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Blood Glucose Monitoring Chart Pet Details Pet’s name: Owner’s name: Breed: Sex: Age: Feeding time (am/pm or ad libitum): Weight: Body condition (please indicate): Overweight Neutered: Correct weight Yes No Underweight Treatment Number of units of Caninsulin: Frequency of administration (SID/BID): Please record time of injection(s) on the graph 35 2 4 6 8 1 2 3 4 10 Date: Tick relevant box for timescale used 12 14 16 18 20 22 24 8 9 10 11 12 30 Blood glucose mmol/l 25 20 15 10 5 5 6 7 Hours from start of monitoring Time glucose curve started: Vet’s name: Practice name: Time insulin administered: Clinical signs evident in the animal at the time of BG curve (please tick) Tel No: Fax No: For more information or to download a printable version of this form, visit www.caninsulin.co.uk www.caninsulin.co.uk 71755.47DiabetesInterpretationCallbackGMChart-3.indd 1 30/01/2015 13:57 Diabetic Interpretation Callback Request Form Vet / Nurse Name: Veterinary Practice: Contact No: Preferred contact time: a.m. p.m. Client name/animal’s name: Species: Breed: Age and weight: Sex: Neutered: Body condition (please indicate): Correct weight Underweight Overweight other Diet: History Please attach the animal’s full history with all relevant information including: date of diabetes diagnosis, diagnostic tests performed, doses of Caninsulin administered, Please also email or fax any blood glucose curve charts, urinalysis reports or other laboratory results..
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