OneTouch vs Relion meter results

[Scott & Buster]

Hi all,

I started Elmsley using my old OneTouch meter since I had it and some test strips on hand, however it's time to pay out of pocket for the strips and... wow.

I grabbed a Relion Premier Classic yesterday, and I am testing side by side with the OneTouch to get an idea of how to judge the Relion numbers. I am seeing some pretty big gaps that would impact the amount of insulin I am giving.

OneTouch/Relion:
PMPS: 250/318
PM+4: 98/109
AMPS: 237/273 (Relion retest, was 308 originally)
AM+4: 108/113
PMPS: 208/261

When the readings are in a normal range the two meters are pretty well in agreement, however preshot the Relion is 15-20% higher.

Had I gone with the Relion numbers I would have shot too much insulin and been dealing with lows since his 2.5 units drops him around 200 points around +4:

Insulin dose OneTouch/Relion:
PM: 1.75/2.5
AM: 1.75/2 (would have been 2.5 with original reading)
PM: 1.5/2

Are Relion meters not as good with higher readings? Do I just need to shoot for 80% of a reading above 200? How are these meters on lows? Do I just have a bad meter?

I thought it could be the OneTouch being bad but I've tested myself on it, my personal meter, and the Relion, and the two OneTouch were in agreement and the Relion returned the closer reading since I was in a normal range.

 

[Larry and Kitties]

It is acceptable for hand BG meters to have an accuracy of +/_ 15-20%. Because it is a % difference that is why the BG value are closer together as the BGs decrease. Best is to stick with one metter except if something requires you to go to another meter.

 

[Scott & Buster]

Best is to stick with one meter except if something requires you to go to another meter.

Thank you for taking time to reply. $78+/mo compared to $18+/mo for test strips is requiring another meter.

@FrostD - do you have any suggestions for adjusting his Prozinc to match the known readings difference? Or should I just shoot based on 80% of the reading and know that doing the math is the cost of saving $60/month?

 

[FrostD]

Thank you for taking time to reply. $78+/mo compared to $18+/mo for test strips is requiring another meter.

@FrostD - do you have any suggestions for adjusting his Prozinc to match the known readings difference? Or should I just shoot based on 80% of the reading and know that doing the math is the cost of saving $60/month?

Take the numbers at face value. Dose is still based off nadir, and in the lower numbers the variance does not matter as much.

Speaking of which, I would say he earned at least one reduction down to 2.25U based on those nighttime tests, as he likely went below 90. The 1.75U is looking pretty good, you can hold that or try 2U...though I suspect he'd earn a reduction pretty quickly on 2U.

 

[Scott & Buster]

Take the numbers at face value. Dose is still based off nadir, and in the lower numbers the variance does not matter as much.

To clarify/confirm, those nadirs were shot based off the OneTouch number. Had I shot based on the Relion he likely would have had hypo episodes both times since his glucose drops ~20 points per quarter unit of Prozinc at +4. I reduced from his current 2.5 units because he didn't have 200 points to drop without going low.

Am I looking at his dosing incorrectly? If his preshot is 237, and he needs to be around 100 without having a hypo incident, he would need 1.75 units to be around 108; if he had a 300 then his full 2.5 to get him to 100?

 

[Shelley & Jess]

When I first started out I borrowed my mom's One Touch Ultra while I got the hang of testing (she was getting free strips), then, when my testing ramped up, I purchased my own Ultra. Even between the same models one always read lower than the other. Afterwards I switched to the newer Verio model, (can't get Relion in Canada).

You may have read 'pick one meter and stick with it' because every meter is different, some more so than others, and you'll drive yourself crazy trying to compare the two.

Your PMPS numbers could be considered pretty close if you look at meter variance*

Using meter variance at 20%:
PMPS: 250/318 could equal 300/318 or 250/254
PM+4: 98/109 could equal 118/109 or 98/87
AMPS: 237/273 could equal 284/273 or 237/218
AM+4: 108/113 could equal 130/113 or 108/90
PMPS: 208/261 could equal 250/261 or 208/208

If concerned about the number try a little less insulin, see how he does, gather the data for the new meter and go from there.


*NOTE about meter variance by @Marje and Gracie
The 20% variance only applies to tests taken with a single meter. That means if you use Meter A and you take a test and then later take another with Meter A, there is an allowable 20% meter variation. That helps us tell whether the cat is actually flat or going up or down. If the numbers are within 20% of each other, they are, for all intents and purposes, the same number. The 20% meter variation does not apply to human meters of a different type."

A lot of times, it’s not anything to really think about but when you are wondering if the BG is really flat or not, it’s something to consider

 

[FrostD]

To clarify/confirm, those nadirs were shot based off the OneTouch number. Had I shot based on the Relion he likely would have had hypo episodes both times since his glucose drops ~20 points per quarter unit of Prozinc at +4. I reduced from his current 2.5 units because he didn't have 200 points to drop without going low.

Am I looking at his dosing incorrectly? If his preshot is 237, and he needs to be around 100 without having a hypo incident, he would need 1.75 units to be around 108; if he had a 300 then his full 2.5 to get him to 100?

In addition to what Shelley mentioned -

The goal is to shoot the same dose every time, as long as preshot is above 200. Below 200 is when you start to adjust, but the hope is he slowly comes down and you continue to shoot a consistent dose.

That said, some cats benefit from a sliding scale. I'm not entirely sure he's one of those cats yet. I think you just had a few missed reductions that ended up needing your altered doses. So I would try to keep that 1.75U if he's above 200 for at least 5 days to see if he settles down a bit. Under that, you can look at partial doses using your best guess.

 

[Scott & Buster]

I think you just had a few missed reductions that ended up needing your altered doses. So I would try to keep that 1.75U if he's above 200 for at least 5 days to see if he settles down a bit. Under that, you can look at partial doses using your best guess.

Sorry for the late reply... we were dealing with a series of "lows" - even with a dose below 1.75u. At one point he tested a 39... but no symptoms of a low, which got me really suspect of the meter... and very leery of dosing.

He had a vet appointment last Saturday and I took both meters and tested with the same blood sample they ran labs on. The Relion was about spot on - 304 compared to 299 on the lab values... the OneTouch was 196... about 100 off. Either the OT meter went south, or I got a bad batch (across multiple vials) of test strips. I got my answer on the Relion meter... but we're basically starting over with trying to find the right dose of insulin.

We also got an answer on concurrent diseases - chronic pancreatitis and CKD (stage 2) confirmed. He got some subQ fluids while he was at the vet, and apparently you have to adjust the dose of insulin on those days... we got our first symptomatic low (in the 50s - tired and "off" gait) that night off 1.75u (we have permission to take him back to 2.5 units if needed). So of course, more doubt in dosing, especially since as the fluids processed out the same dose produced different results. My vet said he could benefit from subQs maybe once a week or so... so figuring out new dosing is going to be a challenge. At least I saw the writing on the wall with his BUN results and switched him over to PLAY with the lower phosphorus than Fancy Feast so don't have to contend with a diet change at the same time.

 

[FrostD]

The fluids is generally more about timing and location, most people are able to maintain consistent dosing regardless of fluids but ProZinc is a little tricky.

Do you know where the vet gave fluids in relation to the shot? And how long after the shot? Recommended volume of fluids? Did they do anything else at the vet or give any other meds?

Pancreatitis is my most hated disease in cats because there's nothing you can actually DO except manage symptoms. Most of us with p'titis cats keep a med kit at home - Cerenia for nausea, ondansetron for vomiting, Mirataz or ciproheptadine for appetite stimulant, buprenorphine or gabapentin for pain, foods you can easily syringe, syringes, and cans of tuna in plain spring water (the water itself when added to water or food is often enough to get them eating). Fluids as well but I'd consult vet on how much and how often for pancreatitis flare specifically, too much is bad for the heart.

Glad you caught the CKD early! Recheck in a few months I assume?

As far as dose, from what I see on SS I would actually go with 0.5U and try to shoot that consistently if it's safe. He's stuck in a vicious cycle of bouncing and lows, so I'd do a slight "re-baseline" to get him settled and see where he's really at.

 

[Scott & Buster]

Do you know where the vet gave fluids in relation to the shot? And how long after the shot? Recommended volume of fluids? Did they do anything else at the vet or give any other meds?

I don't know offhand how much & where they gave fluids, however I am assuming scruff; they're using a drip with an 18g needle (ouch). He got the fluids around 5 hours after his morning shot and 7 hours before his evening shot where we bounced low. He also got a B12 injection - the vet wants him to get one every few weeks. She is comfortable with me giving him his fluids weekly-ish at home (but not the B12 injection... we'll have to have a talk about that because I can inject the bag or use the port in the line while giving fluids). I figured once she approves the prescription order for the Ringers that there would be dosing instructions.

Here are the meds he is currently on:

• Prozinc Insulin 2.5u MAX BID 8/6/22 (reality is <1.75u still)
• Proviable Probiotic 1 capsule SID PM 8/15/22
• Famotidine 2mg SID every other day PM 8/14/22
• Cerenia 4mg SID every 3 days AM 8/14/22
• Lysine Supplement 250mg BID 7/16/22

I keep a tab on his spreadsheet with his meds. I've got approval for EOD on the Cerenia and daily on the Famotidine, however if he can do well on 3 days for Cerenia and EOD on the Famotidine I'd like to keep him there and have something I can increase/move to without having to reach out if needed. He's not got Ondansetron, though I have talked with the vet about it - I am sure she would prescribe if I pushed, she is just more familiar with Cerenia. We're not on any pain meds (yet) - he got a shot of buprenorphine at the vet when they first treated him, however I didn't see a lot of change other than he slept a ton and it made it hard to get him to eat so he had a low that day. We've also briefly mentioned gabapentin, however the vet said something about it impacting blood sugar?

I have some Mirataz on hand from previous cats with CKD, and I don't think that this vet would say no if I asked for it for Elmsley, however he's not having appetite issues (thankfully) - he still eats like he just got out of prison. Luckily his pancreatitis is "mild" - he "barely" pops on the snapFPL - and hopefully it stays that way.

I am also probably going to ask to put him on Zyrtec on Monday - he's got chronic runny nose & congestion, been through 2 rounds of antibiotics, and chlorpheniramine didn't touch it and only made him sleepy. Hopefully his proviable also kicks in sooner rather than later for his chronic diarrhea.

Glad you caught the CKD early! Recheck in a few months I assume?

As far as dose, from what I see on SS I would actually go with 0.5U and try to shoot that consistently if it's safe. He's stuck in a vicious cycle of bouncing and lows, so I'd do a slight "re-baseline" to get him settled and see where he's really at.

I've been expecting the CKD diagnosis since May, even before his first labs were run. He got so thin, and the diabetes so out of control, before I took him in that it's not a surprise he's got organ damage. Recheck definitely in a few months, though I am hoping that the chronic part of the CKD is very slow since we're closer to getting the diabetes under control. His BUN has doubled since his first test, however he's also not drinking an entire bowl of water everyday anymore, so hopefully these are true numbers and they really haven't progressed much over the past 2 tests he's had.

I am so proud I actually came to the same realization about his insulin dose on my own before I saw this today - I dropped him down to .75u this morning after no shot last night again to try to get him in a place where he can get back to 2 a day.

 

[FrostD]

It's a lot to manage!

As for the B12, there are multiple forms for different uses. Did she say why she wants to give the B12 injections?

 

[Scott & Buster]

As for the B12, there are multiple forms for different uses. Did she say why she wants to give the B12 injections?

Officially, for the pancreatitis, however he's also got chronic diarrhea and his last labs said we need to keep an eye out for anemia. So all of the above maybe?