? switching to Levemir and AT2 to human meter

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Carol & Murphy (GA)

Carol & Murphy (GA)

Member Since 2015
I was about to switch insulins tomorrow (prozinc to Levemir) but I need to be out 3-4 hours right at mid cycle (from +6 to +9 or +10) so I couldn't monitor - would that be safe or should I wait for another day?

Also, I have been using an AT2 meter for 10 months now (quite happily I might add) since I have been advised it will be easier to follow the L&L protocol using a human meter, and given that I still have 4 unopened boxes of Freestyle lite strips I use with the AT2 (along with a few boxes of AT2 strips) I bought a freestyle lite meter today (cheap - under $15) Incidentially the meters look and function identically
I tested it on myself - normal reading - I tested Murphy on AT2 (264 - a normal reading for him) then I immediately tested him on the human meter with freestyle lite strips and it was 89! I was anticipating human readings to be lower, but not that much lower! I don't know if I can get used to this
 
The number will color code so you know what it means.
See also Human Glucometer and Veterinary Lab Reference Numbers and Notes in my signature.
 
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Not sure what you're looking at. Perhaps you are confusing the measurement units?

There are 2 different measurement systems for glucose measurement.
Converting between the 2 measurement systems:
milligrams per deciliter: mg/dL / 18 = mmol/L
millimoles per liter: mmol/L * 18 = mg/dL​

Just let the spreadsheet color code it.
 
Sorry BJ - maybe I wasn't clear
Murphy's blood sugar on AT2 was 264 mg/dL and using the same drop of blood measured it on human meter and it was 89 mg/dL
My question (or observation) was this is my first time using a human meter and I am shocked by how far off the human meter reading is from the AT2 (the AT2 reading is at +11 so it is a normal reading for Murphy)
 
When in doubt, re-test. An insufficient blood drop may read erroneously, as may out of date, contaminated, or improperly used test strips.
 
Strips were from a brand new, unopened vial. Maybe it was too little blood although I have been doing this multiple times a day for almost 11 months and have gotten pretty good at testing, and the blood volume was the same I've used to test hundreds of times. Maybe it was just one of those things, but it happened at a bad time (the inaugural use of the human meter). I'll keep dual testing
 
I don't know much about the AT2, but this sounds like an awfully big difference to me!
Since you are switching to Levemir, maybe you should post this on the Lantus/Levemir forum.
 
That is a big difference between the AT2 and FS Lite. I use the AT2 and FS Lite meters and that difference does not seem correct. Here are some same blood drop comparisons I have done with the two meters:

AT2 9.9 FS Lite 6.8
AT2 6.3 FS Lite 4.2
AT2 23.1 FS Lite 16.2
AT2 16.1 FS Lite 11.6
AT2 7.1 FS Lite 4.8
AT2 22.1 FS Lite 13.4
AT2 3.5 FS Lite 2.0
AT2 17.8 FS Lite 12.2
AT2 25.8 FS Lite 18.3
AT2 5.6 FS Lite 3.6
AT2 12.8 FS Lite 8.3



This is in mmol/l so you would have to multiply by 18 to get the US number equivalents.
 
I just repeated at +4 same drop of blood AT2 gave a 309 and Freestyle lite 213 --
I think this is a big difference - one way below the renal threshold and one above
 
Carol & Murphy said:
I just repeated at +4 same drop of blood AT2 gave a 309 and Freestyle lite 213 --
I think this is a big difference - one way below the renal threshold and one above
Click to expand...


These numbers actually sound about right with my own testing comparisons. On my same blood drop comparisons for instance I had:
398 on AT2 and 241 on FS Lite
290 on AT2 and 209 on FS Lite
320 on AT2 and 220 on FS Lite

The numbers on this forum are mainly quoted as human meter readings, so I would assume that would also include the renal threshold.

The differences between the AT2 meter and FS Lite meter are larger at higher numbers and closer at lower numbers. For example from my testing:

AT2 43 FS Lite 36
AT2 56 FS Lite 45
 
Each of those meters is allowed to read +/- 20%.
To see if 2 numbers overlap,
Multiply the low number by 1.2: 213 * 1.2 = 255.6
Multiply the high number by 0.8: 309 * 0.8 = 247.2
If the results switch order, the ranges overlap and the numbers may be considered the same.
 
according to BJ's notes, the renal threshold of 280 is based on actual cat laboratory values. so it would be close to 280 on AT2 meter, but considerably lower than that for the human meter readings. All these months I felt badly that Murphy was mainly in the yellows and pinks - all I had to do was switch to a human meter and he would have been blues and yellows.
 
Carol & Murphy said:
I just repeated at +4 same drop of blood AT2 gave a 309 and Freestyle lite 213 --
I think this is a big difference - one way below the renal threshold and one above
Click to expand...
No. Both test results are most likely above renal threshold!

Merck's Manual indicates more than 280 mg/dL as above renal threshold (when glucose spills into kitty's urine). 280 is a lab value, not a value seen on a human meter.

When one is using a human meter, being above renal threshhold will be seen when kitty is throwing lower numbers than 280 mg/dL (since human meters run lower than lab values). And the difference between lab values and results from a human meter are much greater at higher numbers than in the low range.

Example: Using diastix sticks along with a human meter, my guestimate as to when Alex would spill glucose into her urine was when she was running in the 140 mg/dL - 180 mg/dL range on a human meter. Obviously, I can't be exact using diastix because they don't show what's happening in "real time", but it was a conclusion I felt comfortable drawing after quite a bit of testing over time.

I've seen many members quote and cite references giving 200, 240, 250, or 280 mg/dL as "renal threshold" in cats. What they neglect to mention... or perhaps don't know... is they should be referring to those numbers as lab values. It makes a difference!



ETA: Sorry, I didn't see the responses above while I was typing.




 
BJM said:
If the results switch order, the ranges overlap and the numbers may be considered the same.
Click to expand...
Very interesting indeed!
But if they are the same number (309=213 - 247=256) because they switched order how do we interpret that in the view of "renal threshold"? Which number matters 309 or 213? I'm a bit confused here. From my comparison AT2 meter reads very close to the lab value at the vet.
I would also like to say that my own comparison of meters is very similar to Mary Ann's.
Using BJM calculations all my numbers overlap but do we ignore the difference after calculation which sometimes seems to big, for example 6.8 v 6.3 = 5.4 v 7.6 so lower number on human meter is much higher (by 2.2 points).
Any thoughts?
@BJM apology to you as I'm sure you have given me that information (how to recalculate) before and I didn't really took it in as I did not have a lot of data on how my meters compare so today's post was very useful for me, many thanks.
Best regards to everybody.
 
Hi Marlena It's confusing indeed My AT2 reading has also been very close to the vet lab's reading
Murphy's amps was 283 on AT2 but 191 on human meter - I guess that is okay if you only want to look at trends, but we don't only look at trends - we look at the actual numbers
I was going to be switching to human meter as I switch Murphy from Prozinc to Lev tomorrow but I think I need to switch insulin first and then meters, otherwise I will be clueless - I didn't anticipate this much of a difference with every comparison I do. I'm keeping a tab on my SS with the comparisons I do just for some reference points for myself
 
I don't get hung up on if a single number as "it" when using home meters; they are most useful at lower numbers for safety purposes and for seeing general trends (the color coding of the spreadsheet). Not to mention that the lab reference value for renal threshold is an average which means some cats may spill glucose in the urine at higher values and some cats will spill glucose at lower values. ITs called individual differences, known here as "Every Cat Is Different".

In measurement theory, all measurements have what is called the standard error of measurement, even measures of length and weight. You will always have some variation in the values that are obtained, from various sources. Things like was this batch of strips made exactly identical to any other batch of strips, did the person measuring do it exactly the same way, was the measurement tool identical, were there environmental factors affecting the measurement (an example is heat tend to expand metals, so if your length measurement is using a metal ruler, it may give a slightly different value in the heat of the desert vs the cold of the Arctic), and so on.
 
I hear you BJ, but in the L&L protocols, the actual numeric value is the basis of action
I am going to start Lev tomorrow and was going to switch to a human meter
however the go slow protocol states the following:
"My cat's pre-shot level was way below the usual value. Should I give the injection?
A4.4. There's no hard and fast rule, but if you don't have data on how your cat responds to insulin, here are some general guidelines.
  • Below 150 mg/dl (8.3 mmol/L), don't give insulin.
  • Between 150 and 200 (8.3-11.1 mmol/L), you have three options: a.) give nothing; b.) give a token dose (10-25% of the usual dose); c.) feed as usual, test in a couple of hours, and make a decision based on that value.
  • Above 200 (11.1 mmol/L) but below the cat's normal pre-shot value, a reduced dose might be wise.
  • In all cases, if you are reducing or eliminating insulin, it's wise to check for ketones in the urine.
  • Above the normal pre-shot value, give the usual dose, but if the pre-shot value is consistently elevated, it's a good idea to schedule a full glucose curve to see whether a change in dose or insulin is appropriate. In most cases, the target "peak" value should not be below 100 mg/dl (5.6 mmol/L), and for some cats it might be higher."
If I switch meters now, I won't know what his normal preshot would be, correct? I'm thinking I should continue the pet meter for a few weeks (and maybe dual test with both AT2 and human) to get a handle on how he is reacting to Lev, or should I just go ahead and change insulin and meters at the same time so I can follow the protocol?
 
@BJM Thank you very much, one has to accept the variation and circumstances and that nothing is straight forward when dealing with FD.
I ask questions as I try to make sense of it all and I have to make decisions, it is rather difficult.
One of the difficult decisions I had to make recently was to decide if Rocky is ready for OTJ trial so basically to stop insulin or not. When I took into consideration that I use AT2 it complicated things further as I realised that some of his blue numbers would be green if I used a human meter and when I looked at some other cats SSs the caregivers stopped giving insulin on blue numbers on human meter. I was torn between desperately wanting a strong remission so to carry on with injections and not wanting to give unnecessary treatment.
I really value your opinion and appreciate your help. If you have a spare moment and could look at Rocky's SS and tell me what you think I would be so grateful.
Best regards,
Marlena
 
We call it off the juice/remission when there are 14 days of glucose tests between 40-120 mg/dL (2.2-6.7 mmol/L) on a human meter. He's a hair higher than that yet still in decent numbers without insulin, so you might keep monitoring after the 14 days.
Also consider how he is doing in other ways, such as the Secondary Monitoring Tools in my signature. The ones which are most sensitive for diabetes are food and water intake and output, dehydration, urine ketone and glucose testing, and behavior. Those are non-specific for diabetes, ie, may indicate other issues, so they are worth checking routinely (there is a linked chart in the tools' descriptions).
Also watch for signs of oral or bladder infections as infection may raise the glucose again.
 
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Carol & Murphy said:
I hear you BJ, but in the L&L protocols, the actual numeric value is the basis of action
I am going to start Lev tomorrow and was going to switch to a human meter
however the go slow protocol states the following:
"My cat's pre-shot level was way below the usual value. Should I give the injection?
A4.4. There's no hard and fast rule, but if you don't have data on how your cat responds to insulin, here are some general guidelines.
  • Below 150 mg/dl (8.3 mmol/L), don't give insulin.
  • Between 150 and 200 (8.3-11.1 mmol/L), you have three options: a.) give nothing; b.) give a token dose (10-25% of the usual dose); c.) feed as usual, test in a couple of hours, and make a decision based on that value.
  • Above 200 (11.1 mmol/L) but below the cat's normal pre-shot value, a reduced dose might be wise.
  • In all cases, if you are reducing or eliminating insulin, it's wise to check for ketones in the urine.
  • Above the normal pre-shot value, give the usual dose, but if the pre-shot value is consistently elevated, it's a good idea to schedule a full glucose curve to see whether a change in dose or insulin is appropriate. In most cases, the target "peak" value should not be below 100 mg/dl (5.6 mmol/L), and for some cats it might be higher."
If I switch meters now, I won't know what his normal preshot would be, correct? I'm thinking I should continue the pet meter for a few weeks (and maybe dual test with both AT2 and human) to get a handle on how he is reacting to Lev, or should I just go ahead and change insulin and meters at the same time so I can follow the protocol?
Click to expand...
Carol, maybe switching meters at present is not a good idea.
You could try to carry on with two meters for a while or you could just use AT2 (I love this meter!), make a note of the numbers you getting but putting the calculated number (AT2 number x 0.8) on SS or putting AT2 number on SS and make a note of your calculated number.
Would you consider a different human meter? I really like AccuChek Aviva.
And if join the L/L "gang" (ha ha calling them that in the best possible meaning) they would probably appreciate the fact that you give results from human meter.
I'm seriously thinking about switching to AccuChek but what stopping me at the moment is the cost of test strips. If my insurance covers it I will start using it again.
 
BJM said:
We call it off the juice/remission when there are 14 days of glucose tests between 40-120 mg/dL. He's a hair higher than that yet still in decent numbers without insulin, so you might keep monitoring after the 14 days.
Also consider how he is doing in other ways, such as the Secondary Monitoring Tools in my signature. The ones which are most sensitive for diabetes are food and water intake and output, dehydration, urine ketone and glucose testing, and behavior. Those are non-specific for diabetes, ie, may indicate other issues, so they are worth checking routinely (there is a linked chart in the tools' descriptions).
Also watch for signs of oral or bladder infections as infection may raise the glucose again.
Click to expand...
Thanks again.
So top number of 120 is 6.6. If you meant human meter that would more less equal 7.9 on AT2.
I have some issues with Rocky like arthritis, not being very active and not wanting to play much, eating a lot, I mean A LOT of grass and too much grooming. His test results are not perfect but the vet ignores them as not significant, for example his folate level is too low but used to be too high previously so I stopped giving supplement, other tests are inconclusive. I guess I will have to repeat them. But I have a feeling that something is not right but the vet has no clue and I have to push for particular tests.
'sigh'.
 
Marlena said:
You could try to carry on with two meters for a while or you could just use AT2 (I love this meter!), make a note of the numbers you getting but putting the calculated number (AT2 number x 0.8) on SS or putting AT2 number on SS and make a note of your calculated number.
Click to expand...
Hi Marlena -
If Rocky's folate is low it is easy to supplement with the zobaline. I understand how difficult it is to determine if Rocky is ready to be OTJ (I hope so)
I am not sure what you mean by a the calculated number - I don't think there is a clear scale to equate AT2 and human meter readings - what BJ was doing ( I think) is to illustrate that since every meter reading has a variance of +/- 20%, those two readings could represent the same number
 
Carol & Murphy said:
Hi Marlena -
If Rocky's folate is low it is easy to supplement with the zobaline. I understand how difficult it is to determine if Rocky is ready to be OTJ (I hope so)
I am not sure what you mean by a the calculated number - I don't think there is a clear scale to equate AT2 and human meter readings - what BJ was doing ( I think) is to illustrate that since every meter reading has a variance of +/- 20%, those two readings could represent the same number
Click to expand...
Carol, please ignore what I mention about calculated number - it is not a valid point.
Regarding Zobaline - I would not use it for two reasons. First: the main ingredient is B12 which Rocky, according to the blood test, has too much of (probably due to supplementation I used) and second: it has folic acid in it NOT folate. It is a big difference and I would not use folic acid for myself or Rocky. When I was giving Rocky supplemental vitamins with folic acid his folate in blood was too high because folic acid can be toxic and body will not use but throw it out in the blood (there is a conversion problem). The only form of folic acid I would use is the active folate 5-MTHF. High levels of un-metabolized folic acid in the blood have been associated with many health problems. I need to find out why he has low levels of folate and high levels of B12. But my vet hasn't got a clue so I have to repeat tests and do my own research.
 
Marlena said:
Carol, please ignore what I mention about calculated number - it is not a valid point.
Click to expand...
I appreciate you retracting your statement, Marlena. It's very important for those following along to know and understand there is not a scale to equate AT2 and human meter readings.
 
Jill & Alex (GA) said:
I appreciate you retracting your statement, Marlena. It's very important for those following along to know and understand there is not a scale to equate AT2 and human meter readings.
Click to expand...
Yes, of course, it can not be as I have my own record of comparison and can clearly see that's not possible. The difference varies and many people wrote about it here many times. It is quite a complicated issue.
But BJM's way of calculating the numbers gives a kind of idea and can be useful in some ways.
 
Marlena said:
Yes, of course, it can not be as I have my own record of comparison and can clearly see that's not possible. The difference varies and many people wrote about it here many times. It is quite a complicated issue.
But BJM's way of calculating the numbers gives a kind of idea and can be useful in some ways.
Click to expand...
Sorry, BJM's way of calculating the differences between readings from a pet-specific meter and a meter calibrated for humans was based on her interpretation of a statement in the Roomp/Rand TR Protocol. BJM's interpretation was proven to be flawed when one of the authors of the protocol weighed in on the subject. BJM was asked to remove the link to the info from her signature (which she did) and many of her posts have since been edited to remove the misinformation.

I'm not interested in digging up all the controversial posts and threads, but they're all a matter of record for anyone who wants to dig through past posts. I can save you the trouble. Bottom line (in a nutshell), in the interest of safety in the low range, a buffer was inserted in the TR Protocol for Lantus or Levemir (by nature an aggressive protocol). The reduction number is 50 mg/dL when using a meter calibrated for humans. 68 mg/dL when using a pet-specific meter. That's it. No other number ranges were addressed. I also might add, it doesn't necessarily mean 50 mg/dL (human meter) = 68 mg/dL (pet specific meter).
 
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