Timing is Everything

By Dr . Joi Sutton|2018-09-07T14:27:54-04:00Updated: August 22nd, 2018|Pet Care, Pet Diabetes, Pet Newsletter|501 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

501 Comments

  1. 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. 🙂

  2. 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

      Hello!
      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

  3. 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!

  4. 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.

  5. 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.

  6. 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!

  7. 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.

  8. 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.

  9. 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!

  10. 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

  11. 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!

  12. 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.

  13. 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.

  14. 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?

  15. 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.

  16. 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

  17. 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!

  18. 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

  19. 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.

  20. 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).

  21. 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!

  22. 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.
      Best,
      Joi

  23. 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.

  24. 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!

  25. 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.

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