Timing is Everything

By Dr . Joi Sutton|2018-09-07T14:27:54-04:00Updated: August 22nd, 2018|Pet Care, Pet Diabetes, Pet Newsletter|485 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. Connect with Dr. Joi on LinkedIn


  1. 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.

  2. 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!

  3. 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!)

  4. 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.

  5. 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?

  6. 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

  7. 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

  8. 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!

  9. 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.

  10. 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

  11. 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

  12. 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!

  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. 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

  15. 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

  16. 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

  17. 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

  18. 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

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

    *crush a pill in her FOOD (silly typo)

  20. 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

  21. 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

  22. 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!

  23. 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!


  24. 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!

  25. 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

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