Munchkin - Test Readings & Dosing, and now KETONES?!

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rvontrapp

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Previous Thread, just for reference.

Well, we had an interesting weekend. All three kitties had the sneezes on Friday, but Munchkin did much better over the weekend. I didn't get a curve on Saturday and I wish I had now. We slept in (a LOT) and got a late start to the day, and it was a gloomy, nasty day - not storming, just constantly drizzling. Had a couple errands to run and helped a friend move some stuff, but I still wish I had made time - at least for a couple checks. I did get a couple checks on Sunday though.

And on Sunday, I started to wonder if Sue was right in what she said about a week ago - that the readings from the Saturday curve (4/27/13) were flat, not because Munchkin's bs wasn't rising with his cold, but that the insulin dose was working well.

Saturday morning - three hours late on Munchkin's bs test and insulin shot; bs was 290 & gave 1.0u.

Saturday night - at +12 Munchkin's bs is 177 and 30 minutes later 174. I can't stay up any later (already well past our bedtime) so no dose. I start wondering if 1.0u is too large of a dose.

Sunday morning - 21 hours without an insulin shot and bs is 272. Started kicking myself for not getting a curve on Saturday. 272 is borderline on dosing scale (>270 = 1.0u, 220-270 = 0.8u) but I'm not comfortable giving 1.0u again. Gave 0.8u and plan to test at nadir.

Sunday "nadir" - at +6.5 bs was 183. Not too bad, feeling good about deciding to go with 0.8u instead of 1.0u.

Sunday at +9.5 - BS reading is 150. Delayed nadir/long cycle = too large of a dose at 0.8u for bs reading of 272? Maybe the cold was elevating his bs and now its coming back down.

Sunday night - PMPS = 186, gave 0.4u. Certainly 0.4u can't be too much. +2 = 199 and +3.5 = 210. Great readings.

Monday morning - AMPS = 224. I don't know what to give. According to the scale I should give 0.8u, but I have doubts. If Munchkin's bs does the same thing it did on Sunday and he has a long cycle with a low-ish number at +12, then I know that 0.8u is too much. But 224 this morning is not the same as 272 on Sunday; 50 points apart. Remind myself that a nadir of 150 is not hypo, not even close. Sooo LATE for work! Gave 0.8u and completely expecting a lower, possibly unshootable, number when I get home from work.

On Monday:
Loaded all the weekend readings into my spreadsheet and did some analysis. Still thinking 1.0u and 0.8u might be too much, but I'll know more when I get home. Reminding myself that 150 is not hypo and well within our target range. We want Munchkin's readings to stay between 100 and 250 (per vet), but we also want shootable numbers at pre-shot tests. The 1.0u dose on Saturday gave a reading at next shot time of 176 - borderline shootable. Ditto, for Sunday with the 0.8u dose, gave a reading at next shot time of 186 - also borderline shootable.

But, before Munchkin got sick, a dose of 0.8u would result in the next pre-shot reading being 18 -20 points lower, on average (examples - 4/25: 237->210, 4/24: 230->208). While he was sick, a dose of 0.8u would result in the next pre-shot reading being higher (5/1: 230->257, 257->306). And, then on Sunday night, Munchkin is almost over his cold and 0.8u dropped his bs 86 points (272 -> 186). Really starting to believe the cold was elevating his bs readings. I want more readings before I change anything. Told myself to wait and see what the Monday PMPS reading would be.

Also, doubting if my vet is right and I'm trying too hard. Jumping at shadows, etc.

Monday afternoon - Remember, on Monday morning gave 0.8u for AMPS of 224. Expecting a lower, possibly unshootable, number. Got a reading as soon as I got home, +10.5 is 304. He bounced, had to. Right?

Monday night - PMPS = 297. Thought about it, and Munchkin is solidly within range to give 1.0u (>270=1.0u). So, I give 1.0u and wonder if I'm shooting the bounce. +3 bs is 174; I think I shot the bounce. Not feeling good at all. Here it is only 3 hours post-shot and already his bs is 174; a drop of 123 points in 3 hours. Sheez! I didn't get up in the night to check his bs; in hindsight, maybe I should have done that.

Tuesday morning - AMPS = 437. I believe I shot the bounce last night, and/or 1.0u is just too large of a dose. On 5/4 the dose of 1.0u dropped Munchkin's bs a total 114 points, shot-time to shot-time. Last night the same dose resulted in a rise in bs from shot-time to shot-time, 140 points. 5/4: 290->176, 5/6: 297->437. Didn't want to shoot the bounce again so gave 0.6u. Poor guy looks rough, bleary-eyed. Not feeling well, not too enthused about breakfast (atypical for him), but not sneezing (the girls are though). Tried to watch and see if he used the litter box so I could check for ketones, but he didn't while I was home. Normally follows me around in the morning while I get ready but not this morning, hiding in a hidey-hole somewhere out of sight.

Okay, so that has been my reasoning over the past few days. Sorry so long, again. What does everyone else think? Am I completely deluding myself and something else is going on? Maybe now that the cold is over, are Munchkin's insulin needs reduced? What should my dosages be?
 
Re: Munchkin - Test Readings & Dosing

Hmmm. Well, for starters, I LOVE how you are starting to analyze the data and thinking the dose over before you give it. I have no brilliant suggestions; I think you are doing great.

I have no explanation for the red this am other than a bounce. But previously, he is in very nice numbers. I would suggest letting the cold go away and keep on doing what you are doing. Except for this am, he has been in very nice numbers - near regulated numbers.
 
Re: Munchkin - Test Readings & Dosing

I agree, you're doing great, getting good numbers.

The only thing I might disagree with is keeping Munchkin's bg's between 100 & 250. I agree that keeping them under the Renal threshold (250) is good but I think that our vet's tell us not to let them go under 100 because they don't want to stress us out, but the more time that they can spend in normal non diabetic numbers (50 - 120) the better.

You don't have to worry about hypo numbers until the bg drops below 50. BUT if you have your hypo kit ready, can test and stay on top of the numbers and can steer the numbers with food, why wouldn't you want to let that happen.

The more hours per day that any cat can stay in double didget (green) numbers, the more time it allows the Pancreas to heal. I always believed that regulation was the goal and remission was the brass ring. You are very close to regulation, keep your mind open to reaching out for that brass ring when ever you get the chance. We'll be here to help you.
 
Re: Munchkin - Test Readings & Dosing

Really liking the readings Munchkin is giving, all in the low-mid 200s and below renal threshold. :smile: I had to give his shot almost an hour early last night; I wasn't paying attention to our schedule and we had plans in town during his PM shot time last night.

Rob (or Robin?), I'd like Munchkin to be in some lower numbers, and even below 100, if given the chance. But I can't be there to monitor him and steer it with food - got to work. He has been lowering his bs readings and his needed dose over the past several weeks, and hopefully the pattern will continue. I am suprised his dose has come down so much in a relatively short time frame, suprised but very happy! After a couple weeks of responding similarly to a dose, over a day or two his bs seems to start going lower with the same dose --> so then he needs a smaller dose, otherwise he starts bouncing. It is hard for me to see it on his spreadsheet but when I pull out the readings and sort by dose it shows up. (I'll try to post my chart sorted by dose in Munchkin's spreadsheet on another tab so maybe you can see what I'm talking about.)

I guess I'm planning to see how he does at around a 0.4u dose for a few days (up to a couple weeks) and go from there, for now - unless ya'll see something in his numbers that indicates the need for a change. Please let me know if I am missing something! I know I am close to the situation and sometimes I miss the forest for the trees. Overall, he readings are trending lower over time, little by little. With time, maybe we can work our way into the 100s at pre-shot and into the double-digits mid-curve. I agree Rob, the more time Munchkin spends in those kind of numbers - the better all around! I'd love to make remission a reality, but if I get too hooked on the possibility . . . I fear I may forget to appreciate regulation. I'm so thankful for the progress we are making.

Thank you Sue for the link to the ketone webpage. I appreciate the reminder. It was just what I needed to make sure I don't become complacent. Tested ketones last night too and some improvement, reading was "slight". Hopefully the cold is passing; he didn't have any coughing fits last night or this morning, but he is still acting a little out-of-sorts.

Thank you everyone for all your help and support!
 
Re: Munchkin - Test Readings & Dosing

Ok, I've got to change the dosing schedule in my signature because it is not even close to what we are doing now. Got blue readings last night and this morning! Did I call it or what!? After a few shots at a dose, pow!, the same dose gives a lower reading. (And tonight or tomorrow, just to prove me wrong and throw me off, his readings will probably be wacko - just wait and see.) I'll make sure to do a curve this weekend, or at least get as many readings as I can. Do ya'll think I should just document the curve of a "regular" dose of 0.4u for readings 200+ and 0.2 for readings <200? Or should I be gutsy and give a little more, and do a curve of that cycle?

We had some snuggles this morning and he followed me around while I got ready for work, so I think he is feeling better. I haven't heard him coughing in several days. And we are feeding a little bit extra and he's actually leaving a little food in his dish, so he's not hungry - and consequently not tempted by treats at test time. He could care less. Doesn't make my life easier, but not a big problem either, yet.
 
Re: Munchkin - Test Readings & Dosing

Beautiful! And it's great info to know that how long he takes to settle into a new dose. Re the curve. I don't know how aggressive to be. He is in regulated numbers and not bouncing on the doses you are giving now. You could be a little more agressive This weekend since you can be home and see if he goes down in the greens at nadir. I think your issue will be, Rebekah, that you want to keep him with shootable prehots during the week without skipping (as you can't monitor during the week). I guess experiment a little this weekend and then decide on Monday.

Getting them OTJ requires being a little agressive with dosing, but with lots of monitoring to keep them safe. Can you think of any way to do that during the week, at least for a week or so?
 
Re: Munchkin - Test Readings & Dosing

Oh, don't I wish I could! I work about 30 minutes from our hometown. I've tried to pay the water bill a couple times during my lunchbreak and I end up being late back to work. I just can't make it home and back in the time I have. I'll keep thinking and see if there is any way . . . my husband was on swing shifts and might have been able to help some then, but he just got transferred to day shifts (with a promotion! Yay!).

You are right, I need to have shootable preshot numbers during the week so I can't get too aggressive, but I'm sure I can be more agressive than 0.2u. I'll see what I can do this weekend. If Munchkin seems to keep being predictable, I might do a "regular" dose and curve on Saturday, and then maybe a more agressive dose and curve on Sunday. I'm very curious to see how low he goes with 0.4u. But if he gives me some funky readings tonight or tomorrow morning (then a "normal" curve will probably be out of the question), then as it seems safe I'll be more agressive with tomorrow's AM dose and do a curve of that. Or, at least that's my game plan until/unless something changes.

So, so pleased with where we are at with Munchkin's dosing and diabetes management!
 
Re: Munchkin - Test Readings & Dosing

Bit of a pickle here. Got home from work early and just checked Munchkins sugar -167. Great! And then checked ketones too - "moderate" which is roughly 40 ml/dl. Should i be worried or be doing something to compensate?

BTW - I already called the vet and he said not to worry unless his blood glucose reading started rising uncontrollably. Still want yall`s opinions though.
 
I don't like any ketones past trace. Can you pee on a strip yourself to be sure you are getting an accurate read? How is he acting? Is he eating okay? Check to see if he is dehydrated - pull up his back and see if it springs back.
 
Well, i`m not at the house (no internet at the house) so i can`t double check the accuracy of the strips (or my reading of the strips) but they should be fine since i`ve stored them properly and they are less than three weeks old. After the vet expressed some concern over munchkins unintended weight loss, i have been feeding extra and he has been eating it. Not dehydrated, but not home to double check. He has been behaving odd by not pestering us at mealtimes but i had started thinking it was just because him tummy was full and he was content. Other than that he has been pretty normal.
 
I don't know, Rebekah. Last month we had a cats die on the board in an hour with ketones when her bean went out to get some different food. They usually aren't eating and are acting as if they feel awful and Munchkin sounds in better shape than that. I think I'd be tempted to take him to the ER (since your vet isn't concerned) and have them test him and determine whether he is dehydrated. Better safe than sorry.
 
I can double check on the dehydration when i get home. My husband is watchinghim now and all is well. No er here. The vets here take turns being on call and no telling who you get if you call in an emergency.
 
Very strange weekend at our house. I haven't updated my spreadsheet yet (or my signature) but I will after I post. Munchkin's sugars have not gone above 200 since AMPS on last Thursday (but did not monitor during the day on Thursday). We did curves on Saturday and Sunday. His readings have been hovering around 170 - 200 for pre-shots, and going down to 156 & 171 at nadir. Nadirs were late on Saturday and Sunday giving a long "cycle", though not much of a cycle with very little drop for nadirs.

"Moderate" ketones (40) in Munchkin's urine mid-afternoon on Friday and didn't get another sample to check again until this morning. This morning it was "Moderate" to "Large" amounts of ketones (about 60). He's been behaving normally all weekend and looks bright and attentive this morning. Both on Friday and this morning he is hydrated and eating; ate good all weekend. The only anomaly, he started sneezing again on Sunday and still sneezing this morning. I called the vet on Friday and he said not to be concerned unless his sugar also started to rise - which it hasn't. I called them again this morning to update them and get some feedback about what, if anything, to do. Dr. Ruff isn't in yet but will give me a call back once he gets there.

I'm trying hard not to panic; I know ketones are nothing to play with. Its just Munchkin is not showing any signs that he is not feeling well or having any ill effects. I almost feel like I'm trying to fix something that isn't broke.
 
It does seem strange but I would insist that the vet test for ketones. (if he won't, go to an ER). I am guessing the strips are off in some way, but I wouldn't want to be wrong and have him suddenly crash.

BTW, the numbers are very nice.
 
I'm contemplating taking the afternoon off so I can take him in for blood tests, even if the vet isn't too concerned. Haven't heard back from the vet yet, so he may want me to bring him in anyways. This afternoon is my best chance, because the rest of the week at work is packed. I checked the strips on myself on Friday when I got home and I got nothing, not even a trace of ketones. I know ketones can be elevated in the morning after not eating all night, and that's "normal". So they may not have risen any over the weekend, but still! They shouldn't be there at all!

The vet commented on Munchkin's weight loss since November and I'm wondering if something else is going on, causing the weight loss and consequently the ketones. We've been feeding extra by about 30% - 50% since the vet appointment a week-and-a-half ago, and I put out double the food this morning. But if he is sick with something else, extra food will do nothing or next to nothing.
 
I'm reading up on hyperthyroidism right now. Want to be familiar with the possible tests and treatments before our visit. Any input? Tips?

Plus, I've got to get a butt-load of work done today if I want the afternoon off.
 
Ketones are a by-product of fat breakdown.
If the incoming calories are insufficient for the metabolic needs or if there is an insulin deficit, fat will get broken down for energy. It happens in starvation, too.

Hyperthyroidism will increase the metabolic requirements for food, so if the diabetes is otherwise controlled, something else is definitely going on.
 
I'm still stuck at work nailbite_smile
I called the vet at lunch because I hadn't gotten a call back. They said they hadn't forgotten about me but were extra-busy, as they usually are on Mondays, and would call me back. Thinking about calling again to say I'm showing up as a "walk-in".
 
And, I just got the vet's call right after I posted last. Not feeling so good about all this. He thinks the ketones are from unregulated diabetes, and I guess he doesn't believe the readings I've been getting are accurate. Is that possible? I know we are on a super-small dose of insulin, and we have room to take his sugar lower, but can his sugar be 170 - 190 and he is still metabolizing fat and spilling ketones?

Even if my meter is a human meter, they should only be off by about 40 - 50 points, right? 190 + 50 = 240 which is right at the renal threshhold, so its possible his diabetes isn't regulated enough? He asked if I have been checking his urine for sugar and I haven't. That would answer one of my questions, wouldn't it? If this is truly from poorly regulated diabetes.

No appointments available until tomorrow, but we are scheduled for tomorrow at 4PM.
 
I have to admit, Rebekah, I am not feeling good about this. This is the same vet that was not worried about slight/moderate ketones? If he thinks Munchkin is unregulated, he should have jumped all over the ketones problem. Your meter could be a little lower than his especially if he uses the PetMeter, but we are not talking high numbers regardless. Munchkin is getting good numbers, on any meter.

A regulated cat ranges from mid 200s at preshot to double digits at nadir. Munchkin is often there. We want to see numbers below the renal threshold and he is there almost all the time, so his pancreas has the opportunity to heal.

What would you think about just going to the ER? They can at least test for hypothyroid and ketones. I hate to see you wait till tomorrow. I have no experience with ketones that are not connected to diabetes but I know they are deadly.
 
I know! I don't understand. If he thinks Munchkin is unregulated then why is he not concerned with the ketones? Does he think I screwed that test up too? At what glucose readings does a cat start to metabolize fat because there is insufficient glucose or insufficient insulin?

Munchkin isn't getting double-digits at nadir, his cycles were flat again. But he did that when he was sick a week-and-a-half ago, a flat cycle.

I'm really upset. There isn't any vet ER here. I could call the vet we boarded him at a few weeks back and see if they would agree to see him. They haven't treated him in a long time.
 
Better today. Went to the vet where Munchkin boarded about a month ago to be seen as a walk in. It took almost forever to be seen; literally the last patient of the day. His sugar was 297 in their office on their pet-specific meter. Not bad all things considered. The lab samples had already been shipped off to the lab, so couldn't do any blood work - or at least not any faster than seeing our own vet this afternoon. Not able to confirm the ketones. The vet said Munchkin looked good and his readings were good.

Busy day today and will add more as I am able. Thanks everyone!
 
Just spoke with my boss and we are keeping Munchkin's appointment this afternoon. We need to do bloodwork, period. I'm feeling better today because I checked his urine ketones this morning and they were "trace". Thank God!

They didn't do a check for ketones in his urine yesterday. (Why? I don't know.) I had not brought my ketone strips with us when we went to the vet (but I brought everything else in case they had wanted to keep him overnight) so I couldn't even offer for us to check for ketones there in the office with my strips. I never thought they wouldn't check his urine, or wouldn't have the means to check urine, or they did check it when they had him around back and they didn't mention it.

He said given how good Munchkin looked that he was suspecting the strips were off, for one reason or another. One theory was that feline urine reacted differently than human urine giving a false positive; he said the multi-test strips they use to check for blood and/or bacteria(?) in urine, they always give a false positive on the erythrocytes (I think). They are multi-test strips for something but they always give a positive on one of the tests. I don't buy it and I don't think the vet truly believed it either; it doesn't make sense because then the strips would be off consistently and I had a "slight" reading a week ago and this morning, not the "moderate" or more. He did say if the strips were not off, then he couldn't explain the cause of the ketones.

He did say he thought Munchkin might not need insulin anymore. I'm not trying that until we get bloodwork results. Munchkin has lost 3.5 pounds since he boarded there in April. Something is wrong. Inaccurate strips will not cause Munchkin to lose weight. So, bloodwork this afternoon with our regular vet. Although they might not find any ketones by then, given that they were "trace" this AM.
 
I have always heard urine is urine and it doesn't matter to the strips.

I do think something else might be going on. Blood work should help you figure out this puzzle. Nice he is back down to a trace, but I would emphasize to the vet that he has been higher and that is not normal.
 
Mystery solved.

Went to our vet appointment yesterday and Munchkin had ketones in his urine (50) and glucose (1000). Pulled out our meters and did a couple side-by-side comparisons between my ReliOn Prime and the vet's Alphatrack, and the two readings were different by over 100 points. Did blood work to confirm and check to see if anything else was wrong. Blood work confirmed the higher glucose readings from the Alphatrack. Looks like no kidney damage and liver enzymes were good, but high cholesterol. Munchkin's blood sugar has probably been closer to 300 and above for weeks. And I recommended the ReliOn Prime to other FDMB members!

I was, and still am, shocked. I'm glad it is nothing more serious than unregulated diabetes. The diagnosis is the same as it has always been, and the protocol to treat is the same as always: test, dose, low-carb food, etc. We can do that. I just can't help but be dissappointed. All this "progress" I thought we were making . . . it was all fake.

The vet is going to get me a price on an Alphtrack and strips. I guess that is what we will be buying unless ya'll know of someone here who has one they don't want. I'll poke around the site and see if I can find one. Not excited about the higher priced strips. So dissappointed.
 
That's an unusual difference, Rebekah. We know that the AlphaTrak consistently is 30 points higher than the human meters in most cases. People who use the AlphaTrak put it in their signatures so we can adjust for that difference. But I have seen many people who compare the ReliOn to their vet's meters and the difference is in the 20% variance.

Disappointing for you. Wonder if your ReliOn is just a faulty meter. Re the pet meter - yes, the strips are very expensive. I do know they are available on the internet and are quite a bit less than the vet price.

But I am glad the mystery is solved and now you can feel better about how to help Munchkin.
 
Yes, I'm glad to now know what's going on, and there is plenty we can do to help. I ordered the AlphaTrack yesterday through our vet - $122. It should arrive today or tomorrow. I also ordered the control solution for the ReliOn. I should have done that when we first bought it. Don't know when it arrives, but it was free through ReliOn's website. I'm wondering if our ReliOn meter is bad too, on a pet or on a person. Everyone else on FDMB seems to do well with them.
 
Have you tested your blood with the ReliOn?

You might also call ReliOn and tell them that the meter tested far below your doctors. (don't mention you are using it on a cat; they will just say they are not made for a cat. Of course, no human meters are made for a cat...). Sometimes they send a new meter free.
 
Both my husband and I have used it on ourselves and it seemed okay. I took my OneTouch meter back to work right after I got the ReliOn, and never really compared the two meters. Duh, I should have though. At the time we were having trouble getting enough blood to use the OneTouch and we were new at testing, and I just didn't want to fool with it.

I bought another ReliOn meter yesterday to hold us over until the AlphaTrack arrives, and I compared the two. Why another ReliOn? I have the strips and the control solution is on the way, and everyone else likes the ReliOn. I'm hoping it is just that the first ReliOn I picked was inaccurate, and not the whole line. Besides, it is only $16. If I end up throwing them both away, I won't feel too bad about the wasted money. Last night the readings were a little over 40 points apart in the 200s (230-ish & 270-ish?); this morning they were 7 points apart, also in the 200s. This time all the readings are within the 20% acceptable variable, but I'm not putting too much stock in the readings. I mean, they seem okay, but the evidence against them is just too much.

When the control solution is here, I am hoping it will answer some of my questions. If my first meter is inaccurate (or both meters), I do plan to call them. Whether I get a free meter or not, they need to know when their meters are acting up because there are lots of people also depending on them to be accurate.
 
ReliOn is a brand, not a specific meter. Some folks have been getting this confused.

The Confirm, and Micro, have worked well for most folks. They are sold under their generic name on ADW as Glucocard 01 and Glucocard Micro.

Research has been done which suggest that human glucometers will read about 30-40% lower than the lab or pet-specific meters will. This is OK, as the reference numbers we use for hypo, control, etc. are based on using human meters unless explicitly specified they are for pet-specific meters such as AlphaTrak.

I've added 2 columns for the upper and lower estimated lab values to this spreadsheet Test Value Ranges so that you may examine between the meter's test values, +/- 20% and the estimated lab values
- if test is 30% lower, then test divided by 0.7 = estimated lab value
- if test is 40% lower, then test divided by 0.6 = estimated lab value
 
I've got an unopened canister of test strips so I guess I could see if maybe a different batch of strips gives a (wildly) different reading. My OneTouch from work is going home with me tonight to do some comparing, on me. Munchkin wouldn't let me poke him that much, not to get that many samples.

Right, ReliOn is a brand and ReliOn Prime is my meter type or model. Have other users been dissatisfied with the Prime, or noticed more accuracy with the Micro or Confirm?
 
All-righty then,

I know this will probably be a longer post cause I have lots to run by ya'll. I'm sorry, but not sorry enough to not write it. We leave for a 10-day trip in exactly one week, so I need to get a dosing plan, and fast. I'm (loosly) planning to do a curve Saturday at a dose of 0.4u twice a day, no matter how high the readings are. Also planning to use multiple meters at each test time to get a feel for how the readings vary. If the readings are too high, should I increase the dose and do a curve on the increased dose on Sunday? Past this weekend, I won't be able to do any more curves before he has to be boarded for our trip. So, if we increase the dose this will be my last chance to track Munchkin's readings in response to an increased dose.

Should I even be considering boarding him at the boarding facility where he caught the cold? I don't know if catching a cold at a facility is a deal-breaker. The boarding facility can test and dose him every 12 hours. At the vet's office, there are 10 hours between tests & doses in the daytime and 14 hours between tests & doses overnight.

I've spent a good bit of time this AM reading older threads about comparing readings from different meters and how meter results are comparing with lab values and vets' values. And I spent last night reading up on my meters (Owners Manuals and tech sheets) and studying BJ's "test value ranges" ss. Check me on this and see what I am understanding correctly and what I have mixed up.

*Most FDMB members are using the ReliOn Micro and Confirm, and I can find very few who are using the Prime. The ReliOn Prime is a newer ReliOn brand meter. Most members are liking the Micro and Confirm.

*As a general rule of thumb the human meters (ReliOn meters and other brands) are giving results 30 - 40 points lower than the AlphaTrak. Or 30% - 40% lower than the AlphaTrak and the lab values? (I was always adding 30 - 40 points, not 30 - 40 percent -- big difference!) As the reading climbs, I should expect the gap between the human meters and the AlphaTrak to widen? i.e. - with a reading of 100 on a human meter, the AlphaTrak reading is expected to be 143 - 167, then +/- the 20% allowed variance for an expanded range of 114 - 200. At a reading of 200 on a human meter, the AlphTrak reading is expected to be something like 286 - 333, then +/- the 20% variance for a range of 229 - 400?

*Human meters are allowed a variance of 20% in their test result and the "actual" blood sugar level. According to the tech sheets with the AlphaTrak strips, the "Average Bias to Reference" is -1.6%, and the "Average Coefficient of Variation" is 5.3%. Maybe those numbers mean something and maybe they don't, they are both averages, not total possible variances like +/- 20%, right? If anybody understands those terms, please educate me.

*With the AlphaTrak there is an 85 point range/window in the "acceptable" control solution reading. On my OneTouch UltraSmart there is a 37 point range/window for an acceptable control solution reading. The ReliOn Prime (control solution(s) have not arrived yet) has two ranges listed on the strip bottle, to correlate with the two control solutions. They also have narrower acceptable ranges like the OneTouch, but I didn't write down exactly how many points. Wouldn't meters with narrower control windows be more consistent from reading to reading, versus a meter with an (acceptable) range of 85 points? (control solution reading should be 100 - 185 per literature with test strips) Or am I thinking about this all wrong? The AlphaTrak is a pet meter and not subject to the FDA (or whoever) guidelines of +/- 20% variance maximum on human meters, so the variance of the AlphaTrak could be more or less than +/- 20%?

*The AlphaTrak owners manual says it can get an accurate reading if using fresh, whole blood from a test tube with EDTA or heparin anticoagulant. My ReliOn Prime does not state whether or not the addition of an anticoagulant would influence the accuracy of the reading. So when I tested the venous blood at my vets' office from the tube, the anticoagulant could have thrown off the reading? My vet got a reading of 290 on the venous blood and I got a reading of 129 on my ReliOn meter, off of the same blood.

*Renal threshold - what is it? On a human meter it is 240, and on an AlphaTrak it is 270? Shouldn't renal threshold be defined more like 162 - 189 on a human meter, if the AlphaTrak reads 30% - 40% higher instead of 30 - 40 points higher?
 
Readings from last night:
AlphaTrak - 301
ReliOn Prime (1) - 231
ReliOn Prime (2) - 220
OneTouch UltraSmart - 292

Readings from this morning:
AlphaTrak - 328
ReliOn Prime (1) - 216
ReliOn Prime (2) - 224
 
Okay, I am not a math person but I might have a few answers.

I think we consider that AlphaTraks run 30 points higher than any human meter. So if someone posts with a 70, we consider that they are close to a low number (40) So add that to your ReliOn numbers to start with. Then, if you count the 20% variance, you aren't too far apart. So say the 216 on the ReliOn could really be 259 (is my math right) plus 30 points to match the AlphaTrak - so it is 289 vs 328 on the AlphaTrak.

Since we generally are looking at ranges, not specific numbers, it doesn't become terribly important (in my humble opinion) until you get down in the lower ranges. You would probably dose the same for 289 as you would 328.

I understand your frustration but do think you can drive yourself crazy with two meters. I am concerned about the ketones but wonder if that was more sickness/poor appetite than numbers higher than your meter showed. (Look at ShadowsCaretakers thread - BJ had some great info on ketones for him)

Renal threshold. I have seen it from 250 -280 depending on what source people are quoting. I would go with the lower number just to be safe and say if he is under 250, this is a good thing and his pancreas should be healing.

Re the vet. I don't like that your normal vet can't dose and check more often. Even with the cold, I think I'd try the other one.
 
I do not use my beloved OneTouch much anymore, because the strips are so expensive, but I keep it (with strips) as my back up meter.

Whenever I tested my OneTouch UltraSmart with my vet's AlphaTrak they were always within about 8 points of each other, and the OneTouch would also be within that range (8 to 10 points) when compared to Blood Work done by IDEXX labs. I usually have my meter with me when at the vets, and test him right on the exam table.

Now, because of the money saving on the strips, I use the Arkray Vital, and it is okay.

I believe I have heard that with most human meters, the difference between them and the AlphaTrak in BG tests is in the higher numbers, and once the kitty is in the lower numbers (100 and below), that the two meters come closer together in their test values.
 
You might find it helpful to review this table of Test Value Ranges It shows the FDA allowed +/- 20% around a test value which indicates the range in which the test likely falls.

It also shows the estimated lab value that would be obtained if the human glucometer is reading 30% or 40% lower than a lab or pet-specific meter as noted in Dosing protocol for cats on glargine or detemir using daily home monitoring of blood glucose concentrations to adjust insulin dose
It is very important to note that blood glucose concentrations measured using a whole blood
glucose meter calibrated for human blood may measure 30-40% lower in the low end of the range than glucose concentrations measured using a serum chemistry analyser or a plasma-equivalent meter calibrated for feline use.
Click to expand...
At higher numbers, a human meter, pet-specific meter, and lab test may vary greatly. It doesn't matter - too high is too high. In the higher numbers, you make the same corrective action of increasing the insulin and determining what else may be contributing (stress, infection, high carb diet, etc)
 
Did I mention ya`ll are awesome! Thanks for the replies. Went for lunch at the cafe and they had internet access, thought I`d pop in to see if i got some replies, and i`m glad i did. 4 hours into the curve today and doing ok so far. Made our reservations for the kitties at the boarding facility and got their booster shots yesterday. The girls still get a little dry food every now and then as a treat, and they got some yesterday for being good at the vets office. Problem is that munchkin swiped some too. Not much but apparently enough since his bs reading this am was 400 on the AlphaTrak2, couldnt have been more than a tablespoon or two of dry food, but still enough. Dose of 0.4 u and down to 300 per AT2, 200 per R.O.Prime at 4 hours post shot.
Cafe is closing and got to go. Thanks again!
 
Per AlphaTrak2
On 0.4u dose Munchkin was getting readings of 300 - 400 (inadvertently with some dry food, he swiped it from the girls) at pre-test. Increased the dose to 0.6u on Sunday and went down to nadir of 273 (from a pre-shot of about 300 - 320). Plan to stick with this dose for a few days and see how he does. He is not under the renal threshold but I don't want to jack up the dosages too fast either. He is testing higher at preshots than he was a week ago, but not by much. Pre-shots, low 300s on the AlphaTrak2 is low 200s on the ReliOn Prime, and we were previously getting high 100s a little more than a week ago on the ReliOn Prime for pre-shots.

Still not quite sure what we will leave for instructions with the boarding facility, or which meter. If anything goes wrong I'd want them to have the AlphaTrak2 readings to give to the vet. But, I can leave one of the ReliOn Primes with them this week to practice on, so they can get the feel of testing before we are out of town.

We can't really afford to test with the AlphaTrak2 all the time; the strips are too expensive. We hoped that we might get enough readings this past weekend (on all 4 meters) to find a meter that was consistent, and figure out what the conversion formula was between meters. So we could test on the ReliOn Primes and be able to predict what the reading would be on the AlphaTrak2 (AT2), but still have the AT2 to double check, if we needed to. When we got the second ReliOn Prime (RO), we saw how consistently close the readings were between the two meters. There is no way the first Prime meter we got was a bad meter.

I am not sure how to load all the data we got into a spreadsheet, but I'll work on it maybe during lunch so ya'll can see what we came up with. The OnTouch UltraSmart (OT US) is about 30 to 40 points below the AlphaTrak2 readings, most of the time. Sometimes it is as much as 60 points less or as few as 10 points less. It is not the easiest to predict the AT2 readings using the OT US, besides the OT US meter has to go back to work during the week and can't be home to use all the times we need it. The ReliOn Primes are, I think, better predictors of what the AT2 readings will be. The RO Primes are almost always within 10 points of each other, but sometimes as much as 20 points. And I think they are 30% to 40% less than the AT2, but I need to double check the math before counting on it.
 
Once you've downloaded the template, you go into your Google Docs account and upload/import it. Then, in Google Docs/Drive, you can enter, edit, and delete as you want.

Just pick 1 meter to use all the time; you'll drive yourslef crazy to make them correlate with each other. The most important range for them to be useful is LOW, because of the risk of hypo. Any high test (over 200), regardless of human vs pet-specific meter, just means you have more work to do controlling the diabetes.

My signature link, Secondary Monitoring Tools has a few other ways to assess your cat, besides focusing on the glucose tests. Is the cat eating, drinking, peeing, pooping, purring, playing, preening/grooming? Are there ketones in the urine? Is the weight stable? Amount of water being drunk decreasing? And so on.
 
Isn't it amazing how even that little bit of dry food, 1-2T, kicked up his numbers? Now you know why we call it contraband! :lol: :lol: :lol: :lol:
 
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