Here's a copy/paste of discharge notes. I'll put the labwork onto the s/s but this is quicker for now.
Assessments:
Potential reasons for her hard to control diabetes include pancreatitis, hyperlipidemia, Cushing's, or less likely acromegaly. Kidney infections may also be playing a role. Her triglycerides are severely elevated in a manner consistent with idiopathic hyperlipidemia of cats. I am concerned if she has that, it could be the cause for her pancreatitis and diabetes. Ultra lowfat diet is recommended. If that does not reduce her triglycerides to less than 500-1000, then bezafibrate will be recommended.
For her ketotic episodes, more aggressive home management when ketones are present can be tried. Today, her glucose around 445P was still quite high at 333. We gave her an extra 1U of your regular insulin at that time. Generally speaking, when ketones are present, she will need more insulin, even if she is not eating well. To address this, you can monitor her glucose and, when her glucose is over 300 and ketones are present, give her an extra 1U, or 0.5-1.5U as you become more familiar with the effect of this protocol, to help suppress ketones and help her feel better with a more normal glucose reading.
Study: Abdominal ultrasound date of exam March 24, 2021
No free fluid is seen within the peritoneal space. No enlarged lymph nodes are seen. The urinary bladder is moderately distended. No calculi are seen. The spleen is mildly enlarged and slightly hypoechoic but no focal masses are seen. The liver, gallbladder, and extrahepatic bile duct are normal. No stomach or intestinal wall thickening is seen. Intestinal layering is normal. The ileocecocolic junction is normal. Both kidneys measure within normal limits and have good corticomedullary distinction, the right kidney is 4.8 cm in length, the left kidney is 4.3 cm in length. No renal pelvis dilation is seen. The adrenals are larger end of normal, the right adrenal is 5.5 mm in width, the left adrenal is 4.4 mm in width. The pancreatic duct is mildly dilated. The pancreatic tissue is normal. No peripancreatic inflammation is seen.
Conclusion:
The appearance of the spleen may indicate inflammation, hyperplasia or extra medullary hematopoiesis. Diffuse neoplastic process such as mast cell tumor is considered unlikely but aspirates are possible. The dilation of the pancreatic duct is of unknown and questionable clinical significance. There is no sonographic evidence of pancreatitis at this time.
MEDICATIONS:
Levemir insulin - Continue with 5U SQ twice daily.
Ondansetron (she foams when Cerenia is given as a suspension) - Give once to twice daily as needed for nausea.
Lactated Ringer's solution - Give 100-150mL SQ once daily as needed for dehydration.
Regular insulin - When blood glucose is running >300 and appetite is picky such that increasing her Detemir is not
comfortable to give, ok to give 1U SQ once every 4 hours, or up to every 2 hours for more severe elevation.
DIET:
Ultra low fat diet is recommended for Minnie. Ideally this would be Purina OM, or possibly Hill's w/d. If she won't eat these, the lowest fat diet she will eat is what is recommended.
PLAN FOR RE-EVALUATION:
Since Minnie is not feeling well this week, we will try to suppress ketones and rehydrate her at home. I ideally recommend repeating the fluids tomorrow as well.
is a Youtube video that demonstrates this or she may also get these on an outpatient basis at a vet clinic. Recheck fasting triglycerides are recommended in 1-2 weeks. If pancreatitis management and lower fat diet is not helping, bezafibrate will be recommended.
TRIGLYCERIDE 3145 mg/dL (range 25-160)
Test Results Unit Lowest Value Highest Value Qualifier
Total Protein 7.6 g/dL 5.2 8.8
Albumin 4.5 g/dL 2.5 3.9
Globulin 3.1 g/dL 2.3 5.3
A/G Ratio 1.5 0.35 1.5
ALT (SGPT) 50 IU/L 10 100
Alk Phosphatase 70 IU/L 6 102
BUN 53 mg/dL 14 36
Creatinine 1.1 mg/dL 0.6 2.4
BUN/CREAT RATIO 48 4 33
Sodium 148 mEq/L 145 158
Potassium 4.1 mEq/L 3.4 5.6
Chloride 110 mEq/L 104 128
Comment(s)
Lipemia 4+. Magnesium may be increased by 25%. See online reports for specific comments regarding this interference. No other significant analyte interference.
Test Results Unit Lowest Value Highest Value Qualifier
WBC 10.6 10^3/μL 3.5 16.0
RBC 10.0 10^6/μL 5.92 9.93
HGB 13.6 g/dL 9.3 15.9
HCT 43 % 29 48
MCV 43 fL 37 61
MCH 13.5 pg 11 21
MCHC 32 g/dL 30 38
Platelet Count 179 10^3/μL 200 500
Platelet count reflects the minimum number due to platelet clumping.
Platelet Estimate Adequate
Neutrophils 72 % 35 75
Bands 0 % 0 3
Lymphocytes 17 % 20 45
Monocytes 2 % 1 4
Eosinophils 9 % 2 12
Basophils 0 % 0 1
Absolute Neutrophils 7632 /μL 2500 8500
Absolute Lymphocytes 1802 /μL 1200 8000
Absolute Monocytes 212 /μL 0 600
Absolute Eosinophils 954 /μL 0 1000
Absolute Basophils 0 /μL 0 150
And the dose increase 
