C09994774 / invoice 10000

05/03/2026 DATE/TIME of CONSULTATION: 23:12hrs, Thu 05/03/26
CLINICIAN: Alycia Tsiang 
PRESENTING COMPLAINT: Unwell - known diabetic 

HISTORY:
Known cushings, has been on trilostane 
Has been diabetic for ~1 year. Tonight she had an episode where she fell off the couch, dropping on her back legs and shaking 
Seemed disoriented. O gave her some additional food
Insulin given at 7pm, ate her full dinner as normal 
Currently working with diabetes specialist - currently on toujeo 13IU BID 
Ketones & glucose present in urine, increased dose to 17IU 2 days. Seemed ok with new dose. Had 17IU this evening, and then O found an email from vet saying should change to 15IU instead of 17IU (thought to be this high) 

CLINICAL FINDINGS: 
BG checked on presentation: 3.8
Given some food - ate happily, BG checked 20 minutes later: 7.8 

QAR
No tremors noted
Oral exam MM pink, CRT <2s
Thoracic ausc HR 120bpm no m/a. Increased BV sounds consistent with panting 
Abdo palp tense but comfortable
Temp 38.6
LN small & symmetrical
BCS 5/9 
Integument - healthy coat 

PROBLEM LIST:
- Known diabetic, hyperA
- Suspect hypoglycaemia event

OPTIONS PROVIDED:
1. Admit for monitoring overnight
2. Monitor at home
O comfortable to take Luna home tonight 

DIAGNOSTIC TESTS:

DIAGNOSIS:
Hypoglcaemic event

TREATMENT:

CLIENT COMMUNICATION/PLAN:
Discussed to reduce toujeo back to 13IU tomorrow AM - will forward results to diabetes vet for ongoing management
Discussed if tremors/disoriented, O can put honey on gums
Freestyle libre placed for glucose monitoring