? AlphaTrak Readings

Discussion in 'Lantus / Levemir / Biosimilars' started by bxkitty, Oct 27, 2018.

  1. bxkitty

    bxkitty Member

    Joined:
    Oct 23, 2018
    Hi everyone!
    I'm sure there's a few different time zones on here (I'm EST myself), so I'll understand if it takes some time for someone to see this and give advice :)

    I finally managed to try a glucose curve tonight. I only started trying to test a few short days ago. Sophia's numbers were in the double digits (nothing crazy low according to my AlphaTrak manual). On my way home from work, I called the vet's office to give them her numbers and ask about what they would mean for her insulin intake. The girl I spoke with was super nice and everything, but she made me realize there was stuff I didn't know because I had never asked or never even thought to ask. What I mean is, shouldn't the doctor assume (or try and remember) that you may still be new to diabetic cat life, despite all the research you can do yourself online, and tell you everything you should know before you suddenly realize you need info on another thing?

    Anyways, here's my main question to ask:
    My vet's office said that if Sophia's levels are >150, I should give her the insulin, 100-150 is the 'okay' range, and <100, do NOT give insulin.
    Those of you who have used AlphaTrak for monitoring, would you say these numbers given to me are true or are the numbers in the AlphaTrak monitor (<65 = too low; >250 = too high) a better number guide to follow? (I tried looking up levels online and got different acceptable GB level ranges a lot of the time).

    Here's Sophia's readings from tonight:
    [​IMG]

    P.s. I was never asked or told them which glucometer I was using. Idk if they made an assumption on their endor if these were overall general numbers to go by.
     
  2. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    Normal BG using the AT2 meter is 65 to 150. IDEXX labs uses a range of 72 to 175 as normal. Looking at your BG testing to date, Sophia has stayed pretty much within normal range on the AT2 (and definitely within normal range using IDEXX range) without insulin. On the days you gave insulin, Sophia's numbers are absolutely perfect however because there is no pre-shot test, we don't know how much the insulin dropped her BG on those days.

    Lantus is a depot insulin which means that while the body uses some of the insulin given each cycle it also stores some in a "shed" to be used when the insulin given starts depleting so the full effect of a specific dose of insulin (in this case 1u) generally takes a few days of consistent insulin dosing to build up the "depot" and see the real effects of that dose. I notice Sophia was diagnosed in Sept. Has she been on 1u the whole time?

    There is also a phenomenon where too much insulin can look like too little and I find it interesting that Sophia's BG is higher on the 26th than it was for the 2 days prior. This along with the BG readings suggests to me that 1 unit may be more insulin than Sophia needs if Sophia needs insulin at all.

    I'm really glad you decided to start testing Sophia at home given the numbers you have on your spreadsheet. It is really the only way to keep Sophia safe.

    If I were you, I'd check Sophia's BG first thing in the morning or evening before feeding her and at least 2 hours after her last meal so the reading is not food influenced. Don't give her insulin, feed her and then check her BG again 3 hours later to see if her BG has gone down, stayed roughly the same or gone up. If it has stayed the same or gone down, it's likely Sophia's pancreas is working at least to some degree and you may want to do a trial to see if she has gone into remission. This would involve testing morning and night daily to see if her BG stays in normal range without insulin. If she stays in normal range for a period of 14 consecutive days, then you can consider her in remission. If at any time during that trial period, Sophia's BG starts going up, then I would post here for advice about whether to resume insulin and if so, what dose to give.

    Was Sophia eating dry food and switched to the wet DM diet since diagnosis? Sometimes diet change alone can bring BG numbers down.

    The dosing advice your vet offered is not the way we dose here and without more data given the readings you have accumulated so far, I would be hesitant to give any insulin for any reading below 200 until you get a bit more data. I'm inclined to think she might need less than 1u if she needs insulin at all:).
     
  3. bxkitty

    bxkitty Member

    Joined:
    Oct 23, 2018
    Thank you for all the info and advice!
    I only recently got info on pre-shot testing thanks to this forum, and I've been having a bit of trouble learning/knowing how long before her food/shot time would be okay enough to do a reading because the closer to food time it is, the less cooperative with staying still in order for me to warm her ear and prick it for the test she is. -_- If you happen to have any advice on this, I'd appreciate it :)

    Sophia has been on 1u since her diagnosis. I had initially started using urine strip tests with her since I was very afraid about how GB testing would go with her. She doesn't like to be touched too much and may get upset over it (e.g. scratch and/or hiss). Once the test strips started turning a blueish color closer to the negative reading, I consulted with my vet on the next steps to take, and he highly recommend the glucometer testing. - And after getting a bit more info on testing and insulin, I agree that maybe she might be better with a lower dosage, however, I only have full unit syringes; never thought to ask if the pharmacy had 1/2 unit ones too when I initially got them. I think I was probably too overwhelmed by everything to think about it.

    10/26, I had given her her insulin in a different part of the house (I usually use the bathroom for this, but it was preoccupied and I didnt want to wait), and I realized after the fact that the needle wasn't 100% in but that only a small amount of the insulin may have been injected. So this may be why her preshot reading for that night is in the 100s. I also didn't give her any insulin that night based on the info I received from my vet's office. And I know I should test her maybe 4 times a day minimally (?), but I'm low on strips at the moment and will be getting more soon in the mail, and I plan on doing another curve on Wednesday when I'm off of work.

    Sophia was switched to a wet food diet as soon as her treatment started. She had been eating dry food otherwise. However, since then, she's been only eating the prescription food for mealtime. I was informed that if I test too soon after eating that the reading may be a little skewed because of this. 10/24 I did a reading roughly 2 hours after she had eaten and the numbers were below 65 (I tested her blood twice, a few minutes apart), however, she was perfectly fine. I even did a test with the solution to see if the reading was off for whatever reason. I then tested her 3 hours after that and the number was a bit higher. So, I think maybe 3 hours after eating may be a good minimal number of hours to wait?
     
  4. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    Yes, I'd wait 3 hours and see what she does without insulin at least for a few days. Keep track of your readings on her spreadsheet and if her numbers start going up, she may need some insulin but perhaps not a full unit. We recommend having syringes with the 1/2 unit markings because with our little ones, a 0.25u change in dose can be significant. Seems as though the diet change has lowered Sophia's BG....the question is whether it has put her into remission or not.
    If you do find her numbers going up, please post and we will help you sort out next steps. Fingers crossed she stays in good numbers.
     
  5. Marje and Gracie

    Marje and Gracie Senior Member Moderator

    Joined:
    May 30, 2010
    Welcome to this forum!

    I hate to throw a monkey wrench into the “works” but I’d like to offer a different take than Linda (Mr.WorfMen’sMom).

    First, there is no set normal range for the AT2 (or any pet meter). You can look at the information provided by Zoetis and it tells you that below 65 is considered too low but it never references a “normal” range. We intentionally don’t identify one on any of the information in the stickys because there is no way to translate the numbers from a human meter to a pet meter. The normal range from the labs are based on their equipment and it reads differently than the AT2.

    I’m not sure where Linda got the 65-150 but, as an example, my vet would say “normal” is 68-138 but admits that is not documented in literature anywhere; it’s just her general approach. The way we approach it in this forum is that if you are using an AT2 and following Tight Regulation, dose reductions are earned for a newly diagnosed cat (less than one year diabetic) by a drop below 68. After that, we use the same cutoff numbers for the AT2 as we do for human meters when we are following the TR protocol.

    For Start Low Go Slow, the reduction number is 90 regardless of whether you are using an AT2 (or other pet meter) or a human meter.

    When determining whether Sophia is on a good dose or not or whether she needs insulin or not at any given time, we would not use any lab reference number to make that determination. In other words, to say she’s in normal numbers by IDEXX range is not applicable here in terms of the methods we follow to regulation.

    The correct term to convey how lantus (or levemir) is stored for slower release is always “depot” although they have different ways they form the depot and slow release. Lantus forms an insoluble precipitate in the subcutaneous fat (the “depot” ) and slowly releases into tissue. Here is information regarding the insulin depot.

    This “phenomenon” referenced does not apply here. At +5 in the pm cycle, her BG was 85 and then 98 at AMPS. That’s pretty flat. Her numbers then climb because the dose was lowered at AMPS and no shot was given at PMBG.

    We don’t know yet if Sophia’s depot is driving these lower numbers; it can take up to six cycles to see the effects of the 1u disappear (the depot to deplete). However, her dose should have been dropped to 0.75u the morning of 10/25 based on the low numbers in the previous evening cycle. Because of the effects of the depot, we might have suggested another reduction was not necessary after the drop to 65 on 10/26.

    We don’t normally go from 1u to remission because we want a strong remission. However, it is possible that Sophia is doing so well because the dry food is gone and it is possible she is no longer insulin dependent but we need to give it a few more days to see what happens with her BG. It’s important to get those tests in...especially the AMBG and the PMBG and a mid cycle test so we can evaluate whether she will need insulin or not.

    Although we don’t have a “no shoot” number in this forum, we usually advise new members with little data that if the BG is 150 or lower, they should stall without feeding and post for help. We can then run you through options of whether to shoot or not. But.....you will see many members shooting the kinds of numbers you are getting. Some of their cats are just on a drop of insulin but they are following the protocol to remission. Whether her pancreas is working well enough to allow her to be insulin independent is yet to be determined.

    Great job on getting the SS up and running and getting some numbers entered.
     
    Last edited: Oct 27, 2018
    Jill & Alex (GA) likes this.
  6. bxkitty

    bxkitty Member

    Joined:
    Oct 23, 2018
  7. Marje and Gracie

    Marje and Gracie Senior Member Moderator

    Joined:
    May 30, 2010
  8. bxkitty

    bxkitty Member

    Joined:
    Oct 23, 2018
    @Marje and Gracie That makes perfect sense. Sorry about that xD and thank you for helpful tip and link :)
     
    Marje and Gracie likes this.

Share This Page