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Handling, Storing & Administering Insulin to Dogs
Veterinary & Aquatic Services Department, Drs. Foster & Smith
Liver and Pancreas
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Insulin is available in concentrations of 40, 100, and 500 units/ml. There are corresponding syringes to use for the measurement of the three concentrations of insulin. If using insulin with 40 U/ml, you must measure and administer it with a U-40 syringe; using a U-100 or U-500 syringe would result in the wrong amount of insulin being given, with perhaps a fatal outcome. There may be several types of U-40 syringes available, manufactured to deliver low or high doses. The measurements marked off on those syringes designed for giving a low dose are often easier to read. Find out from your veterinarian (or pharmacist) what syringes are available for you to use with the concentration of insulin your dog is receiving.

How is insulin stored and handled?

Insulin comes in a glass vial with a rubber stopper, and must be stored in the refrigerator. Do not use the insulin beyond its expiration date.

How is a dose of insulin measured?

Parts of insulin syringe: barrel, plunger, needle guardThe concentration of insulin is measured in units. Insulin syringes are marked in units, and may also be marked in milliliters. Be sure to use the unit scale. Also, be sure you are using the appropriate insulin syringe for the concentration of insulin you are using.

An insulin syringe has 4 basic parts: the barrel, plunger, needle, and needle guard. Many brands of syringes have the needle permanently attached to the syringe barrel so it cannot be removed.

  Mixing the insulin vial by rolling between the palms of the hand1. Prior to removing a dose of insulin from the vial, mix and warm the contents by gently rolling the vial between the palms of your hands. DO NOT SHAKE INSULIN as that will cause air bubbles to form, and it will be more difficult to get an accurate measurement. NOTE: We have used a pink solution instead of insulin to better illustrate the steps.

Insert empty syringe into insulin vial2. Hold the vial stopper-side-down, remove the needle guard from the insulin syringe, and insert the needle of the syringe into the vial through the rubber stopper.

Full syringe3. Pull back on the plunger of the syringe to draw the insulin into the syringe once, then inject it back into the bottle. Redraw the proper dose back into the syringe. This is helpful in accurately dosing as insulin may stick to the inside of the plastic syringe or an air bubble may be present in the syringe. If any air enters the syringe, you can also expel that back into the vial by keeping the vial upside down, and the needle of the syringe pointing up.

Insulin syringes showing correct and incorrect measurements4. Recheck that you have withdrawn the proper amount of insulin.

5. Remove the syringe from the vial and replace the needle guard.

6. Return the insulin to the refrigerator.

7. You are now ready to administer the insulin.

How is an insulin injection given?

To acquaint yourself with what giving an insulin injection may feel like, it is often recommended to practice by injecting water from an insulin syringe into an orange.

To be sure your dog gets his insulin, and does not receive extra doses (from other members of the family who may not know the insulin was given), record the time of each insulin injection on a designated calendar.

  1. When giving your dog an insulin injection, you may, at first, want someone to help you hold and/or distract the dog while you are giving the injection. Scratching the dog on his head, getting his attention with a toy, or placing an enticing treat (very small piece of cooked chicken) near his nose may help focus his attention away from the injection. The needle is extremely thin, and the injection almost painless.

  2. Remove the needle guard from the syringe filled with the appropriate dose of insulin.

  3. Giving a dog an injectionIf you are right-handed, hold the syringe in your right hand. With your left hand, pick up fold of skin along your dog's back or shoulders (use a different site every time). Some veterinarians recommend giving the injections under the skin on the sides of the chest and abdomen, since it may be better absorbed from these sites.

  4. Push the needle through the skin at about a 45º angle. Be careful not to push the needle through the entire fold of skin and out the other side, or accidentally into your finger.

  5. Pull back slightly on the syringe plunger to be sure the needle is not in a blood vessel (if it is, blood will enter the syringe as you pull back the plunger), and then administer the insulin by pushing the plunger with your thumb.

  6. Withdraw the needle from the dog's skin, and replace the needle guard.

  7. Reward your dog by scratching his head (if he likes it!), giving him the very small piece of cooked chicken, and talking to him. (Once you are more comfortable giving him injections and do not have to concentrate on what you are doing quite so hard, talk to him throughout the procedure.)

  8. Record the time of the insulin injection on the designated calendar.
  9. Needle/syringe disposal boxPlace the needle and syringe in a puncture-resistant container. These are available, sometimes free of charge, from your veterinarian or pharmacist. Follow your local regulations regarding disposal.


If the dog does not receive the entire dose of insulin, (e.g., some leaked out of the injection site, the needle went through the entire fold of skin and the dose was injected into the air, etc.) do NOT, we repeat, do NOT give more insulin. Wait to give more insulin until the next scheduled dose. Occasional missed doses are easily tolerated, overdosage can be fatal.
 
References and Further Reading

Diehl, KJ. Long-term complications of diabetes mellitus, Part II: Gastrointestinal and infections. In Greco, DS; Peterson, ME (eds.) The Veterinary Clinics of North America Small Animal Practice: Diabetes Mellitus. W.B. Saunders Co. Philadelphia, PA; 1995: 731-752.

Ford, SL. NIDDM in the cat: Treatment with the oral hypoglycemic medication, glipizide. In Greco, DS; Peterson, ME (eds.) The Veterinary Clinics of North America Small Animal Practice: Diabetes Mellitus. W.B. Saunders Co. Philadelphia, PA; 1995: 599-616.

Garcia, JL; Bruyette, DS. Using oral hypoglycemic agents to treat diabetes mellitus in cats. Veterinary Medicine; 1998 (August);736-742.

Greco, DS; Broussard, JD; Peterson, ME. Insulin therapy. In Greco, DS; Peterson, ME (eds.) The Veterinary Clinics of North America Small Animal Practice: Diabetes Mellitus. W.B. Saunders Co. Philadelphia, PA; 1995: 677-690.

Ihle, SL. Nutritional therapy for diabetes mellitus. In Greco, DS; Peterson, ME (eds.) The Veterinary Clinics of North America Small Animal Practice: Diabetes Mellitus. W.B. Saunders Co. Philadelphia, PA; 1995: 585-598.

Lutz, TA; Rand, JS. Pathogenesis of feline diabetes mellitus. In Greco, DS; Peterson, ME (eds.) The Veterinary Clinics of North America Small Animal Practice: Diabetes Mellitus. W.B. Saunders Co. Philadelphia, PA; 1995: 527-552.

Miller, E. Long-term monitoring of the diabetic dog and cat: Clinical signs, serial blood glucose determinations, urine glucose, and glycated blood proteins. In Greco, DS; Peterson, ME (eds.) The Veterinary Clinics of North America Small Animal Practice: Diabetes Mellitus. W.B. Saunders Co. Philadelphia, PA; 1995: 571-584.

Muñana, KR. Long-term complications of diabetes mellitus, Part I: Retinopathy, nephropathy, neuropathy. In Greco, DS; Peterson, ME (eds.) The Veterinary Clinics of North America Small Animal Practice: Diabetes Mellitus. W.B. Saunders Co. Philadelphia, PA; 1995: 715-730.

Nelson, RW. Diabetes mellitus. In Birchard, SJ; Sherding, RG (eds.) Saunders Manual of Small Animal Practice. W.B. Saunders Co. Philadelphia, PA; 1994: 249-256.

Nelson, RW; Feldman, EC. Insulin resistance: Etiologies and diagnostic approaches. Presented at the 81st Annual Convention of the Wisconsin Veterinary Medical Association. Madison, WI; October 20, 1996.

Nelson, RW; Feldman, EC. Treatment strategies in the management of canine and feline diabetes mellitus. Presented at the 81st Annual Convention of the Wisconsin Veterinary Medical Association. Madison, WI; October 20, 1996.

Norsworthy, G. Choosing the right insulin type and dosage for diabetic cats. Veterinary Medicine. 1998 (April);314-318.

Norsworthy, G. Does this cat have diabetes? Veterinary Medicine. 1997 (November);947-949.

Norsworthy, G. Dysregulation in diabetic cats: Part 3. Veterinary Medicine. 1999 (May);431-432.

Norsworthy, G. Peculiarities in diabetic cats. Veterinary Medicine. 1997 (December);1026-1027.

Norsworthy, G. Performing a blood glucose curve in a diabetic cat. Veterinary Medicine. 1998 (May);425-428.

Norsworthy, G. Recognizing and treating hypoglycemia in diabetic cats. Veterinary Medicine. 1998 (August);707-711.

Norsworthy, G. The initial steps in treating diabetic cats. Veterinary Medicine. 1998 (March);223-226.

Norsworthy, G. Using oral hypoglycemic drugs to treat diabetic cats. Veterinary Medicine. 1998 (July);616-617.

Norsworthy, G. What to consider before you treat a diabetic cat. Veterinary Medicine. 1998 (January);31-34.

Peterson, ME. Diagnosis and management of insulin resistance in dogs and cats with diabetes mellitus. In Greco, DS; Peterson, ME (eds.) The Veterinary Clinics of North America Small Animal Practice: Diabetes Mellitus. W.B. Saunders Co. Philadelphia, PA; 1995: 691-714.

Plotnick, AN; Greco, DS. Home management of cats and dogs with diabetes mellitus: common questions asked by veterinarians and clients. In Greco, DS; Peterson, ME (eds.) The Veterinary Clinics of North America Small Animal Practice: Diabetes Mellitus. W.B. Saunders Co. Philadelphia, PA; 1995: 753-759.

Struble, AL; Nelson, RW. Non-insulin-dependent diabetes mellitus in cats and humans. The Compendium on Continuing Education for the Practicing Veterinarian. 1997;19(8): 935-944.


RELATED ARTICLES:
Blood Glucose Curves in the Diagnosis & Regulation of Diabetes in Dogs 
Terms Commonly Associated with Diabetes Mellitus in Dogs 
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Diabetes Mellitus in Dogs 
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