Sun 6-13 OM - Meter frustrations (again)

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Sheila & Beau GA & Jeddie GA

Sheila & Beau GA & Jeddie GA

Member Since 2009
OK, so remember when I bought the *new* TrueTest meter because I got an awesome deal on it and the strips? But then the numbers were SO far different than the TrueTrack meter I have used for 2+ years? Well, I am down to the last dozen or so strips for the TTrack so I want to start using the 150 strips for the TTest meter - so I started testing in tandem with both meters on same drop of blood. Arrrrggghhh! I got 218 and 140. How in God's name does the SAME company make two meters that test so far off? The new one is supposed to have fancy, super accurate programing and features. So does that mean my old meter has been reading off this whole time?

Well, anyway.... I am hoping that by having a dozen tandem numbers I will get an idea of how the new one might effect my dosing decisions. For instance tonight those two numbers mean the full dose - so no difference there.

He was 86 at +4 this afternoon, btw, on the old meter and the pmPS on that meter is 40 pts lower than last night's PS.
 
I'm wondering if the fact that it's newer means it has different technology which perhaps does not interact with cat's blood as well. For example, Monique wrote a very good post about how meters actually work and why the human ones may treat animal blood differently and result in different results. http://www.felinediabetes.com/phorum5/r ... sg-1840808

Strips are available on Ebay at very reasonable prices. I know you can't wait very long to receive them, but for future reference.
 
OK - read that - makes sense - except, I am comparing two human meters so should the "error" run the same on them. Also, I seem to recall that Michele tried the TrueTest meter and got higher numbers that her other meter (that she had run out of more expensive strips for) - the Contour maybe?

This am the numbers were 146/94. I am hoping that I can find an average percent variable so I can guesstimate a number that is in line with his past tests.
 
Oh Shelia I'm sorry you having problems with the meter but..............I have read a dozen times that people were having problems with many of those TRUE-brands of meter with wildly varying values. I have no idea which one is "most accurate". I doubt that the technology is that much different (old vs. new) there haven't been any significant advantaces in the meters for several years.

My only suggetion would be first to compare both to a third (other manufacturer) meter and see which 2 have the most simular values. The Walmart meter seems to be popular and quite affordable so perhaps you could get one and a package of strips and compare 3 meters (oh joy right?) that way if it turns out the Walmart meter and one of the others are simular you would have 2 meters that are acceptable and the "outlier" you should probably retire (or save it for emergency and checking OTJ kitties).

In my opinion the numbers you are getting are quite satistically significantly different to make assumptions. Picking 1 meter and sticking with it is important and I would be inclined to go with a newer model.

I have 4 meters (1 is still unopened) 2 of the meters measure almost exact (OneTouch Vita, Abbott Freestyle Freedom Lite) they are both calibrated for plasma equivelant. My favorite and most used meter is the Bayer Contour which was required for the Lantus/Levemir trial in the German Forum. This meter (one of the few) gives the result in whole blood glucose values (I think the Contour sold in the US is plasma values though) the results I get with that meter are somewhat lower (pretty predictably about 10% lower) which is exactly what would be expected between whole blood and plasma.

I don't know what local stores you have or how much the prices vary, but from the number of complaints I have read here on the forum and seen (even by humans) concerning the True Track/True Test etc. models I would recommend avoiding them and choosing another brand in a simular price range.

I recall the price for the Walmart strips being around $22 for 50.

Just so you know....here in Germany there are no store brands or the like only the brand names and all strips are pretty much in the same price range.

For example the Freestyle 50 strips from the local pharmacy cost 35€ ($45)
50 strips from an online medical shop costs 26€-29€ ($33-$37) and usually has free shipping.
I mostly get strips on Ebay (which are likely illegal-because Human diabetics who get thier supplies paid by the health insurance get more than they need each month then sell them on Ebay which is actually insurance fraud) but I end up paying 40€-€50 for 100 strips so makes me happy. :-D

Same reason I used 1 syringe per day instead of each shot, our only option is the BD Microfine +Demi (for half unit marks) and a box of 100 syringes costs €37 ($48) from an online supply shop (I once bought a bag of 10 from the local pharmacy in an emergency and paid 5€ which means they would €50 for the whole box!) Since almost all humans use the pens the availiblity of such syringes on Ebay is small. Although I was able to buy a box of U40 (for Caninsulin) from Czechoslovakia really cheap (13€ for 100) and I ended up donating them to my vet :roll:
 
Sheila, you can get a free Contour meter at this site for comparison (comes with 25 extra test strips):

http://www.contouroffer.com/ContourUpgr ... er=contour

I know that is not going to help you now, but maybe go with the Walmart brand Monique is talking about.

I love the Contour, always have, but of course, everyone has their favorites. I know some don't care for it. Recently I compared (with the same strips) my 'older' Contour with this newer model linked above and they were only 10 points off.

Have you tried testing one of your civies with the two meters to compare that way?
 
Thanks, Monique. I read that old thread where you explained the red blood cell sizes being different between humans and animals... interesting and something I didn't know.

The thing is that I *really* want the new True Test meter to work! I know - crazy and emotional. It has better functions/operations than the old and doesn't need coding. Since strips are so much the cost factor with home testing, I need to have a meter with cheaper strips. I still refuse to buy from Walmart because as a corporation they are despicable.

So, the newer model looks to be 35% lower than than the older one, which is well outside the variance rate. Is that what you mean by too statistically significant to make assumptions? (BTW, the two meters test me differently too 93 vs 63, if I remember correctly). But if I use the newer meter maybe I can get Jeddie OTJ! :roll:
 
OK, tonight's numbers are really odd.... Well, no, they are just as odd as before: 278 and 174.

BTW, the meter variance seems to be about 36%. I have been going back through some numbers and wondering about if the True Track (the one I have always used) has been wrong this whole time - and driving myself nuts because that would make the 201 that caused me to restart Jeddie on insulin really 128.... and some of the lows that Beau had going OTJ that were in the mid 30 actually in the low 20s....

Well, either number is high for tonight and he got .6u.
 
Maybe it is worth a trip to the vet with both sugarsnaps and both true-whatever meters and a third one you trust to compare with vet's blood draw?

My Relion is ALWAYS within 20 or less points of the vets draws...Also, the avivva accucheck and relion are in tandum as well.

Relion has a new meter out that can download readings to computer automatically. I'm going to look into the price of the download equipment. It also holds up to 360 some readings...$12 for meter, strips are 50 for $20, 100 for $40.
 
The thing is that I *really* want the new True Test meter to work! I know - crazy and emotional. It has better functions/operations than the old and doesn't need coding. Since strips are so much the cost factor with home testing, I need to have a meter with cheaper strips. I still refuse to buy from Walmart because as a corporation they are despicable.

So, the newer model looks to be 35% lower than than the older one, which is well outside the variance rate. Is that what you mean by too statistically significant to make assumptions? (BTW, the two meters test me differently too 93 vs 63, if I remember correctly). But if I use the newer meter maybe I can get Jeddie OTJ! :roll:
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Yea I really want alot of things to work too but they don't :lol: (like the Caninsulin for example) I didn't realize Walmart was "black listed" :shock: are there other generic lines of meters from other pharmacies (Target, Walgreen's, Cosco, CVS...) Perhaps one of those is comparable.

That's kind of what I meant about making assumptions (you know the saying right...makes an ...) Is it true that the "old" meter is always measuring higher than the "new" one? I think it is dangerous (well at least risky) to conclude that there is usually a 36% varriance because I think you will find the percentage is not always steady and possibly increases/decreases according to how higher or low the absolute value is. While a higher reading like 380 may be be 38% lower on the new meter (236) a lower number like 90 probably isn't so far off and likely has a vaairence of under 20%. In any case I don't see much point in embarking on a big experiment trying to dertemine how to compare apples with oranges (most will say it can't be done) not to mention you are concerned about cost but are using double the test strips!

Here is what I would do. If you have a decent supply of strips for the "new" meter and a supply source for more strips then use that one and retire the old one. I would also oder the Contour that Pamela suggested (hey it's free!)and for curiosities sake (reminds of the other saying....killed the cat! :o ) test it against your new meter and maybe the old one (3 rd opinion). Based on these numbers from the new meter his values aren't so bad! What does his behavior and gesalt tell you? If he appears like you would expect with those numbers then it's probably a good indication they are "accurate" on the other hand if I was measuring numbers under 200 frequently but had a cat that was hanging on the water dish, losing weight and going through 20 Kg of litter a week plus throwing ketones I would seriously question the meters accuracy! I would set his dose for now at .5U (easier to measure) plus I'm not convinced that the minute .1U changes have a huge effect untill you are really dosing just .1U (I think it has a placebo effect on the person but very little on the cat) I would accept that Jeddie maybe a very ordinary cat (unlike his roomate Beau ;-) ) who could very well fit the protocol nicely. Have confidence in your meter that it is giving acceptablly accurate values which are more on the safe side than your old meter was and shoot that .5U as regularly as possible and hold it until he gives you a 40 something at least 2x (if he goes below 40 reduce immediatly) A dose of .5U is not much, think of it this way in a person that would be offset by 1 square of a Hershey bar for the next 12 hours! I know you are away alot but try to test as much as possible I'm sure it will only be for a short time then he will be OTJ. When he has earned a decrease give it to him (it's like a reward for both of you) so make it count and reduce by .25U and go with that. Your last reduction will be that .1U which you keep until he goes below 50 on it or has at least 10 days "in the green" then countdown time. Don't make it complicated don't panic over any single number (high or low). Hold the dose until you have to change it (going below 40 or 50, or staying to high) A high Preshot means nothing it happens most important is that the numbers go down. A bounce is a bounce and from my experience the magnitude of the bounce isn't related to the magnitude of the low which caused it but rather to how accostumed the cat is to higher numbers. They decrease with time.

Let the Preshot determine when you should test. If he has a lower than usual preshot (<120) then give the full dose and test early (+1 or +2 latest) if he's going up then no worries leave out whatever food you would and test him when you come home. If he is dropping already after preshot then feed some gravy on top of the food and check again before you leave and leave out plenty of food (he will take care of his needs and the dose is low enough that it can't send him too low) Keep in mind that Levemir also has a shorter duration when the dose is lower (the larger the dose the longer it works) so he shouldn't be in any danger as long as he has a few bites to eat during the first 6-8 hours of the cycle. If he has a higher Preshot (>200) you don't need an early test leave food out and test when you come home. Try and test a few times at night to try and catch a sign to reduce, and as much as possible on the weekends etc.)

I think in less than a month or two Jeddie will be OTJ.
 
Monique & Spooky said:
Keep in mind that Levemir also has a shorter duration when the dose is lower (the larger the dose the longer it works) so he shouldn't be in any danger as long as he has a few bites to eat during the first 6-8 hours of the cycle.
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Now that is something I have suspected, and sort of incorporated into my dosing with both boys, but never saw in "black and white" here before. At least not that I recall.

Monique, thanks for the detailed information. It all makes a lot of sense.

As to the new meter (It's actually call the True Result), I did some research on it and read reviews. It is made by Home Diagnostics who has the results of a meter comparison using this meter, the Countour, One Touch Ultra and Freestyle. This meter is as accurate as the Contour when both are compared using the Parkes Error Grid. http://www.homediagnostics.com/our_products/downloads/bgm_true_result/10-14 ACCURACY STUDY.pdf
However, there is a slight shift to higher numbers on the Contour versus the control and a slight shift to lower numbers with the True Result - both within the ISO standards - which I learned are +/- 20% for readings ABOVE 75 mg/dl and +/- 15 mg/dl for numbers below 75. That's 15 points, not 15%. At 75, 15 IS 20%, but for, say, 50 it is 30%.

And, yes, his numbers look really good with the new meter. Let's see how your prediction holds in a month. I will be sure to tell Jeddie that he is "on deadline" now! :mrgreen:
 
I would say the meter is accurate enough for home monitoring purposes (I expect your old meter may be less accurate) so using the newer one is probably a good idea.

The action of Levemir related to dose has been mentioned several time by Steve (&Jock) I can't find it right now, but I think simular things have been shown in human studies as well. it seems cats on Levemir seem to respond more simularly to how it works in humans, Lantus differs slightly more in it's action between species.

From the Wiki Pet diabetes:
Notice that Jock's dose (3.25U for 6.5kg) here is higher than those shown in the Novo experiments (0.5 U/kg), and that his peak is close to 11 hours. This is consistent with the shifting peak time shown in the 0.2, 0.3, and 0.4U/kg cases above. But it's consistent with human times, not the usually sped-up feline times. Possible explanation: The protein-binding time-delay action of Levemir is not dependent on the animal's metabolism, or at least not the same part of it that makes other insulins run faster in cats.

Notice that except for the rise at the beginning (typical, due to slow onset), the curve is nearly symmetrical, gradual on both sides, and lasts 21 hours before returning to previous level. This means it's very easy on the animal both at the beginning and end of its action, and it can easily be overlapped to the next dose without surprises or difficult calculations.
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Found this study from Canada quickly:
3.3.2 Pharmacodynamics

The dose-response relationship and duration of action of the to-be-marketed (100 U/mL) insulin detemir preparation (injected SC) was investigated in subjects with Type I diabetes mellitus under isoglycemic clamp conditions. The mean glucose infusion rate (GIR) profiles for five SC insulin detemir doses ranging from 0.1 U/kg to 1.6 U/kg and one NPH insulin dose (0.3 IU/kg) were considered. Both the area under the glucose infusion rate (AUCGIR) and the maximum GIR increased proportionally with increased doses of insulin detemir.

To determine the insulin detemir dose equipotent to 0.3 IU/kg of NPH insulin, the equivalent insulin detemir dose was interpolated from estimates of
AUCGIR(0-24h). In terms of AUCGIR(0-24h), it was estimated that a dose of approximately 0.3 U/kg (0.29 U/kg) insulin detemir would give the same glucose lowering effect as 0.3 IU/kg NPH insulin with a GIRmax of
1.4 mg/kg/min.

The duration of action for insulin detemir was varied and apparently dose-dependent. It ranged from 6 hours at the lowest dose to approximately
24 hours at the highest for a range of doses including those that were clinically relevant.
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http://www.hc-sc.gc.ca/dhp-mps/prod.../drug-med/sbd_smd_2006_levemir_081683-eng.php
 
Monique & Spooky said:
The action of Levemir related to dose has been mentioned several time by Steve (&Jock) I can't find it right now, but I think simular things have been shown in human studies as well. it seems cats on Levemir seem to respond more simularly to how it works in humans, Lantus differs slightly more in it's action between species.
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I've always liked how Dr. Bernstein explains it in his book. Here is an online excerpt from that section. In it he talks about the variability of absorption between large and small doses. I believe this is what you were referring to Monique?

http://diabetes-book.com/book/chapter7.shtml

"THE LAW OF INSULIN DOSE ABSORPTION

If you do not take insulin, you can skip this section.
Think again of traffic. You’re driving down the road and your car drifts slightly toward the median. To bring it back into line, you make a slight adjustment of the steering wheel. No problem. But yank the steering wheel and it could carry you into another lane, or could send you careening off the road.

When you inject insulin, not all of it reaches your bloodstream. Research has shown that there’s a level of uncertainty as to just how much absorption of insulin actually takes place. The more insulin you use, the greater the level of uncertainty.

When you inject insulin, you’re putting beneath your skin a substance that isn’t, according to your immune system’s way of seeing things, supposed to be there. So a portion of it will be destroyed as a foreign substance before it can reach the bloodstream. The amount that the body can destroy depends on several factors. First is how big a dose you inject. The bigger the dose, the more inflammation and irritation you cause, and the more of a “red flag” you send up to your immune system. Other factors include the depth, speed, and location of your injection.

Your injections will naturally vary from one time to the next. Even the most fastidious person will unconsciously alter minor things in the injection process from day to day. So the amount of insulin that gets into your bloodstream is always going to have some variability. The bigger the dose, the bigger the variation.

A number of years ago, researchers at the University of Minnesota demonstrated that if you inject about 20 units of insulin into your arm, you’ll get on average a 39 percent variation in the amount that makes it into the bloodstream from one day to the next. They found that abdominal injections had only a 29 percent average variation, and so recommended that we use only abdominal injections. On paper that seems fine, but in practice the effects on blood sugar are still intolerable. Say you do inject 20 units of insulin at one time. Each unit lowers the blood sugar of a typical 150-pound adult by 40 mg/dl. A 29 percent variability will create a 7-unit discrepancy in your 20-unit injection, which means a 280 mg/dl blood sugar uncertainty (40 mg/dl x 7 units). The result is totally haphazard blood sugars and complete unpredictability, just by virtue of the varying amounts of insulin absorbed. Research and my own experience demonstrate that the smaller your dose of insulin, the less variability you get. For type 1 diabetics who are not obese, we’d ideally like to see doses anywhere from ¼ unit to 6 units or at the most 7. Typically, you might take 3–5 units in a shot. At these lower doses, the uncertainty of absorption approaches zero, so that there is no need to worry about whether you should inject in your arm or abdomen or elsewhere.

I have a very obese patient who requires 27 units of long-acting insulin at bedtime. He’s so insulin-resistant that there’s no way to keep his blood sugar under control without this massive dose. In order to ameliorate the unpredictability of large doses, he splits his bedtime insulin into four small shots given into four separate sites using the same disposable syringe. As a rule, I recommend that a single insulin injection never exceed 7 units."
 
I wonder what insulin he is talking about because I would think that Humulin is absorbed a lot differently than leve or lantus.

I was just talking to someone I know from work - a very nice woman in her early 60s who is very obese and diabetic. I am guessing over 400 lbs. She just had gastric bypass surgery about 6 weeks ago and has lost 37 lbs and says she feels great and has more energy than she has in a long time - and you can see that in her face - like a great stress has been taken from her. She uses levemir and said she was taking 365 units a day of it!!! OMG, can you imagine? She said her dose has already dropped to 60 units a day. That's a sixth of what she used to take. Now I wonder if she has a zero in the wrong place, but still the difference is amazing. She was so insulin resistant before and now she isn't. Wow. I am really hoping she does well after this surgery. Doc told her another 15-20 lbs and she may be off insulin all together.
 
Sheila & Beau & Jeddie said:
I wonder what insulin he is talking about because I would think that Humulin is absorbed a lot differently than leve or lantus.
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Well, he uses Levemir with a bolus of a faster acting insulin at mealtimes. I think he is talking though about insulins in general and their absorption factor.

Sheila & Beau & Jeddie said:
I was just talking to someone I know from work - a very nice woman in her early 60s who is very obese and diabetic. I am guessing over 400 lbs. She just had gastric bypass surgery about 6 weeks ago and has lost 37 lbs and says she feels great and has more energy than she has in a long time - and you can see that in her face - like a great stress has been taken from her. She uses levemir and said she was taking 365 units a day of it!!! OMG, can you imagine? She said her dose has already dropped to 60 units a day. That's a sixth of what she used to take. Now I wonder if she has a zero in the wrong place, but still the difference is amazing. She was so insulin resistant before and now she isn't. Wow. I am really hoping she does well after this surgery. Doc told her another 15-20 lbs and she may be off insulin all together.
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I love hearing human success stories like this, just like with Cindy's Mom (TT thread). I also love that her doctor is encouraging her by suggesting she maybe could eventually go off insulin altogether. Could you suggest to her to get Dr. Bernstein's book? She could learn a lot from him on how to go about reaching her goal.

I can't even fathom 365 units a day! I wonder what kind of insulin(s) she is on?
 
Sheila & Beau & Jeddie said:
I wonder what insulin he is talking about because I would think that Humulin is absorbed a lot differently than leve or lantus.

I was just talking to someone I know from work - a very nice woman in her early 60s who is very obese and diabetic. I am guessing over 400 lbs. She just had gastric bypass surgery about 6 weeks ago and has lost 37 lbs and says she feels great and has more energy than she has in a long time - and you can see that in her face - like a great stress has been taken from her. She uses levemir and said she was taking 365 units a day of it!!! OMG, can you imagine? She said her dose has already dropped to 60 units a day. That's a sixth of what she used to take. Now I wonder if she has a zero in the wrong place, but still the difference is amazing. She was so insulin resistant before and now she isn't. Wow. I am really hoping she does well after this surgery. Doc told her another 15-20 lbs and she may be off insulin all together.
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Sheila, does she know that an unusual number of gastric bypass patients go completely off insulin? I found that amazing. And just like with her rapid drop in dose, it's almost immediate, they don't have to lose a huge amount of weight first.

Oh, I guess she does. I hadn't read all the way to the bottom of your post yet!
 
Not sure, but the diet after bypass surgery is no sugars at all - they actually cause something called glucose dumping, which I don't fully understand, but it makes you really sick - like you'd rather just die. It is a real incentive to not experience that again, so no sugar. Low glycemic foods and protein are whats allowed. And, from two women I have known who had the procedure, you loose your taste for meat, so the diet is almost all fruit, veggies, and some dairy. So no wonder the insulin needs decrease rapidly.
 
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