Oliver's AlphaTrak vs Relion Confirm numbers

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Peggy & Oliver

Peggy & Oliver

Member Since 2015
Below is a link to a spreadsheet with some of Ollie's numbers since yesterday. Today I decided to do a glucose curve with the two meters. The AMPS was not successful with the Relion but the rest until now were ok. One more to go. I think he's had it with me today! ;)

The curve is confusing and in some spots, so is the comparison. Especially when the RC showed the SAME number at +2 and +8 while the AT's numbers were quite different. I'm posting it in the hopes that it may help someone besides me. Not quite sure how to deal with this info - not quite what I would have expected.

Also I missed a step somewhere because it's not updating.

https://docs.google.com/spreadsheets/d/11v-kVl6SCBApvdQik49ODsRhDEPcYucX3UbENvniS0w/pubhtml
 
Doing great there! Lantus has a nice gentle curve.
We have 2 protocols for using Lantus, Tight Regulation and Start Low, Go Slow. Both are explained in the Lantus forum.
Since you've got your signature going, plus a spreadsheet, you're ready to start posting there.

One of the interesting things about using Lantus, is that when following the Tight Regulation protocol, you can shoot low to stay low, because you'll have test data showing that it is safe to do so. It also is possible that following TR may enable you to get him to a diet controlled state and off of insulin (OTJ).
 
Thanks, bjm, been here for a while. I posted (badly) a spreadsheet with a comparison of AlphaTrak Numbers to Relion Confirm. I want to add something to it but it's not working so I must have done something wrong. The comparisons between the two sets of numbers are confusing. For example during his curve today, at +2 and +4 the Relion read as 69 for both. Yet the AlphaTrak had him at 120 and 84, respectively so I am not sure if there was a change or not.
 
PeggyS-bb said:
Thanks, bjm, been here for a while. I posted (badly) a spreadsheet with a comparison of AlphaTrak Numbers to Relion Confirm. I want to add something to it but it's not working so I must have done something wrong. The comparisons between the two sets of numbers are confusing. For example during his curve today, at +2 and +4 the Relion read as 69 for both. Yet the AlphaTrak had him at 120 and 84, respectively so I am not sure if there was a change or not.
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oops I see the new spreadsheet isn't even here at all. aargh
 
The comparison between the AT meter and the human meter is not directly linear or a percentage difference. While we think the difference between the two meters at low ranges is somewhere between 30% and 40%, we do not have definitive information regarding what the differences are at moderate or high ranges of numbers. This is largely because at moderate and higher numbers, the difference really doesn't matter so not much scientific information is available. Different things can also influence what number you get.....for instance, were your tests done with the same drop of blood? And then of course there is the allowed FDA variance of both human and pet meters of up to 20% so there are a lot of factors coming into play here.

I am one of the individuals double testing with both a pet and human meters and while I know it is frustrating to try to compare the two, please don't get hung up on individual numbers. If you look at the pattern of either meter once you have more data, (looking at the colours on the spreadsheet or if you make a graph), the pattern will be pretty much the same. It's the pattern that let's you start determining how things are going and how to move forward regulating your furball.

I would suggest you pick one meter and use that as your gauge for dosing or whether to shoot or not. If you want to continue doing some dual testing, that would be great as we can use all the data we can get, but don't drive yourself crazy with the number differences. Believe me, enough of us have done this to know it's not worth the headache. With more data, we may eventually be able to come to further conclusions but right now none of us are sweating it!
 
MrWorfMen's Mom said:
The comparison between the AT meter and the human meter is not directly linear or a percentage difference. While we think the difference between the two meters at low ranges is somewhere between 30% and 40%, we do not have definitive information regarding what the differences are at moderate or high ranges of numbers. This is largely because at moderate and higher numbers, the difference really doesn't matter so not much scientific information is available. Different things can also influence what number you get.....for instance, were your tests done with the same drop of blood? And then of course there is the allowed FDA variance of both human and pet meters of up to 20% so there are a lot of factors coming into play here.

I am one of the individuals double testing with both a pet and human meters and while I know it is frustrating to try to compare the two, please don't get hung up on individual numbers. If you look at the pattern of either meter once you have more data, (looking at the colours on the spreadsheet or if you make a graph), the pattern will be pretty much the same. It's the pattern that let's you start determining how things are going and how to move forward regulating your furball.

I would suggest you pick one meter and use that as your gauge for dosing or whether to shoot or not. If you want to continue doing some dual testing, that would be great as we can use all the data we can get, but don't drive yourself crazy with the number differences. Believe me, enough of us have done this to know it's not worth the headache. With more data, we may eventually be able to come to further conclusions but right now none of us are sweating it!
Click to expand...

Thanks. I will put his results as an added sheet to my workbook here. And then I will give the double testing a rest!
 
Both meters have the potential to read +/- 20% from what a lab would get.
 
PeggyS-bb said:
Thanks. I will put his results as an added sheet to my workbook here. And then I will give the double testing a rest!
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Well, I didn't give double testing a rest. Continued for a while and I'm convinced that you are right, there is no way to find a formula to convert AT numbers to Relion Confirm numbers. However, I have enough data to know when I will give Ollie an insulin shot and when I won't, with either monitor. So, thanks for all your support and listening to me work this through. Started taking the plunge this morning and we'll see how it goes. So starting today Oct 30 we will use Relion Confirm. I added a sheet to my Excel workbook to show the comparative numbers that I was able to get.
 
Actually, when I put your paired data into Excel, it comes up with
y = 1.3362*Relion Confirm + 16.522.
The Pearson r = 0.924872 which is pretty good.
 
If you draw a scatter plot with the X-axis being the Confirm number and the Y-axis being the AT2, it looks like this.

PeggyS.png
 
BJM said:
Actually, when I put your paired data into Excel, it comes up with
y = 1.3362*Relion Confirm + 16.522.
The Pearson r = 0.924872 which is pretty good.
Click to expand...
I'm not so good with stats - thank you for running the numbers :) To me it seems they are so far apart but I've been able to come up with the lowest number that I will shoot based on my data so hopefully that will be ok.
 
I just took a quick peek at Oliver's spreadsheet and it looks like you shot 1u of Lantus with a reading of 79. That is really low to be shooting and Oliver should be watched closely tonight at least until he is past his expected nadir which would be 4 to 7 hours post shot.

You don't have a lot of mid cycle readings and dosing is based on the lowest reading of the day. If Oliver is only at 79 at PMPS, he may have been much lower at some point today. Please check his BG now and let us know what it is? You may need to steer his BG up a bit to keep him a little higher tonight!
 
I will test him now and if that's the case I'm going back to Alpha track and I'll just have to deal. Will let you know asap.
 
You don't need to go back to the AlphaTrak. But our rule of thumb here is not to shoot under 200 on a human meter until you have some mid cycle tests to see how the insulin is working for your cat. Each cat is different so this number has a built in safety margin!

What time is it where you are located? What time did you give Oliver the insulin?

If Oliver is lower than his PMPS of 79, I'd feed him some high carb food with a tsp. of karo or honey to get him rising a bit. Gravy variety of canned food would be great!
 
MrWorfMen's Mom said:
I just took a quick peek at Oliver's spreadsheet and it looks like you shot 1u of Lantus with a reading of 79. That is really low to be shooting and Oliver should be watched closely tonight at least until he is past his expected nadir which would be 4 to 7 hours post shot.

You don't have a lot of mid cycle readings and dosing is based on the lowest reading of the day. If Oliver is only at 79 at PMPS, he may have been much lower at some point today. Please check his BG now and let us know what it is? You may need to steer his BG up a bit to keep him a little higher tonight!
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He is 67 Relion ; 102 Alpha Trak You are saying that 79 is too low to shoot on Relion?
 
Yes. Until you get more data, I would not shoot a full dose unless he is at 200 or above on the Relion. Give Oliver a 1/2 to 1 tsp of karo or honey now. If he won't take it directly, rub it on his gums.
How long ago did he get the insulin?
 
MrWorfMen's Mom said:
You don't need to go back to the AlphaTrak. But our rule of thumb here is not to shoot under 200 on a human meter until you have some mid cycle tests to see how the insulin is working for your cat. Each cat is different so this number has a built in safety margin!

What time is it where you are located? What time did you give Oliver the insulin?

If Oliver is lower than his PMPS of 79, I'd feed him some high carb food with a tsp. of karo or honey to get him rising a bit. Gravy variety of canned food would be great!
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I've got high carb treats. He's fine so far.
 
PeggyS-bb said:
Insulin at 8:02 pm, 1 unit.
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He hasn't even been above 200 on the Alpha Trak since Sep 4. I can't imagine what it would be like for him to be at 200 on the Relion! The vet started him out at 2 units and was surprised I lowered it to 1. He happily lapped up his 1/2 teaspoon. The vet says he should be 11 pounds and he is a little less than 13 so I'm keeping him at 1/2 can Wellness twice per day. He's been doing incredibly well. Much of the neuropathy is gone, he can crouch and use the litter pan and eat normally without having to lie down.
 
PeggyS-bb said:
I'm in NY and it's 10:34 pm so it's been 2.5 hours since insulin.
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So at +2 he is 67 Relion and 102 Alpha Trak. He was happy to lap up Karo. It says it has vanilla in it! Is that really ok for him to have? And his Whisker Lickins treats which he is usually not allowed to have anymore.
 
PeggyS-bb said:
So at +2 he is 67 Relion and 102 Alpha Trak. He was happy to lap up Karo. It says it has vanilla in it! Is that really ok for him to have? And his Whisker Lickins treats which he is usually not allowed to have anymore.
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I thought I understood that low on the human meter would be between 40 and 50.
 
Ok so you are in the same time zone as me.

Peggy (I assume that is your name?), Oliver is fine right now. I am just concerned that he is early in the cycle and his BG is dropping already. He could go even lower and he might go low enough to need some serious monitoring tonight. The reading of 79 is a good reading for a diabetic or non-diabetic cat so with insulin on board, he could be heading toward becoming hypoglycemic. That's why I asked you to get another reading.

Oliver's numbers actually look pretty good to me. I noticed you withheld a couple of times when his reading was in the low 100's but there were no mid cycle tests to see how low he had gone during each cycle and that is what makes me think he needs to be watched tonight. You made the right call lowering the dose to 1 u instead of 2 because obviously Oliver doesn't need that much.

I have to stay up late tonight to shoot my girl (appts. wreak havoc with schedules!) so I will stay with you and we will keep monitoring Oliver for a bit until we are sure he's not going to go too low.

Please get another reading at 11pm and let me know how he's doing.

Word to the wise.... some cats do go hypo without showing symptoms until it gets severe.
 
You are right. 40-50 on a human meter would be low. But you don't have any data to tell just how much impact the insulin is having on Oliver without mid cycle testing. He may have been going close to those numbers recently so shooting at 79, makes me feel monitoring is necessary until we see where he is going tonight. You've never shot insulin at that low a reading till tonight!
 
MrWorfMen's Mom said:
Ok so you are in the same time zone as me.

Peggy (I assume that is your name?), Oliver is fine right now. I am just concerned that he is early in the cycle and his BG is dropping already. He could go even lower and he might go low enough to need some serious monitoring tonight. The reading of 79 is a good reading for a diabetic or non-diabetic cat so with insulin on board, he could be heading toward becoming hypoglycemic. That's why I asked you to get another reading.

Oliver's numbers actually look pretty good to me. I noticed you withheld a couple of times when his reading was in the low 100's but there were no mid cycle tests to see how low he had gone during each cycle and that is what makes me think he needs to be watched tonight. You made the right call lowering the dose to 1 u instead of 2 because obviously Oliver doesn't need that much.

I have to stay up late tonight to shoot my girl (appts. wreak havoc with schedules!) so I will stay with you and we will keep monitoring Oliver for a bit until we are sure he's not going to go too low.

Please get another reading at 11pm and let me know how he's doing.

Word to the wise.... some cats do go hypo without showing symptoms until it gets severe.
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I never shoot below 120 (Alpha Trak) and when I went away the sitter was not allowed to shoot unless it was over 150. We're talking Alpha Trak numbers.
 
The vanilla won't hurt him.

The 120 on the AT meter is still low to be shooting without mid cycle data. I have a cut off point with the AT of about 180 unless I am going to be around to monitor with a mid cycle test.
 
The nadir is the lowest glucose post-shot.
We want that to stay above 50 mg/dL on a human meter and 68 mg/dL on an AlphaTrak.
To safely shoot low to stay low, you need to have more mid-cycle tests in the +5 to +7 hours after you shoot.
Are you following the Tight Regulation guidelines or Start Low, Go Slow?
 
I have to run upstairs and give my geriatric kitty his pill. I'll be back in few minutes! Let's see where Oliver is at 11pm after the little hit of carbs. The karo won't last long but the treats will stay in his system a little longer.
 
MrWorfMen's Mom said:
You are right. 40-50 on a human meter would be low. But you don't have any data to tell just how much impact the insulin is having on Oliver without mid cycle testing. He may have been going close to those numbers recently so shooting at 79, makes me feel monitoring is necessary until we see where he is going tonight. You've never shot insulin at that low a reading till tonight!
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I never used this meter by itself until tonight. I shot at 120 or more on Alpha Track
 
MrWorfMen's Mom said:
I have to run upstairs and give my geriatric kitty his pill. I'll be back in few minutes! Let's see where Oliver is at 11pm after the little hit of carbs. The karo won't last long but the treats will stay in his system a little longer.
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I have my son on the phone. He is a medical lab tech and knows this stuff. He will help me through. Thanks!! I will test in a few mins.
 
On 10/24, he dropped from 155 to 84 on 1 unit, a drop of 71 mg/dL, using the AT2.
If he drops a similar amount from the 79 on the Confirm, he could be in real trouble.
You've got a long night ahead as high carb wears off quickly while Lantus keeps going and going.
Here are instructions for managing low numbers.
 
Ok. You gave him some carbs and he is up a bit but as BJM says, you need to keep monitoring. The carbs you gave him are not going to last through the cycle. Lantus is long acting insulin so until the effects of the Lantus start wearing down, Oliver needs to be watched. If you don't have any high carb food in the house, is there anywhere close by you could pick some up? The high carb food would last much longer and be a much better way to steer his BG in this situation. Most of us keep some in our hypo kits in case.

If you don't have and can't get any high carb food, do you have any vanilla ice cream. We don't want to load Oliver with too much food now as he may need it more in a few hours or sooner depending on when his nadir occurs this cycle and we don't want him filled up and refusing to eat. A bit of ice cream isn't too filling and can be used to boost his sugar.

I'd give him a tsp. of his regular food now and check him again in an hour...sooner if he shows any symptoms of hypo.
 
Peggy, have you taken another reading yet? If not, please do and post. It's really important that you keep track of Oliver's BG tonight to keep him safe.
 
Tested again at 12:30 am. He's Relion 75; AT 117 (At 11:30 he had about a tsp of his regular wet food). He is feeling very well. Meowing as usual, curling up, purring. And he just went to play with his toy. He is pretty happy that I'm up with him.Thank you for all your help. I'm going to close out of here now. My son is helping me. Thanks again!
 
Ok that is your call but please keep an eye on Oliver tonight and don't let your guard down until he has had at least two or three consecutive readings that show his BG is rising. He's down again now and could go hypo on you. I don't want to alarm you but I am concerned.
 
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One other thing, if you do need any further assistance tonight, please put a 911 in front of the title of your thread. There is a box on the left side of the title that drops down and the 911 is in there. Just edit the title on this thread so the history is available for whoever is around.
 
MrWorfMen's Mom said:
One other thing, if you do need any further assistance tonight, please put a 911 in front of the title of your thread. There is a box on the left side of the title that drops down and the 911 is in there. Just edit the title on this thread so the history is available for whoever is around.
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Good morning, Mr. W's Mom,
Just want to let you know that we are awake and all is well. Posted this morning's numbers on Oliver's s/s. Again, I want to thank you for all your help. My son is a certified medical lab tech and supervises a lab. He stayed on the phone with me for hours. He does this sort of comparison as we do with Relion vs AlphaTrak on the big hospital machines and the process is similar. He took a long time explaining to me what I have to do going forward and I understand now. Shooting low was the opposite of what I would ever want to do so it was an error on my part last night. It's his opinion that the Relion numbers are really the more actually accurate, it's just it will take some proper calculation to translate them into the number I need in order to really know whether it's time to shoot or not.
Thanks so much for taking the time to help me out last night and Ollie is great this morning. Thanks to BJM too and anyone else who may have chimed in last night. Have a good day today.
 
Oh Peggy thank you so much for the update. I am so pleased to hear Oliver is doing well. I have to admit, I have been sitting here holding my breath wondering!

I assume your son works in a human lab so that obviously gives him a good base of knowledge about human glucose but the composition of human and cat blood is not the same. The cat's glucose is largely carried in the plasma of the blood whereas with a human most of the glucose is in the red blood cells. That's why there is a different meter for our pets. The value the AT meter gives you is closer to a lab result from a lab calibrated for animal blood.

So in reality the Relion meter is not more accurate. Both meters are right...they are just calibrated to read different types of blood, thus the different readings and all you have to do is follow the reference ranges for the type of meter you are using. If you are going to use the numbers from the Relion going forward, then the protocols here provide reference numbers for you to use with a human meter to make decisions about dosing Oliver.

Once you get more mid cycle tests, you will be able to give Oliver some insulin at lower readings if needed and there are a lot of hands on "experts" here to guide you should you have questions about what dose to give because believe it or not, missing doses isn't always the best answer either. This morning however, it was the right call!

Did you have to steer Oliver's BG with food/karo last night to keep him in the 70's? That 98 this morning could be a bit of a bounce from going even lower last night after your +6 reading of 74. If he did go lower, he may be more sensitive to the insulin now too.

I would suggest you get a couple of tests in mid cycle today if you can, to see where he goes without insulin on board. Tonight, I'd suggest you post in the Lantus/Levemir section if you are unsure what to do and someone can give you advice on whether to shoot or not and if so, what dose would be safe. I'm thinking his numbers may be up today so please don't panic if they are.This is a normal reaction after going to low numbers his body is no longer accustomed to.

Are you using syringes to inject Oliver or the insulin pen? You have to use syringes to be able to give .25 or .50 doses for instance and quite often those low doses are needed to keep a cat safe but keep their numbers at a low enough level to rest the pancreas and hopefully promote remission.

I know all this get very complicated. The important thing is that Oliver is OK. I'm sure you are a bit blurry eyed! But you gained a lot of experience last night!
 
MrWorfMen's Mom said:
Oh Peggy thank you so much for the update. I am so pleased to hear Oliver is doing well. I have to admit, I have been sitting here holding my breath wondering!

I assume your son works in a human lab so that obviously gives him a good base of knowledge about human glucose but the composition of human and cat blood is not the same. The cat's glucose is largely carried in the plasma of the blood whereas with a human most of the glucose is in the red blood cells. That's why there is a different meter for our pets. The value the AT meter gives you is closer to a lab result from a lab calibrated for animal blood.

So in reality the Relion meter is not more accurate. Both meters are right...they are just calibrated to read different types of blood, thus the different readings and all you have to do is follow the reference ranges for the type of meter you are using. If you are going to use the numbers from the Relion going forward, then the protocols here provide reference numbers for you to use with a human meter to make decisions about dosing Oliver.

Once you get more mid cycle tests, you will be able to give Oliver some insulin at lower readings if needed and there are a lot of hands on "experts" here to guide you should you have questions about what dose to give because believe it or not, missing doses isn't always the best answer either. This morning however, it was the right call!

Did you have to steer Oliver's BG with food/karo last night to keep him in the 70's? That 98 this morning could be a bit of a bounce from going even lower last night after your +6 reading of 74. If he did go lower, he may be more sensitive to the insulin now too.

I would suggest you get a couple of tests in mid cycle today if you can, to see where he goes without insulin on board. Tonight, I'd suggest you post in the Lantus/Levemir section if you are unsure what to do and someone can give you advice on whether to shoot or not and if so, what dose would be safe. I'm thinking his numbers may be up today so please don't panic if they are.This is a normal reaction after going to low numbers his body is no longer accustomed to.

Are you using syringes to inject Oliver or the insulin pen? You have to use syringes to be able to give .25 or .50 doses for instance and quite often those low doses are needed to keep a cat safe but keep their numbers at a low enough level to rest the pancreas and hopefully promote remission.

I know all this get very complicated. The important thing is that Oliver is OK. I'm sure you are a bit blurry eyed! But you gained a lot of experience last night!
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Yes my son works in a human lab and he was talking about the stats and the way they calculate the numbers between machines/monitors, not about the actual glucose levels in cat vs human. I guess it's not so much accuracy as consistency in the numbers that he was talking about.

I gave him a little food before I went to get some sleep. He didn't need any further high carbs. He has made such amazing progress and is on a good trajectory and in the long run I'll have to make a decision about which monitor I can live with. Ollie is also asthmatic and has been on inhaled steroids for years. That doesn't go away. Fortunately, the inhaled don't impact the system as much as oral steroids although I'm sure they have some effect - but when he was first diagnosed years ago he had had some depo and dexamethose injections. More recently, he had very small amounts of oral steroids up until August for itchy skin. He is an allergic kitty but most of his fur and skin problems are much improved since treating him for diabetes. He was overweight and had those steroids early on. A sensitive kitty, I'm sure all that led to the diabetes.

We use syringes with the vial of lantus, not pens.

Thanks again, I do appreciate your concern for my orange boy.
 
My pleasure to help. I think we all kind of adopt all the cat's here especially when dealing with a potential problem. Oliver is doing beautifully and I have my fingers crossed that remission is just around the corner for him and you!
 
good morning, Peggy.

Wow, Oliver is doing amazing! I would like to encourage you to post on the Lantus & Levemir forum, if you haven't already. You almost have him tightly regulated already, and they can help you fine-tune his dosing to get him even better. Shooting low is actually a GREAT way to make progress with Lantus & Levemir, as long as you learn to do it in a way that is safe. What he did last night, we call "surfing" - he stayed at pretty much the same nice, flat numbers all night. It is a thing of beauty, and once a cat is surfing mostly under 100 all the time we often see some pancreas healing going on. Lantus is at its best when it is used to hold numbers flat rather than trying to pull down high numbers - if we can learn to work with that (safely) then great things can happen. .

Most people use human meters, so it's not as much a matter of translating the numbers to what you already know from the AT as it is just understanding his patterns with whatever meter you choose to use. You'll get it, don't worry. You've done a great job already.
 
Wow! Just saw Oliver's +4 of 96. I think he's trying to tell you something like.....I'm ready to stop all this nonsense. Please do post in the Lantus/Levemir section tonight and get some expert eyes on Oliver because he may need some small doses to get him all the way to remission but things are looking pretty optimistic right now! When it comes to finessing doses, there are a number of folks here with years of experience who can help you do this safely and hopefully without any more sleepless nights! GO OLIVER!
 
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