Blood Glucose Check Intake Form Owner*Date* Date Format: MM slash DD slash YYYY Pet*Chart #*Diabetic patients require frequent monitoring of blood glucose to make sure we are dosing insulin appropriately. In newly diagnosed patients, we generally start with quick "spot checks" to get a ballpark estimate of a pet's blood glucose. In order to get the most accurate data for long-term treatment, a blood glucose curve is recommended. For a curve, your pet will be here all day for blood sampling every 1-2 hours to monitor response to insulin.Did your pet eat this morning?YesNoIf so, what time?Current DietDid you give your pet insulin?YesNoIf so, what time?How many units?Please comment on your pet's behavior at home in the last week, or since the last change in insulin dose:Energy LevelIncreasedDecreasedNo ChangeAppetiteIncreasedDecreasedNo ChangeThirstIncreasedDecreasedNo ChangeUrinationIncreasedDecreasedNo ChangeDo you have any other concerns about your pet?Phone number where you can be reached today*Email* EmailThis field is for validation purposes and should be left unchanged.
