Timing is Everything

By Dr . Joi Sutton|2018-09-07T14:27:54-04:00Updated: August 22nd, 2018|Pet Care, Pet Diabetes, Pet Newsletter|494 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

494 Comments

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

    You are appreciated!

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

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

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

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

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

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

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

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

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

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

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

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

    Any tips or advice?

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

    Thank you.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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