Another low PS...what is going on

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AmyB

AmyB

Member Since 2019
I think I'm going to try 1.75 today because Salem's pre-shot an hour ago was 160 on ReliOn and 250 on AlphaTrak. Now it's 155/225?? Is it normal for it to just go down like that? I mean I know it's not by much but still. I don't want to not give him anything but it's staying pretty low. Also do the two meters normally have that big of a discrepancy? I'm mostly using the ReliON for everyday stuff but I need to use the AlphaTrak to give the vet some numbers since it's what they use up there.
 
There can be up to 20% variance in readings from the same meter, so 160/155 and 250/225 are basically the same number.

And yes there is generally variation in the meters, which varies. I’ve had them read two points apart and nearly 100 points apart. That’s why it’s generally best to stick with one meter for your own sanity lol, trying to compare readings will drive you crazy
 
Yeah that makes sense. I'm trying to just stick to one, but the vet wanted me to give him readings with the AlphaTrak so I bought one just for that. I just don't know how to tell what the more "accurate" number is? I know neither one of them are really technically "accurate", but I just want to have an idea of where his glucose is at. It's confusing when he's safe to shoot on one but not on the other?
 
The difference between your Relion and AT2 meters will be greater the higher the BG. At low range numbers the difference won't be that big but at high readings it can be very significant looking. And as mentioned, both have a variance allowance so if the human meter reads on the low side and the AT2 on the high side, the difference can be surprising.

Neither meter is more accurate than the other. Cat blood differs from human blood. The human meter is reading cat blood as if it were human whereas the AT2 is reading cat blood as cat blood. They are two totally different measures. Picking one meter and using it is the best way forward. If you did a curve for a day and took tests with both meters, the curve would look very similar but the curve line for the AT2 would be higher than the human meter curve.

As for safe to shoot numbers, stick to one meter for decision making. On the human meter we recommend not shooting under 200 until you have lots of data. Once you have data, you can slowly back that up. So if you get a pre-shot of 190, you try shooting. If that works well, you can then back up to 175 for instance. Systematic trials are really the only way to know how low a pre-shot is safe to shoot for your cat.
 
I had the same dilemma when I first switched too, but it’s really the trends that are more important not the exact numbers, other than the take action number and the ranges you’re trying to be in. That being said, I think most if not all of the protocols here were written using human meters. I eventually learned how my cat responded to the dose, and that makes it a lot easier to know what the true no shoot number is for your particular cat
 
from what I understand, the reagent on the strip is similar for most of the "human" meters, and a slightly different combination on the "pet" meters, so there will most always be a difference between the readings ... but each meter will "draw the same curve" -- in other words, you compare the meter readings to the readings from the same meter .. the scales are different, however LOW is LOW and HIGH is HIGH and increasing numbers (or decreasing numbers) tell the same story :smuggrin:

it's like snapshots selected from a video -- one picture doesn't tell the whole story but a series of them, does ;)

remember, the vet is getting information from the manufacturers of the meters marketed to them .. so most of them are biased towards those -- but vets have been using the meters originally designed for use by humans, for many years before these "pet-specific" meters were ever developed -- and the protocols/advice on this board was developed years ago using the meters in use at that time ("human" meters) :):joyful:
 
Actually the reagent is the same on the AT2 meter and the Abbott human meter strips. The difference is in the algorithms and how the meter calculates plasma glucose. Cats and humans carry different percentages of glucose in their plasma and each meter is designed to read based on the blood it's supposed to read. The AT2 has to be coded because the strips are batch tested to determine what code will provide the most lab accurate readings for cats, dogs or other species.
 
MrWorfMen's Mom said:
Actually the reagent is the same on the AT2 meter and the Abbott human meter strips. The difference is in the algorithms and how the meter calculates plasma glucose. Cats and humans carry different percentages of glucose in their plasma and each meter is designed to read based on the blood it's supposed to read. The AT2 has to be coded because the strips are batch tested to determine what code will provide the most lab accurate readings for cats, dogs or other species.
Click to expand...

thanks -- I was getting information elsewhere, glad to know what the reality is -- not sure if the reagent on the Arkray strips and the Abbots are the same, thanks for the correction
 
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There are different reagents used in human meters. Depends on the meter. The Arkay strips may very well be a different reagent as are other makers. The AT2 meter was developed from the original Freestyle Freedom Lite human meter so uses the same reagent as the Freestyle meters.
 
So really the goal isn’t so much the numbers themselves, but staying within a range and seeing the pattern of how he’s reacting to it? I think I’m overthinking a lot of this even though it is pretty confusing. I should be more focused on getting curves to see what it’s doing rather than focusing on the individual numbers.
 
Exactly. Don't focus on individual numbers. Each reading is a moment in time.......your spreadsheet is a movie. Candy said it well above .....
CandyH and Catcat said:
it's like snapshots selected from a video -- one picture doesn't tell the whole story but a series of them, does
Click to expand...

Curves are fine if you can't get mid cycle tests BUT a curve is still only one day out of many. Random testing daily can be more accurate than curves because kitty may be having a very good or bad day when you happen to be doing a curve. That said, a curve helps immensely when mid cycle testing is difficult to do due to work schedules etc.
 
Yeah my biggest problem right now is that his mid cycle hits when either I’m at work or asleep. I should be able to get some this week though. I just feel like I have no idea what dose he should actually be on so I’ve been keeping him at 2 because at least it’s bringing his numbers down.
 
Well today we're at 127 AMPS so I'm just going to skip. I'll be at work all day. I suspected he was going low at night and I was right. I mean not dangerously low but pretty low. He also sits and sleeps in the closet all night so I'm not sure he feels well when it drops.
 
I would reduce the dose to a max of 1.75u tonight if pre-shot is high enough to shoot. You really don't want to be skipping shots if at all possible and reducing a bit might even things out so you can shoot more consistently every 12 hours. It's highly likely Salem is feeling poorly due to the ups and downs with his BG.
 
Yeah I think I’m going to reduce it. He’s just not coming back up enough with the 2 now.
 
Would it be safe to give him either .5 or 1? Just so he'd have something in his system?
 
I think at that pre-shot it would be better to skip. While you did shoot 2u once at a pre-shot of 90 without any problem I would not have recommended it. There is no telling what Salem might do with a reduced dose and if he happened to have a particularly active cycle, there is the potential for him to go lower than ideal. Best to try shooting those lower pre-shots when you can monitor IMHO and to take the shootable number down in small steps to ensure safety.
 
I think I’m more comfortable doing that anyways. I skipped the other day and he went up a little bit but it wasn’t super high at least. And when I shot the 2 on 90 I was feeding him high carb stuff the whole time to make sure he didn’t go lower and I definitely can’t do that today. I think I’ll try the 1.75 for a few cycles and see how that goes.
 
Welp after not shooting this morning his PMPS is at 240??? This whole continually dropping thing is throwing me off. He should be okay to get 1.75 tonight I assume but I'll keep an eye on him tomorrow when I give it.
 
AMPS is 122....I woke up around 4 I think and took his BG with the AlphaTrak and it was 280 something at nadir? I really don't understand! Should I bump him down even more today and just see what it does? Could it be possible he's bouncing and that's why he was so high at nadir last night and down this morning? He's pretty lethargic at night and now he's super perky this morning.
 
Okay I stalled a little bit and he went up to 160. I'll be home in the afternoon to test him so maybe I can go ahead and give him 1 or 1.5U?
 
Well skipping doesn't seem to be bothering his AM numbers much at all. Interesting.
I assume you cannot monitor through the day today. If that's the case, I think I'd skip again. Wish he'd do this for the PMPS instead so you could try a lower dose on the low pre-shot.
Tonight reduce him down to 1.5u and see what he does. All you can do right now is try to find a dose that can be consistently shot twice daily. Overall he's not doing badly so patience is key.
 
I'll actually be home this afternoon so I can monitor. And yeah he's been acting mostly fine and I've been testing for ketones and all that so I'm not too worried about him getting a little high. Would you recommend 1 or 1.5 as a lower dose? He's at 160 but the food doesn't bring him up too much.
 
Ok we crossed posted. If you will be home for expected nadir (around +5/6) then I'd try 1u at the lower pre-shot. The problem right now is that we don't know if 1.5u will result in low pre-shot like 1.75u did so I'd reduce to 1u for this cycle. That should be fine until you come home to test. Leave some LC food out for Salem to eat in your absence just in case he needs it.
 
Yeah I'll only be gone for 2 hours today, around +2 to +3 so I can test during nadir. 1U seems a safe bet I think. It didn't even make a dent when I started him out I think but I also started him on insulin and switched food over at the same time and I think he's had a huge drop just from the wet food. I wish I had been monitoring him from the beginning so I could have seen what it did but oh well.
 
Okay I just gave 1U so we'll see what that does. I'm wondering if I need to have the vet look at his teeth again. He checked them and said they looked fine but Salem is pretty much nonstop licking his lips and smacking his mouth and I know he's not nauseous bc he's eating just fine so I have no idea what that is.
 
Never hurts to get his mouth checked again. Things can get missed with a visual inspection since most cats are none too pleased with someone prying their mouth open to look. Could be something was brewing that didn't get noticed at last check.
 
Okay +6 we're at 163 so it at least did something? I think I'm going to try the 1.5 tonight. I'm worried about changing his dose around too much but he's going low at night and then not coming back up and I'd rather avoid that. I'm trying to decrease it slowly at least?
 
I agree not changing doses is best but this morning's pre-shot was much lower than you've shot before, thus the reduction suggestion. If BG is 200 or greater tonight then I agree 1.5u would be the way to go. Kind of surprised by that +6. Seems like it may be a very flat cycle.
 
Yeah I’m hoping I can stick with the 1.5 for a few days and see what it does. I just want to find a dose that works but he’s making it hard! I’m glad I’m testing and doing all of this bc if I had gone by what the vet said he probably would have had a hypo by now. But his overall BG has dropped a lot so maybe I should talk to him about that.
 
Did you change Salem's diet when he was diagnosed from high carb (perhaps dry food) to the low carb wet diet? If so that can have a very significant effect on dropping BG. Your vet started Salem off on a higher than normal starting dose. That 2u plus a diet change likely would have sent Salem very low.
 
So the vet started him on 1u and we went up by half units every week. But I did switch him over to wet food at around the same time and then I found out later that there are certain wet foods with lower carbs than others so I started doing that about two weeks ago so I’m sure it had an effect. The problem is also that he was going off of one blood test done at the vet usually at around +4 when I don’t think Salem hits nadir until around +6. So it’s probably a combination of all of those factors?
 
Yes definitely a combination. And one off tests in the vets office....well...that just won't work. The change to the LC wet diet though has probably made a big difference.
 
Okay PMPS on the ReliOn is 166 and on the AlphaTrak 2 it's 268??? He's safe to shoot on one but not the other so I have no idea what to go by.
 
Okay I tested the AT2 using the control solution and it was fine so I'm just going to go based off of that. I'm going to assume he's probably okay to shoot the 1.5 tonight but I'm definitely not going higher than that.
 
Amy, I know my human meter tended to read low at low range numbers. I also know it's been suggested the Prime reads a bit low but at what range(s) I am not sure. That said, if using the Prime as your only reading, take it at face value and NEVER assume it's reading low. Since you have the AT2 and the reading is well over the no shot threshold we use with the AT2, I agree with your decision to go ahead with the 1.5u dose.
 
Okay good, I'm really trying to stick to one or the other but it's helpful to have both at times like this. He really needs to get a higher dosage tonight I think so I'm going to try the 1.5. I'll leave food out just in case, but it's less than I've given him the previous nights.
 
Just for future reference, I would add a comment into the remarks column about the readings difference and the decision to go ahead with the insulin tonight.
And make sure you get a before bed test so if he is dropping you can set an alarm to retest or prop him up with higher carb food. It really helps to grab a test around +3 or so if possible as that will often tell you if the cycle is going to be an active or quiet one.
 
+2.5 we're at 154 on the AT2. I might set an alarm for +5 just to see where he's at? Maybe this dose is going to be a good one...
 
He’s skyrocketed up to 412 this morning.....I genuinely don’t know what to do. He’s just laying on the floor in the closet and he seems like he feels awful.
 
Which meter is that 412 on? Are you checking Salem for ketones?
Can you also bring the spreadsheet up to date...it makes it so much easier to assess the picture. :)
 
412 is on the AlphaTrak. I tested him at +5 and he was 212 this morning. And I tested him for ketones two days ago and he was fine.
 
I'm scared that all of this lowered dosing is making things worse. I might take him into the vet today and just make sure nothing else is wrong.
 
And I might take him back up to 2 and do a curve using the AT2 today because I'm wondering if my ReliOn is running really low and causing me to shoot lower when I shouldn't.
 
I'd check the ketones again as soon as you can just to be on the safe side. That reading on the AT2 would likely be a pink on the Relion so take a deep breath. I have to wonder how low he went yesterday on the 1 unit and if he went low and was still lower at PMPS then what you are seeing now is a bounce. I'm not sure what to tell you. I think Salem is likely feeling punky because of wide swings in BG. How about testing with the Relion and see what that reading is? I still think you are confusing and frustrating yourself using both meters. The AT2 is going to read higher the higher the BG and that looks far more scary than it really is.
 
DO NOT take him back to 2u. It wasn't allowing you to shoot twice daily consistently and that often means the dose is a bit too high. If Salem is bouncing that bounce could break anytime and if it does and you can't monitor, he could potentially get into trouble.
 
Okay he's at 258 on the ReliOn so maybe try the 1.5 again and see what it does?
 
Good idea! :)

From now on I would also note any AT2 readings in the remarks column rather than in the cells (or stack them in the cells) but it gets really confusing when the PMPS is showing the Relion reading and then the reading at +3 is from the AT2. The pattern of readings is being lost. The pattern will look basically the same for both readings but the Relion pattern will be lower overall.
 
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