C09984009 / invoice 10000

Reason: Low ReadingIntern DCDraft History:Aston presents for recheck for DM Management.Aston has been managed for diabetes mellitus and chronic enteropathy by ARH Medicine since december 2023.  December 2025, O emailed clinic regarding difficulty with insulin dosage after an episode of vomiting and refusing food. Aston vomited after he had breakfast and insulin inj which decreased his BG to 2.7mmol/L on Freestyle libre. O promptly managed it by rubbing honey on his gums. He was happy to eat dinner willingly afterwards and O resumed insulin as normal (4.5IU at the time). Since then, O found his BG levels have been difficult to manage with 4.5IU dropping his BG to 3, and O reduced to 4 IU which still decreased BG to 3. O then reduced to 3.5 IU which BG remains up high 20s even before a meal. Upon a telephone discussion, O was advised to continue with Caninsulin 3.5IU BID. On 24/02/26, O presented as an emergency recheck to ARH IM for reading of 3.0 mmol/L on CGM post breakfast insulin. On presentation, Alphatrak BG was 6.0 mmol/L with no observed signs of hypoglycaemia. The previously reported recurrent gastrointestinal signs were persisting and was becoming more frequent, making insulin administration difficult for O. After a review of recent BG curves, insulin dose was decreased to Caninsulin 3IU BID from 3.5 IU BID. Today, xxxCurrent medication:Caninsulin 3 IU BID Beransa monthlyExamination Findings:T: xMM: pk moistP: x  bpm  CRT: 1-2sR: x bpmDemeanour: BARHydration: EuhydratedWeight: xxx kg (-  600g)Body Condition Score: 4/9Cardiovascular: G 3/6, left apical systolic murmur, no arrhythmiasRespiratory: WNLAbdomen: WNLPeripheral LNs: WNLOcular: Bilateral enucleation. Ears: WNLIntegument: WNLOral exam: C2G2 , foul breathsMusculoskeletal WNLGait: WNL considering no visionNeurological: WNL, normal mentation, BARRectal: NPLaboratory: BG Alphatrak - xProblems list: Diabetes mellitus Chronic enteropathyBiochemical hepatopathy Assessment: XxxClient communication:XxxPlan: XxxK    Vital Signs