C09990023 / invoice 10000

Reason: Libre sensor placement    Vital Signs    

Reason: Please Call Owners Today.. DM Check In. History: Current Toujeo dose = 4u BID SQ Latest CGM assessment documents biphasic glucose curves following Toujeo adminstration with post-prandial glucose spikes. Nadir remains ideal-to-low (3.3-3.8mmol/L), occurring at approx 10-12h post-Toujeo admin. Onset of action of Toujeo post-admin seems delayed by several hours leading to a post-prandial spike with readings of >23mmol/L. This is a consistent finding. Average glucose is 11.7-15.2mmol/L which is reasonable at this stage. At home:- eating; good appetite- drinking/urinating; 430-450ml per day (60ml/kg/d)- demeanour; happy and playful - vomiting/diarrhoea; none - weight; stable- urinary ketones zero last few days- issues with administration; Mowgli very jumpy and doesn't stay still. Possibly variable dosing happening due to this. Plan:- elect to trial 10% decrease in caloric intake and add in post-prandial exercise - monitor CGM ongoing and check in at end of weekOffered the following but owner declined in favour of option above. - if feeding appropriate amount, add in Caninsulin at meal-time @ 0.25U/kg (1.5U BID SQ). Should buy a VetPen to allow accurate half unit dosing.- continue to monitor, slight increase in risk of hypo due to current nadir and added use of lente insulin- the dose of Toujeo and/or Caninsulin may be altered depending on glucose response over the next few days.Client Communication: :A phone consultation was held with MonaLisa, Mowgli's owner, on 02/03/2026 to review his recent Libre glucose curve data. The erratic nature of the glucose curves was discussed, particularly the post-prandial hyperglycaemic spikes exceeding 27 and the occasional hypoglycaemic episodes, with one reading as low as 2.9, although this was without clinical signs. His reduced but still present polydipsia was reviewed, noting a decrease in water intake from approximately 920 ml/day to 430-450 ml/day, with most drinking occurring at night. His demeanour remains bright and playful, with a good appetite and no vomiting or diarrhoea. Urine ketone checks have been negative, and glucosuria has reduced.The challenges with administering the Toujeo pen due to the short needle and Mowgli's restlessness were discussed, acknowledging that this could occasionally lead to incomplete dosing, which may account for some of the high glucose readings.The potential addition of a short-acting insulin (Caninsulin) at 1.5 units twice daily was discussed as a means to control the post-prandial spikes, alongside a reduction in the Toujeo dose to 3 units twice daily to prevent further hypoglycaemia. The owner expressed a preference to avoid adding a second injectable insulin if possible.As an alternative initial step, a plan to trial dietary modification and increased exercise was agreed upon. It was explained that exercise can help lower blood glucose independently of insulin. The owner was advised on the importance of ensuring a full dose of Toujeo is administered by priming the pen and holding it in place for a sufficient duration. The potential for this trial to be unsuccessful was communicated, with the understanding that insulin therapy modification would be the next step.The plan is to reduce Mowgli's food intake by approximately 10%. Specifically, the Royal Canin diabetic kibble will be reduced from 75g to 65g per meal, and the small amount of wet food topper will also be slightly reduced. A morning walk will be added to his routine.A follow-up discussion was scheduled for the end of the week to review the glucose charts and determine the next steps in his management.    Vital Signs