Timing is Everything

By Dr . Joi Sutton|2018-09-07T14:27:54-04:00Updated: August 22nd, 2018|Pet Care, Pet Diabetes, Pet Newsletter|327 Comments
  • Cats and dog eating food

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

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

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

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

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

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

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

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

How about the timing of meals?

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

Different Eating Habits Of Diabetic Pet

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

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

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

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

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

The Timing of Insulin Injections

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

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

Timing of Insulin Injections: Before or After Meal?

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

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

Have a question or comment? Then post below! I always enjoy hearing from my readers!


NOTE: Consult your veterinarian first to make sure my recommendations fit your pets special health needs.

About the Author: Dr . Joi Sutton

Dr. Joi Sutton is a 1993 graduate from Oregon State University. She has practiced both in emergency medicine and general practice. Dr. Sutton has done extensive international volunteer work though Veterinary Ventures, a nonprofit organization that takes teams of veterinarians to undeveloped countries for humane medical care. She also runs a small animal practice in South Florida.

327 Comments

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

    Hello,

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

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

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

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

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

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

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

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

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

    Thanks

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

    Any advice would be appreciated,
    Thanks,

    Rachel

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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