Addressing the meter concerns

[Libby and Lucy]

I see a number of people getting upset over meter variances. Please try not to focus too much on the exact numbers! Either the cat is getting the right amount of insulin, or they are not. Exact numbers don’t matter. What matters are trends and patterns over time.

We are following a tight regulation protocol. In tight regulation, in general:

* Green = ok amount of insulin
* Not Green = not enough insulin

That’s it, in a nutshell. It doesn’t really matter much if the number is 150 or 250 or 350. You’ll be increasing within approximately the same time frame and by approximately the same amount with any of these readings, so it’s not that big a deal if one meter says something different than another meter when in that range.

All meters are going to fluctuate somewhat. Freestyles do tend to run a bit lower in high numbers (by design – remember all the big ad campaigns about the new FSL strips? I don’t pretend to understand the science, but they are intended to measure differently than other strips). In normal numbers, the numbers on which we base dosing decisions, they are quite accurate. That is when I NEED to know my meter is accurate – in the low numbers. I wouldn’t want a meter to tell me my cat is at 80 when she is at 30, KWIM? If I had to choose, I would rather the meter tell me she is at 30 when she is really 80. Fortunately most meters are pretty accurate in numbers under 100.

If you are worried because your meter is showing all flat numbers (whether flat blue or flat yellow or flat pink), that does not mean your meter isn’t working. A lot of people expect to see insulin bringing the numbers down. People expect to see the numbers gradually come down with each increase in dose. In fact, with Lantus it almost never happens that way. The most common response is to see flat, flat, flat until the cat hits a good dose. Then one day BAM! You’ll wake up to green. That’s why we call it a breakthrough. It happens all at once. So flat yellow, or flat pink, just means your cat is not up to his/her dose yet.

I’m not trying to say that meter accuracy in high numbers is unimportant to humans. Humans have a whole different set of health concerns than cats, and I have no experience with those. I’m just talking about cats and almost 4 years of experience with our tight regulation protocol. :smile: I’m also sure it is likely that there are some malfunctioning meters out there (of every brand), but probably not all of them.

What I’m trying to say is BREATHE. Use the meter you like. And never forget to look at the cat, not just the numbers.

My flame-proof suit is on, fire away. ;-)

 

[skybar22]

I am going to respond again, here, only because I am experiencing something that is different. By believing morgaine was regulated, I was unaware that she was developing complications due to unregulated FD. FS is so far off that it reads low to mid blues when Morgaine was actually over her renal threshhold. i kept seeing those lower numbers and scratching my head when i checked her urine glucose. Meanwhile, Morgaine developed neuropathy, a bladder infection, a fungal infection of her claws, and potential kidney issues though that seems to be okay for now. I just do not think the FS is worth the aggravation since it is so far off from all the other meters I compared. I am a stickler for control and I spent some time believing Morgaine was in safe numbers and then regulated when she wasn't even close. She has suffered because of this and is now having to battle some issues that I could have avoided had i known. It could also mean the difference between remission and no remission since i have been using the freestytle on her for almost a year and didn't even think she needed insulin until June when the vet said she was exhibiting all of the signs of unregulated diabetes and she confirmed it with a very high fructosamine which I didn't believe due to meter readings. I believed her kidneys were involved in her symptomology.

I do understand the reasoning regarding cats and our protocol here but why would any of us want to use a meter that is so far off other meters. So, I will get my data together, write it all up and post it here and send copies to my health care team, my insurance and Abbott Labs. Knowledge is power and the more we understand about this issue the better. Of course we all have to decide for ourselves but for me and Morgaine, the FS just doesn't cut it. Watching morgaine walking on her hocks right now breaks my heart. I know the pain and discomfort of diabetic neuropathy. It effects the nerves of the body and even the bladder which may be why she is currently incontinent. I have watched her deteriorate before my eyes thinkiong she had to be having kidney issues. Fortunately she isn't at this time. Fortunately it is FD, a treatable disease that can be controlled.

I love this community and am so appreciative of all here and especially grateful to the guidance you provide Libby, as well as the guidance of Jill, Sienne, Marje and others. I just need to be honest about how sad i am regarding my kitty because she is now suffering from poor control and I do blame the FS meter and feel it is appropriate to warn others and to pass on what my fidnings are.

 

[Lisa and Do Lou (GA)]

with all due respect Libby I disagree with this after what I have gone with lately with Do Lou I have to agree with Rosalie on this and I do appreciate everything everyone has done on my behalf as well but to me the variance the freestyle is throwing is completely unacceptable

 

[Marje and Gracie]

This doesn't involve me but I just had one point I thought might be worth making. I hope Linda will forgive me for using Weezer as an example but Linda was using a FS. We cannot know of course but if Weezer's nadirs had been in the above 300 range instead of the 200-299 range, then her dose increases, per the protocol, would have been an increase by .5u every three days (6 cycles) instead of by .25u. Linda has spent a lot of timing raising methodically by .25u when she possibly should have been raising by .5u. We won't know but if yesterday's and today's numbers are an indication and if nadirs have been in the 300s......just sayin'.......

 

[Libby and Lucy]

I just don't like to see anyone paint anything with too broad a brush. I also really hate to see anyone upset to the point of despondence over something that may or may not be broken.

I do applaud you, Rosalie, for doing the research and following up with the company. It sounds like you have a bad meter, or bad strips, or both. I can see your points, but then again there is my mother. She absolutely insists that the ONLY meters that are accurate for her are the Freestyle meters. Her doctors seem happy with how she is doing too. In fact, when Lucy was on insulin I kept trying to get her to switch to Aviva so she could get me free strips for that, but she refused to change. :lol:

With Lucy, I switched between an older Freestyle Freedom and an Aviva often, depending on whether mom had given me strips. I didn't like the Freestyle Freedom, but only because the strips sipped so slowly. The Freestyle tended to read slightly lower, but well within allowable ranges. With Jazzy, I used a new Freestyle Lite most of the time, but also used Aviva and ReliOn sometimes. I never noticed any significant difference.

So, could there be a meter problem? Sure. Or could Morgaine's renal threshhold be lower than usual? Sure, I've seen that before. There is actually a lot of debate over where a cat's renal threshhold usually lies, and of course ECID too. Offhand I can't recall any studies pointing to diabetic cats experiencing renal issues at a higher rate than non-diabetic senior cats. UTI, yes, they are definitely more prone to those when they are spilling glucose.

Anyway, it's worth looking into the problems you are having and trying to figure it out. I just don't want people to jump to the conclusion that their cat is poorly regulated without looking at all the possibilities.

 

[Cini Mini's Mom]

I would just like to add that the Alpha Trak I am using does make a difference in readings and what kind of monitor a person uses. I had no idea that you had to subtract 30 points from the Alpha Trak reading to get the "true" reading of the cat's BG. If you look at Cini's SS on the tab that says AlphaTrak you will see he was daily in the red danger zone unbeknownst to me! Here I was thinking he was doing great at a 67 BG when in fact it was 37!

 

[Libby and Lucy]

We cannot know of course but if Weezer's nadirs had been in the above 300 range instead of the 200-299 range, then her dose increases, per the protocol, would have been an increase by .5u every three days (6 cycles) instead of by .25u. Linda has spent a lot of timing raising methodically by .25u when she possibly should have been raising by .5u.

ok, but we're just talking about a difference of a few days each time. Probably at most a few weeks added to his total treatment time. For those people who hold onto doses forever, there would be more difference, but for those of us following a tight regulation protocol we don't tend to sit on doses for very long.

 

[Barbara and tuffy]

I too started with the AlphaTrak. Switched to ReliOn after 3 1/2 months because of the price of the stirps. I never had a large variance between the ReliOn and the AlphaTrak. I tested with both when I made the switch to check on the variance. I do remember being told, just pick a meter and stick with it. The only other meter I used once I switched was the Precision X-tra. I used that to test for ketones, but I also used the same drop of blood with the ReliOn so my readings for the ss were with the same meter.

 

[skybar22]

Gosh, i am so tired but i have to respond to you Libby and i love you so do not take my persisitence personally. you are an amazingly generous woman and very knowledgeable about FD, far more than i am.

Since there are a few others on this board with very similar issues and concerns, I went ahead and did my own comparisons. I was okay with what was going on with Morgaine until I realized something was way off. I believed her RT was lower as well but now i don't. I now believe she spent lots of time over her RT and now all those early numbers I got make sense because she was much higher than I realized. Also, makes sense that the vets kept finding unregulated FD when i insisted she was not based on Meter readings. She would have started insulin 6 months earlier as she was running in the mid blues or so i thought and no one felt I should put her on insulin if her numbers were under 150 and sometimes under 125. i spent several sessions on the phone with Dr. Lisa trying to figure it all out. she even suggested that the glucose in urine could be something rare, like Fanconi's, more common in dogs. So, I do think we neeed to be serious about warning about this.

My endo approves of the FS as well. Most diabetics who test a lot control their diabetes better so they remain in good control and their BGs are normalized. So, I accepted the FS for almost a year.

Granted, things with our cats won't make a huge difference in their treatment for the most part. I would have done things differently but i basically just kept raisng her dose and now i do believe we are close to a good dose since I started to see lots of green before she got the UTI. But I absolutely drove myself nuts trying to understand the meter results with what i was seeing and I spent lots of money on labs and vets since i believed something else had to be wrong.

So, with all that said, Scott at Abbott sounded like he really wanted to get to the bottom of this and he agrees that something is way off, though he believes it has to be the strips maybe another recall is in store. In any event, if the meter is reading correctly for some then by all means stick with it. I wish i could but I don't trust it anymore and neither should anyone else who feels this way..