Tools and materials

Customized client discharge form

To create a customized client discharge form, please follow the steps below and input the requested information. After you click on "Create Discharge Form," you will be directed to a page to view your customized form. If you are satisfied with your choices, print out your customized form. If you are not satisfied with your choices, you will have an opportunity to return to this page and edit your selections.

Step 1:

Please input the following information about your clinic:
Clinic Name:
Clinic Address:
Clinic Telephone Number:
Veterinarian's Name:

Step 2:

Please select the information you would like to include on your customized client discharge form (you may select all or none of the options for additional information).

Dear ,
Your pet, has diabetes. Because diabetes is caused by a shortage of insulin, your pet will need treatment with insulin such as Vetsulin® (porcine insulin zinc suspension).

Administering Vetsulin
Please give {Pet's Name} [X] units of insulin [once/twice] daily.
Please input number of units:
Please select: daily

Please select from the list below for additional information to include on your customized form:
Administer your pet's insulin treatment at the same time every day.
Vetsulin should be refriderated and stored in an upright position.
Do not freeze. Protect from light.
Vetsulin should be gently mixed by slowly rotating and inverting the vial several times or by rolling the vial between the palms of the hands before withdrawal of each dose. Avoid vigorous shaking.

Feeding your dog
{Dog's Name} must be fed times a day.

Please select from the list below for additional information to include on your customized form. If you have a cat patient, skip ahead to the feeding your cat section.
Always feed your dog before administering Vetsulin. If your dog is not eating, DO NOT TREAT WITH VETSULIN.
If your dog has a reduced appetite and eats only half of its meal, reduce the daily dose of insulin by half. If the situation lasts more than 2 days, contact the clinic.
Feed your dog at the same time every day.
Your dog's diet should be consistent and appropriate. A nutritionally complete, dry or canned dog food should be fed in consistent amounts at the same time each day.
Give enough food to maintain your dog's weight.
Extra tidbits and treats should be avoided, unless appropriate for diabetic dogs. This requires cooperation from family and friends, too.

For dogs on once-a-day administration of Vetsulin:
Food should be rationed two-thirds in the morning prior to the morning injection, the other one-third in the evening about 8−10 hours after the morning injection.

For dogs on twice-a-day administration of Vetsulin (2 options):
Food should be rationed half in the morning prior to the morning injection, the other half in the evening about 8−12 hours after the morning injection.
OR
The first small meal is given prior to the morning insulin injection. The second meal is usually given 7 to 8 hours later. A third small meal is given prior to the afternoon/evening insulin injection. A fourth meal can be given last thing at night.

Feeding your cat
Feed your cat either twice a day just before administering Vetsulin OR allow your cat to graze on food free choice throughout the day. (Twice-a-day feeding is the best choice for diabetic cats.)
For cats, canned food is preferred over dry, because it tends to contain fewer carbohydrates. A high-protein, low-carbohydrate diet is ideal for diabetic cats.
Help your cat achieve and maintain its ideal weight. If your cat is overweight, help it lose weight gradually. If you cat is underweight, initially feed it a high-calorie diet until it reaches its optimal weight.

Exercise
It is important for {Pet's Name} to exercise.

Please select from the list below for additional information to include on your customized form:
Maintain a consistent amount of exercise for your pet.
Avoid heavy or prolonged periods of exercise.

Monitoring your pet
It is important that you learn to monitor {Pet's Name}.

Please select from the list below for additional information to include on your customized form:
Measure your pet's water and food intake daily.
Measure your pet's urine for the presence of glucose and record the result daily.
Measure your pet's urine for the presence of ketones and record the result daily.
Check your pet's urine "X" times a day.

Please select: times a day.

Please select the additional content that should be included with this item:
Early in the morning, at the time of the Vetsulin and first meal.
Late in the afternoon, before the second meal.
Late in the evening.

Reevaluation of your pet
{Pet's Name} will need to be reevaluated in "X" "days/weeks/months"; please schedule an appointment. Please call our clinic if you have any problems or questions.
Please input:
Please select:

Additional Instructions:


Step 3:

If you have finished entering your information and making your content selections, please click on the button below to view your customized client discharge form.