What does an "ideal" Lantus curve look like?

[Livvy's Lady]

We're working hard to get our little Livvy feeling as healthy as possible. Her diabetes has paled in comparison to the fact that she likely has a lesion (meningioma) on her right forebrain (see http://www.felinediabetes.com/FDMB/...-cat-similar-experiences.177940/#post-1963661 for symptom description). Only an MRI would say for sure, but the neurologist is fairly confident.

Given this, we're trying to get her diabetes regulated while we consider next steps for her neurological issue.

My question, what does an ideal Lantus curve look like? The primary care and internal medicine vets seem happy with numbers under 200. That seems like a high goal to me. And, should the "curve" be flat - not much variability throughout the day?

Thanks!

P.S. I should add that we're not following TR or SLGS at this time given Livvy's neurological symptoms - just trying to keep her feeling as well as we can.

 

[Tracey&Jones (GA)]

The ultimate goal on Lantus should be like a Mona Lisa smile. According to my vet's lab work range - 72-175.

PS don't look at Jones sheet - his is a little reversed due to the prednisolone he is getting.

 

[Livvy's Lady]

I should have added, "using an Alpha Trak II meter".

The ultimate goal on Lantus should be like a Mona Lisa smile. According to my vet's lab work range - 72-175.

PS don't look at Jones sheet - his is a little reversed due to the prednisolone he is getting.

Thanks, very helpful. I should have added that I'm using an Alpha Trak II meter. Is your vet's lab work range on the "cat" scale? Thanks very much once again!

 

[Sienne and Gabby (GA)]

If you look on the Lantus website (for humans), they describe the ideal curve as "flat." At the minimum, you want the numbers to be below renal threshold since diabetes is had on the kidneys. While renal threshold varies for each cat, below 200 (on a human meter -- it is probably close to the same on an AT meter) is acceptable. (You can find your cat's renal threshold by using Ketodiastix -- these test for glucose as well as ketones in the urine. At the point where glucose isn't spilling into the urine, your cat's numbers are below renal threshold. Or, just use below 200.)

We generally encourage most members to try to keep their cat in a normal BG range. With an AT meter, that would be above 68. Since you're using a spreadsheet that's been calibrated for an AT meter, basically, you want to see green or low blue numbers if you're shooting for normal range. Given the current neurological issues, I would not want to see Livvy's numbers drop too low. When we first had a kitty here with cerebellar hypoplasia, we encouraged @Anne & Zener GA to keep a close eye on Zener's numbers since we didn't know how low BG might affect Zener's neurological functioning. In Livvy's case, I would encourage you to gather the data so you know what's going on.

 

[Livvy's Lady]

If you look on the Lantus website (for humans), they describe the ideal curve as "flat." At the minimum, you want the numbers to be below renal threshold since diabetes is had on the kidneys. While renal threshold varies for each cat, below 200 (on a human meter -- it is probably close to the same on an AT meter) is acceptable. (You can find your cat's renal threshold by using Ketodiastix -- these test for glucose as well as ketones in the urine. At the point where glucose isn't spilling into the urine, your cat's numbers are below renal threshold. Or, just use below 200.)

We generally encourage most members to try to keep their cat in a normal BG range. With an AT meter, that would be above 68. Since you're using a spreadsheet that's been calibrated for an AT meter, basically, you want to see green or low blue numbers if you're shooting for normal range. Given the current neurological issues, I would not want to see Livvy's numbers drop too low. When we first had a kitty here with cerebellar hypoplasia, we encouraged @Anne & Zener GA to keep a close eye on Zener's numbers since we didn't know how low BG might affect Zener's neurological functioning. In Livvy's case, I would encourage you to gather the data so you know what's going on.

Thanks so much. This is very clear and helpful. We'll shoot for geeens and low blues. It's good to hear confirmation that a conservative approach makes sense for a kitty with neurological issues, too. Thanks again!

There does seem to be some correlation between Livvy's BG being high and her neurological symptoms being exacerbated. So we have to walk a fine line and, as you suggested, gather data.

 

[Anne & Zener GA]

We would always looks at those "ideal" curves and chuckle, rarely saw one with our Zener. He had cerebellar hypoplasia, sweetest boy ever. We never saw any BG regulation with Zener, but we tested enough to keep him safe and try to keep his numbers in normal range. We also started with the AlphaTrak, but switched to a human meter after 8 months or so, wish we had switched sooner, as the human meter was easier to use and much cheaper and seemed to work just as well. Lotsa vines for your Livvy, it's hard to balance multiple conditions.
Liz

 

[Gill & George]

We may switch to a human meter. I see lots of testing in our future. What about them makes them easier to use?

It's not so much the ease of use, but the cost of strips, and availability of strips, with the strips for the pet meters you need to order them, whereas the human meters are readily available at short notice in a pharmacy.
I discovered it made sense to have a back up meter, when George, sent his meter for a swim in his drinks fountain

 

[Livvy's Lady]

We would always looks at those "ideal" curves and chuckle, rarely saw one with our Zener. He had cerebellar hypoplasia, sweetest boy ever. We never saw any BG regulation with Zener, but we tested enough to keep him safe and try to keep his numbers in normal range. We also started with the AlphaTrak, but switched to a human meter after 8 months or so, wish we had switched sooner, as the human meter was easier to use and much cheaper and seemed to work just as well. Lotsa vines for your Livvy, it's hard to balance multiple conditions.
Liz

Thanks for sharing your experience. It's not easy going with multiple conditions, is it? Shoot, it's not easy with one! Luckily, Livvy is probably one of the most easy going patients ever. So that's a blessing.

We may switch to a human meter. I see lots of testing in our future. What about them makes them easier to use?

Thanks again!

 

[Livvy's Lady]

It's not so much the ease of use, but the cost of strips, and availability of strips, with the strips for the pet meters you need to order them, whereas the human meters are readily available at short notice in a pharmacy.
I discovered it made sense to have a back up meter, when George, sent his meter for a swim in his drinks fountain

Oh, dear. I can imagine all sorts of things that could go wrong and which would make having a backup meter a good idea.

I went through a far greater number of the Alpha Trak test strips than expected when we first got it, so I can see how readily-available human meter strips would come in handy. (And not just the FreeStyle Lite strips - those seem to be interchangeable with the Alpha Trak strips, but they cost near $90 US for a box of 50 at our local pharmacy!)

 

[Anne & Zener GA]

I think the human meter used a little less blood and the strip seemed to suck up the blood more easily. And it seems like the reading came up more quickly. Hard to remember, since we switched 6.5 years ago.
Liz

 

[Sienne and Gabby (GA)]

The AT strips and Freestyle strips are NOT interchangeable. At one point, Abbott made both the AT and the Freestyle meters. Abbott no longer manufactures the AT meter. I would not rely on getting accurate readings using Freestyle strips in an AT meter.

 

[Livvy's Lady]

I think the human meter used a little less blood and the strip seemed to suck up the blood more easily. And it seems like the reading came up more quickly. Hard to remember, since we switched 6.5 years ago.
Liz

Ok, I understand perfectly - I can barely remember what I had for breakfast. Thanks for commenting!

 

[Livvy's Lady]

The AT strips and Freestyle strips are NOT interchangeable. At one point, Abbott made both the AT and the Freestyle meters. Abbott no longer manufactures the AT meter. I would not rely on getting accurate readings using Freestyle strips in an AT meter.

Interesting. Like others on this board, I bought Freestyle Lite strips and tested them against the AT strips (with control solution and using the same drop of blood) with the AT meter. The control solution result was basically right in the middle of the acceptable range, and the results with the two strips with the same drop of blood were within 10 points. I did this only because (stupidly) I was running low on AT strips and could buy the Freestyle Lite strips locally. Now I am well supplied with AT strips. I only planned to use the Freestyle Lite strips as back ups. But now I'm wondering, should I be suspicious of them? Everything seems to be OK with using them. And any rate, thank you for raising a red flag, I'll try to just keep with AT strips...unless we change meters altogether to human meter.

 

[MrWorfMen's Mom]

The AT strips and Freestyle strips are NOT interchangeable. At one point, Abbott made both the AT and the Freestyle meters. Abbott no longer manufactures the AT meter. I would not rely on getting accurate readings using Freestyle strips in an AT meter.

Not sure where this information came from but the AT2 meter and the AT2 strips ARE still manufactured by ABBOTT. Zoetis who specializes in Animal health products partnered with Abbott to develop the AT2 meter years ago and the only thing that has changed is that Zoetis purchased Abbott's Animal Division and are now marketing the meter under their name. The packaging has changed but the meter and strips have not.

Zoetis is not in the business of manufacturing glucometers or the strips. The patents on the strips for both the Freedom Lite and AT2 meters are identical. Zoetis would have had to get new patent numbers if they were now manufacturing the AT2 strips or contracting their manufacturing to anyone other than Abbott because Abbott did not sell any human product rights to Zoetis. The butterfly logo on the strips for both the AT2 and Freedom Lite are also still the same and again, Abbott would not allow another company to use a logo it still uses for it's own human products. The AT2 and Freedom Lite meters also share patent numbers so again, Abbott is not going to sell a patent they are still using.

The difference between the Freedom Lite strips and the AT2 strips is that the AT2 strips are Freedom Lite strips that have been batch tested to determine which code on the AT2 meter will produce the most accurate glucose readings. Without the code for each vial of Freedom Lite strips, results will not be as accurate as is possible with the AT2 meter/strips set to the correct code. It adds another variable to the existing 20% meter variance allowance. AT2 strips So while I am not advocating using the Freedom Lite strips in the AT2 meter, they are a viable alternative should one find themselves running out of AT2 strips especially when facing a cat in low numbers.

 

[Livvy's Lady]

Not sure where this information came from but the AT2 meter and the AT2 strips ARE still manufactured by ABBOTT. Zoetis who specializes in Animal health products partnered with Abbott to develop the AT2 meter years ago and the only thing that has changed is that Zoetis purchased Abbott's Animal Division and are now marketing the meter under their name. The packaging has changed but the meter and strips have not.

Zoetis is not in the business of manufacturing glucometers or the strips. The patents on the strips for both the Freedom Lite and AT2 meters are identical. Zoetis would have had to get new patent numbers if they were now manufacturing the AT2 strips or contracting their manufacturing to anyone other than Abbott because Abbott did not sell any human product rights to Zoetis. The butterfly logo on the strips for both the AT2 and Freedom Lite are also still the same and again, Abbott would not allow another company to use a logo it still uses for it's own human products. The AT2 and Freedom Lite meters also share patent numbers so again, Abbott is not going to sell a patent they are still using.

The difference between the Freedom Lite strips and the AT2 strips is that the AT2 strips are Freedom Lite strips that have been batch tested to determine which code on the AT2 meter will produce the most accurate glucose readings. Without the code for each vial of Freedom Lite strips, results will not be as accurate as is possible with the AT2 meter/strips set to the correct code. It adds another variable to the existing 20% meter variance allowance. AT2 strips So while I am not advocating using the Freedom Lite strips in the AT2 meter, they are a viable alternative should one find themselves running out of AT2 strips especially when facing a cat in low numbers.

Thanks for this explanation. This is the first time I've heard about the batch testing of the AT strips. Now I finally understand the reason for entering the code on the AT with a new vial of strips, and why there's no code on the Freestyle Lite strips. I've been bothered by that, and am glad to understand it. Now I'm more comfortable with my strategy of using the Freestyle Lite strips as backups.