Timing is Everything

By Dr . Joi Sutton|2018-09-07T14:27:54-04:00Updated: August 22nd, 2018|Pet Care, Pet Diabetes, Pet Newsletter|477 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.

477 Comments

  1. Michael Collins September 12, 2022 at 11:06 am - Reply

    My cat Buddy is 15 years old and just recently diagnosed with diabetes. It’s been a few weeks of back and forth monitoring by my vet and nothing really seems to be getting him back to normal. They have only recommended a 1/2 unit of insulin – once a day – based on his weight – he has always been thin. I was curious – does this seem like it’s not enough? I have been giving him snacks during the day. Should I be? It seems like he is at his best in the morning after he has not eaten during the night. Just trying to figure this out. Thank you.

    • Dr . Joi Sutton September 18, 2022 at 6:31 pm - Reply

      I’ve yet to meet a pet who was regulated on once daily insulin. Typically we treat with insulin every 12 hours. Have you checked his blood glucose since he was diagnosed and started on insulin? Typically we do a blood glucose curve 5 to 7 days after starting insulin. Half a unit is a conservative dose for a cat, but if he is very small it might be appropriate. It all has to do with the blood glucose levels. I have a series of 4 articles I wrote ages ago on this website called “back to basics”. They might get you on the right track. VeterinaryPartner.com also has a series of great introductory articles for newly diagnosed diabetic pets. Chat with your vet. And know that diabetic cats do better on low carb diets—-that mans canned food. Dry food is much higher in carbs that canned food. They make diabetic canned kitty diets. And get a pet glucose meter. The easiest to use is the Alphatrak. Do chat with your veterinarian who has examined him.

  2. Patricia Doyle September 10, 2022 at 9:00 am - Reply

    Hi,
    My 8 yr old cat has been diabetic for 3 yrs. He came back from remission, back on Lantus currently 3U twice a day. I was unable to get him off kibble entirely. Mostly LC wet food but 1 tbsp kibble AM and PM. Problem is sugars 11-16 range. Recent neuropathy, getting worse. I’d like tighter sugar control but at least once a week he drops below 8, I skip his insulin and 12 hrs later he’s 22. Then 2-3 days to get 11-12 range, then it happens again. Food intake never varies, and exercise is nil now – can hardly walk. I don’t know how to make sugars better to improve the neuropathy.
    Thanks

    • Dr . Joi Sutton September 10, 2022 at 4:34 pm - Reply

      The neuropathy means he is not regulated. It does take some time for a diabetic neuropathy to resolve once his diabetes is back under control. You can give b vitamin injections as that may help the neuropathy but the evidence is lacking. It certainly would not hurt him. I do wish you’d remove the dry food as dry food makes it harder to regulate a diabetic cat. Have a chat with your veterinarian who has examined him. Best, Joi

  3. Amy September 7, 2022 at 8:50 am - Reply

    Gm! I have a 9yr old schnoodle and we’re having a hard time regulating her BG. She was previously hospitalized in July for several days with pancreatitis and diabetic ketoacidosis – that’s when we found out she’s was diabetic and since then we’ve been trying to regulate her BG. In the hospital she was on a low dose of levimir bc they said it was the only one working, but that caused too many hypoglycemic episodes at home, so we switched her to vetsulin mid August. She’s getting 2 units of vetsulin right now at 6am and 6pm on a cooked/canned food diet. A higher dose was making her drop into hypoglycemic range and vet thought she was having Somogyi effect. She has a Libre sensor and her graph still looks like a yo-yo. Her BG starts working it’s way up to HI (400+) about 3 hours before her insulin injection and drops down about 3 hours after injection. Sometimes at night it starts to go up at midnight and stays high until 3 hours after her morning insulin dose (which ends up being about 9 hours in the HI range). Any suggestion you have on how to possibly fix this issue or things to try would be greatly appreciated.

    • Dr . Joi Sutton September 10, 2022 at 4:30 pm - Reply

      Are you giving her any snacks between meals? Does she have obesity or dental disease that could be causing insulin resistance? Continue working with your vet til you find the best dosage. A libre sensor is great but if you question a reading you can still do a blood glucose sample with your glucometer.

  4. Matt August 27, 2022 at 2:18 pm - Reply

    Hello! This question may have already been covered but I couldn’t find an answer sorry. Our diabetic Westie is almost 15, she’s stable and doing well. She would gobble up her 2 meals a day (a mix of half diabetic dry, half diabetic wet). But it’s got to the point where she is totally bored of the food. We know she hasn’t lost her appetite because when we mix in plain natural yogurt or chicken juice she once again gobbles it down. Do you have any advice on what we can safely mix in to her food each morning and evening? We don’t want to continue giving her natural yogurt as the amount will not be good for her. And juice from chicken isn’t always possible. But without any of these she just walks away from her bowl. Thanks for any help!

    • Dr . Joi Sutton September 3, 2022 at 6:29 pm - Reply

      First of all, chat with your veterinarian who has examined your sweetie. Next, it is best for a diabetic to eat the full meal at once as it provides a more consistent glucose pattern than snacking. I don’t think adding a bit of yogurt is bad for her, so if she likes it and has no adverse effects I’d continue that. Are you checking her blood glucose curves and has she had recent labwork to make sure she doesn’t have another concurrent medical issue?

  5. Nancy smith August 12, 2022 at 5:14 am - Reply

    Hello, my Minnie schnauzer has uncontrolled diabetes after 2 years. We’ve tried everything, Every test in the book (no cushings, no pancreatitis, high blood pressure (on meds), super high triglycerides (on meds), pancreas sludge (on meds), protein in urine (on meds). His weight is stable if I feed big meals. We tried Lantus and vetsulin, changing food from hills gastro to royal cabin low-fat, dry to combo to wet. We’ve tried increasing insulin. He always starts out on a dose looking good, but then after a few weeks he is back up over 500 many hours and not going much below 400. With all the symptoms also, peeing 90 seconds at a time, leaking all Over the house. Excessive thirst. We are at 11 units morning and night. I try to vary location of injections. But he prefers areas that are thicker. (Back of shoulders). I wonder if this could be a problem but I don’t have much choice, as he jumps through the roof otherwise. I also wonder if a third dose a day could help. If I give him another meal. Mostly he’s energetic snd seems healthy, he’s 10. I’ll try anything. I’m home every day.

    • Dr . Joi Sutton August 14, 2022 at 1:34 pm - Reply

      You sound very committed. I’ve never given 3 times per day insulin as the doses could overlap and result in hypoglycemia. You might consider levemir which I’ve successfully used in dogs. It sounds like it’s time to seek help from an internist. Most large cities these days have a specialty hospital with Ann internal medicine specialist on staff. I assume you are doing close glucose monitoring at home and have eliminated any source of insulin resistance infection (such as dental disease) and being overweight. Chat with your vet about a referral to an internist. Good luck.

  6. Kimberley August 3, 2022 at 12:11 am - Reply

    My 12 year old cat named
    Sweetie ironically has been diagnosed this weekend with diabetes. Canadian- her BGL was 27 mmol/L. After her first dose of Lantus 1u, her BGL was 12mmol/L. We have now wet food only diet. Her legs aren’t wobbly anymore! However, I do notice she almost has barely had any water in the past 2 days. Is this because she is getting more moisture in her food? While I’m very happy the glucose isn’t being dumped anymore.. I feel a little worried to see such little urine now. She is adjusting very well to the changes otherwise. Thank you so much for your guidance.

    • Dr . Joi Sutton August 6, 2022 at 5:32 pm - Reply

      I think you are likely correct! There is more moisture in canned food. And if her glucose is below the kidney threshold you won’t be scooping our big clumps of pee in the cat box.
      Good job getting her on canned food only. Keep monitoring her blood glucose and let’s hope you get her into remission.

  7. Stacey Farr July 31, 2022 at 3:37 am - Reply

    My diabetic cat has pancreatitis as well and despite many trips to the vets and lots of days in the vets for his curves and adjusting his insulin and diet, they’re still not happy with his levels.

    It started over a year ago with what we now think we’re symptoms of pancreatitis (vomiting and noisy stomach) but it wasn’t diagnosed for some time until he started to rapidly lose weight. He was then diagnosed with pancreatitis and diabetes. We struggled for some time just to get him to stop losing weight and ended up on a hypoallergenic diet but a high volume (twice the recommended volume) fed over 5 meals (main bigger meals 12 hours apart and smaller meals in between) and he’s now either holding steady on his weight and occasionally putting on a little.

    We’ve taken every bit of advice and suggestion our vet has made; changing foods, insulin dose etc. But we still have a cat whose blood sugar appears too high.

    My issue is that whenever my cat goes to the vet for his curve, we arrive at 8:30am but he generally doesn’t then get fed and his insulin until around 9:30am. His starting blood glucose is reading as in the 30s when they start and comes down over 6 hours to around 10.

    At home his injections are at 7:30 am and pm.

    I’m starting to wonder if the two hour lateness of the injection could be causing his blood glucose to rise higher than it would normally be on a 12 hour interval?

    • Dr . Joi Sutton July 31, 2022 at 2:35 pm - Reply

      My own cat has battled pancreatitis for 5 years and it’s a tough disease. She also has kidney disease and IBD and briefly was diabetic. Pancreatitis is a stinker!

      A blood glucose of 30 is too low.

      I would like you to get a blood glucose meter and doyourcat’s Blood glucose curve at home. THAT is the most accurate. The Alphatrak meter is the easiest to use in my opinion. I wrote an article on home glucose checking ages ago that you can find on our blog if you type in the search box for pet articles “Tip’s and Tricks”.

      Then you can share the numbers with your veterinarian. 🙂

  8. Eddy July 27, 2022 at 11:50 am - Reply

    My 12 year old Cat was just diagnosed with diabetes. I live alone and I work in the film industry. Unfortunately this means my work schedule is very wild and uneven during the week. For example last week on Monday I was up at 4am and left my place at 4:30am, and wasn’t back home until 6pm. It was the same on Tuesday, but then on Wednesday I didn’t start work until 11am and wasn’t home until 12am, and on Thursday I worked 1pm to 2am, and Friday I started work a 4pm and worked until 3am Saturday.

    So I am very worried about what I am going to do about giving my cat his injections. Not only will I almost never be able to give them to him every 12 hours, but they often wouldn’t even be at similar times during the day. Is it even possible for him to remain healthy on such an erratic injection and feeding schedule? Is it wrong for me to even try and make that work? I would hate to lose him, but for his own health should I consider giving him away if I can find someone to take him? But what happens if I can’t? I’m very worried about what this means for him.

    • Dr . Joi Sutton July 31, 2022 at 6:17 pm - Reply

      Yes, you should treat. Whenever I diagnose a cat with diabetes my hope is to get the kitty into diabetes remission. By using a longer lasting insulin such as glargine (or a glargine generic) or PZI AND feeding a LOW CARB diet (this means canned only, my fave is Purina DM which is very low carb) AND doing home testing you can increase your odds of getting your kitty into remission. Really, for diabetic cats get rid of kibble which is higher in carbs than canned food.
      Perhaps it’s time to get friendly with a neighbor who could help. If there is a day when you can only give one injection for that day, the blood glucose will be higher, but if you are feeding a low carb diet then hopefully the overall levels won’t be as high. There may be a pet service that could pop by. As your vet clinic if any of the vet staff want to be part of your cat’s diabetes treatment team. Any chance your cat could come to work with you? Again, remission would be ideal. No more dry kibble for your kitty. Good luck!

  9. Vicki July 18, 2022 at 3:07 pm - Reply

    On June 16th, during a long awaited wellness visit, our cat’s Glucose came back at 425. We immediately changed her food and two weeks later, her Glucose was 515. We started Insulin, 2U 2xdaily on July 1. On July 5 her Glucose was in the 50s and the insulin was reduced to 1U 2xdaily. On July 12 her Glucose tested again in the 50s, the insulin was reduce to 1U 1xdaily and we started monitor with a Libra system. As of this morning, the Libre is showing an average Glucose level of 79. We read every hour, between breakfast and dinner, the last two days for a curve. The Glucose read in the 50s most of the day with the exception of first thing in the morning when it was between 90 and 113. We’re now worried about giving her the insulin. Could we have reversed the diabetes diagnosis this quickly? Is there another explanation?

    • Dr . Joi Sutton July 24, 2022 at 9:09 am - Reply

      Absolutely you can get a cat into remission within weeks. It doesn’t happen often, but if you get rid of the glucose toxicity (the pancreases gets cranky when the glucose is high). I’d like to think I’m good at managing diabetes because I wrote these articles for year, but when my own cat (who has battled pancreatitis for about 5 years) became diabetic a few months ago I got her into remission within 3 weeks. Sort a sliding scale with your vet as to when to give insulin. At those glucose levels I doubt your vet would have you give insulin. The freestyle libre is great for monitoring the blood glucose. It’s not quite as accurate as an Alphatrak but it is great for trends and this is a great application for a libre sensor when you kitty is going into (or maybe already is in) remission. Do keep your kitty on a low carb (cannned food only) diet.
      Chat with your veterinarian who has examined your sweetie. Good job!

  10. Judy Dutton July 11, 2022 at 11:30 am - Reply

    I have a dog on 5 units of insulin. I do the injections at 8:30 am & 8:30 pm. One day next week have an appointment at 7:00 pm and won’t get back till after 11:00 pm. Can I give her the pm injection at 6:30 pm this one time. Thanks

    • Dr . Joi Sutton July 17, 2022 at 8:16 pm - Reply

      If your sweetie is predictable and well regulated, you could probably get away with this if you gave a slightly lower dose. If your sweetie is fragile or a poor eater or prone to hypoglycemia I’d likely wait til you got back and dose him then. When you are gone, no one would be there if he became hypoglycemic. Ask your veterinarian who has examined your pet. Checking blood glucose levels at home is very helpful.

  11. Sharon July 5, 2022 at 12:43 am - Reply

    Hi, I have a 13 year old cocker spaniel. He has diabetes for over 2 years now. Control on kibble for 12 months but sadly it gradually made his gut very unhealthy and I’ve had to change to homemade. He hasn’t been controlled since.
    The biggest issue is at 3pm and 3am his sugars start to rise and with two hours they have gone from between a nadir of 8 and 11 to 25 and above. He gets fed at 5.30am and 5.30pm. How do I combat this fast increase?

    • Dr . Joi Sutton July 10, 2022 at 7:52 pm - Reply

      I think you need to consult your veterinarian for assistance. Clearly something isn’t right and your sweetie needs an examination and some labwork to get to the bottom of the disregulation.

    • Claire July 22, 2022 at 3:05 am - Reply

      Hi Sharon, did you ever figure out what was causing this? I’m dealing with the same thing, high levels at fasting, he drops fairly quickly, and around 3 he rises quickly. He also gets fed 5:30 am/pm

  12. Nancy June 30, 2022 at 10:25 am - Reply

    Hello, I keep reading that 12 hours apart for my dog’s insulin is preferable, but I’d like to understand what the insulin is doing (long or intermediate) at different times after injection. If I know my dog is typically very high for 3-5 hours at certain times of the day, I feel like if I understood exactly what the insulin is doing and how the injections react with each other when there are two a day, then I could adjust the timing to optimize for my dog.

    • Nancy June 30, 2022 at 10:37 am - Reply

      I’d like to add, “Hi” for my mini schnauzer dog is over 500. A good reading is 250-350. He was diagnosed over a year ago, had every test multiple times. He’s on Lantus 11 units twice a day. He had been on vetsulin up to 16 units twice a day, it stopped working well. Lantus worked for a while, then stopped working well. He’s not loosing weight, he eats well, he leaks urine whenever he’s above 350 which is a lot of the time.

      • Dr . Joi Sutton July 4, 2022 at 10:23 am - Reply

        Nancy, it does not sound like your pet is regulated on Lantus either, even if it is better than when he was on Vetsulin. Are you doing blood glucose curves at home? Chat with your vet about the curve results. We use curves to determine where the blood glucose bottoms out (the nadir). We use the nadir to adjust the dosage. We don’t want him leaking pee.

        • Shirley Rocha July 20, 2022 at 4:48 pm - Reply

          My cat is on 5 units of insulin , his glucose is 26 right now and I can’t reach his vet, what can I do??

          • Dr . Joi Sutton July 24, 2022 at 9:10 am

            Feed your cat! If your cat is non responsive you can smear some Karo syrup on its gums and get to the vet (or emergency vet) right away. Don’t give more insulin until you speak with your vet.

    • Dr . Joi Sutton July 4, 2022 at 10:28 am - Reply

      Each pet absorbs and metabolizes insulin a little differently. And injections can overlap. We don’t give insulin to pets more than twice daily in order to minimize the risk of hypoglycemia.
      Humans can sense when they’re feeling hypoglycemic and get some food. Humans also can check their blood glucose themselves to fine tune matters.
      Consistency in portion size and what is fed and doing the same insulin amount with the same portions twice daily helps quality of life. The trick (as I said in my
      Riordan comment) is to find the correct dosage based on blood glucose curves.

  13. Gynn Infusini June 26, 2022 at 5:58 am - Reply

    Good morning is it ok to give my dog his insulin 3 hours earlier then the time. I usually give him his insulin 4am – 3pm bc it works with our schedule Every day at the same time for 5 years now. But today I have somewhere to be so I was wondering if I should skip the insulin? Or give it to him at 1pm please help

  14. Joyce Srok June 16, 2022 at 3:54 pm - Reply

    I have a 13 yr old miniature poodle first told bladder infection then disfunction liver and thyroid. Turned into pancreatitis and then to diabetic. I am trying to do the curve at home. She is 9 Lbs. She was in hospital for 9 days and now home for last two weeks. Still has pancreatitis and is hard to feed. I cannot get her to eat the prescription diet food so I am doing boiled chicken breast adding in peas and carrots and green beans. I tested her first and she was in normal range of 221. I feed her a small amount this morning but she really does not want to eat. Gave her the insulin at same time as every day. I am testing every two hours and my tests are saying 88 then 79 then 92. I am concerned about the numbers being so low.
    If she is in normal range in the morning should I wait to give her insulin? She is on a pretty much no carb diet trying to heal the pancreatitis, which she seems to be feeling pretty good today. No vomiting or diarrhea in some time now

    • Dr . Joi Sutton June 19, 2022 at 6:53 pm - Reply

      Joyce, 221 is not normal, but is a good first morning (pre-insulin) number! The 88, 79 and 92 are normal numbers. If she isn’t eating you could cause hypoglycemia if you give insulin. Years ago I wrote a series of articles on this site called “back to basics”. You might want to read those 4 articles. I also wrote one on hypoglycemia.
      You might also chat with your vet about some anti-nausea meds like cerenia and zofran to help her get through her pancreatitis. They come in injectable form for vets and oral pills for pet owners.
      Chat with your vet first thing in the morning. If the glucose is normal your vet may skip the dose. I can’t advise you as I’ve not examined your pet, but your concerns are accurate.

      • Joyce Srok June 21, 2022 at 6:43 am - Reply

        I was told that she is good between numbers of 100-250. What is the normal range for a dog?

        • Joyce Srok June 21, 2022 at 1:17 pm - Reply

          Could you please tell me where the numbers should be? What is the normal range is it 60-111 for all dogs even if they have diabetes? Is that where you need to shoot for?
          What is the range I found that says 100-250 for the majority of the day? I am so confused on what range I should be trying to keep her in!

          • Dr . Joi Sutton June 26, 2022 at 6:12 pm

            I wrote n article on just this back in 2014. The link is
            https://www.adwdiabetes.com/articles/what-is-normal-blood-glucose-range-pets

          • Dr . Joi Sutton June 26, 2022 at 6:16 pm

            If most of her numbers are below 200 to 250 for a dog (or below 250 to 300 for a cat, the pet will likely have no clinical signs of the diabetes (excessive thirst and urination). Those are the estimated glucose thresholds in their kidneys when sugar spills into the pee and causes excessive thirst and urination.
            Make sense?

        • Velvet's Mom August 28, 2022 at 3:17 pm - Reply

          My 15yr old cat was dx’d with diabetes last month and it has been “challenging” to say the least – from regulating her levels to checking with a glucometer to changing the feeding pattern of 3 other cats from grazing to meals.

          I like/trust my vet (fired the first one) but would love your input – I appreciate your perspective. Velvet is not, nor ever been overweight. The freestyle libre quit after 3 days. (Have a recommendation for getting a free replacement) Her levels have been over 500 a lot, gradually trending down with 7u of Vetsulin 2x a day. Very low carb canned food + 1/8th tsp of Yaccon root. Yesterday, we hit an all-time low of 154. This afternoon, I randomly checked at noon and she was 73 (6hrs after inj). Have her a little honey + some higher carb food. 2hrs later, she was at 172. And was acting totally fine the entire time.

          Two questions: At what point do you recommend trying a different insulin? What is the “normal” range for a cat? (I see multiple ranges from 80-120 and some say 150-300 is normal.)

          • Dr . Joi Sutton September 3, 2022 at 6:38 pm

            For my outside reference lab (a big national lab), the blood glucose range for cats is 64 to 170. And for dogs it is 70 to 138. My in house chemistry analyzer lists a normal range of 70 to 150 for cats and 60 to 110 for dogs. It’s all statistics. They test a bunch of “normal” pets to determine a normal range with that chemistry analyzer. Ranges for various machines are in the same ballpark – but not exactly the same exact numbers.

            Do continue to check the blood glucose as perhaps your kitty might be reaching diabetic remission.

            7 units is a hefty dose for a cat, so please chat with your vet about stepping back the dose now that you are getting blood glucose values in the normal range. 🙂

    • Joyce Srok July 1, 2022 at 10:48 am - Reply

      I am having a very tough time getting my dog in the good range. Seems she is either very high or very low .
      We live where it’s way too hot to walk outside except for as soon as it’s light enough to do so. So we are walking first thing. My meter says she is 158, we go out and walk and when we get back she is at 50. Is that ok since we just walked? I am walking before food and before insulin since you should not exercise for an Hour or two after insulin.
      I am afraid I am making things worse. I am afraid she will have a seizure with it dropping ( I have had to take her to emergency with seizure when it dropped before) so I’m scared to have that happen. Is it ok that it drops low during or after exercise? She seems fine walking. We don’t run I just go at her pace. If she falls behind me we slow or sop until she wants to go.
      Can you tell me how long after I walk her does that affect her level? Does it affect it for an hour or two? Should I then wait to feed and give insulin?

      • Dr . Joi Sutton July 4, 2022 at 10:20 am - Reply

        Joyce, a blood glucose of 50 is indeed bothersome! Chat with your vet about possibly dropping the insulin dose. I don’t quite understand why you don’t feed your pet and given insulin at the same time and THEN take your pet for a walk. Exercise helps flatten the curve! Walking after a meal is fabulous for minimizing blood glucose peaks. I think changing the order of events (feeding/insulin first and then a walk) would be very helpful. And of course you can check her blood glucose to see how much it affects her levels.

      • Joyce Srok July 6, 2022 at 4:48 pm - Reply

        I read that you should not walk or exercise for one to one and a half hours after insulin injection because it can change to absorption rate of the insulin so I was afraid to feed inject and then walk right after. It’s too hot to feed inject and wait for an hour or two to walk. We walk as soon as light enough

        • Dr . Joi Sutton July 10, 2022 at 7:55 pm - Reply

          I don’t know why anyone would discourage exercise after eating. Exercise could potentially affect the absorption slightly, but doubtful to any significant degree. Exercise after a meal is a great way to minimize a blood glucose spike. 🙂

    • Joyce Srok July 1, 2022 at 10:50 am - Reply

      I am having a very tough time getting my dog in the good range. Seems she is either very high or very low .
      We live where it’s way too hot to walk outside except for as soon as it’s light enough to do so. So we are walking first thing. My meter says she is 158, we go out and walk and when we get back she is at 50. Is that ok since we just walked? I am walking before food and before insulin since you should not exercise for an hour or two after insulin.
      I am afraid I am making things worse. I am afraid she will have a seizure with it dropping ( I have had to take her to emergency with seizure when it dropped before) so I’m scared to have that happen. Is it ok that it drops low during or after exercise? She seems fine walking. We don’t run I just go at her pace. If she falls behind me we slow or stop until she wants to go.
      Can you tell me how long after I walk her does that affect her level? Does it affect it for an hour or two? Should I then wait to feed and give insulin?

  15. Darlene Clogston June 10, 2022 at 12:39 pm - Reply

    I just started fostering a 7 year old diabetic Male cat
    I’ve been giving him his insulin every 12 hours
    He always wants food in his dish so it’s easy to do the injection , my question is , Is it normal for him to be drinking Lots of water all day ?

    • Dr . Joi Sutton June 12, 2022 at 9:06 pm - Reply

      If your diabetic kitty is alway thirsty, the odds are the diabetes is not yet regulated. Have you spoken with your vet about home glucose monitoring? That is the best way to check blood glucose. I have an article from a few years ago on this website called “Tip’s and Tricks” for getting a glucose sample. My favorite option is the Alphatrak meter for pets, or you could have your vet place a freestyle libre sensor.
      We rarely get the insulin dose right on the first try. We need to test glucose curves and adjust the dose. It’s also very important for diabetic cats to be on low carb food—-ideally canned only and less than 10% carbs. That will help control the blood glucose significantly.

  16. Kim May 26, 2022 at 5:42 am - Reply

    I’m wanting to change my dogs feeding and insulin schedule. She has been at 345 in the morning and 345 in the afternoon. I’ve done that cause that’s what fit our Schedule. We are now able to do 830 in the morning and 830 at night. Is that ok to change?

    • Dr . Joi Sutton May 30, 2022 at 5:57 am - Reply

      Absolutely you can change. If you can adjust it over a few days that would be best, but if you need to change it abruptly due to a work schedule change, let the insulin ride high for a few hours rather than giving it shorter than the 12 hour span for the dose when you change schedule.

  17. Kirsi and Mango May 23, 2022 at 12:05 am - Reply

    Hi , if my cat threw up close to the insulin dose time , of course you worry he may do it again after eating for the shot . How long after an injection is it safe for a cat to throw up , so that you don’t have to worry about rubbing honey on their gums ?
    My cat likes to eat grass , he’s not one to throw up after like my other cat ,it but just in case .
    Even if a hairball causes him to randomly to throw up after a shot , when are we clear with the insulin ?
    Thanks

    • Dr . Joi Sutton May 30, 2022 at 5:29 am - Reply

      There are so many different scenarios here that I couldn’t even begin to tell you when you can give insulin again. If your cat is acting fine and only vomits once you might just skip the dose of insulin and pick up at the next feeding. Cats do occasionally vomit. If there is an underlying issue then your cat may vomit repeatedly. Nobody has a crystal ball. If you are not already checking blood glucose levels at home, you really should start. There’s no way of looking at a cat and knowing what the blood glucose level is. You need to test. Knowing the blood glucose level may help you to know if you might give a partial dose or skip a dose in situations like this. Further, you can do more accurate blood glucose curves at home than at the vet clinic where a cat will no doubt get stress hyperglycemia from sitting in a kennel all day. Chat with your veterinarian who has examined your sweetie for a plan.

  18. KC Warren May 19, 2022 at 6:09 pm - Reply

    Dr. Sutton: I have a shy diabetic cat who nibbles dry food throughout the day, and receives a bit of canned when I give him his twice-daily insulin. However, I’m planning a vaca and my cat care person has said he won’t eat in front of her. She can, however, give him his injections. Is it ok to assume he’ll eat when she leaves a nice plate of canned food and is gone? I’m thinking that would be ok. Thanks (go Beavs! I’m in Corvallis). 🙂

    • Dr . Joi Sutton May 22, 2022 at 5:44 pm - Reply

      If only I had a crystal ball to give you a guarantee! If your kitty is well regulated then you are likely ok. Cats can do weird things when their humans leave. If your kitty isn’t prone to an emotional hunger strike when you leave, you will likely be fine if your cat is currently well controlled. (That’s a question for your vet!) Do check with your veterinarian who has examined your kitty.
      Yes, go Beavers! Enjoy your trip. 🙂

  19. Steve Chiang May 10, 2022 at 9:56 am - Reply

    As one of the guardians of a recently diagnosed diabetic 7 years old Giant Schnauzer, I have poured thru everything I can find online about canine diabetic. This is the best article by far. Thank you.

    • Dr . Joi Sutton May 22, 2022 at 5:39 pm - Reply

      Thank you!

  20. Victo April 27, 2022 at 8:29 pm - Reply

    Thank you so much for this information. I have a diabetic cat and this has been very helpful!

  21. John Yanik April 26, 2022 at 9:16 am - Reply

    My dog is very thin Miniature Schnauzer and the injections seem to be hurting him. He is pulling away when I inject him and is now starting to even pull away anytime I reach for his back! He has only been getting injections for two weeks, how can this continue?

    • Dr . Joi Sutton May 1, 2022 at 3:31 pm - Reply

      Are you massaging his skin before and during and after the injection? Massaging the area stimulates nerve sensors in the skin and minimizes the discomfort.
      Initially you’ll start by giving injections in your pet’s scruff where injections tend to cause less sensation. Then as you get good you’ll wat to travel down the back and up the other side for injection sites. Be sure to rub/massage/stimulate the skin before/during/after the injections.

      Ask your vet for a lesson! Watch how your vet or on of his vet team gives injections. 🙂

  22. Schuyler March 27, 2022 at 8:55 am - Reply

    I have been working with my vet for two years to regulate my 12 year old dog. He was doing well until about 2 weeks ago. We are now doubling his insulin and he is still sluggish. He also has Cushings disease which I know is not helping. I regularly give his insulin at 8AM and PM but he eats at 7:30 am and 4:30pm. Could that be hurting his progress

  23. Kristin March 18, 2022 at 5:29 pm - Reply

    Hi Dr., my cat became diabetic in the past 4 months, he is 13 and 17lbs. He always eats around the same time daily 9am/6pm. I do make sure he has eaten before a shot but he doesn’t eat 12 hours apart, it is usually around 9am and 6pm. I give insulin 12 hours apart, after eating but not right when he eats except in AM which is same time (after food). My question is if it will cause big problem if he eats at night at 6ish and his shot is at 9pm, shots always are 9pm/9pm. But never if he doesn’t eat, he’s fat- he loves to eat.
    Thank you, Dewey’s Mom

    • Dr . Joi Sutton March 18, 2022 at 6:19 pm - Reply

      It would clearly help his glucose regulation if you fed him and gave the insulin at the same time, every 12 hours. If you are feeding a low carb canned diet there won’t be as much fluctuation in his glucose values compared to feeding dry food. (Dry food is higher in carbs. I recommend canned food only for diabetic kitties.) I hope you adjust his feeding times to every 12 hours!

  24. Janet Thatcher March 12, 2022 at 10:33 pm - Reply

    My dog gets his shot 7am & 7 pm. But the time changes tonight. Spring forward one hour. What do I do?? Sorry so late

    • Dr . Joi Sutton March 18, 2022 at 6:15 pm - Reply

      When changing the timing of insulinit is nice if you can adjust it over a couple days, but if you are springing forward know that the glucose may be a bit higher when you give the injection the next morning. If you are falling back it may be a bit lower. Checking the glucose may help you adjust the insulin dosage if needed.

  25. Charlie Kabath March 8, 2022 at 6:00 am - Reply

    My cat is very emotional. If there are any loud continuous sounds outside or someone entering my apartment she becomes very nervous. On the occasional visit to the veterinarian her being she will skyrocket. Trying to do a BG curve at the vet never works. I have broken up the testing times on different days to try and get a proper curve and it seems to work.
    I am needing to schedule a visit soon for dental work but she is currently in remission. Any advice on how to prepare her for this visit?

    • Dr . Joi Sutton March 12, 2022 at 4:00 pm - Reply

      Indeed I do have a suggestion! At my clinic when I have a skittish kitty coming for a visit I will send home a dose or 2 of gabapentin for the owner to give before the exam. For the typical cat it is 100 mg 2 to 3 hours prior to the vet visit. A capsule can be sprinkled into a bit of canned food as it doesn’t have much taste. (Be sure to skip breakfast as we want your kitty to be hungry to actually eat the canned food laced with gabapentin.) gabapentin decreases anxiety in addition to being an analgesic. It may also cause mild sedation. It’s inexpensive. And if your sweetie is really anxious you can give a dose the night before in addition to the dose prior to the exam. At my clinic I call this a “previsit pharmaceuticaal” and give them out for free. It is less stress for the kitty and safer for my vet staff who is working with an anxious kitty during the visit.
      I also spray my scrubs with feliway whenever I work with kitties. It’s a pheromone. Feliway comes in a spray and wipes. In our cat exam room we have a Feliway plug in.
      Also, you might ask your vet office when might be a slower time of day so that there aren’t barking dogs and a lot of hub bub in the office when you take her in.

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