AlphaTrak vs. ReliOn Premier Blu

[arthur-kitty]

I just wanted to post regarding the difference between readings on an AlphaTrak vs. a human meter.

I know a direct conversion is not possible, but I feel like I wish I had seen something like this before I purchased the AlphaTrak.

I had to purchase an AlphaTrak due to my vet not wanting to look at numbers from a human glucometer. All readings were taken from the same drop of blood.

RO = ReliOn
AT = AlphaTrak

259 RO
287 AT

192 RO
275 AT

342 RO
407 AT

340 RO
465 AT

I am surprised by the amount of difference. For anyone who's done similar... What are your thoughts?

 

[CatherineGenet]

I've read in several places that a human meter's reading should be adjusted for a feline by increasing the result by 15 to 20% though I'm not sure what to believe. You're seeing some much wider differences between these two meters---that second one you list is a 43% increase in the Alpha Trak over the Relion. I don't like supporting AlphaTrak just because the test strips are over a dollar each and I often have to use several for each test as my cat doesn't produce much blood from ear pricks so I often get an error and have to start over. I like supporting companies that charge reasonable fees, especially when it comes to products to help animals who need medical help like our diabetic cats. That is why I stay away from so-called "prescription foods". Just imagine if humans who, for instance, needed salt-free diets had to get their groceries from a medical office and only if a doctor wrote a prescription. There are so many loving pet owners who can't afford such things.

I wonder if there might be some other variable that isn't instantly obvious in your testing comparisons that might account for the different readings between the two meters. Stress after getting the first stick, for instance, might create a difference or age of test strips and probably other variables I'm not thinking of.

 

[arthur-kitty]

It's crazy different right? I'm not sure which meter is messing up. I kind of what a second glucometer because Arthur has been having some wild numbers as of late.

 

[arthur-kitty]

A second human glucometer that is!

 

[Suzanne & Darcy]

The AT generally reads higher than human glucometers. That’s why the protocol calls for taking action if the cat drops below 68 on an AT. With a human meter, we want them at 50 or above. There’s no direct comparison (i.e., there’s no mathematical formula you can use to convert between one and the other.). It’s just like we were talking about on your main thread - where vets often will say you should use an AT but then they also recommend using Libre sensors (which are for humans.). And then the Libre opens up another can of worms because they tend to read much lower in the lower BG numbers (causing panic among caregivers at times and/or causing caregivers to do insulin reductions when they are not warranted.). When using a Libre you always need to have a backup human meter and know how to test to check the Libre. Very often I have seen the Libre reading too low. Anyway, I know you are not using that with Arthur (thank goodness because they really add another level of confusion.)

And don’t get me started on the so called prescription foods frequently recommended by (uninformed) vets for diabetic cats. They are so high in carbs it will require quite a bit more insulin to get the cat regulated. They are worse than just expensive— they are inappropriate foods for diabetic cats.

 

[arthur-kitty]

The food thing is honestly disturbing that dry super expensive food is sold as diabetes safe....

 

[SmallestSparrow]

When Methos was on Bexacat I used a human meter primarily for regularly checking ketones, and occasionally checking glucose (Precision Xtra by Abbott). After switching to insulin I got an alpha trak3. Like you, I found a wide variation not mathematically related, but in each instance the AT read higher. This is because human meters are designed take a drop of human blood and through an enzymatic reaction in the strip translate that (I believe colorimetricly into a glucose value—so the electronics were designed with human standards.

In cats, 93% of the glucose is located in plasma and only 7% of the glucose in the red blood cells.In humans, 58% of the glucose is located in plasma and 42% of the glucose in the red blood cells.

Packed cell volume is also used in the design of the chemical reaction that results in the meter reading. PCV in cats is about 24-45%, and humans typically have a PCV range of 37-50%.

To quote Dr McCoy, I’m a Dr not an engineer, so please don’t ask what algorithms were involved but you can see why values vary.

Add on top of that that depending on whether the meter meets FDA or ISO standards there’s varying degree of precision (how reproducible is a result) and accuracy (how close is the result to the true value). The alpha trak met ISO standards so in theory is more accurate and precise than my Xtra. Enough to matter—idk.

I suspect vets use the Libre, despite knowing it doesn’t provide the best data, because some pet parents can’t or won’t do ear sticks so less than ideal data would be better than none.

I know almost all here use human meters, and seem to manage just fine. But I can empathize with a vet —I wouldn’t want to be held medically responsible for adjusting a human patient’s insulin based on results they got using an alpha trak

I think the solution many use of human meter for personal testing and AT for vet curves is a good compromise. If I didn’t need to be absolutely certain what BG was I’d rather use the human meter…except I will say I love how little blood the AT needs and how fast it is. But ouch the price.

 

[JL and Chip]

To quote Dr McCoy, I’m a Dr not an engineer, so please don’t ask what algorithms were involved but you can see why values vary.

I almost snorted my coffee.
That might be the first Star Trek reference I’ve seen here in my nearly 20 years.

Also, if you want to get into the weeds on handhelds, there’s also the seldom discussed issue of anemia affecting results (and plasma being more accurate, including in humans I believe). And anemia isn’t uncommon in the population we see around here. Alas, that’s probably a topic for Think Tank.

As for human glucometers… it’s all we had back in the day. I’d like to think that the adjusted reference ranges for human meters are adequate to accommodate the different blood makeup. Of course, perhaps it’s possible that I’ve “been assimilated.”

Seriously, though, I understand the trepidation of using a human meter when a vet pushes a pet meter, especially when the whole feline diabetes thing is new and daunting. And I understand why some vets are hesitant to recommend human meters at all, given how litigious folks can be. But human meters were used in the key published studies and protocols that were developed for FD so it does muddy the waters a bit when we don’t have published data on pet meters. I have no problem sticking with my human meter (but I do have backup meters and an AT for good measure).

 

[JL and Chip]

I am surprised by the amount of difference. For anyone who's done similar... What are your thoughts?

Back in the day I did a LOT of comparison testing between meters. I found that some (including my AT) was a bit sensitive to too much or too little blood on the strip and could sometimes throw wonky results in those scenarios. Something to keep in mind if you see unexpected deltas.

It was also pretty consistent that the lower BG readings were closer numerically and the higher BGs farther apart (makes sense from a percentage standpoint).

I also pondered whether using the same drop of blood might have altered the second reading because the surface of the bead of blood had already been broken. Or if you “milk” the ear too much, is the sample more serous or diluted??

I even recall doing back-to-back tests, one from each ear, and getting noticeably different results. I posted about that one I was so stymied, lol (I was a newbie at the time).

My point in all of this is mostly to say that you can drive yourself crazy with the comparisons or analysis. We’ve had a few folks over the years chart comparison results. It’s interesting, yes. But most of us eventually become comfortable with a particular meter and just go with that.

 

[SmallestSparrow]

I almost snorted my coffee.
That might be the first Star Trek reference I’ve seen here in my nearly 20 years.

Also, if you want to get into the weeds on handhelds, there’s also the seldom discussed issue of anemia affecting results (and plasma being more accurate, including in humans I believe). And anemia isn’t uncommon in the population we see around here. Alas, that’s probably a topic for Think Tank.

As for human glucometers… it’s all we had back in the day. I’d like to think that the adjusted reference ranges for human meters are adequate to accommodate the different blood makeup. Of course, perhaps it’s possible that I’ve “been assimilated.”

Seriously, though, I understand the trepidation of using a human meter when a vet pushes a pet meter, especially when the whole feline diabetes thing is new and daunting. And I understand why some vets are hesitant to recommend human meters at all, given how litigious folks can be. But human meters were used in the key published studies and protocols that were developed for FD so it does muddy the waters a bit when we don’t have published data on pet meters. I have no problem sticking with my human meter (but I do have backup meters and an AT for good measure).

Back in the day before we had human meters I was told to cover the litter with Saran Wrap and use glucose dip sticks for my diabetic cat. We also just gave the dose guesstimated until the next vet visit. So there’s something to be said for progress. Although use of leeches made a comeback in my profession

Yes re anemia…I like that the AT has an alert for that. I use the AT because my cat has an adrenal tumor and I can’t afford to be guessing at the ball park range his results may be. Between my concern I’m not getting insulin into him (from being told for three years I was just incompetent when my last Cushing cat couldn’t be regulated—serious self doubt) to the unpredictable amount of steroids on any given day, I need to limit other confounding variables. That’s on top of the fact that accuracy/precision can be off 10% w/ the AT (more with some human meters)

that said, I again note that as a physician if a parent asked me to adjust their child’s insulin dose based on home readings done with a pet glucometer I’d explain why I can’t legally or ethically do that. So I give the vets some grace.

I think for the day to day a ballpark number is good for most “vanilla” diabetic cats and a real positive if the cheaper cost allows more frequent testing. As long as there’s clarity when discussing what meter gave the result, and vets aren’t pressured to use a system not validated for use in pets I don’t think it matters

There’s no point in charting comparisons —there is no mathematical translation because of the many variables not only within the same meter, or meters of the same brand, but also which enzyme system is in the strip, altitude, temperature, etc.

 

[SmallestSparrow]

Back in the day I did a LOT of comparison testing between meters. I found that some (including my AT) was a bit sensitive to too much or too little blood on the strip and could sometimes throw wonky results in those scenarios. Something to keep in mind if you see unexpected deltas.

It was also pretty consistent that the lower BG readings were closer numerically and the higher BGs farther apart (makes sense from a percentage standpoint).

I also pondered whether using the same drop of blood might have altered the second reading because the surface of the bead of blood had already been broken. Or if you “milk” the ear too much, is the sample more serous or diluted??

I even recall doing back-to-back tests, one from each ear, and getting noticeably different results. I posted about that one I was so stymied, lol (I was a newbie at the time).

My point in all of this is mostly to say that you can drive yourself crazy with the comparisons or analysis. We’ve had a few folks over the years chart comparison results. It’s interesting, yes. But most of us eventually become comfortable with a particular meter and just go with that.

I’ve driven tech support crazy at Abbot and Zoetis, squeezing info out of them about how their meters work to better understand wonky results.

I’ve often gotten results when repeating a test that seemed off that are different. In all but three cases the results, while different, were within the meter’s accuracy/precision standards. For example I think someone started this by saying they got a 530 and 480 (or similar) on AT. Considering the 10% allowable variance for AT those results are essentially the same number. (Below 100 on the AT it’s not 10% I think it may be +/- 15 iirc…I’ll never get to that range)

For the three times I had significant outliers:
1. For AT users there’s a small hole at the top of the wicking area. That’s a vent. Don’t get blood on top of it
2. I got blood on top of strip but not on vent; tech support couldn’t come up with a reason so we decided it was a bad strip (that’s why they say to repeat and I will do a third if still off). I also do a control check
3. Abbott couldn’t explain why I got a ketone result of 2 then 0.2, 0.2…and wouldn’t trouble shoot because it was for a cat. Hence my new centrivet ketone meter

other big sources of wonky results: is there contamination on your hands or on the cats fur (this is why Zoetis instructs avoiding touching strip to test site but rather only touch top of drop, and to clean and DRY cats ear prior to test

 

[SmallestSparrow]

I've read in several places that a human meter's reading should be adjusted for a feline by increasing the result by 15 to 20% though I'm not sure what to believe. You're seeing some much wider differences between these two meters---that second one you list is a 43% increase in the Alpha Trak over the Relion. I don't like supporting AlphaTrak just because the test strips are over a dollar each and I often have to use several for each test as my cat doesn't produce much blood from ear pricks so I often get an error and have to start over. I like supporting companies that charge reasonable fees, especially when it comes to products to help animals who need medical help like our diabetic cats. That is why I stay away from so-called "prescription foods". Just imagine if humans who, for instance, needed salt-free diets had to get their groceries from a medical office and only if a doctor wrote a prescription. There are so many loving pet owners who can't afford such things.

I wonder if there might be some other variable that isn't instantly obvious in your testing comparisons that might account for the different readings between the two meters. Stress after getting the first stick, for instance, might create a difference or age of test strips and probably other variables I'm not thinking of.

Are you sure the error is due to too little blood? I ask because when i first changed to the AT I got an error (twice. Cursing as I totaled up the cost of three strips). Then I realized the AT takes a longer time to get ready for the drop and I was getting ahead of it bc my human meter shut off quickly so I’d developed a fast test habit.
If you look at the meter once you insert the strip it takes a moment then flashes the pet code then another pause before finally showing a strip moving toward the blood drop. If you put blood on the strip before you see the strip/drop symbols moving toward each other you’ll get an error code (code 3 iirc).
I ask bc it really requires a drop so tiny I can barely see it. There have been a couple of ear sticks where I thought no way but methos was tired of cooperating and I went for it and was rewarded with a beep.

that said the drop should preferably be big enough that you won’t touch the skin with the strip (in part to avoid contaminating the puncture site, in part bc if there’s food or old blood etc in the fur it can alter the test results)

 

[arthur-kitty]

Back in the day before we had human meters I was told to cover the litter with Saran Wrap and use glucose dip sticks for my diabetic cat. We also just gave the dose guesstimated until the next vet visit. So there’s something to be said for progress. Although use of leeches made a comeback in my profession

Yes re anemia…I like that the AT has an alert for that. I use the AT because my cat has an adrenal tumor and I can’t afford to be guessing at the ball park range his results may be. Between my concern I’m not getting insulin into him (from being told for three years I was just incompetent when my last Cushing cat couldn’t be regulated—serious self doubt) to the unpredictable amount of steroids on any given day, I need to limit other confounding variables. That’s on top of the fact that accuracy/precision can be off 10% w/ the AT (more with some human meters)

that said, I again note that as a physician if a parent asked me to adjust their child’s insulin dose based on home readings done with a pet glucometer I’d explain why I can’t legally or ethically do that. So I give the vets some grace.

I think for the day to day a ballpark number is good for most “vanilla” diabetic cats and a real positive if the cheaper cost allows more frequent testing. As long as there’s clarity when discussing what meter gave the result, and vets aren’t pressured to use a system not validated for use in pets I don’t think it matters

There’s no point in charting comparisons —there is no mathematical translation because of the many variables not only within the same meter, or meters of the same brand, but also which enzyme system is in the strip, altitude, temperature, etc.

Woah? The AT can detect anemia??? I had no idea.

 

[SmallestSparrow]

Woah? The AT can detect anemia??? I had no idea.

It won’t give a number but im pretty sure it was one of the optional alarms (it was in the full manual not quick start ) once cats sorted and my pulse normal I’ll look for it.
When the app works I like it. Sadly it often doesn’t but that’s a positive

 

[SmallestSparrow]

Woah? The AT can detect anemia??? I had no idea.

Still not normal at my house BUT in the full user manual (download from zoetis site or its in the resources section of the app) pg 11 details setting up glucose warnings (hi/low) and turning on Hct (hematocrit) warning. Hct warning is off by default

Page 29 under error codes shows how if the Hct is too low (would affect the glucose number) a little blue Hct-L shows up under the number next to the cat icon.