50 am - Reply

    My dog is diabetic. She has been hospitalized a couple of time due to pancreatitis and low blood sugar. I feed and dose every 12 hrs as recommended. I’m disabled and home mostly so this is not a problem.
    Penny is a generally a voracious eater, I try and give a small snack at noon and her main meal at midnight along with my other dog. She gets 7 units each dose. My question is am I underfeeding her at noon with just a snack? She also has a thyroid condition so weight gain is an issue. Her main meal consists of a couple of tablespoons of Hill’s Science Diet XD diabetic food, shredded chicken and diced turkey with beef or chicken broth. Her noon snack is usually a Denta Stik or 1/2 a stick of Pupperoni.

    Your advice would be appreciated.

  37. Dr . Joi Sutton October 17, 2018 at 8:49 pm - Reply

    Hi, Kirk! You will find it easier to manage her diabetes if you feed equal portions every 12 hours. And of course you should run a blood glucose curve every few months or 5 to 7 days after changing the insulin dose.

  38. Marie November 7, 2018 at 9:20 am - Reply

    Our 4 year mini pincher was just diagnosed with diabetes, he is on 2 shots per day since august 2018, now he wont let us give him insulin he has had so many shots. can we put the insulin in his food, he will still get it into his body? stressed all out.

    • Dr . Joi Sutton November 7, 2018 at 7:42 pm - Reply

      I’m sorry, but insulin must be injected. It you put it into the food the body would simply digest it. Perhaps you could give the injection while e pet is eating to distract him? You know to massage the area prior to the injection, as you give it and afterwards, yes? It hurts less if you rub the skin like that. Chat with your vet about injections tips to make it hurt less.

  39. Keri Fillmore November 7, 2018 at 9:15 pm - Reply

    My boy is on vetsulin, he only gets one dose in am. I have been feeding him at 9 & 4 religiously. When we check his sugar prior to dinner and 7 hours after his shot he is at 137-177 tonight I decided to check him at 8:30 ( almost 12 hours from first shot and sugar was 380 however he isn’t showing signs of high sugar like thirst or increased urination. He has been on this dose and schedule since Feb. no episodes like before he was diagnosed where he was having several accidents in the home and while asleep.
    I don’t see many dogs that are on 1 daily dose but this insulin peaks at 4 and 7 hours according to there site.
    Would you change anything like add 2 Nd dose after dinner?

    • Dr . Joi Sutton November 10, 2018 at 9:20 pm - Reply

      I have never seen a dog (nor cat) regulated on once daily insulin. Yes, vetsulin does have FDA labeling for once daily dosing, but it doesn’t last that long in the body. As you saw, the blood glucose was up to 380! Please chat with your vet about giving vetsulin every 12 hours, with equal amounts of food at each dose of insulin. He will likely feel better when you change him to twice daily dosing. Again, have a conversation with your family veterinarian. 🙂

  40. Heidi November 17, 2018 at 8:45 pm - Reply

    Our 14-year old toy poodle just started Vetsulin this week at 2 units twice a day. She is also on Entyce due to her being a reluctant eater. Because she has a collapsing trachea, we treat her with Hydrocodone Homatropine (which I think is also known as Hycodan) as needed. Will this cough syrup be an issue now that we are treating her for diabetes?

    • Dr . Joi Sutton November 18, 2018 at 10:03 pm - Reply

      I do not think there is any effect of hydrocodone on insulin levels nor a drug interaction with insulin. There are a few meds that do affect blood glucose or insulin sensitivity. If the pet must stay on a med that does affect insulin or blood sugar, we will typically adjust the insulin dose and keep the pet on the med unless there is a good alternative to the medication. 🙂

  41. Maria December 6, 2018 at 7:57 am - Reply

    What if we weren’t able to give our dog insulin for two days ?if he eats on the next expected time for his insulin do we still give him the insulin if he is acting normal ?

    • Dr . Joi Sutton December 6, 2018 at 9:44 am - Reply

      Do please give the insulin as soon as you can. Without insulin, the pet will drink and pee excessively and get dehydrated and feel crummy. If you have any concerns, contact your veterinarian promptly. 🙂

  42. Scott Hill December 14, 2018 at 7:06 pm - Reply

    People at my vet clinic acted like 10-12 hours doesn’t make that much of a difference . Then I read in other places that it does . I want to do the best for my pup regardless of whether or not it is an inconvenience to me etc. It’s just that feeing at 9:30 and 9:30 seems to be a long time for her . I give her some boiled chicken to curb her appetite . I have another pup non diabetic that squeals out if he doesn’t get feed at 9 and 5 . Worrking out so far just was excited today to hear 10 hours is OK . But wanted to check , want her to have longest / best quality life possible . Thanks

    • Dr . Joi Sutton December 16, 2018 at 3:57 pm - Reply

      Well, if at all possible, give the injections every 12 hours. And give equally portioned meals. The better glucose control will improve your pet’s quality of life. It’s that simple. The better the glucose control, the fewer side effects such as urinalysis tract infections. She is able to last 14 hours overnight. Why can’t she last 12 hours during the day? Clearl6 sometimes life gets in the way, but aim8ng for 12 hours as your routine is the best. That’s what I would do if my own
      pet was diabetic.

  43. Stefanie Facchini December 26, 2018 at 5:24 am - Reply

    Hello Dr. Joi

    My vet instructed me to give Lola 7 IU once a day at 8 am. Then to feed her again at 4 pm without a second injection. I regularly check her glucose level. Before bed, it’s often around 20 on a gluco-meter. Is that normal when her reading is within the normal around at 4 pm?

    I think she should get 2 injections per day instead of one but am not sure what an appropriate amount is for a 7.5 kg dog. Any advice for me? Thank you .

    • Dr . Joi Sutton January 3, 2019 at 9:44 pm - Reply

      Rarely can a pet get a single injection of insulin per day. I’ve sure never seen a pet regulated with a once a day insulin injection. The Vetsulin label suggests once daily, but again, I have never ever seen it be adequate once daily. Typically we feed equally portioned meals, every 12 hours, with equally portioned doses of insulin. It would be illegal and dangerous to give you specific dosing advice for a pet I’ve not personally examined. Chat with your veterinarian about making the change. Also, you can learn a lot by reading the 2018 AAHA DIABETES GUIDELINES which are easily found online. Education is key to a well regulated pet. The AAHA guidelines are a good read. Chat with your vet. 🙂

  44. Joan December 28, 2018 at 5:28 pm - Reply

    My diabetic dog refuses to eat 12 hours apart. If he eats a small amount and I give him 1/2 his dose , and then decides to finish his meal 3 hours later, should I give him the other 1/2 of his dose?

  45. Charlene Kendrick December 28, 2018 at 9:29 pm - Reply

    My bishop has been diabetic for a white! She is all over the place with her levels.

    Do I check her before I feed her then give injections? I have to check her each time! I have been waiting to give her injections after she has eaten a while! Then I saw what you wrote was wrong for me to do! So what order do I do it!
    Check,feed, injections or
    Feed, check, injections!

    Thank you so much!

    • Dr . Joi Sutton January 3, 2019 at 9:36 pm - Reply

      Blood glucose curves are great for helping us see how a particular pet responds to a particular insulin. And yet, some times when a pet is erratic you may yet need to check the blood glucose each time and adjust the dosage as needed. I prefer that you check the glucose, feed the pet, the. Once you know how the pt has eaten give the insulin then. Of course, you need to chat with your veterinarian who has examined your diabetic pet and knows your pet.

  46. Bill Cochran January 11, 2019 at 1:44 am - Reply

    My Lhasa Opso 13’years old has Cushing’s disease and diabetes. Taking 2 shots of 6 units of
    Vetsulin daily and 30 mg of Vetoryl once a day. BG is spuratic and mostly high. Cortisol remain
    somewhat high. Would you recommend trying Ashwangha and if s what dosage.

    • Dr . Joi Sutton January 13, 2019 at 8:18 pm - Reply

      I’ve no experience using this herb.
      Certainly cushings makes diabetes difficult to treat. You must closely monitor the cushings and run labwork every 3 months or so.
      The recommendation for diabetics is to use the vetoryl TWICE DAILY rather than once daily. Vetoryl decreases the formation of cortisol in the body. If it is used Ockham once daily it is difficult to manage the diabetes.
      Have a chat with your vet about altering the dose regime to twice daily and what the new dose will be.
      Best, Joi

  47. Sandi Lindsey January 11, 2019 at 11:17 am - Reply

    My 15 yr old, 12 lb Chinese-Crested dog, Blue, was diagnosed with diabetes last month. The vet recently upped his insulin to 7 units on the U100, but he is STILL drinking a magnificent amount of water and peeing like he has to fill a pool. Is the never-ending thirst just the new norm?

    • Dr . Joi Sutton January 13, 2019 at 8:22 pm - Reply

      If your sweetie is still drinking excessively, the diabetes is probably not under control. Of course, there are other possible reasons for your pet to be drinking excessively. You’ll want your vet to run a urinalysis, urine culture and CBD/chemistry profile to check for other issues such as kidney disease, cushings or a kidney infection.
      Are you checking your pet’s blood glucose at home? Running blood glucose curves are the best way to determine if the diabetes is under control. I hope you are monitoring his glucose. Good glucose regulation will hopefully alleviate his thirst.
      Have a chat with your vet!

  48. Tara January 26, 2019 at 11:25 pm - Reply

    My Yorkie was just diagnosed with diabetes Friday . She is on vetsulin every 12 hours.. I started at 7 Friday night and 7 am this morning and 7 this evening. I need my mom to help me out when I work during the week… she told me to change her times for 10 and 10 because she doesn’t want to help out in the mornings. Can I just change her times like that ? I’m scared to mess up or cause her any complications

    • Dr . Joi Sutton January 27, 2019 at 7:40 am - Reply

      It’s nicer to change he time gradually, say an hour each day. However, since you would be pushing the time back you could just change the time, just like that. We wouldn’t want you to shorten the time abruptly as if she still had insulin in her system adding more could cause hypoglycemia. Make sense?
      How lovely that your mom is helping! It takes a village. 🙂 Joi

  49. Steven February 23, 2019 at 5:41 am - Reply

    Hi, Some mornings our dog eats her breakfast and then we give her her shot then go for a walk. Some mornings she may eat half then finish the rest when we get back in 10-30 mins. Is it okay to let her finish her breakfast when we return or must take it away. She never gets a shot on an empty stomach. Thank you.

    • Dr . Joi Sutton February 25, 2019 at 8:45 pm - Reply

      If she doesn’t eat it all at once but then regularly eats the rest once you come back from your walk that should be ok. Don’t take it away from her. And of course, chat with your vet who has examined her and knows her station and glucose curves. 🙂

  50. Anonymous February 25, 2019 at 2:59 am - Reply

    My dog is 11 and has been on insulin for about 6 months. She has stayed about the same. She had her first 4 curves and then one after a couple of months and then a few months inbetween and is still at the same 12 unit level. I feed her and give insulin at 7:30 am and then feed and insulin at 6:30 pm every day. It works well and this is how my schedule has to work. I have only missed 2 injections in 6 months and was late 1 time. She does fine with this schedule so I am going to just let it stay for now. Daylight saving time will be in a couple of weeks so she will have her injection 10 hr in between because I am not going to wait at night to feed her til 7:30. By the way I hate daylight savings time!

    • Dr . Joi Sutton February 25, 2019 at 8:48 pm - Reply

      If life were perfect and we didn’t have these pesky little things like employment and commitments I’d want you to give the insulin every 12 hours. Unfortunately, life is not perfect.

  51. Oreo March 11, 2019 at 8:22 pm - Reply

    Hi. My 12 yo cat was diagnosed with diabetes a couple of months ago. I currently give him 8 units of insulin 2x day. He has been on the same dry food for several years now. It about in the 34% Protein range. I would like to get him switched to either a wet food or a much higher Protein/low carb dry food. But I am very nervous to do so. How I can properly manage his insulin during this change. Should I drop him all the way down to 2 units/feeding (that is where we started and worked up to 8 units). Is it safe to have him under-dosed for a while until we figure out where he needs to be. I do have the testing supplies at home. How many times and what times of the day should I be testing him when making this change?? Thank you!

    • Dr . Joi Sutton March 16, 2019 at 4:18 pm - Reply

      You are absolutely on the right track that changing him to a canned low carb diet and not giving kibble whatsoever will lower his insulin requirement. Good job. Kibble will definitely cause higher blood glucose levels for cats than canned food. However, I cannot legally guide you how to do this as I’ve never examined your kitty. This is a question you must pose to your vet. Yes, you will likely need to drop the insulin level down to one or 2 units (as we typically start most cats on a unit) and start again, but I cannot tell you what is best for your cat. You clearly will need to monitor the glucose level closely when you take him off the dry. Chat with your vet. You can find carb content of most commercial cat foods online by searching cat food compositi9n chart.

  52. Anonymous March 23, 2019 at 11:41 am - Reply

    Good morning my cat is almost 14 and she was diagnosed with diabetes about 2 months ago. I have been doing two shots per day about 12 hours apart. She is usually starving so works out well. My question today is that she is not feeling well this morning. Didn’t eat and I’m not sure if I should give her a shot on an empty stomach. I poured a little tuna juice on her food to entice but of course she drank the juice but no food. It’s already almost 2 hours overdue.

    • Dr . Joi Sutton March 24, 2019 at 7:28 am - Reply

      You need to take her to the vet pronto. Pets who are usually voracious eaters are typically ill if the6 turn their nose to a meal suddenly. Do you have a pet blood glucose meter? If not, I strongly suggest you get one to help guide you through such instances. Do get her to your veterinarian!

  53. Toni Day April 6, 2019 at 5:17 pm - Reply

    Sometimes, we go out with family for dinner and have to be there earlier than when I normally feed my 13-year old diabetic Puggle. On normal every day routine, she is fed and given injection 15 minutes after her meal, every 12 hours, without fail. She is not finicky, but will sometimes, on occasion, throw up after she eats. I think she just eats too fast. This is why I wait 15 minutes to give her the insulin. I am wanting to know if it’s harmful to feed and give insulin an hour early on those occasions when we have to leave the house early.

    • Dr . Joi Sutton April 6, 2019 at 7:34 pm - Reply

      This might be a good time to check her blood glucose as a spot check to help you make dosing choices. And of course have a chat with your vet. You might also give a smidge less insulin when given an hour early. Do chat with your veterinarian who has examined your pet and knows her medical history.

  54. Joe Barnes May 2, 2019 at 6:22 pm - Reply

    So, what about those of us who cannot afford to give our pet two doses of insulin a day?? Just on one dose I am spending a hundred dollars every twelve days for the insulin and food, I am going bankrupt and my dog is suffering.

    • Dr . Joi Sutton May 6, 2019 at 7:06 am - Reply

      This message breaks my heart. ADW strives to help folks afford diabetes, whether human or animal.
      It is a rare pet (and I’ve not met one yet in my 26 years of practice) who does well on once daily insulin. I wish healthcare was free, but that is not the world we live in.
      Chat with your vet about diet and insulin options. Some insulins are more expensive than others. For example, Novolin (from Walmart) is much less expensive than a very similar drug, Humilin. Vetsulin is quite pricey for big dogs. Levemir is my fave dog insulin as it lasts so long and it is quite potent in dogs. Unfortunately, since it is so potent in dogs we can’t accurately dose levemir for small dogs. If you buy a 3 cc levemir pet (and use it as a vial, continue using an insulin syringe so you can make small dose adjustments as needed) it is perhaps the most affordable insulin for dogs. (If you and your vet make this change, know the dose of levemir is typically about 1/4 of the dose of other insulins as it is so potent in dogs. Start low and sneak up on the dose as with any insulin.)
      Your dog needs to eat regardless… perhaps change from a prescription diet to as close as you can match in an over the counter diet to save money.
      Home testing saves clients dramatically compared to testing at the vet office. And, if you home test and educate yourself, you will have fewer (usually costly) diabetic complications.
      It sounds like you need a heart to heart with your veterinarian! I hope you are home testing.

  55. Ted June 14, 2019 at 11:14 am - Reply

    Because of my work schedule, I give my dog insulin at 3:00am and 3:00pm. On vacation next week and would like to change shot times to 9:00am and 9:00pm if possible. Just for that week. How would I do that without messing up his levels. Thanks

    • Dr . Joi Sutton June 16, 2019 at 4:20 pm - Reply

      It’s easiest on your pet if you can gradually adjust the timing, say an hour or 2 each day. This isn’t always possible. In fact it might be rough on your sleep! You could also skip an injection just prior to the new schedule or give a lower dose for the dose prior to the new schedule. It helps if you are checking the blood glucose at home. A brief period of a high blood glucose level is safer than a brief period of hypoglycemia. Be sure to have a lesson with your pet sitter before you leave!

  56. Elma June 15, 2019 at 11:00 am - Reply

    Should insuline be given in the morning or evening?

    • Dr . Joi Sutton June 16, 2019 at 4:31 pm - Reply

      It is a very rare pet that would require insulin only once a day. Frankly, I’ve yet to encounter a pet who was well controlled on once daily insulin injections. Typically we give insulin approximately every 12 hours. We give the injection with a meal and try to avoid mid meal snacks (unless of course the pet is hypoglycemic).

  57. Corinne June 25, 2019 at 9:43 pm - Reply

    Hi! My mini pins was diagnosed w diabetes a year and a half ago. We use vetsulin 7 units bid. She tried a lot of diabetic food like royal canine and it severely constipated her and flared up her anal glands. Is there a certain food you recommend? Any certain dog treats or snacks ? I haven’t really found the right snack and I am worried the treats will make her sugar worse. My dog is on a schedule and she knows when it is snack time so I need some ideas . I have had to increase her dose to 10 u bid in the last week. I test her blood sugar and want to know best time to check sugar ? 2 hours after eating? I want to make sure I am doing everything right for her. Thank you in advance for help 🐶

    • Dr . Joi Sutton June 29, 2019 at 2:33 pm - Reply

      Hello! Royal canin has numerous diets. I suspect you tried their “diabetic” diet. It’s quite good, but if her anal sacs didn’t agree with it you should chat with your vet. Maybe she has an allergy to one of the ingredients. Dogs with anal sac issues often respond to high fiber diets, but you could also try adding fiber like psyllium or pumpkin. There are other good high fiber low fat diets that may be just the ticket for a diabetic dog. Or, your vet might suggest a hypoallergenic diet if there is concern for a food allergy.
      As far as when to test a diabetic dog, I like folks to run a blood glucose curves periodically or a week after a insulin dose change. If you change a pet’s insulin dose you should do so gradually to void the somogyi swing. That means if you increase the dose rapidly you could cause the blood glucose to plummet. The liver responds to low blood glucose by changing stored glycogen in the liver back to glucose.
      To run a blood glucose curve, check the glucose just before mealtime/insulin, then every 2 hours until the next mealtime/insulin. If the glucose goes below 150 mg/dL, check it hourly until it starts to rise again. 5is way we don’t miss the nadir (the low point). Share the results with your vet to adjust the insulin dose up or down if needed.

  58. Susan Harrell June 30, 2019 at 12:17 pm - Reply

    Hi, my poodle has been diabetic for 3 months also a Cushing pup. I do will with the testing /feeding . Right now unfortunally all he will eat is grain free fresh Pet . Everything else he get ( snacks ) or homemade turkey jerky treats . He’s on a 9 to 9 schedule . He’s still running hi in the am (low 400’s high 3’s) but about 3 to 4 hrs he drops down as low as in the 40’s . I can get him back up . Should I start treating him once i know he’s heading in the direction ? Should I lower his insulin? I have on order a homemade food that come in the mail and is cold / fresh . Hoping that this will help as I know what he’s eating now is to high in fat . I have a FreeStyle Libre on him also but do poke before insulin and for curves .just stressed about the sudden lows afte after the shots. Thank you in advance 🙂

    • Dr . Joi Sutton July 3, 2019 at 2:18 pm - Reply

      Do of course chat with your veterinarian, but a blood glucose of 40 is too low! You will need to back off on the insulin dosage.
      Human meters supposedly tend to underestimate the blood glucose of dogs and cats, but by how much I don’t know. It likely varies from meter to meter. Perhaps compare your human meter reading to your vet’s veterinary blood glucose meter or consider getting a veterinary look glucose meter.
      Cushings makes diabetes more difficult to regulate. Great job with the home testing!!
      Have a chat with your veterinarian. 🙂 Dr Joi

  59. Ray July 4, 2019 at 10:22 pm - Reply

    My 9 yr old Male Savannah was just diagnosed with diabetes and I’ve started the twice a day insulin injections. 1 week prior to diagnosis, he started to urinate in the hallway. He’s been on the injections for 3 days now and continues to urinate in my hallway. Is this something that could stop after his insulin levels become more regulated?

    • Dr . Joi Sutton July 5, 2019 at 10:42 pm - Reply

      Absolutely! Inappropriate urinations could be from the dilute urine (must be frustrating for a pet to feeling the constant need to urinate) or from a urinalysis tract infection. Or both. Urinary tract infections are extremely common in diabetics as the excess sugar makes the urine an inviting site for bacteria. Make sure your veterinarian knows your pet is peeing in the hall so your vet will check for a UTI. Sometimes in dilute urine it’s hard to recognize a UTI. Your vet may need to run a urine culture.
      Finally, be sure to clean up the hallway with an enzymatic cleaner. Otherwise the urine smell may linger and your pet may continue going potty there.
      As yo7 are new to having a diabetic pet, do be sure to get a pet glucose meter. Your pet’s blood glucose should be monitored at home for improved regulation of the diabetes!

  60. Tracy July 22, 2019 at 2:38 pm - Reply

    Due to an emergency my cats insulin dose was given at 2 pm not 8 am, should I skip the evening dose or give her the full 4 ml at 8 pm?

    • Dr . Joi Sutton July 28, 2019 at 1:04 pm - Reply

      If you miss a dose and it is more than 2 or 3 hours late you could either skip that dose, or you could give a fraction of the dose. Here is where having a blood glucose meter is very helpful in guiding your choices. Have a chat with your vet as well.
      Best, Dr Joi

  61. David Quadagno July 25, 2019 at 3:51 pm - Reply

    Our toy poodle has been diagnosed with diabetes. She is doing very well on one unit of insulin and is fed at 7 AM and 7 PM and injected right after she eats. She is a good eater. I tried using reagent strips and I catch urine while she is urinating. They indicate a nice glucose curve. My question is the the first urine in AM is always negative for high glucose. Yet in the late afternoon her glucose goes up above approximately 300 mg. Does this sound ok? I would have thought glucose numbers would be up in the first urination in AM. Thank you so much for the wonderful service you provide

    • Dr . Joi Sutton July 28, 2019 at 1:13 pm - Reply

      You can’t really do a “curve” on urine glucose. I would not alter the insulin nor judge the glucose control on urine glucose. It can be helpful, but it’s far more crude than blood glucose. Very pet has a different threshold in the kidneys for when they spill glucose into he pee. It could be 200 or 300 mg/dl blood glucose before you see glucosuria.
      Please consider getting a blood glucose meter and running the blood glucose curve at home. That men’s checking the blood glucose every 2 hours from one injection til the next. If it drops below 150 mg/dl then check it hourly until it rises again. This way we don’t miss the point where the glucose “bottoms out”.
      Best, Dr Joi

      • David Quadagno July 28, 2019 at 1:28 pm - Reply

        Thank you very much and I will do a glucose curve using blood.

  62. fran August 16, 2019 at 3:13 pm - Reply

    Back again with SUZIE!!! So, Suzie has been on Vetsulin (hate it) for 1.5 years never consistent FBG or nadirs so i am up 24/7 performing BG. Lantus was great but i never slept worrying just how low Suzie’s BG could go..and DVM would not guide me with Levemir. And though Suzie has never had any physical symptoms associated with DM..FBG of 440 vs 80 is concerning. It makes me wonder at times if the pancreas has a little insulin in there somewhere kicking in every once in awhile. Also, have researched whether she should still be on Ursodiol that was only prescribed at beginning since no liver or digestive issues… We feed Suzie now 25 minutes before administering Vetsulin hoping it could delay the sudden BG reduction lasting longer at 10+ hours. Merck provides no insight into the stability of vetsulin. Soo. if some dogs only receive it once/24 hours and most receive twice/24 hours (like suzie), how does one know that whether Vetsulin kicks in inconsistently causing these ridiculous fluctuations in nadir times and FBG..Any advice appreciated..’The “every dog is unique” claim has become irritating with regard to these blood glucose issues.

    • Dr . Joi Sutton August 21, 2019 at 10:47 pm - Reply

      Most pets respond consistently to a particular insulin, but there are other factors such as exercise that can affect the blood glucose. You are correct when you suggest that sometimes your pet may produce some insulin but largely doesn’t produce insulin. Have you considered seeing an internal medicine vet specialist?

  63. Stacy August 24, 2019 at 8:53 am - Reply

    Recently my 13 or so female dog was diagnosed with diabetes. Her first level was in the 600’s then 4oo’s ,300,s, 264 and back up again 364 . She is up to 9 units of insulin . She is a very picky eater . In good physical shape walks up to 2 miles per day .constantly screams when gets her injection . I give it to her early in the am 5-6 am while sleeping and again 12 hrs later when she takes her naps . What advice can you give me . HELP !!

    • Dr . Joi Sutton October 19, 2019 at 10:02 pm - Reply

      Try distracting your pet with the meal or a toy during the injection. And of course rub the area prior to giving the injection and then afterwards. Rubbing an area stimulates nerves in the skin and really does make it feel better. Additionally, your vet or vet tech can help guide you.

  64. Lynn September 27, 2019 at 6:41 am - Reply

    Hi, my 14 year old cat has been diagnosed with diabetes. She is on catsulin vet pen 3 units twice daily. This is week 3, her sugars were still 29 this week when at the vet. Up from 22 the week before but down from an initial 32. I’ve been so upset with it all! Tears the lot.

    Does this sound ok? Her eating and drinking has lessened. Her weight is up slightly and demeanour is bright. Giving the jags isn’t fun. She’s a very nervous rescue cat so being held twice daily isn’t enjoyable for her. I’m trying to remain as calm as possible and have been inticing her to me – had chased her a couple times which I realise isn’t great. I’m reducing kibble and giving canned/tray foods without the gravy. Small amount of chicken to get her over to me!

    • Dr . Joi Sutton October 19, 2019 at 10:15 pm - Reply

      Lynn, do take your cat to the vet for re-evaluation. I’m glad you’ve cut the kibble. I’d prefer your cat to be on canned only and no kibble whatsoever. I would also strongly recommend home glucose testing.

  65. Cheryl Cotter October 4, 2019 at 2:32 pm - Reply

    My cat has been diagnosed with diabetes this week. We are in the process of getting him with his insulin. He had been a feral cat until we took him in 5 yrs ago. He will be difficult to get to eat one meal not two. He eats dry food. He is afraid of me somewhat. How can I get him to eat the two times so I can give him his shots

    • Dr . Joi Sutton October 19, 2019 at 10:21 pm - Reply

      Clearly it is tricky when medicating a semi feral cat. Do your best and know that there may be times when you miss a dose due to his demeanor. It may be more difficult checking blood glucose levels as well. Do yourself a favor and feed canned food only. Canned food is much lower in carbohydrates than dry food. Good luck!

  66. Liliana October 5, 2019 at 8:53 pm - Reply

    Hi My fur baby is almost 14 and a diabetic and for the last two days after her breakfast and 10 units of insulin I been finding her looking sleepy so I tested her BG and seeing it is low around 3.7 and 4.5 not her normal 7.2. Why is she going into a hypo after breakfast please.. She has no infections at this point and no pancreatic either but does have arthritis and slight heart mummer. Shes on no other medication to be causing her to be low. Can you shed a light on why my baby is doing this. She is not vomiting, good appetite and regular toilet breaks. Thank you

    • Dr . Joi Sutton October 19, 2019 at 10:22 pm - Reply

      You need to take your pet to your veterinarian for a thorough examination and probably lab work. This isn’t a simple answer over the Internet. Your pet needs an exam. Best, Joi

  67. Jayne Myers October 11, 2019 at 11:35 am - Reply

    My 10yr old shorkie, kaiden been just diagnosed. Really struggling the 12 hours apart. Breakfast at 8 then tea around 5pm. Can’t last till 8. Is this OK. Please advise. TIA

    • Dr . Joi Sutton October 19, 2019 at 10:24 pm - Reply

      It’s much better for your pet’s blood glucose regulation to give the meals and insulin dosing every 12 hours. Do try!

  68. Michelle October 20, 2019 at 11:08 am - Reply

    My cat has been gettingg two shot of 2 units per day for a month and a half. Tested blood glucose last night with pet advocate and it was 4.4 before eating so didn’t give shot. This morning before eating it was 9. Should I give the shot? Vets told me under 9 not to??

    • Dr . Joi Sutton November 3, 2019 at 10:43 pm - Reply

      Let’s hope your kitty is approaching remission. At the very least you should check the blood glucose before each injection and chat with your vet about a sliding scale for the insulin dose based on what the blood glucose level is. Chat with your vet about parameters. At this borderline level your vet might advise a lower dose of insulin if you cat eats a really good meal. Or you may skip the insulin until the next dose. Chat with your vet to sort a game plan for your kitty! Remission is easier to achieve if your cat is on a canned low carb diet rather than kibble.

  69. Cynthia S. October 27, 2019 at 8:31 am - Reply

    Question, I can’t find the answer to this anywhere. My 13 year old Golden had suffered seizures from becoming diabetic. When we got him back, we weren’t properly told when was the best time to give him his insulin other than once every 12 hours. That part has been poorly timed so he gets it at 3. And we didn’t even know he’s supposed to eat before hand. What do we do? Also is there a way to adjust and implement a new injection time. Basically, I want to change the time of insulin shot to something we can actually do at night and to when we can give him food. Because 3am and 3pm is doing a bad number on my sleep.

    • Dr . Joi Sutton November 3, 2019 at 10:50 pm - Reply

      That does sound like a rough time for your schedule! Clearly you love your pet. Why don’t you try adjusting the injection time an hour later each day until you find a time that works for your sleep schedule.

  70. Missy October 30, 2019 at 7:37 pm - Reply

    My 7 yo Schnorkie ate only a few bites for breakfast this morning and only received 1/2 his dose at 8:30 when we finally gave up getting him to eat more, he normally eats 7-7:30. Tonight I tried to get him back on track and he was so hungry so he ate a really good meal and got his full 3 u it’s at 7:10. Now I feel like I have made a huge mistake giving it so early.

    • Dr . Joi Sutton November 3, 2019 at 11:23 pm - Reply

      Please don be so hard on yourself. Do get a pet glucose meter so that if you need to stray from the regular routine you can make an educated choice about the insulin dosage. Chat with your vet for guidance about future situations!

  71. Karen Fogg November 5, 2019 at 9:37 am - Reply

    I have a 5 year old 85 lb diabetic dog I’m at 50 everyday .. I go up two more I was wondering how far I can go out I have a hundred syringe…

    • Dr . Joi Sutton November 9, 2019 at 3:33 pm - Reply

      Karen, I’m not sure I understand your question. Perhaps you should ask your family veterinarian and show him or her what you mean about the syringe.

  72. Chance's mom November 17, 2019 at 1:17 pm - Reply

    Hello Dr. Sutton. I have a 10 y.o. German Shorthair/blue heeler that was recently diagnosed with diabetes (he was in DKA). He will not eat ANY type of vegetables. What other diabetic treats do you recommend? He has always liked rawhide bones, are those safe to give him?
    Thank you!

    • Dr . Joi Sutton December 14, 2019 at 4:20 pm - Reply

      Treats aren’t necessary. Low carb tiny treats would be best, for example a tiny bit of lean meat. Most of the calories should be given at mealtime (when insulin is given) for best glucose regulation. If your pet does well wi raw hides that would be fine. Again, most of the calories should be near the insulin dosing.

  73. Sophia Mazurek November 22, 2019 at 6:39 am - Reply

    Thank you for your article. Our cat was dia62 days ago. Stage 2 diabetes We have a finicky 21 year old with a bladder infection, and would like to shift her schedule from 8:30 to 6. Because she is “up”at 6 but back to bed at 8:30 – we currently have to wake her up – sort of – to eat. How possible is the shift?

    • Dr . Joi Sutton December 14, 2019 at 4:29 pm - Reply

      It’s best to give the injections every 12 hours but the time of day doesn’t matter so much. If you wish to change the time of day, just adjust it slowly over a few days, maybe half an hour or hour at a time. Great question!

  74. Kristen November 30, 2019 at 7:16 pm - Reply

    Hi, I have a 91/2 yr old Maine coon. Emma was diagnosed 1 1/2 years ago. I have kept a strict 12 hour schedule but was told to wait 30 minutes before her shot? I was recently told by a new vet at my clinic that she has peaks and I should give less insulin? I’m a little confused. I would love your advice as I thought we were good? I must admit she does ask for kibble ( We feed RD diet) once in the afternoon and once at night but that’s it. Thank You for any help

    • Dr . Joi Sutton December 14, 2019 at 4:35 pm - Reply

      I prefer that you give the injection as she eats (or once you recognize at she is eating if she is finicky).
      And even a little bit of dry can cause a higher blood glucose than canned food only. Canned food is much lower in carbs that dry food.
      Do you run blood glucose curves? I Px,aim curves several places in the articles over the years. If you type curves into the search box of articles it should get you to an article that helps explain how we interpret curves. The back to basics article series is also helpful to understand how we interpret and choose insulin dosing.
      You might also google the 2018 AAHA diabetes guidelines. That’s an extensive review of current recommendations for pet diabetes.
      Education is key!
      🙂 Joi

  75. Jennifer December 1, 2019 at 2:47 pm - Reply

    My 55lb Terrier mix dog was diagnosed last summer with Diabetes & almost died on me. He is now blind & that happened quickly. I give him 2 shots a day & try my best to keep the same times. He loves FOOD… And always is hungry, he will be laying down & ill hear his belly growl. I have him on Hill W/D right now. Is there something else I could be giving him to curve his appetite? A different kind of food?

    • Dr . Joi Sutton December 14, 2019 at 4:42 pm - Reply

      W/d is a great choice…. It’s low in fat and high in fiber. If he is still hungry you could give him some green beans. Who doesn’t love green beans!
      You could give him Ocu Glo to help his vision. I think all diabetic dogs should be on Ocu Glo to help diminish the deleterious effects of diabetes on the retinas and cataracts. If our pet has diabetic cataracts, your vet might consider ketorolac (or other anti inflammatory) to decrease the risk of uveitis. Have you taken your sweetie to a vet ophthalmologist for a consult? Most large cities have vet “eye doctors”. They can even remove he cataracts to restore some vision. 🙂

  76. Leslie December 2, 2019 at 10:51 pm - Reply

    My dog is 8 yr old Maltese he has been an epileptic dog most of his life. So he is currently on Phenobarbital and potassium bromide. Just recently diagnosed now with diabetes supposed to get insulin twice as you say but in the last week he has had zero appetite for morning meal. Talk to vet she suggested trying just one insulin injection at night only. And raised the units some, previously giving 10 units twice day now she says try 13 units at night. Won’t this hurt him??

    • Dr . Joi Sutton December 14, 2019 at 4:45 pm - Reply

      Great question!
      I’d prefer that your pet got equal doses twice daily rather than a once daily dose of insulin.
      Have you considered an appetite stimulant such as mirtazapine? Or an antinausea med such as Zofran or Cerenia? Those would be good options. Diabetics may feel nausea and these may help improve the appetite. Chat with your vet about this.

  77. odalys ramos December 5, 2019 at 11:48 pm - Reply

    My dog resenly was diagnostic diabetic I give him insuling every 12 hrs 10 unit at night like at 11 pm and in the morning at 11 am he eat at 6 am and at 5 “pm do I doing well

    • Dr . Joi Sutton December 16, 2019 at 8:32 pm - Reply

      Well, it would’ve lap his blood glucose control (and therefore his quality of life) if you gave the insulin at the same time as the insulin. If your pet is food motivated and couldn’t imagine missing a meal, then give the insulin as he starts to eat. If he is finicky then you might watch to make sure he is eating before the injection. 🙂

  78. Jeremy December 14, 2019 at 8:51 am - Reply

    How quickly can cats go into remission? My cat was diagnosed with diabetes about two months ago, and our vet has us feeding him wet food and giving 2 units of Vetsulin twice a day. Last night he had what clearly appeared to be a hypoglycemic event, so we (eventually) got him to eat a little of his old kibble so he could bounce back, and this morning we’ve returned him to his wet food and are not planning on giving him any insulin today. We usually feed him at 6:45 am/pm, make sure he eats a little, and give him his shot at 7. Going forward, should we just give him a longer time to eat first (an hour?) and adjust his dose accordingly? Some days he eats well, others he doesn’t.

    • Dr . Joi Sutton December 16, 2019 at 8:29 pm - Reply

      You are right on the money and answered your own question correctly. Cats can go into remission in as short as a week, but 2 months is not uncommon. Great job. Now, if we are approaching remission, please check the blood glucose before each dose. Yes, adjust accordingly. Work out a sliding scale (which may be no insulin at all when it is below a certain number (I’ll let you and your vet choose these amounts). Do continue canned only food. If you do achieve remission, keep an eye out for old symptoms as remission may be transient or permanent.

      Great job!

  79. Mallory December 18, 2019 at 1:50 am - Reply

    Just wanted to say thank you for taking time to answer questions. My 15 year old chi mix has had diabetes since 2016 and it has been a journey…he got cataracts soon after diagnosis but luckily we have great eye surgeon here in SF so they were able to save his left eye. Having a diabetic dog is hard and I feel shame in that I did let him get overweight so of course I blame myself. Anyway, thanks again for all the great info you give out.

    • Dr . Joi Sutton December 22, 2019 at 4:53 pm - Reply

      Happy holidays and thanks for the note!

  80. Michele K December 20, 2019 at 6:26 pm - Reply

    My 13 year dog was diagnosed with diabetes over the summer. It feels ever changing, and lately, while his blood sugar will drop as low as 125 after his insulin shot, before meals (which we do as close to 12 hours apart as possible,) he rises to 500-600+. This leads him to hunger and discomfort in the last 1-2 hours before his next meal. He’s agitated and whines and everyone is sad and upset until meal and insulin. What can I do to help him during that last couple of hours?

    • Dr . Joi Sutton December 22, 2019 at 5:03 pm - Reply

      This is a pickle. If his nadir (where the blood glucose bottoms out) is at 125, you are likely pretty close to the best dosage for him with whichever insulin you are currently using. You might chat with your vet about if there is another insulin to try that may last longer for him such that his blood glucose doesn’t skyrocket up to 500 or 600. Each pet metabolizes different insulins differently. Some insulins (i.e. Levemir) may last longer than others (ie vetsulin or NPH).
      Also, if he isn’t already of a high fiber diet, using a high fiber diet may help slow gut transit time and make him feel fuller longer. You could try giving him some canned green beans which are very low in calories to help him get through the last hour or 2 til dinner time.
      Have a chat with your veterinarian about your pet.

  81. Rochelle December 21, 2019 at 4:06 pm - Reply

    I give my cat 2 units if insulin twice a day at 8 am and 8 pm every day. My question is if once in a while I am not home at 8 in the evening how long after 8:00 can I still give the injection? And after how long is too late to give the injection and I should just skip that dose?

    • Dr . Joi Sutton December 22, 2019 at 5:11 pm - Reply

      Great question!!!
      Good job getting the injections every 12 hours most of the time. However, life is not perfect and sometimes you won’t be able to accomplish this. In general, if you are 2 hours late and your pet is well controlled in general, you can likely give the injection without worry. You might check a blood glucose the next morning to make sure you don’t need to drop back the dosage the next morning, but you are likely okay to do so. If the injection is several hours late (i.e. 11 pm or midnight or 1 am) then you might drop the insulin dosage by half but still give it. And the following morning, since it was given more recently than usual, you might check it again. If you are gone til the wee hours I’d likely skip the dose and give the normal dose at 8am as ou normally do. Just know with the skipped dose your pet’s blood glucose will be elevated and will need to pee more and drink more due to the high look glucose level for that period.

  82. Elizabeth Ritz December 22, 2019 at 8:09 am - Reply

    Hi My 13 year old miniature American Eskimo has diabetes and was diagnosed in April of 2019. Her diabetes was regulated but then a few weeks ago she had an episode where she appeared to be hypoglycemic. The vet decided to lower her insulin dose from 5 units to 3 units. Now she is back at 5 units and it is still hard for her to be regulated. She gets her food and insulin at 10 am and 10 pm every day. When I checked her blood sugar, her blood sugar is at 130 during the day at 4pm , but at night it rose to 319 at 3:20 am. She is very restless at night, appears to be uncomfortable and drinks more water. Why would her blood sugar be lower during the day and higher at night? I give her the same amount of food I exactly measure it and she eats both with no problem. Her bed time ritual usually is to sleep with me in my bed, but now she stays for an hour and doesnt want to be bothered. Also she is very skinny and it is hard to give her a shot by rotating the injection site. Any tips? I’m so desperate thank you.

    • Dr . Joi Sutton December 22, 2019 at 5:22 pm - Reply

      Well, she is likely more active during the day than at night, so at could account for some of the difference between daytime and night time blood glucose levels. Still, that seems like a big difference if you are feeding equal meals and equal insulin doses. Your pet no longer seems regulated.
      Are you doing spot checks at 4 pm or are you doing a full blood glucose curve? Curves give us so much more information than spot checks. A spot check tells you what the blood glucose is at that moment but doesn’t tell us if the blood glucose is rising or falling.
      A curve means checking the blood glucose every 2 hours from one insulin injection til the next, and checking hourly if the blood glucose is less than 150 mg/dl until it starts to rise. (This hourly bit is so we don’t miss where it bottoms out.) If you aren’t doing curves, please do one and chat with your vet.
      That you say she is now skinny, do please have a full blood profile and pancreatitis testing and urine culture done to look for other causes of insulin resistance. Dental disease is another common cause of unregulated diabetes.
      Do you rub her injection sites before and after the injections? That may help decrease discomfort of the injection. Insulin injections (even with a tiny needle and small dose of insulin) do tend to be more irritating in lets who are quite thin compared to pets with normal body condition.
      Do chat with your veterinarian. 🙂

  83. Maria December 24, 2019 at 8:56 am - Reply

    Starving cat!
    Our cat was diagnosed with diabetes a few months ago and we are still trying to control his glucose levels. We feed him only twice a day, 12 hours apart, but we find ourselves administering more insulin than we did in the beginning. We started at 1ml now we are up to 3ml 2x a day and his glucose levels are about the same each time we check before a feeding. (In the 300s) He is on a special diabetic food diet but howls for food as early as 3am some nights. Also I notice his behavior has changed. He no longer sleeps in bed with me (he did return to our room a few days after his initial injections but doesn’t seem to have the energy as of the last few weeks) Our feeding period has been 5am and 5pm. How long is insulin good for? Our vet says 3 months but the pharmacy says 28 days. I’m wondering if the insulin is losing it’s effectiveness or if there is something else we can do to control his appetite and glucose levels. Our cat is 13 yrs old. The vet has suggested a device we can essentially glue to his back to monitor his levels all day so we can look at the curve. Any suggestions/thoughts would be helpful. Thanks

    • Dr . Joi Sutton December 31, 2019 at 5:14 pm - Reply

      All insulins are approved for 28 days. We veterinarians routinely abuse this FDA approval due to cost constrains of our veterinary clients. I try to use the smallest vials possible (often this means a 3 cc pen) so that we are less likely to have to discard insulin. The smaller containers are more expensive per cc but the overall cost is less for a 3 cc vial (i.e. pen) than the typical 10 cc vial. The insulin I feel most comfortable using for 4 months is glargine/lantus. Of course an insulin should be inspected before you pull up a dose for cloudiness or debris which are sure signs that the insulin has gone bad. If your pet is not responding as he once did it may indeed be that the insulin has gone bad. You should chat with your vet about a new vial.

      Continuous glucose monitoring is the wave of the future for pets but it is still in its infancy. If your vet is using it, do please give it a chance!

      Keep up the good work!

  84. Judy December 31, 2019 at 10:24 am - Reply

    Thank you for your article my dog was recently diagnosed with diabetes and I was really upset about what I did wrong. I have a very trusted vet but I have so many questions . What kind of treats can I give him that would be OK and not effect his glucose numbers. Also what is the best food? Thanks for your help.

    • Dr . Joi Sutton December 31, 2019 at 5:33 pm - Reply

      For diabetic DOGS we typically give a low fat, high fiber diet. (CATS typically get very low carb diets for best glucose regulation.)
      In general we want both dogs and cats to receive the majority of calories fed at the same time as the insulin injections, so snacks should ideally be kept to a minimum and be the similar content as the main diet.

  85. Tara Lucas January 2, 2020 at 4:45 pm - Reply

    what to do if it is time for cat’s insulin shot but his blood sugar is within normal range (75-150)? it is time to give my cat his second insulin shot of the day but his blood sugar is 96…

    • Dr . Joi Sutton January 5, 2020 at 10:01 am - Reply

      Of course have a chat with your veterinarian (who has examined your pet) for a game plan, but you should skip his dose of insulin. Let’s hope that your kitty is reaching remission! In such cases I encourage a sliding scale, meaning that you adjust the insulin dose based on what the blood glucose level is at that time). Chat with your vet about the insulin dose for various ranges of blood glucose (assum8ng your cat eats the meal of course).

  86. Linda January 4, 2020 at 7:22 pm - Reply

    My Westie Lucy was just diagnosed with diabetes She is eating Honest Kitchen limited ingredient fish with Taste of the Wild kibbles. By what I’ve been reading canned dog food is better with lower carbs and higher protein Can you guide me in switching My vet doesn’t seem to think it makes any difference Want to do the best for my dog

    • Dr . Joi Sutton January 5, 2020 at 10:15 am - Reply

      Traditionally we have fed diabetic dogs a high fiber diet that is low in fat. We want both soluble fiber to slow the glucose surge after a meal and insoluble fiber to slow gut transit time and help your pet feel full longer. Additionally, as many pets have become diabetic post episodes of pancreatitis we typically feed them a low fat diet. If we cut out much of the fat, we have protein and carbs to choose to make up the remainder of the diet. A very high protein diet is not necessary for dogs to achieve good glucose control. Vets have found that high protein and low carb diets help diabetic cats, but it hasn’t yet been shown to improve diabetic control for dogs. Cats and dogs are very different in regards to nutrition. Of course, any special snacks you might give should be given near meal time (when insulin is given), and I’d advise them to be low carb.
      There are several diabetic diets on the market for dogs! They are high in fiber and lower in fat. Royal Canin, Hill’s and Purina all have diets designed by nutritionists for diabetic pets.

  87. Beth January 12, 2020 at 10:10 am - Reply

    I have a 40 lb lab border collie mix who has been diabetic for about 4 years. Recently she had (attempted) dental surgery but had a cardiac event after being given premed opoids and surgery was not performed. (Never got to anesthesia step.

    Now, we are at about 48 hours later and she has yet to really eat a full meal. Her appetite is spotty so my insulin doses are also. I am struggling with how much food I can give her before a dose. She seems to like scrambled eggs..but then will suddenly stop. Will eat a little wet food but stops. Previous to her surgery insicdent her appetite was declining and I attributed it to her teeth being in pain..since she started to spit out kibble and be better with soft food. Any guidance on any general rules for how much to feed before meds when you are doing with a dog that is eating a variety here and there but not a lot of one thing? She gets 19 units of insulin and previously ate 4 cups of Hills WD a day.

    • Dr . Joi Sutton January 12, 2020 at 9:44 pm - Reply

      Clearly when things aren’t going well, you need a game plan with your veterinarian who knows your let and has examined your pet. I hope you have a blood glucose meter to help you and your vet decide how much insulin you should give. I suggest you and your vet make a “sliding scale” for her insulin dose based on how much she is eating at that meal and what her blood glucose is at that time. If your vet hasn’t already done further diagnostic tests to determine why her appetite is off, it is likely time.
      I do hope she turns around!

  88. Geraldine Nash January 14, 2020 at 11:22 am - Reply

    I have a recently had my cat diagnosed with diabetes. I have him eating a can of Friskies in the morning at 7:00 a.m. then give him an injection at 7:30 a.m.and repeat the same regime at the same time each evening for 7:00 p.m and shot at 7:30 p.m.. I think the can is close to 6 ounces. Is that enough food or is it too much…I just don’t know..Could someone please tell me the exact amount of food that is acceptable.

  89. Amanda Swiderek January 17, 2020 at 7:17 am - Reply

    Thank you for the great article. Having a simple, clear article helped a bunch. After leaving the vets office, lots of questions arise and the internet sometimes makes your mind spin even more when researching your pet’s new diagnosis. I appreciate the clarity your atticle brought.

  90. Marie Sloan January 20, 2020 at 9:21 am - Reply

    Do I need to worry about having my Diabetic dog’s nails trimmed? How about brushing her teeth with Virbac enzyme toothpaste? She is recently diagnosed Minature Schnauzer 14 yo. Do you have a practice in Oregon still? Thank you for your help.

  91. Sharon L. Maxwell January 22, 2020 at 7:40 pm - Reply

    Have an unregulated recently diagnosed diabetic cat. Am I doing more harm than good giving him 1. Oz. Portion of chicken breast between meals he gets fed at 5 am 11 am and 5 pm with insulin injections of vetsulin at 5am and 5pm. He has always been a big eater and now acts like he’s starving to death. Thank you. His glucose curve was done today and it was in the 400s down from 540. His vet increased dosage up to 4u from 3u. Thanks again from a worried let mom!

  92. GaoXiang February 23, 2020 at 11:46 pm - Reply

    Dr. Sutton I’m,I’m in China. I don’t have pet specific insulin here. Is there any way to buy pet insulin? I use Lantus insulin glargine, which is used by people. Now I take it once a day. The weight of pet is 19kg, the dosage of insulin is 0.45ml, Her glucose is very high,The lowest in a day 15nmol / L. what can I do if I can’t reduce it all the time? Do I need to take it twice a day? I asked the domestic pet doctors that they said it can’t be done twice a day.

    • Dr . Joi Sutton March 6, 2020 at 8:17 pm - Reply

      I’ve used both NPH and levemir quite a bit in dogs. Both work well. Know that dogs are very sensitive to levemir and the dosage is about 1/4 of the units you’d likely give of other insulin types. I’ve not used glargine in dogs though it is my favorite insulin for cats. This is not to say glargine wouldn’t work in a dog, but it hasn’t gained favor from those vets who have tried.
      Insulin rarely works once a day for pets. Twice daily is better. You are welcome to email me at joi.suttondvm@adwdiabetes.com

  93. Claudia February 29, 2020 at 6:39 pm - Reply

    I give my cat Lucy her insulin every 12 hours but today I have to leave early and it will be 3 hours early to the time of her shot. I give her shots at 8am and 8pm. So I’m leaving at 4:30pm. Will it be okay to give it to het so early or should I wait until I get home which will be late probably after midnight! Thanks Claudia Brotman

    • Dr . Joi Sutton March 6, 2020 at 8:40 pm - Reply

      I’d likely wait and give it when you got home late at night, but give a lower dose. Home testing is very helpful in these situations. Life is never perfect. A brief period of a high blood glucose is safer than a brief period of a low blood glucose.

  94. Sharon March 17, 2020 at 7:56 am - Reply

    Hi, I have a 10yr cocker spanial who has jus been diagnosed with diabetes. He is having his first curve done tomorrow. My problem is he has a sensitive stomach and has been feed 5 small meals a day to help with this. Two of these meals are fed while he is being walked, kibble from the pocket. He has 30grm of hypoallergenic kibble with 30grm white fish in morning so I can give him his insulin. 70grms of kibble while out on his walk straight after. 11.35 he has 70grms white fish, 30grms green beans and 30grms of white rice. 2.30pm 30grms kibble out on walk. 5.45 fish, green beans and rice again and insulin. 9.45 30grms of kibble and fish.
    He has currently lost alot of weight but the vet tells me that hopefully he will.put this back on once insulin under control.
    Please let me know if I should change his eating routine. I will try anything that is going to help him.

  95. Helen adams April 22, 2020 at 3:08 am - Reply

    My diabetic dog usually bites my hand off at meal times , she has 139 grams of wet/ dry Royal Canine low fat food . She then has 4.1 units of insulin
    Just recently she isn’t eating as well, and today she only ate 92 grams of food do I gave her 2 1/2 units of insulin. This scares me because I don’t know why she’s not eating … she is 16 and sometimes suffers from pancreatitis, she is well regulated usually and isn’t over weight. I feed and inject her every 12 hours and she doesn’t have food in between those times
    What shall I do ? .

    • Dr . Joi Sutton April 26, 2020 at 10:13 am - Reply

      This is a question for your veterinarian who has examined her. Pancreatic can be tricky and smouldering. You might check for a flare up and consider having anti nausea mds such as cerenia and zofran at home for such episodes. Call your vet. Best, Joi

  96. Lynn April 24, 2020 at 12:28 pm - Reply

    I just want to thank you for keeping your site replies—even to a 2014 article that was enormously helpful—open and current. No other comments or questions at this time just a thank you for your helpfulness

    • Dr . Joi Sutton April 26, 2020 at 10:13 am - Reply

      Thank you!

  97. Denise Burkholder May 3, 2020 at 10:24 pm - Reply

    We have an aussie that was recently diagnosed diabetic. I am well versed in taking care of diabetic dogs as I used to dog sit for a friend who had to be out of town frequently. My problem is we have 3 dogs at home and they get a 32 oz. cup of kibble in the morning split between 3 bowls that they graze on all day. How do I go about figuring out how much to separately feed the aussie. He is around 46 pounds and in good shape for his 14 years besides some arthritis. I did buy some canned food as I know they have to eat before getting their shot. I plan on 8 am and 8 pm (I am retired so time doesn’t matter). Not sure how much he SHOULD eat before his shot. I know he will eat the canned food readily but grazes on the kibble. Hope you have some good suggestions. Thank you,

    • Dr . Joi Sutton May 26, 2020 at 5:39 pm - Reply

      First of all, these are questions I’d like you to discuss with your veterinarian as your vet who has examined him will know if there are co-morbidities and your pet’s body condition score. For example, if your pet also had kidney disease it might alter the diet choice. And if your pet is pudgy we’d want to gradually get him to normal body weight to lower insulin resistance brought on by being pudgy. Typically I tell clients to give the injection as the pet dives into a meal as most diabetics are food motivated. If our pet is finicky or has mild nauseas and has a spotty appetite, eating a third or half would be nice before giving the insulin injection would be nice.
      The 2018 AAHA Diabetes Guidelines might be an interesting read for you. You can google it online.
      Best, Joi

  98. Leslie and Stu May 13, 2020 at 5:26 pm - Reply

    Hi Dr Joi
    Our 12 year old tabby was recently diagnosed with diabetes. We are administering insulin injections and doing our best to adhere to every 12 hours. We wait for him to start eating and finish about half his food before giving him his injection after which he returns to eating. How long should we wait before we remove the unfinished food? Thanks so much!

    • Dr . Joi Sutton May 26, 2020 at 5:34 pm - Reply

      Cats are frustrating in that they often prefer to nibble rather than meal feed. I’d pick up the uneaten food after 2 or 3 hours.
      Low carb food (canned food essentially and preferably one of the diabetic canned foods) are your best chance to reach diabetic remission.
      Good job!

  99. Trudie Baggett June 5, 2020 at 12:06 am - Reply

    Hello Dr. Joi,
    I was pleased to come across your website! My chiuaua mix was diagnosed with DM in March 2020. The clinic had me leave her for 12 hours, 2 days back to back. They did 2 curves on her. One with vetsulin and I thought the other was humilin? Her bg was running 570 something before treatment. They decided to go with the vetsulin once every 12 hr at 4 units. In May I missed one dose and had to rush her to vet for dehydration. They tested her and again her bg was 523. Vet increased her dose to 5 units. I bought a meter and vet showed me how to do. At that time her reading was 573 post injection at 1 1/2 hours. Vet said could do a curve at home since $ is an issue. Since I am by myself testing is very difficult. She fights me growls and snarled. Vet said with her reading that high, good chance they will increase dose. I tested on ear but couldn’t get enough blood. Unable to test on her paws. She’s never bitten but I’m scared to push it. Thought about muzzle but will have to get a ride to pet store, I don’t have a car. Need to get started testing asap and report to vet readings. I’m at a loss for suggestions how to test her and fighting her which makes her mad and me extremely frustrated. ANY help please. Asked vet, but she had no answers.

    • Dr . Joi Sutton June 7, 2020 at 8:00 pm - Reply

      Trudie, I wrote an article to help folks with home testing. It’s on our website and called “Tips & Tricks For Collecting The Perfect Blood Sample From Your Pet”. Go to the articles tab and type this into the search box for the pet articles.
      A soft blue muzzle is never a bad idea if you are anxious.
      And of course you can order an Alphatrak starter kit from ADWDiabetes even if you don’t have a car.
      Never be afraid to ask your vet for help.

  100. Terry June 17, 2020 at 12:26 am - Reply

    Kitty-sitting for my daughter and have been vigilant about injecting insulin every 12 hrs. but tomorrow evening I will be away at the 8 pm injection. Do i inject 2 hrs early or 2 hrs late? he eats whenever I feed him and has little snacks throughout the day. He is 18 yrs. old. He can eat whenever he wants!!! And he lets me know when he is hungry!!

    • Dr . Joi Sutton June 21, 2020 at 8:23 pm - Reply

      This question would be best answered by his veterinarian who has examined him! However, if I had to choose i would choose a smidge late rather than a smidge early. A short period of a high blood glucose is safer than a short period of a low blood glucose (if you have he insulin early). Additionally, if he did become hypoglycemic from the early dose it doesn’t sound like you would be home to help him. Have a chat with his veterinarian.

  101. Vicky June 20, 2020 at 7:53 am - Reply

    hello Dr . Joi Sutton,
    i accidentally forgot to inject the insulin for my dog to night and did it 2 hours and 15 mins later than routine time. Is it ok if he gets the next one (tomorrow morning) the same time and same amount as usual? This was the first time that I forgot. Thank you.

    • Dr . Joi Sutton June 21, 2020 at 8:19 pm - Reply

      Good question. You might then lower the next dose as she got this dose late. It would be best if you checked her blood glucose to help guide you.

  102. Sharon June 24, 2020 at 11:26 am - Reply

    Alfie had excessive drinking for 5 days, dropped urine sample off at vets last fri am. Vet rang pm to say had diabetes. Gave insulin bloods 19. Vets sat am insulin after food, bloods 28, no insulin pm. Vets same sunday, monday bloods 25 only 1 insulin, tues 2 insulin at vets but no bloods, today 1 insulin after food, bloods down to 5.5, vet advised no insulin tonight, no food or insulin tomorrow morning, vets at 9 for bloods.

    Everyone is saying to change vets as insulin should be 2 a day from start. Any advice appreciated

    • Dr . Joi Sutton June 28, 2020 at 5:37 pm - Reply

      Although Vetsulin is FDA labeled for once a day dosing, I have never seen a pet’s diabetes effectively controlled on once a day insulin. It is unusual for a vet to choose once a day dosing. Do chat with your vet about twice daily dosing and I recommend you read the 2018 AAHA Diabetes guidelines which can readily be found on the internet. My basic articles on the adwdiabetes website can be found under articles then pet articles and typing into the search box “back to basics”. Those 4 articles outline my simple approach to pet diabetes for pet owners for newly diagnosed diabetic pets.

  103. Maggie Bryson July 7, 2020 at 7:21 am - Reply

    Good morning
    My 12 year old Bichon is a diabetic. His count is up and down. He gets food and insulin between 6:00 and 6:30 each morning and evening. My problem is that he does not eat all of his morning food. I have been leaving the rest for him to eat later. Is this ok or should I just give a snack at lunch. He comes and begs for food if mine is there. Another problem is our 10 month old Bichon is a grazed. I am now giving the same food for both. She is little and needs to graze. What should I do about the eating between injections.

    • Dr . Joi Sutton July 12, 2020 at 10:06 pm - Reply

      Chat with your vet. Ideally you would feed 2 equal meals (every 12 hours) and give an insulin injection every 12 hours with each meal. Small dogs are able to have meals. You may just need to change the small dog’s habits. If you don’t leave food out at all times there will be an appetite when the food is set down for a meal.

  104. Lynn Vialpando July 11, 2020 at 10:14 pm - Reply

    My Lil doggie is diabetic for 5 years now,,he also has cusshings,,,after all this time we r having trouble controlling his sugar,,,the vet is concerned too. Also & very important,,I cant get this doggy to eat more than 5-6 oz of ANYTHING,,,he wont eat much often..ive ran out of ideas for food. He even turns down steak! Cooked or not!!( I always be very careful of what I feed him,,making sure it is comparable with his illness) He is 13 yrs old & wgt iss 18lbs,,he is chichi &chitzi,,,& dachsen (cant spell!)

    • Dr . Joi Sutton July 12, 2020 at 10:12 pm - Reply

      It can be quite difficult to regulate the blood sugar when a diabetic is also cushingoid. Is your pet on vetoryl to control the Cushings disease? Have you had recent bloodwork? Have a chat with your veterinarian. And if you are unable to sort the Cushings and diabetes (again, very tricky to manage cushingoid diabetics) you might ask for a consult with a local internist.

  105. Dawn July 13, 2020 at 1:02 am - Reply

    Dr Joi, thank you for writing this article. It has helped me so much with my boy Buster. I really love the article on how to draw blood when doing a glucose curve. I’ll try the elbows since he’s older and has little hat there. Thanks again.

  106. Debra De Bode July 19, 2020 at 8:37 pm - Reply

    Hello, Dr. Sutton: I found your article on diabetes in pets and thought I’d see if you can answer this question. Our 3 year old Irish Water Spaniel was diagnosed with diabetes almost a year ago and also was diagnosed with EPI at the age of 1 year. Getting everything in balance for him has taken some time, but he is back up to a good weight and doing well for the most part. We have him on a regular, 12 hour schedule for his meals and Vetsulin. Just over the past couple of weeks (so, summer weather) he has had three episodes of extremely low blood glucose levels while hiking with us (this shows up as stumbling, and weakness and we’ve verified his BG upon getting him back home). We have started to carry a small bottle of glucose with us for an emergency, but wonder if it would make sense to give him a small amount of food – maybe an egg or 1/2 cup of cottage cheese – before we take him to exercise so that he’ll have some energy to burn. Our usual schedule is to take him hiking or swimming in the late afternoon or early evening, and his meals with insulin shots are at 8am and 8pm (so he is nearing meal time when he is exercising, thus the idea to give him a little food as a boost). Thanks very much for any thoughts on this.

    • Dr . Joi Sutton August 11, 2020 at 9:42 pm - Reply

      That is exactly what I would suggest. As you clearly understand, exercise will lower the blood glucose. Or, you could check the blood glucose just before the hike to see if you should bring a snack along. A snack is a better choice that bringing along sugar. Good job.

  107. Gregory Staley July 28, 2020 at 12:06 pm - Reply

    Doctor, How should my cat’s insulin be re-mixed before injection? It comes from the fridge. Rolled, tumbled, but I know not shaken? We are concerned because we did an injection from a new vial that was not properly remixed and had a scare with hypoglycemia. Thanks, Greg

    • Dr . Joi Sutton August 11, 2020 at 9:51 pm - Reply

      It depends on which insulin you are using. Glargine (my favorite insulin for cats) doesn’t need to be mixed. PZI (a very good insulin choice for cats) should be rolled. And when Vetsulin (not my fave for cats but great for dogs) came back on the market a few years ago they now tell us to vigorously mix it.
      Do chat with your veterinarian.

  108. Gregory Staley July 28, 2020 at 12:13 pm - Reply

    Doctor, We are a few months into diagnoses and treatment of our small cat’s diabetes. Haven’t found the sweet spot yet. She is constantly hungry, ravenous. BS at 400 after six hours. I understand that to be a continuing symptom. We would like to split our cat’s daily dosage into three parts rather than two so that we can feed her three times a day. Are there any disadvantages here?

    • Dr . Joi Sutton August 11, 2020 at 9:56 pm - Reply

      It sounds like you are doing home testing. That’s great.
      Are you doing blood glucose curves to know where the nadir (lowest point) occurs? The nadir helps guide the dosage.
      Are you feeding a canned only low carb diet? Low carb diets can greatly improve your cat’s glucose regulation.
      If you give insulin 3 times daily you would put her at risk for hypoglycemia. The insulin doses could overlap. First let’s have you run a blood glucose curve and chat with your vet with the results. Further, check for a urinalysis infection or dental disease or any other causes of insulin resistance such as obesity.
      Do chat with your veterinarian.

  109. Kim August 1, 2020 at 9:47 am - Reply

    My 6 yr old cat was just diagnosed with diabetes 3 days ago. We were told to give insulin with morning and evening meals. He was a grassier and I immediately switched him to am/pm feeding. I first feeding and injection went ok. Started to eat, gave him injection then finished eating. Next morning , knew he was hungry. Gave injection and went right to his food and ate. That evening..he was hungry. Gave him his injection then food but wouldn’t eat. He went a hid for about 45 min. We had to hand feed him. I know he’ll get into a routine soon I just want to know is what we are doing ok.

    • Dr . Joi Sutton August 11, 2020 at 10:00 pm - Reply

      If your diabetic pet isn’t eating, there may be something amiss. If the loss of appetite persists, especially early on in the diagnosis, you should take your pet to your vet promptly. Are you doing home testing? Home testing is important to regulate your pet and it helps you know what to do regarding insulin in situations such as this. Best, Joi

  110. Chrisitne August 10, 2020 at 9:48 am - Reply

    Hi there – my dog’s glucose readings have been all over the place, and in consultation with the vet we have tried different doses and different types of insulin with not much success. The vet has now suggested giving him insulin 3 times per day at 8 hour intervals. The first dose at 7.00am with his breakfast, the second dose at 3.00pm and then the third at 11.00pm. However my concern is his eating schedule: Breakfast at 7.00am; afternoon snack at 5.00pm and then dinner at 7.00pm. This means that his 3.00pm and 11.00pm insulin dose is without food. Does this routine look right to you? I’m thinking that his food should be given with his insulin?

    • Dr . Joi Sutton August 11, 2020 at 10:09 pm - Reply

      I have never given insulin every 8 hours as I would fear for hypoglycemia. I also think it is important to give the insulin at the time of a meal.
      It’s uncommon to give insulin 3 times daily to a pet. If your pet isn’t difficult to regulate have you consodered going to an internist? Most large cities have a specialty hospital where you could see a vet internist. Or perhaps you might live near a veterinary school. I’d personally seek a specialist opinion before trying 3 times daily insulin.

  111. Michele Buchner August 22, 2020 at 9:47 pm - Reply

    Hello. I have a newly diagnosed 11 year old shih tzu who seemed perfectly healthy until he had a neck injury and was put on prednisone. He ended up in hospital with DKA and vestibular disease symptoms. He stayed in hospital for 5 days. He has no appetite. After reading your article Im wondering if we may be better off on a long acting insulin so he can have a few small meals a day? Also, I saw there is an FDA approved oral medication but I see little chatter on that. Does it not work?

    • Dr . Joi Sutton August 29, 2020 at 9:08 pm - Reply

      Steroids can cause insulin resistance. Unfortunately, once a dog becomes diabetic it is usually insulin dependent thereafter. (An exception to this would be gestational diabetes.)
      Typically we give insulin twice daily, and we like a meal to accompany the insulin every 12 hours. Giving it more frequently could cause overlap of insulin doses and risk hypoglycemia.
      Unfortunately, oral hypoglycemic agents aren’t enough for insulin dependent diabetics, so we use insulin injections for dogs.
      If your dog isn’t eating well, there may be some nausea so you might ask your vet for an anti-nausea medication.
      Do have a chat with your vet. Joi

  112. Adela August 25, 2020 at 10:41 am - Reply

    I have an 18 year old diabetic cat. Diagnosed 1 year ago. Blood panel is great for her age. She is a finicky eater. I give her her shot while eating twice a day 12 hours apart. I leave the food she doesn’t eat out, which she doesn’t finished typically. She is fine during the day but about two hours after her shot at night she becomes restless, dilated eyes and breathing is rapid. We have dropped her insulin shot down and at one point she was off it for two weeks but then I noticed she was drinking a lot again so we put her back on her insulin at 1/2 dose twice daily but in the evening she gets strange….

    • Dr . Joi Sutton August 29, 2020 at 9:13 pm - Reply

      You need to check her blood glucose! I hope you have a meter. Pet meters are best as human meters can underestimate the blood glucose of pets. My favorite pet glucose meter is the Alphatrak. The episodes you describe may be hypoglycemic episodes. If a cat goes into remission it can be abrupt or spotty. I recommend checking the glucose before each insulin injection and doing a sliding scale based on the results when you think your cat may be going into remission. You can sort this with your vet who has examined your kitty.

  113. Gereen Salkowski August 28, 2020 at 8:21 pm - Reply

    Hello. My dog has just been diagnosed with diabetes. She had her first glucose curve yesterday and and the vet increased her units from 5 to 6. Today she she seems tired and depressed. Is that normal behavior due to the increase of insulin? Also, I’m very aware that consistency is the key and that feeding time should be the same every day with the same food and the same amount of insulin. We do 7 am and 7 pm and cut her total calorie intake into two meals. What if I had no choice but to feed her a few hours early or late one day. Do I reduce the insulin amount?

    • Dr . Joi Sutton August 29, 2020 at 9:20 pm - Reply

      If she is lethargic it could be that could be that she had a stressful day at the clinic. (For ansius pets it can be a stress to spend the day at the clinic.) Or, it’s possible that she is hypoglycemic if the dose was raised.
      Have you considered home glucose testing? It takes away the stress hyperglycemia that often occurs in the vet office, so it is more accurate! Additionally, it’s much more affordable to do the blood glucose curve at home rather than paying your vet team to do the blood glucose checks. Additionally, if things go awry (say your pet vomits or doesn’t eat) you can check the glucose to help guide you.
      If you need to give a dose early, then check the blood glucose beforehand (to see where the glucose is) and likely give a smaller dose and a meal. Chat with your vet who has examined your pet. Or, if you must leave several hours early you might just give the insulin later, when you get home. Giving insulin early then leaving opens up the risk of hypoglycemia. If your pet goes hypoglycemic a you aren’t there to take action it could be devastating.

  114. Lee Muehling August 30, 2020 at 8:06 am - Reply

    Hi, I have a female Chow Chow who is blind and has diabetes. I give her her shot every twelve hours. She is a very picky eater. I have just recently had her at our vet for high sugar. I was advised to only give her half a dose when she wouldn’t eat, which I did, hence the high sugar. Now my vet says to give her a full dose regardless if she eats or not, but to keep Caro Syrup around just in case she has a reaction. One thing I failed to ask him yesterday, and today is a Sunday, is how long after a shot, while earring no food, would she show signs of distress? Thank you.

    • Dr . Joi Sutton September 7, 2020 at 6:56 pm - Reply

      I think a better option would be to check her blood glucose level before the dose of insulin and have a sliding scale. If her glucose is low, don’t give her insulin or a small dose. If her glucose is high but she doesn’t eat you might yet give her insulin. Since I haven’t examined your pet I can’t tell you how much to give, but your veterinarian and you can sort a sliding scale for her for various scenarios. If your vet knows you are willing to check her blood glucose at home this could avoid such ups and downs. Karo syrup is an emergency drug. If you can check the glucose you hopefully won’t have to resort to it.
      Next, why is she finicky? If she has a long history of being finicky it might just be her. However, many diabetic pets also have a history of pancreatitis. Have you run labwork recently to see if there is another concurrent issue?
      Best, Joi

  115. Brad P September 3, 2020 at 6:31 pm - Reply

    Hi I’m having trouble regulating my dogs sugars, they are always high. He has protein wasting enteropathy and is on budesonide for that. He eats low fat food three times a day because of the protein wasting enteropathy.

    He receives food at 12pm, 6pm and 12am. But receives 4 units of insulin (caninsulin/vetsulin) at 12pm and 12am (twice a day).

    His sugar only becomes low from 5 am to 10 am and 4:30pm to 7:30pm. The rest of the time it’s high.

    Any tips or advice?

    Also most information for Vetsulin or Caninsulin refers to eating twice a day but how about when a dog needs to eat three times a day?

    Thank you.

    • Dr . Joi Sutton September 7, 2020 at 6:49 pm - Reply

      That is a question you should pose to the doctor who is running his chemotherapy. Can he be on twice daily feedings? That’s would be better for his blood glucose regulation. Budesonode is a good steroid for PLE in that it stays local compared to other steroids that tend to have more systemic effects.

  116. Babak September 7, 2020 at 10:25 pm - Reply

    I have a ten year old bichon frise recently diagnosed diabetic, and was told to give him insulin injection once every 12 hour, after he eat. The problem is he doesn’t eat when it’s time to give him his insulin injection. So I don’t know what to do. He is sleeping mos of the day and night. I don’t know what to do.

    • Dr . Joi Sutton September 13, 2020 at 11:02 pm - Reply

      It sounds like there maybe other issues in addition to the diabetes if your pet sleeps all day and won’t eat. I think a recheck examination at your vet is in order. If your pt isn’t eating there may be some nausea. Your vet could give him anti-nausea medication. Your vet may also run some labwork as well to get to the bottom of it.

  117. Manuel September 9, 2020 at 2:31 pm - Reply

    Dr. Sutton,
    Your replies are truly appreciated. My Yorkie shy from 12 yrs young (7.5 lbs) was dx with DKA during a well-health check up on Aug 19th. He was started on 1 un of Vetsulin kept at the vet office for 2 days to hydrate him, but by Friday I had to take him to vet hospital. His BS was 716.
    Fast forward, I bring him home and his BSs are still fluctuating between 623-489. After consulting the Vet and him knowing I’m an RN I was able to implement a sliding scale. I had him for several days at 5units am and 4 units pm. I have been successful in regulating his BSs. The last 2 days his am BSs have been 190, 157 so I am now at 4 units BID. The reference interval on lab reports indicates 70-143. Would that be the same for a diabetic dog? Right now my scale for pm is anything less than 100 would be 3 units over 100 is 4 units. For AM more than 200 is 5 units less than would be 4 units. What value would be best to use for me to go down to 3 units in AM? One last question. After his hospital stay, he stopped drinking water from bowl on his own. I know WD food has moisture, but I’m still giving him water via a cup to avoid dehydration. Why would he not want to drink water? Thank you in advance for your time!

    • Dr . Joi Sutton September 13, 2020 at 11:06 pm - Reply

      A sliding scale and home monitoring is great. Good job!
      Yes, the normal reference range is the same for diabetic and non-diabetic dogs.
      Since I’ve not examined him I cannot give you specifics as to dosing, but be sure he is eating well when you give the insulin if the glucose is less than 150 pre-dose. We don’t want hypoglycemia.
      If he is drinking less it is likely as you say, the moisture content of the canned food and the fact that his blood glucose is much improved and not causing polyuria.
      Good job.

  118. Anonymous September 14, 2020 at 9:02 am - Reply

    Thank you so very much for your response. My pet continues to do well. His daily BS average for the past week or so has been 131-198.

    You are appreciated!

  119. Marie Waskowec September 18, 2020 at 7:18 pm - Reply

    As I try to find the proper insulin dosage for my 15 year old dog, my vet says I have to keep it the same for at least 7 days before I raise it. He is way to high, over 30 and never drops below 16. I have had him at 6 units for 4 days and am up every hour through the night for him to pee and drink. His food remains the same and at the same time with no treats in between. Can I raise his insulin at least to 7 units now?

    • Dr . Joi Sutton September 20, 2020 at 8:12 pm - Reply

      I have not examined your let. I cannot give medical advice on a pet I’ve not examined. I think you should take him back to see your veterinarian for a recheck. We don’t typically run a blood glucose curve For 5 to 7 days after starting or changing the dose. Of course spot checks are okay, but we don’t typically change the dose on spot checks. We adjust the dose based on curves. Chat with your vet and let him or her know your concerns.

  120. Ivan September 18, 2020 at 8:10 pm - Reply

    Dr. Sutton, 3 y/o chihuahua Papillion mix just got diagnosed diabetic by my vet. Glucose level was 353 and was told to administer 2 units of insulin every 12hrs. Was also told to change his diet to Hill’s Science W/D and more exercise. My vet told me that he is diabetic and no such thing as pre-diabetic based on the 353 glucose level. Is this correct? He is overweight and I have started taking him on walks twice a day. He has already lost 1lbs. I have been trying to do as much research as possible and I have seen that 400 or higher is diabetic and 350 spike could be from stress at vet. This is so confusing and vet did not explain how much food I am supposed to give him so I have been just feeding him 1 cup of food twice a day. He eats his food and I give him his insulin after about 15-20 minutes but after insulin he seems to get tired and sleepy. Is this normal? I am keeping an eye out for hypoglycemia but 2 units of insulin should not cause this if he is truly diabetic? I was not given an appointment to recheck his glucose until 2 weeks from now which is also kind of weird because based on the information I have seen he should be checked 3-5 days to make sure insulin is working? is it possible he is not diabetic or pre-diabetic and just diet and exercise is all he needs to be normal? Should I get another opinion? Any clarification would be very helpful. Thank you.

  121. Cheryl Anne Vieira September 19, 2020 at 10:34 am - Reply

    We have a 12 year old English Setter diagnosed 6 1/2 months ago. We have been struggling with regulation but seem to have arrived at 14 units BID – 8 and 8 with interstitial readings ( she has a Freestyle Libre Sensor) between 90 to sometimes high 200’s. She gets the same food both meals and is a rather finicky eater so we have to hand feed her at least part of the meal – the good thing is that she eats it all that way. My question is that recently, immediately after I inject the insulin, which is warmed, injected into a tent very slowly, she whines for about 15-30 seconds and never did this before. Any thoughts?

    • Dr . Joi Sutton September 20, 2020 at 8:16 pm - Reply

      That’s unusual. Are you moving the injection site around? Typically when we teach a client how to give insulin we teach them over the shoulders as it hurts less there. Then onspce you get good and confident we have you rotate injection sites so the pet doesn’t build up scar tissue that could affect absorption of the insulin. Perhaps try a new site and see if it hurts less. Have a chat with your vet as well. 🙂

  122. Terri Hamilton September 23, 2020 at 1:40 am - Reply

    I have an 11 year old cat who I love dearly and it has been a struggle since January to get his diabetes under control. My vet is frustrated and at a loss of why his blood sugar numbers have been so high for the past 9 months. I am afraid that is probably my fault. I read your article and found it so helpful. I guess I have been very confused on when to give him his shot. I know my vet has explained it to me but from reading your article I think I have misinterpreted what she told me. I am feeding him 12 hours apart but when it comes to giving him his insulin shot I’m off on the times I give it to him. Sometimes its easier for me to see instructions on paper instead of verbal and I feel like now I have put my cat in danger. I will be truthful in saying that I forget to give him his shot right after he eats and when I do remember its probably an hour or more later. I see now that isn’t correct. By giving him his shot so much later after he eats could that be what is causing his numbers to be so high like In the 500’s? For 9 months? I feel just horrible for being so stupid as to not understanding when he should have his shot. Is there hope for him now that I see what I have been doing wrong and will from now on do what your article suggests?

    • Dr . Joi Sutton September 27, 2020 at 9:10 pm - Reply

      Of course there is hope for your kitty. I’m glad you did some reading. I think education is key for diabetes! Another common error is feeding diabetic cats dry food. Ray food is much higher in carbs than canned food. If you are feeding dry food you will like6 notice improved glucose regulation if you change to canned only, particularly one of the diabetic canned foods.
      Good job!

  123. Sarah Thorner October 10, 2020 at 12:34 am - Reply

    I fed my dog at work since I bring him with me. I got completed pulled away due to a work emergency and did not give him the insulin right after feeding. It’s been about an hour. Is it still save to give the injection or do I skip this dose? I don’t know which version is worse. I greatly appreciate any insight and advice!!

    • Dr . Joi Sutton October 12, 2020 at 9:44 pm - Reply

      If it has been one hour since the meal you should be fine to give the insulin now. 🙂

  124. Michele Buchner October 11, 2020 at 9:09 am - Reply

    Hello. My dog has never been a morning eater. He always ate late morning/early afternoon and then again in evening. We are going on our 3rd month since diagnosis and are still struggling to get him to eat in the morning. He eats some but not half of what he needs. Then at dinner he is ravenous and eats great. This is not a matter of him not liking his food. He loves it and in the morning tries to “bury it/hide it” for later. I fear he will never be a morning eater. What do you suggest in these cases? More toppers/tricks and food changes have already been attempted.

    • Dr . Joi Sutton October 12, 2020 at 9:50 pm - Reply

      Ideally, feeding a diabetic dog or cat 2 equal meals and giving equal insulin doses every 12 hours leads to better diabetes regulation. If he eats less at the evening meal he might eat better at the morning meal. If he has a smaller evening meal he might then be hungry by the time morning rolls around.
      Do have a chat with your vet who has examined him.

  125. Maryann Gomez October 14, 2020 at 10:34 am - Reply

    Dear Dr Sutton, I have a playful 11 year old Havanese, Dylan. He has been diabetic for 18 months. It took us a year to regulate him and find a food that ‘worked’. However, breakfast is ALWAYS an issue for him. He hates eating in the morning and although he gets up at 7 am, it is always 10am before he will eat. Then, of course at 6pm he is begging for food and we have to keep him distracted for a few more hours but then he demolishes the evening meal. Any ideas on how we can get him to eat breakfast earlier? Thank you for your help.

    • Dr . Joi Sutton October 18, 2020 at 2:18 pm - Reply

      I think you need to sit him down and have a heart to heart with him, telling him that good blood glucose levels are best achieved when pets eat equal meals every 12 hours. 🙂
      I think what you are doing, which I think is giving the insulin at 10 and 10, is your best bet.

  126. Tess October 18, 2020 at 8:36 am - Reply

    I’m changing my rottweilers food, we’ve been having issues getting ‘fresh’ hills science diet, more than half the bags smell rotten.
    So I’m switching to american journey, hoping it’ll be better, I’m transitioning the food slowly. But I can’t do a cure as it causes seizures, so I’m wondering how long do I wait after feeding her and giving her 14.5 units of 70\30 to check her b. G, im thinking 30 minutes?

  127. Dave W. November 17, 2020 at 1:03 pm - Reply

    My dog was diagnosed with diabetes a few days ago. We’re on a 12 hour feeding schedule. Previously she had her second meal after 8.5 hrs. Can the time be shortened?

    Dave (and Twiggy)

    • Dr . Joi Sutton November 22, 2020 at 6:15 pm - Reply

      Insulin injections could overlap and cause hypoglycemia, so we don’t recommend injections so close together.
      As you are new to diabetes you might consider reading the 2018 AAHA Diabetic Guidelines. They are available for free on the internet.

  128. Kim D November 21, 2020 at 9:20 pm - Reply

    Dr. Sutton,

    My energetic 9.5 year-old min pin, Zo, was diagnosed with diabetes almost 1 month ago. It’s been an emotional roller coaster filled with significantly more lows than highs; his sugars were, of course, the opposite. I had a dog growing up with diabetes who ended up wasting away until he died months later. He was a skeleton and had no energy. I did not want that to be Zo’s fate so I searched the internet like a mad woman to educate myself on canine diabetes. I read AAHA guidelines, searched pubmed, and read blogs. It was encouraging to hear so many success stories in which their pet’s sugars were adequately managed.

    For the first couple of days while waiting for my vet to receive the Vetsulin, I was a nervous wreck. As a human doctor, I’m all too familiar with diabetes and the long and short term effects and complications, namely DKA. He was already in a ketotic state and it was crazy for me why we wouldn’t start another insulin – something they had on hand or something that was readily accessible. My vet was worried about starting something for a couple days and having to switch to Vetsulin and how that would affect his response to treatment/his glucose curve.

    Perhaps I should have been more persistent, because Zo ended up not responding adequately to Vetsulin, which I had been giving him at 1mg BID for 2 weeks prior to getting the glucometer placed atop his skin. Zo’s vet informed me that he had continued losing weight despite initiating therapy. I knew it was not user error on my part; and the vet didn’t suggest any changes to the dose.

    Zo’s sugars were sky high the afternoon and evening after it was placed, registering as >500 at its peak and mid 300’s at its lowest. The same was true for the following day. I then decided to increase the dose to 2 units BID and gave it ~2 days before calling the vet again because his numbers had not budged. He was above 300 >95% of the time. I called the vet clinic and they told me to give it at least a few more days on the higher dose (2 units BID) before we talked about increasing further. By this time, I had found this forum and read your suggestions about levemir. I suggested it, and was told once again about the concern of hypoglycemia and that the manufacturer recommended giving it ~10-14 days before increasing the dose. I understand the algorithm from the AAHA suggests the same, but I could not for the life of me understand how anyone could do that when the sugars were not dropping. I know we treat humans and pets differently but we are definitely more aggressive in treating a patient with ketosis. it doesn’t happen often (thankfully) but if a human patient weren’t responding to a particular insulin therapy we would adjust the dose or switch formulations quickly. I couldn’t let my dog continue to suffer so I did something I tell my patients not to do – I took things into my own hands and continued to increase his Vetsulin dose incrementally based on the numbers I was getting. Meanwhile, I was persistent in advocating for Zo. I even forwarded this blog to my vet and explained my rationale for wanting to switch to a long acting insulin (or just another insulin in general).

    Eventually my vet conceded and 2 days ago, Zo started Levemir. I started 1 unit BID as recommended from my vet, but ran into the same issue – no appreciable budge in his blood sugar after 24 hours – he was maintaining in the high 300’s-mid 400s, occasionally shooting into the >500 range. Again, I took things into my own hands and increased the dose to 2U BID and informed my vet regarding the change and showed him Zo’s glucose curve. He agreed that this was a reasonable decision.

    Over the last week, Zo has lost his sight and I’ve been incredibly sad for him. I realize that he’s adapted to it better than me and sight isn’t a huge deal to dogs, but it’s still sad and I see he’s lost a bit of his spark. I’ve been trying to cheer him on and build his confidence but it’s hard when I’ve felt so helpless.

    It’s been 24 hours since I increased his dose to 2units BID, and this is the first time his sugars have been in the 100s. I don’t feel like we’re out of the woods yet, but this is the first time I’ve seen some light at the end of the tunnel.

    All this is a very lengthy way of saying thank you. Thank you for offering advice and recommendations based on guidelines, scientific evidence, and your own professional experience. My vet and the other vets at the clinic have limited experience with canine diabetes. Not that this is good or bad, but it is what it is. This was the first time he used Vetsulin and the first time he’s prescribed Levemir. If it wasn’t for this website, your articles, and responses to these posts, I don’t know if I would have advocated as much as I did to switch insulin formulations. I am so grateful for your help. You’re doing great work.

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