1 st timer with DKA and bad glucometer

Hi, everyone! Glad to see the wealth of knowledge in this site.

I just want to start with one quick question. I have two diabetic cats Casey and Ozzie. Casey is my critical concern at the moment. Has anyone had a meter that gave glucose readings about 300 pts lower (mg/dl) than lab values?

On Friday took her to the vet nausea vomiting, not wanting to eat. Glucose was up to 577, ketones moderate, but she was holding in there. Ph 7.32 a little not to bad, lytes (electrolytes) all with in normal range and bun a little high 41 and creatinine at 1.7. Liver enzymes and pancreatic were normal. We, vet and I, decided to do an inpatient aggressive day IV fluids, antiemetics, freq blood sugars. By 3 pm she was pretty close to her normal self and ate 3oz of a science hill can for the vet. At 6p, he would probably have liked to keep her overnight, but said she was doing much better and could go home, unfortunately money and stupidity trumped. Well, I figure I've got my subcutaneous fluids and my handy glucose monitor and 20 yrs experience treating DKA (in humans) basic principles same, but used to a hospital ICU with bells and whistles most vets could only dream of not the same at home without that equipment. Oh yeah, and emotional involvement. Ignored the biggest thing I never do at work my gut, Knew things were not right.

Any way so as the night goes she is just off. Checking her sugars every 2 hrs. Started at 274 gave PZI 1unit per sliding scale vet put together for her. Next 76, then climb over the next 24 hrs with min dips here and there looking very normal for a cat that will not eat much despite nausea, antiacid, appetite stimulant, and anti anxiety. Did get her to take about 2-3 oz of high protein, low carb calorie dense shake with vitamins. Roughly 90 cal. Talked with the vet gave him her readings and updates on fluids and meds. By Sunday morning really not well glassy eyes, resp rate looking a little labored. She just looked stressed. Her sugar is 215, 5am with still positive mod ketones ( told to expect). Give her 25o more of Normal Saline with lytes and had to go to work. My husband took her back in by 11 am. Her Glucose by lab 589. I did not have one over 240. I know now what I was assigning to me being nervous and her having way to many meds in her with sedating side effects was rebound in to DKA. By 6 tonight they were asking about resuscitation. So hard on this side. Her labs were marginally improving, but she looked wore out. In humans, this is when they get put on a ventilator and let it work to fix the acidosis while you rest and we do all the changing in fluid and lytes.

Anyways, Just wanted to see if anyone had seen huge discrepancies in their glucometers. I had to buy a new one on fri because my decided it was time to quit. My old one was just a CVS glucometer worked wonderfully inexpensive strips, and always was fairly close within usually 5-10 points. I bought a True Test 2 go great test outs in studies, but I just think it was wrong and she was high all day Sat.

Sorry, if I am rambling just a huge weight of guilt and feeling useless while she fights for her life. Thanks for listening and any insight would be appreciated.

 

Oh, you poor things. I'm so sorry to hear this. I SO hope she will be ok very soon. Don't feel guilty, please. We do all we can for our furries and guilt is just not useful or needed here.

 

Thank you for and Your right. Guilt does no one any good.

 

And there is simply no reason for it. We all do our best. And our babies know it and appreciate it.

 

Hi,

You may be right about the meter.
Folk's experience here is that the 'True' meters can have issues with measuring cats' blood glucose. If I recall correctly (and someone please correct me if I'm wrong) the problem is with the higher numbers. They are unreliable with registering numbers above a certain level. And there have been folks here who thought their cats were in quite decent blood glucose numbers until they changed their meter...

I am so sorry to hear about your girl.
Keeping everything crossed here that she soon recovers from this episode.

Eliz

 

I always wonder how good the accu-chek performa is in that regard.

 

Also, tests at the vet may read 100-180 mg/dL higher than at home due to vet stress.

 

An AccuCheck is a satisfactory meter.
:
Based on previous post, "Tru" meters read low and are really not acceptable for cats. That is likely beacuse meters can use two different means to measure blood glucose:

Blood has two constituents, the red and white blood cells and the liquid (serum). Blood plasma is blood serum without the clotting factor

The blood glucose value obtained via laboratory analysis is the glucose level in the serum/plasma constituents of blood

The glucose is in both the serum and red-blood cells (RBC) themselves. However, the distribution of glucose is different between humans and cats (and dog too)1

In Humans 58% is in plasma/serum and 42% in RBCs

In cats 93% is in plasma/serum and 7% in RBCs

In dogs 87.5 % in plasma/serum and 12.5% in RBCs.

The point-of-use blood glucose meters (the ones we use at home) all use whole blood.2 However, what specific blood glucose they measure varies with the manufacturer. Some manufacturers only measure the glucose in the serum/plasma. Others lyse (disrupt the cell walls of the RBCs) and thus mix the glucose that was in the RBC into the liquid and thus measure total glucose. The meters then correct/adjust the reading to be equivalent to human blood plasma

Discussion:

Since the glucose distribution is different n humans and cats/dogs the resulting BG valve obtained from the human meters will be different that lab values and animal-calibrated meters. Also, some manufacturer's meters will be much different that lab values for animals depending upon which method (lyse cells or only use plasma/serum) they use to measure glucose.


Animal calibrated meters correct the value to be equivalent to lab values.


What clouds any BGs obtained from hand-held meter is that they are only accurate to +/- 20 %. That includes the animal-calibrated meter. Also, do not confuse accuracy with reproducibility. It is expected that one meter with one lot of tests strips to be relatively repeatable, that is if you use the same drop of blood, you BG value will be much close than +/- 20%


References:

1. WHY DO YOU NEED A SPECIES SPECIFIC METER?

2. Glucose Meters: A Review of Technical Challenges to Obtaining Accurate Results