5/31/2026

DVM Intake Exam Estimated age: ~12-16 years based on dentition / condition Microchip noted on Intake? Scanned negative History: Stray Subjective: BARH, pink tacky mm, CRT <2s mildly prolonged skin tent Vomited bile in kennel good appetite when offered wet food no c/s/d reported Observed Behavior - Friendly, soliciting attention Is there evidence of suspected cruelty? No Objective: P = WNL R = WNL BCS 5/9 MCS 2/3 - mild muscle wasting at dorsum EENT: nuclear sclerosis and moderate iris atrophy OU, no nasal or ocular discharge noted Oral Exam: Moderate dental disease (moderate calculus and gingivitis), difficult to see caudal dentition PLN: No enlargements noted H/L: NSR, NMA, CRT < 2s, Lungs clear, eupneic, negative ITC ABD: Tense, not overtly painful, very large but soft bladder, cranial organomegaly U/G: Female - no tattoo or spay scar appreciated but P has small nipples and no mammary development. Spay status unknown. MSI: Ambulatory x 3, RH previously amputated, full orthopedic exam not performed INT: Dirty unkempt hair coat, mild fecal matting LH and R hip, no masses noted, no ectoparasites seen CNS: Mentation appropriate - no signs of neurologic abnormalities Rectal: Normal externally Wood's Lamp Exam: Not performed Assessment: RH amputee Nuclear sclerosis OU Iris atrophy OU Muscle wasting r/o age related vs underlying pathology (CKD vs other) Large bladder r/o stress vs less likely obstruction vs bladder atony Vomiting / intraluminal shadowing in stomach / cranial organomegaly r/o CKD vs FB vs pyloric outflow obstruction (FB vs mass effect) vs other Moderate dental disease Fecal matting Approx 6% dehydrated F (spay status unknown) geriatric DSH Prognosis: Guarded Plan: OK for appropriate intake tasks Shaved plantar aspect of LHL Move into med ICU Cerenia 0.3mL (1mg/kg) SQ ONCE LRS 60mL SQ ONCE vit B12 0.25mL SQ ONCE CBC/biochemistry/T4/UA to idexx (urine collected via cystocentesis) AFAST - Very large but soft bladder with hypoechoic lumen - no shadowing or snow globe effect - Moderate loss of corticomedullary distinction bilateral kidneys - Gastric distension with intraluminal shadowing r/o post prandial / ingesta vs FB vs pyloric outflow obstruction (FB vs mass effect) vs other Overnight fast for AMH test to idexx tomorrow DVM recheck 6/1 - consider repeat AFAST tomorrow when fasted SURGERY: If intact permanent waiver due to age

6/1/2026

Brief recheck exam S/O: BARH - friendly, sweet, soliciting attention. Likes to be held. pink moist mm, CRT <2s Initially food untouched but when wet food dish placed in front of P she ate the whole dish. Large amount of urine in litterbox No stool no c/s/v/d reported overnight A/P: Repeated AFAST now that P is fasted - no masses or evidence of GI obstruction, stomach empty with normal rugal folds, bladder subjectively smaller than yesterday. Other findings as prior. No vomiting overnight Dehydration resolved Other conditions as prior AMH submitted, pending @tt

6/1/2026

Bloodwork / UA interpretation CBC - - Mildly decreased retic hemoglob (13.6L) - little clinical significance, hct WNL - Moderate neutrophilic (22.2K H) monocytic (0.8K H) leukocytosis (26.1K H) r/o partial stress leukogram vs inflammatory vs less likely infectious vs neoplastic Biochemistry - - Moderate hyperglycemia (431H) r/o DM vs less likely stress - Mild SDMA (20H) / BUN (45H) elevation with normal creatinine r/o pre renal (re dehydration vs other) vs renal vs post renal - Mild hypochloremia (110L) r/o GI loss re vomit vs other - Mild hyperproteinemia (9.1H) / hyperglobulinemia (6.0H) r/o inflammatory vs infectious vs hemoconcentration vs other - Marginal ALP elevation (63H) r/o reactive vs 1ary hepatobiliary - Marginal hyperbilirubinemia (0.4H) r/o pre hepatic (hemolysis vs other) vs extra hepatic (pancreatitis vs other) vs intrahepatic vs other - Moderate hypercholesterolemia (381H) r/o post prandial vs DM vs dietary vs other T4 2.1N UA - - Low normal urine SG 1.028 - Low normal pH 5.5 - Glucosuria 3+ - consistent with DM - Ketone negative Bloodwork and PE findings consistent with diabetes mellitus 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 START TOMORROW TO ALLOW FOR CLOSE MONITORING WHEN STARTING INSULIN TO ENSURE NO IATROGENIC HYPOGLYCEMIC EVENTS: ADD ProZinc insulin (U40) 1U (~0.34U/kg) SQ BID TFN ADD SPOT BG to BID (prior to insulin administration) --> 6/9 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 P has not eaten please notify DVM and do not give insulin** **If at anytime ataxia, severe lethargy / weakness, or collapse are seen, give nutrical or dextrose OTM immediately and notify DVM ASAP please** DVM recheck 6/2

6/1/2026

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, this pet 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.

6/2/2026

Brief recheck exam S/O: BARH - friendly, sweet, soliciting attention. Likes to be held. pink moist mm, CRT <2s Excellent appetite for wet food, will also eat dry food if you pet her, social eater. Large amount of urine in litterbox No stool no c/s/v/d reported overnight A/P: Spot BG 500 this AM -- start insulin as planned Immature cataracts OU r/o 2ary to DM Other conditions as prior DVM recheck 6/3 AMH pending @tt

6/3/2026

Recheck geriatric diabetic kitty S/O: QAR, very sweet, comes forward for interaction, ate well overnight, no c/s/v/d noted EENT: No ocular or nasal discharge LUNGS: Eupneic MSI: Ambulatory x 3 with unkempt/matted haircoat CNS: Appropriate mentation BG measurement this AM: 549 A: Geriatric Diabetes mellitus Cataracts OU Dental disease Amputee P: Continue current treatment plan CTM closely on rounds, seek placement for continued care. Will require lifelong insulin administration and regular veterinary visits.

6/5/2026

Recheck geriatric diabetic S/O: QAR, very sweet, leans into petting and head rubs; ate well overnight and this AM, no c/s/v/d noted EENT: No ocular or nasal discharge LUNGS: Eupneic MSI: Ambulatory x 3 with unkempt/matted haircoat CNS: Appropriate mentation BG measurements: 6/2: AM_500, PM_400; 1U insulin BID 6/3: AM_549, PM_; 1U insulin BID 6/4: AM_469, PM_469; 1U insulin BID 6/5: AM_292, PM_; 1U insulin BID A: Geriatric Diabetes mellitus - currently on 1U insulin; eating DM well Cataracts OU Dental disease Amputee P: Continue current treatment plan *CTM daily on rounds *Recheck every 2-3 days; monitor BG daily

6/6/2026

BG 709 @ 6:15pm. Given 1.5u as per 2065

6/7/2026

Recheck geriatric diabetic S/O: QAR, very sweet, leans into petting and head rubs pink moist mm, skin turgor WNL ate well overnight and this AM, no c/s/v/d noted EENT: No ocular or nasal discharge LUNGS: Eupneic MSI: Ambulatory x 3 with unkempt/matted haircoat CNS: Appropriate mentation BG measurements / insulin admin: 6/6 AM 563 PM 709 - rcvd 1U in AM and 1.5U in PM 6/7 AM 347 PM _- rcvd 1U in AM A: Geriatric Diabetes mellitus - currently on 1U insulin; eating DM well this AM Cataracts OU Dental disease Amputee P: Continue current treatment plan *CTM daily on rounds *Recheck every 2-3 days; monitor BG daily

6/7/2026

Addendum - LVT reports P anorexic this PM. BG 215. Advised skip PM insulin and apply TD mirataz once. DVM recheck 6/8.

6/8/2026

Recheck BAR, purring when kennel approached Appetite score 2, mostly eaten food bowls in kennel Skipped insulin yesterday evening due to anorexia Plan: Continue with insulin administration Continue with current treatments and monitoring