Mr. Pants is having large mg/dl swings with very small doses eg. .5U BID

[Zach Pool]

Hello everyone, my cat Mr. Pants has been diabetic for several years now and has been in remission already once. Most recently I had switched to a human glucometer and thought he was approaching remission again. Come to find out human glucometers were giving me readings anywhere from 50 to 70 mg per deciliter higher than the Aplha Trak2. I switched back to the Alpha Trak2 and found his levels to be higher than the normal 80-120 mg/dl levels. When insulin is withheld his tendency is to slowly rise up to levels of 290-298 mg/dl pre meal and over 300 mg/dl afterward. However, with .5 U BID his levels will come down to 109 mg/dl for nadir and rise back to only 160 mg/dl, pre meal. My vet didnt seem to think that using a human glucometer was an issue regarding what his levels were and was IMO to eager to assume he was in remission (noting the gradual climb back to the top 200 levels and breaking 300 mg/dl). However, his need for insulin has obviously decreased as I am terrified to give him more than .5 U BID ( he has come from 2 U SID to 1 U SID to .5 U SID to .5 U BID over the course of the last 2 years). I've just lost another senior cat of 18 years to CKD and am overwhelmed to say the least. I'm burning through test strips like crazy and ultra stressed.

 

[Katherine&Ruby]

Hi there and welcome to the FDMB! So sorry about the passing of your kitty and sorry you are having such a hard time with Mr. Pants but we will try to support you through it.

It's very good that you are home testing and we support using a human meter. Test strips are cheaper and from my experience they read lower than an AlphaTrak. Can you tell us what kind of insulin you are giving Mr. Pants, and can you set up a spreadsheet with some numbers so we can look at them and advise you as to what is going on? There's a lot of helpful info on this thread here about getting your spreadsheet set up and creating a signature: New? How You Can Help Us Help You!

Some of the information you might know already because you're not new to feline diabetes but it will help you understand how the message board generally works.

 

[Zach Pool]

Hi there and welcome to the FDMB! So sorry about the passing of your kitty and sorry you are having such a hard time with Mr. Pants but we will try to support you through it.

It's very good that you are home testing and we support using a human meter. Test strips are cheaper and from my experience they read lower than an AlphaTrak. Can you tell us what kind of insulin you are giving Mr. Pants, and can you set up a spreadsheet with some numbers so we can look at them and advise you as to what is going on? There's a lot of helpful info on this thread here about getting your spreadsheet set up and creating a signature: New? How You Can Help Us Help You!

Some of the information you might know already because you're not new to feline diabetes but it will help you understand how the message board generally works.

Most certainly. Thank you. I will look at this link and create a spreadsheet. I'm curious to why you would use human glucometer knowing their readings are much lower. Do you subtract a certain percentage from your results? Without knowing the true reading how can you be as accurate?

 

[Zach Pool]

Hi there and welcome to the FDMB! So sorry about the passing of your kitty and sorry you are having such a hard time with Mr. Pants but we will try to support you through it.

It's very good that you are home testing and we support using a human meter. Test strips are cheaper and from my experience they read lower than an AlphaTrak. Can you tell us what kind of insulin you are giving Mr. Pants, and can you set up a spreadsheet with some numbers so we can look at them and advise you as to what is going on? There's a lot of helpful info on this thread here about getting your spreadsheet set up and creating a signature: New? How You Can Help Us Help You!

Some of the information you might know already because you're not new to feline diabetes but it will help you understand how the message board generally works.

Also the link you provided for "help us help you" doesnt seem to work.

I have made several curves. Here is the most recent.
.5 U BID lantus administration @ approx. 6:45 am on 8/21 with pre insuline bg @ 290 mg/dl.

8/21
7:28 am 315 mg/dl
9:38 am 198 mg/dl
1:37 pm 141 mg/dl
3:54 pm 109 mg/dl
5:51 pm 162 mg/dl

 

[Zach Pool]

Also the link you provided for "help us help you" doesnt seem to work.

I have made several curves. Here is the most recent.
.5 U BID lantus administration @ approx. 6:45 am on 8/21 with pre insuline bg @ 290 mg/dl.

8/21
7:28 am 315 mg/dl
9:38 am 198 mg/dl
1:37 pm 141 mg/dl
3:54 pm 109 mg/dl
5:51 pm 162 mg/dl

Also....his diet consists strictly of Fancy Feast pate. One small can in the morning at approx 7 a.m and one at night at approx 7 p.m

 

[Zach Pool]

Also the link you provided for "help us help you" doesnt seem to work.

I have made several curves. Here is the most recent.
.5 U BID lantus administration @ approx. 6:45 am on 8/21 with pre insuline bg @ 290 mg/dl.

8/21
7:28 am 315 mg/dl
9:38 am 198 mg/dl
1:37 pm 141 mg/dl
3:54 pm 109 mg/dl
5:51 pm 162 mg/dl

Finally I will add that the discrepancy I have recorded from two different human glucometers vs the Alpha Trak is upward of 70 mg/dl or more in difference.

 

[Sienne and Gabby (GA)]

Here's the link to helping us to help you. I checked. It works -- not sure why the other one didn't.

The reasons that we default to human meters include:

• FDMB started 25 years ago and there was no such thing as a pet specific meter. The published dosing guidelines (e.g., Tight Regulation for Lantus and Levemir) are based on human meters.
• The cost for using a pet meter is close to four times if not more than the cost for strips for a pet meter. We have lots of members who are financially stretched.
• There is a difference in the calibration of a human vs pet meter. The difference is the smallest (abut 18 points) at the low end of normal blood glucose numbers and the gap widens at the upper extremes. The human meter reads lower. Because it reads lower, there's a bit of a buffer. Either way, you get a low number and you need to take action.
• Strips for pet specific meters are not easily available if it's an emergency and your low on strips. At the very least, having a human meter as a back up means you can go to pretty much any brick and mortar pharmacy to get strips.

There are probably other reasons that I'm not thinking of.

We discourage members from using more than one meter. Frankly, it will drive you nuts. Because the difference in numbers between a human and pet meter differ, it's not like you can add a constant number to your results to convert. @Marje and Gracie did a comparison between meters and can offer you more information based on her experience.

It's great that you have your cat on a low carb diet. Many of the caregivers here do not constrain their cats to eating only twice a day. How you feed your cat may ultimately depend on what the data from a curve tells you. For example, if your cat is prone to an early nadir, giving a meal in several installments over the first few hours of the cycle may help to even out the numbers. If your cat was. used to grazing before being diagnosed, there's no prohibition against your cat continuing to graze.

 

[Katherine&Ruby]

Sorry about the link, I fixed it but Sienne also provided you with it.

I'm curious to why you would use human glucometer knowing their readings are much lower.

To add to what Sienne said: using a meter that reads lower than another will also keep a cat safer. If one meter read higher than another, I personally would want to go with the lower number so that I err on the side of caution in case the dose of insulin takes the cat too low. We want to avoid hypoglycemia as much as possible. It makes less of a difference when it comes to higher numbers--when a cat is over 250 on any meter, they are simply too high, but the difference on a human meter between a reading of 60 and a 30 is much smaller, but the 30 is a dangerous number for a cat to be at. Does this make sense?

 

[Zach Pool]

Sorry about the link, I fixed it but Sienne also provided you with it.



To add to what Sienne said: using a meter that reads lower than another will also keep a cat safer. If one meter read higher than another, I personally would want to go with the lower number so that I err on the side of caution in case the dose of insulin takes the cat too low. We want to avoid hypoglycemia as much as possible. It makes less of a difference when it comes to higher numbers--when a cat is over 250 on any meter, they are simply too high, but the difference on a human meter between a reading of 60 and a 30 is much smaller, but the 30 is a dangerous number for a cat to be at. Does this make sense?

It does make sense....however....it also doesnt make sense if you are looking for "tight" control of glucose. The number is the same regardless of the method you use to attain the reading. I agree that the strips are outrageously expensive.....but with a 30 to 40% disparity in readings you are still having to do math....or you are treating a false lower reading as a reality when in fact it is higher and placing your cat outside of remission levels and normalizing being above the renal threshold. If you could compare readings between the alpha trak and a human glucometer of a specific brand with specific test strips finding an accurate and consistent discrepancy percentage to create a formula for attaining accurate results using the human products....and use those same test strips and matching glucometer every time you could still save money....but it would be necessary to do such an experiment if you wanted to substitute human strips and glucometers for pet specific ones. I dont use more than one glucometer either. I simply heard that human glucometers were acceptable and began using one over a year ago assuming the readings would be the same. They simply arent, and once I figured that out I discontinued using it. The only reason I mention having compared the two is to assure you that I know for certain that they read at different levels. Once I established that by confirming it on several occasions I decided to switch back to the aplha trak. To make a long story short I'm not really concerned with the glucometer aspect of the situation so much as I am that my cats bg levels being lowered by as much as almost 200 mg/dl with .5U BID of insulin. It just seems as though he needs an even smaller dose ....potentially .25 U SID....or less. I dont believe that any of the syringes I've seen could measure that accurately.

 

[StarburstMom]

There is variance inherent in every meter, when you try and compare meters it can be a mess because one can be varying high and the other low and therefore be very different, plus you're also adding the variance of human meter vs cat meter. You could drive yourself crazy trying to find the "real" value as a result. And that kinda misses the point. You're trying to find how the number changes, trends essentially....the actual value is only helpful in making sure you don't head to hypo territory, which you haven't. If you haven't yet read the dosage thread in your insulin forum I would recommend you read it through several times (it's a lot of information) so you can wrap your head around how to safely adjust the dose to prevent her going too low. Different kinds of insulin are treated a bit differently based on their traits
In my own experience I have 3 human meters that all gave me different values (they will), but they were all above 100 and that's the main goal at the time, make sure she didn't get too low. I'm currently doing a remission trial on my girl and her Libre sensor was reading her a bit low as it read LO (under 40) when my Relion read 61....plus she hadn't had insulin in days so couldn't have gone hypo without insulin (unless she has a medical complication). There is no way to find a meter that doesn't have variance. But you should confirm the meter and strips are working properly by using the control check fluid (which will have a range to reference rather than a specific number due to this variance).

 

[Katherine&Ruby]

About 99 percent of the cats on the Lantus forum who go off the juice (OTJ) that I have seen over the past year use human meters. The whole tight regulation protocol was built upon human meter numbers. As @StarburstMom says, it's more about trends than actual numbers, except in the case of low number situations.

If you use syringes with half unit markings and use calipers, you can accurately measure .25 units to your syringes: Dosing with calipers

 

[Zach Pool]

About 99 percent of the cats on the Lantus forum who go off the juice (OTJ) that I have seen over the past year use human meters. The whole tight regulation protocol was built upon human meter numbers. As @StarburstMom says, it's more about trends than actual numbers, except in the case of low number situations.

If you use syringes with half unit markings and use calipers, you can accurately measure .25 units to your syringes: Dosing with calipers

Great source! Awesome. Thank you.