C09978700 / invoice 10000

History:History:
* Known diagnosis of Diabetes Mellitus.
* Previous fructosamine (February 2026) was moderately high.
* Glucose curves show good shape but remain higher than ideal range.
* Owner reports variability in glucose readings, suspecting inconsistent insulin injection technique between caregivers.
* Patient is reportedly more active and playful recently.
* Increased exercise appears to cause delayed hypoglycemia.
* Diet is primarily home-cooked; owner reports significant glucose spikes with any form of biscuit/kibble.
* Previous ACTH stimulation test for Cushing's disease was negative.
* Owner reports no current clinical signs consistent with Cushing's disease (e.g., polydipsia, polyuria, pot-belly).

Physical Examination:
Unless otherwise stated - examination normal
* Weight: Minor weight loss (~200g) since last visit.
* Skin and Coat: Some matting noted in fur. A patch of fur was shaved between the shoulder blades for glucose monitor placement.

Other Relevant Clinical Findings:
* A new continuous glucose monitor was placed during the consultation.
--> NEW DEXCOM - SEE INSTRUCTIONS BELOW

Assessment/Summary:
* Diabetes Mellitus with improving but not yet ideal glycemic control.
* Fluctuations in blood glucose may be related to injection technique variability and dietary carbohydrates.
* Concurrent Cushing's disease is considered unlikely at this time given the negative ACTH stimulation test and lack of clinical signs. Deferring further testing to avoid complicating current diabetic management.

Plan and Treatments:
* Continue current insulin therapy.
* Reinforced correct insulin injection technique with owner, suggesting alternative sites.
* Advised strict adherence to a high-protein, low-carbohydrate diet. Avoid all biscuits.
* Discussed commercial fresh food diets (e.g., Lyka) as a potential option.
* Monitor glucose trends closely with the new sensor.

Need for a recheck and if so, when?
* Owner to email glucose readings in 2-3 days for review.

DH

NEW SENSOR DETAILS
BRAND: DEXCOM
How long does it last? 10 days
Where do we order ir from - OWNER SOURCES

How to apply:
Clip fur approximctely 3 inches x 3inches (square)
scrub skin with alcohol soaked swab
Fan to air dry

-->
Remove cap (twist in direction of arrow on side)
Do not rouch anything inside
Press down with reasonable force
Then press button on side of applicator
Hold there for 5 seconds

Thencarefully remove the applicator
Then DEXCOM recommend pressure on disc in a rotating fashion for 3 rotations
(Idea is to get the adhesive pad part under the brobe to adhere to as much skin as possible
Then pressure (hand) on top of probe for 15 - 20 seconds

Then there is a sticker/dressing that sits over the probe (doesnt actually touch the probe) as a secoond back-up adhesive to for white paper asdhesive

looks hopeful!

Excellent adhesions, much bigger paper adhesive circular area than the freestyle libre


Lyka??