5/1/2026

DVM Intake Exam Estimated age: 12 years Microchip noted on Intake? Negative History: Stray QAR MM pink, moist, CRT <2 sec Observed Behavior - Blue; Able to examine, nervous Is there evidence of suspected cruelty? - No Objective: P = 200 hr R = 32 rr BCS 3.5/9 Wt = 8.04 lbs EENT: Iris atrophy noted bilaterally. No nasal or ocular discharge noted. Ears contain a moderate amount of red-brown, coffee ground-like debris, R>L. L ear tipped. Oral Exam: Severe (Grade 4/4) dental disease with significant calculus, gingivitis, gingival hyperplasia, and multiple missing teeth; R side more affected. PLN: No enlargements noted H/L: NSR, no apparent murmur, CRT < 2, Lungs clear, eupneic ABD: Non painful, no masses palpated U/G: FS; L ear tipped MSI: Ambulatory x 4, skin free of parasites, no masses noted, healthy hair coat CNS: Mentation appropriate - no signs of neurologic abnormalities Assessment: -*Otitis externa*: Suspect Otodectes cynotis infestation. -*Severe periodontal disease*: Grade 4/4. -*Underweight*: BCS 3.5/9. -*Geriatric with suspect chronic conditions* Prognosis: Fair Plan: Standard Intake Procedures for Cats Performed -Selamectin applied -Ear cleaning performed -Diet: Wet food only -Diagnostics: Adult wellness bloodwork collected, results pending -Follow-up: Recheck in 2 days for lab results SURGERY: Permanent waiver d/t age -Surgery not needed d/t already altered

5/3/2026

Bloodwork interpretation CBC - Mild lymphopenia (0.486K L) r/o partial stress leukogram vs other Mild thrombocytopenia r/o clumping / artefact vs true (consumption vs lack of production vs sequestration vs increased destruction vs other) Biochemistry - Moderate hyperglycemia (270H) r/o stress vs diabetes mellitus Marginal hypokalemia (3.6L) r/o physiologic variation vs GI fluid loss vs dietary deficiency vs endocrinopathy vs renal disease (unlikely given no azotemia) vs other Mild hypochloremia (107L) r/o GI loss vs renal loss vs other Marginal liver enzyme elevation (ALP 68H, AST 85H) r/o 1ary hepatobiliary disease vs reactive TT4 0.8N Collect UA to idexx - plan pending results Monitor for PU/PD/V/D/A

5/6/2026

Recheck and UA results; reported to not be eating well a few days ago, but follow up note reports eating kitten food well S/O: QAR, curled at back of kennel on shelf, food in kennel appears uneaten, no c/s/v/d noted EENT: No ocular or nasal discharge LUNGS: Eupneic CNS: Appropriate mentation UA (cysto): USG 1.033 (L), protein 1+ (H), glucose 3+ (H), trace ketones, epithelial cells 3+ (H) A: Hyperglycemia, glucosuria - ro stress (high FAS in shelter) vs DM Hyporexia vs anorexia Severe dental disease Ear mites/otitis - treated at intake Elevated AST/ALP Geriatric, underweight; overall poor condition - ro poor husbandry vs systemic illness vs other P: Placed monitoring log Start medical feedings BID Scheduled spot BG tomorrow CTM closely while at QACC

5/7/2026

Spot BG read at 343 mg/DL. // Completed

5/7/2026

Recheck - geriatric cat with comorbidities, hyperglycemia and glucosuria on intake labs S/O: QAR at back of kennel on shelf; appetite yesterday noted to be good, today log indicates poor appetite but some wet food eaten from tray; no c/s/v/d noted EENT: No ocular or nasal discharge LUNGS: Eupneic CNS: Appropriate mentation Spot BG: 343 *LVT noted minimal apparent stress during handling today A: Persistent hyperglycemia, glucosuria once - ro diabetes vs stress Possible decreased appetite - ate well yesterday Severe dental disease Elevated AST/ALP Geriatric, underweight, poor condition - ro poor husbandry vs systemic illness vs other P: Moved to ICU for closer monitoring Monitor appetite closely Check BG SID x 3 days If persistently high, start insulin therapy CTM while at QACC

5/8/2026

BG 382 @ 8:30am

5/8/2026

Spot BG 382 today Hyperglycemia - persistent and climbing despite waxing/waning appetite r/o diabetes mellitus ADD ProZinc insulin (U40) 1U SQ BID TFN EXTEND/INCREASE SPOT BG to BID (prior to insulin administration) --> 5/10 If BG <200 do not give insulin and notify DVM. If BG between 200-350 OK to give insulin as prescribed. If BG >350 OK to give insulin as prescribed but notify DVM. **If at anytime ataxia, severe lethargy / weakness, or collapse are seen, give nutrical or dextrose OTM immediately and notify DVM ASAP please** DVM recheck 5/9 Seek placement, glycemic control would likely improve in a lower stress environment / a different type of insulin / a RX glycemic control diet, and P would benefit from closer monitoring than is possible in the shelter setting

5/8/2026

Discussion: Diabetes Mellitus in Felines: Diabetes in cats is most commonly caused by a deficiency of insulin. Diabetes mostly involves metabolizing sugar, particularly a sugar called glucose. Tissues cannot absorb glucose without insulin, so the level of insulin affects the glucose level. The main symptoms are excessive urination, thirst, appetite, and weight loss. Watching for these symptoms is the best way to know how your pet is doing. Two complications can occur with diabetic cats - if a cat's blood sugar is too high for an extended period of time or if it becomes too low secondary to an insulin injection. Both are emergency situations, and you should see your veterinarian or an emergency hospital immediately. Never alter the insulin dose without discussing it first with your veterinarian. Regulation needs a consistent balance of diet, exercise, and insulin. The current choice of food for diabetic cats is a low-carbohydrate, high-protein diet (usually prescription through your veterinarian). At this time, Dim Sum requires twice daily insulin injections. Diabetes in cats might not be permanent, and it is possible for some cats to enter diabetic remission with the proper management.

5/8/2026

Due to PM treatments being late in the evening and NADIR will be ~4hrs post insulin, OK to start insulin 5/9 in AM to ensure staff will be able to monitor P closely following first injection.

5/8/2026

BG 368 @ 6:00pm Patient to start insulin 5/9 in am

5/9/2026

Recheck - diabetes mellitus, started on insulin this MORNING S/O: BAR, very friendly and approached front of kennel for pets; ate all DM wet food from trays overnight and this AM. No c/s/v/d noted EENT: No ocular or nasal discharge LUNGS: Eupneic CNS: Appropriate mentation BG checks today: AM: 416, 1U PZI administered PM: 255, 1U PZI administered A: Diabetes mellitus - started on insulin today Hyporexia - resolved P: Extend BID BG check for another 7 days to ensure BG stable and regulated with insulin Brief daily rechecks, monitor appetite closely *Seek placement out of shelter ASAP, P is on ARL *Once placed, out of shelter and appetite is stable, consider switching to alternative insulin (i.e senvelgo)

5/10/2026

Recheck - diabetes mellitus, started on insulin 5/9 S/O: BAR, very friendly and approached front of kennel for pets; ate all DM wet food from trays overnight and this AM. No c/s/v/d noted, but witnessed gagging in between bites of wet food EENT: No ocular or nasal discharge LUNGS: Eupneic CNS: Appropriate mentation BG checks today: AM: 318, 1U PZI administered PM: 383, 1U PZI administered A: Diabetes mellitus - under medical management Nausea r/o 2ary to DM vs other Hyporexia - resolved P: ADD Cerenia (0.36mL) 1mg/kg SQ once Brief daily rechecks, monitor appetite closely Seek placement out of shelter ASAP, P is on ARL Note re plan: P is not a candidate for senvelgo given prior injectable insulin treatments

5/11/2026

Recheck - diabetes mellitus, started on insulin 5/9 S/O: BAR, very friendly and approached front of kennel for pets; ate most of DM wet food from trays overnight and this AM. No c/s/v/d noted. EENT: No ocular or nasal discharge LUNGS: Eupneic CNS: Appropriate mentation BG checks today: AM: 394, 1U PZI administered PM: ___, 1U PZI administered A: Diabetes mellitus - under medical management Nausea - appears resolved today r/o 2ary to DM vs other Hyporexia - resolved P: Brief daily rechecks, monitor appetite closely Consider BG curve and increasing insulin dose with placement Seek placement out of shelter ASAP, P is on ARL Note re plan: P is not a candidate for senvelgo given prior injectable insulin treatments

Upon intake they allowed all handling. Staff were able to scan for m/c, place ACC collar, and place into kennel without issue .