Another Glucometer thread

Discussion in 'Feline Health - (The Main Forum)' started by LestatsDad, Jan 18, 2018.

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  1. LestatsDad

    LestatsDad Member

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    Jan 18, 2018
    Sorry for the long post....

    The background - I just joined FMDB after Lestat gave my wife and I a bit of a scare last night. We took him to the Emergency Vets, and his BG at the time was a very low 24. Thankfully, we got him there in time, and he is responding to fluids/dextrose IV, and now they are working on re-adjusting/calculating how many units to have him on.

    In the meantime, I want to get a glucometer for basic spot testing, especially before his insulin is due. I know that isn't as often as I should, but even that probably could have prevented his accidental entry into a hypoglycemic episode.

    I know my choices are Human Glucometer (Relion seems to be the popular one here) vs an actual feline glucometer. I believe what I've learned from reading can be summed up as:

    Human: (Such as Relion) -
    • Better availability and Lower ongoing supply cost, but
    • Lower numbers than the actual Blood Sugar level,
    • No real good calculation/equivalency formula.
    • Numbers are slightly more accurate at lower ranges than higher ranges.
    • Good availability (can run out to wal mart as needed)

    Pet (AT2 or Advocate) -
    • Higher supply cost, but
    • More accurate numbers as they are designed for Feline blood
    • Limited availability unless I make sure my supply exceeds demand. (Online or from vet)

    I've yet to find a happy medium, such as a mid range cost with good availability, and accurate numbers.

    I'm leaning towards one of the Relion models, but before I make that purchase, I was wondering if anyone experienced with it could provide general guidelines for low, normal, and high, even if the Relion values won't match the actual Blood Sugar values, they can at least be used as guidelines.

    I know that normal blood sugar should be about 120-300 for a cat. But how does that translate for Relion values? I guess what I'm looking for would be Relion values that approximately equate to the following (with my guess in parenthesis):
    • Hypoglycemic; Get to Vet ASAP - (less than 60)
    • Low Sugar, but food/Karo Lite Syrup should help - (61-80)
    • Good Sugar levels - (81 - 200)
    • Slightly high, but normal insulin should resolve the issue - (201-25o)
    • High, possible increase of Insulin dose - (251 or higher)
    any hints/advice would be appreciated.

    Many Purrs of Thanks!
     
  2. Larry and Kitties

    Larry and Kitties Well-Known Member

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    Based on how the meters/strips work, tthere should be about the same % difference between human meter and pet meter/lab results. This means that at lower BGs, the numerical difference between mauman meter and pet meter will be smaller,
     
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  3. JanetNJ

    JanetNJ Well-Known Member

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    Normal on a human meter is 50-120 and on a pet meter it's 68-150.
     
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  4. LestatsDad

    LestatsDad Member

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    Jan 18, 2018
    Larry - That makes a lot of sense - thank you!

    Janet - That is fantastic to know! That will be a big help in figuring out where his blood sugar stands!
     
  5. Nan & Amber

    Nan & Amber Well-Known Member

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    Welcome!

    You've done a great job of laying out the pluses and minuses of human vs. pet meters, the only thing I will add is that many of us have found that, in managing FD, absolute accuracy isn't as important as trends in BG. The exception, of course, is at the low numbers. Around here, we use a "take action" number (action meaning feed high carb food or karo) of 68 for pet meters and 50 for human meters. 24 is scary on either, but I'm guessing that was a pet meter at the vet, so, :eek: :eek: :eek: ! Glad Lestat is there getting stabilized, that must have been terrifying!


    I'm not sure I can reproduce your divisions for the human meters. Janet has given the "normal range" of BG numbers, which is probably the most important info. After that, we're usually really looking at patterns over the course of a day to make decisions about giving a bit of food or making a dose change, not responding to an individual number. The exception of course is at the low end, when we definitely want to take action immediately to bring numbers up. HERE is some info about treating hypos with high carb food-- no cutoff number for going to the vet, it's a situational thing (if a cat is showing symptoms, isn't responding to karo, is known to have been given an overdose, etc.).

    Since you're using Lantus, you might want to drop by the Lantus/Levemir forum as well. There's a ton of information in the "stickies" there about dosing that might help you get a feel for how to interpret BG numbers on a human meter (both of the dosing methods used in this group (Tight Regulation and Start Low, Go Slow) were developed using human meter numbers).

    Let us know if you have more questions!
     
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  6. Critter Mom

    Critter Mom Well-Known Member

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    Jun 16, 2014
    Hi Lestat's Dad,

    I'm so glad that you got Lestat to the vets in time and that he's responding well. :bighug:

    I'm also glad to hear that you're getting geared up for home testing. :)

    On accuracy, a glucometer needs to provide readings which are accurate to within +/- a specified percentage of the actual BG value. This is true for both human and pet meters. IIRC in the US it's a legal requirement for a human glucometer to provide readings which are accurate to within +/- 20% of the actual BG level. I don't know what the tolerance specification is for pet meters but I would assume that it would be no broader than for human meters. This information should be obtainable from the pet meter manufacturer.

    While it is true that that human meters will read lower than pet meters when measuring a cat's BG, this is due to differences in the way that glucose is distributed in the blood in cats and humans, not due to a human meter measuring inaccurately. Both human and pet meters can safely and successfully be used to monitor cat BG levels as long as a reference range appropriate to the meter type is applied when interpreting the readings:

    * For readings taken on a human meter, the normal reference range for a cat's BG is 50 - 120 mg/dL.

    * For readings taken on a pet-calibrated meter, the normal reference range for a cat's BG is c. 70 - 150mg/dL (3.9 - 8.3mmol/L; reference range provided by my vet).

    If you were to test the same blood droplet with both human and pet meters they will read differently but both readings will be accurate to within the specified tolerances of the meters used. The mathematical relationship between the meter readings is a percentage type (no 'magic formula', unfortunately). The key thing to note is that for BG in higher ranges there is a large numerical difference between human and pet meter readings, but for BGs in lower ranges the meter readings are numerically much closer together.

    Did a vet give you this range? If yes then that is most likely the 'well-regulated' target BG range used by that particular vet for a diabetic cat being treated with insulin. (Note: With an appropriate long-acting insulin (e.g. Lantus), appropriate diet, and adequate home testing it is possible to maintain a diabetic cat's BG levels in normal, or near normal ranges. Even if not tightly regulating the cat, with adequate home testing and appropriate diet/insulin choices it is certainly possible to maintain a cat's BG under the renal threshold for most, if not all, of the day. (Renal threshold varies from cat to cat but some vets use the nominal value of 200mg/dL as measured on pet-calibrated equipment; human meter equivalent would be lower, but I can't say by how much.)

    • Hypoglycemic; Get to Vet ASAP - (less than 60) -
    • Low Sugar, but food/Karo Lite Syrup should help - (61-80)
    A cat is biochemically hypoglycaemic under 50 on a human meter. If a cat is under 50 then it is time to intervene to raise and keep numbers in the safe range. Whether to treat the hypo at home or whether to head for the ER depends on a number of factors. See this document for further information on treating hypos. (Note: Linked document uses human meter BG values.) Also, see this hypo toolkit document which has a 'shopping list' of supplies to keep at home for dealing with hypo situations.

    • Good Sugar levels - (81 - 200)
    Best: 50-120; Next best: 50 - c. 200 (under nominal renal threshold). If, following insulin treatment and/or change to a low carb diet, a cat can maintain its BG in the 50-120 range for a period of 14 days without any insulin it is said to be in remission, i.e. a diet-controlled feline diabetic.
    • Slightly high, but normal insulin should resolve the issue - (201-25o)
    If BG numbers are persistently higher than 120 then the cat is in diabetic numbers. Some vets won't issue a prescription for insulin unless the cat tests positive for glucose in the urine (renal threshold - varies from cat to cat, could be anywhere from 180 upwards, depending on which reference source you look at). Sadly, the cat may experience damage to pancreatic beta cells, other organs, and the nervous system at hyperglycaemic levels lower than the renal threshold.

    • High, possible increase of Insulin dose - (251 or higher) -
    If a cat on insulin has a BG level persistently above, say, 200 on a human meter then typically the dose would need to be increased to bring the cat under the renal threshold for at least part of the day (and preferably spending some time in the normal cat BG range to increase chance of pancreatic beta cells resting and recovering some function).

    If a cat's BG is over 200/250/whatever at preshot (i.e. before insulin is given) then it should go lower when the dose kicks in. Looking at preshot BGs in isolation is insufficient to determine whether an existing dose is safe. You need to establish the nadir on the current dose in order to determine whether the dose is actually safe and whether the nadir is high enough to support a dose increase. Depending on the insulin in use and the pattern of response of the individual cat, it is possible to see differences of hundreds of points between preshot and nadir BG levels (often only picked up in cats who are home tested), so you really need to know both how high and how low a cat goes on a given dose in order to determine if and when it is necessary - and safe! - to increase the dose.

    Because insulin's a hormone and cats' bodies are dynamic systems, insulin is not a 'dose to effect' treatment. Whereas there tends to be an overall pattern of response that a cat shows to a given dose of a given insulin, there will always be day-to-day variations. As Nan mentions above, one needs to assess overall pattern of response and trends in BG levels rather than focusing on individual readings.

    Hope some of the above is helpful.


    Mogs
    .
     
    Last edited: Jan 18, 2018
  7. LestatsDad

    LestatsDad Member

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    Jan 18, 2018
    Thank you Nan! The "Take Action" is a big number for sure... and yes, the vet Glucometer (I'll assume the AT2) read 24. Wife and I were both a bit freaked out - especially me (since I usually give the insulin, even though I know there was no malice intended in causing the issue). I'll have to look through the pages you recommended as I can.

    I probably am limited to a number as neither wife nor I are home during the day to do spot checks. But I hope/figure the Pre-Insulin number should be a half decent start.
     
  8. Critter Mom

    Critter Mom Well-Known Member

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    Jun 16, 2014
    Yikes! :eek:

    Not fun.

    :bighug:


    Mogs
    .
     
  9. LestatsDad

    LestatsDad Member

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    Jan 18, 2018
    Wow Mogs - All that information is amazing and very helpful for sure. I'll need to read over it a couple times to fully digest it all, but it looks fantastic. I got the numbers (120-300) from Google, but in talking with my vet, and knowing what some of Lestat's readings have been, they sounded about right. He's been over 300 before at spot BG's, and they haven't worried (probably due to the additional stress of the car trip and being at the vet). Even the emergency vet was happy when they got him to 360... I think he topped 400 before they gave him his insulin - that curve/check is tonight, so I'll know more tomorrow.

    Thank you again for all the info!
     
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  10. Critter Mom

    Critter Mom Well-Known Member

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    The preshots will be a good start but even getting a 'before bed' test in every night would help you better determine how safe the current insulin dose is.

    There are helpful hints on when and where to snag tests to build a better picture of how a kitty is responding to a given dose in the following sticky post (from the Lantus & Levemir ISG board):

    http://www.felinediabetes.com/FDMB/...ion-possible-with-a-full-time-job-yes.129378/

    Many of the practical suggestions contained in the above will be helpful for anyone who's treating a cat with Lantus but who is away from the house for a goodly amount of time each day, not just kitties who are following the Tight Regulation Protocol.


    Mogs
    .
     
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  11. LestatsDad

    LestatsDad Member

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    Jan 18, 2018
    Definitely not. Gonna have to have a talk with Lestat about scaring us like that... LOL
     
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  12. Critter Mom

    Critter Mom Well-Known Member

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    This is why only getting checks at the vets can sometimes lead to kitties ending up on too high a dose.


    Mogs
    .
     
  13. Critter Mom

    Critter Mom Well-Known Member

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    Absolutely!! :D

    .
     
  14. LestatsDad

    LestatsDad Member

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    This is another great link! Thank you!
     
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  15. Critter Mom

    Critter Mom Well-Known Member

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    I am an Alphatrak user. Whereas on a normal day I might not exactly be thrilled to see my cat at 360, if she'd previously been at 24 that 360 would have had me turning cartwheels in the ER! :joyful:


    Mogs
    .
     
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  16. Vader723

    Vader723 Member

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    Dec 12, 2017
    I don’t have anything to add that others haven’t already provided, other than a hearty sigh of relief that the hypo was caught and Lestat is in good hands and on the mend!
    Also, such a very handsome boy! I have a soft spot for black kitties :cat:
     
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  17. Maggies Mom Debby

    Maggies Mom Debby Well-Known Member

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    Dec 28, 2009
    I have no info on meters (haven't had a sugar cat for quite awhile), but I can't help noticing everyone's cats names. You have a cat named Lestat and the last commenter in this post has a cat named Vader! I sure hope they don't live up to their literary namesakes...
     
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  18. Critter Mom

    Critter Mom Well-Known Member

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    Quite a fitting name for a sugar! :cat:


    [​IMG]

    ;)


    Mogs
    .
     
  19. LestatsDad

    LestatsDad Member

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    For Lestat, living up to his namesake is how he earned his name. As a kitten, he liked to climb up my wife (or myself), curl near our neck for a bit, and then nip our neck out of the blue. He'd also spread his front legs when jumping, as if they were bat wings and he wanted to fly. :Do_O
     
  20. Maggies Mom Debby

    Maggies Mom Debby Well-Known Member

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    Oh my! And he looks so pretty and sweet!
     
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  21. Critter Mom

    Critter Mom Well-Known Member

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    He's just lulling you into a false sense of security ...

    Mwaaahahahahahah!!! [​IMG]


    Mogs
    .
     
  22. Vader723

    Vader723 Member

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    Hah! Vader is a pacifist love bug, which causes me some distress in regards to the other cats being jerks sometimes, as they are both tremendous bullies! But even Darth Vader wound up being sort of a good guy in the end :)
     
  23. LestatsDad

    LestatsDad Member

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    Jan 18, 2018
    Debby - he can be quite the love-bug for sure... but Mogs is right - he's lulling you in - either that or trying to butter us up for treats, both kitty and human. lol
     
  24. LestatsDad

    LestatsDad Member

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    Jan 18, 2018
    And nearly forgot to say - he's back home. The Emergency clinic has lowered his dose to 1 unit, and wants us to cut out his (and by proxy, his siblings) Purina DM... There will be a riot if we do that! :eek::nailbiting:

    I'll try to get in touch with his regular vet tomorrow, and get their opinion. I'm sure he'll need an official curve in a week or so.
     
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  25. Badtux

    Badtux Member

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    Dec 9, 2017
    On the Relion Confirm 40 is the cutoff below which you start taking emergency action. It seems to read a bit lower than some other human meters probably because of the small sample size. That said, if you're reading in the 40's, it's time to cut back your insulin dose. I cut back from 2U to 1U when I got into the 40's, and then his blood sugar rebounded but never got above 101 and soon settled back down into the 50's with an occasional foray into the 40's and 80's. I ended up cutting him back to 0.5U for a couple of weeks during which he stayed between 50 and 90 with an occasional foray into the upper 40's, then a tiny 0.25U for a few days, then finally discontinuing altogether and have been monitoring him at random times but he's never gotten below 47 or above 83 since then, he's being diet-controlled on the Catkins Diet (low carb high protein).

    So I have to say that normal blood sugar on the Relion Confirm is between 47 and 83 for a healthy controlled cat receiving no insulin because that's what I see on an actual controlled cat receiving no insulin.

    As someone else mentioned, the trends are the important thing. I knew to cut back his insulin when the trends told me. When he settled down into that 47 to 83 area when sampled randomly at various times in his cycle it was time to cut back his insulin and see what happened, generally he spiked up a little after that, then settled back down (I knew to discontinue at the 0.25 because there wasn't a spike, he stayed in the controlled range) . Some people do a spreadsheet. Me, I keep a paper journal with a fountain pen beside it, just because I like fountain pens and real paper (call me a traditionalist, eh?). I can still flip the pages and see the trends just fine.
     
  26. Nan & Amber

    Nan & Amber Well-Known Member

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    Mar 19, 2016
    I don't think I've ever heard that. Have you compared side-by-side readings on the same blood drop from the relion to readings from another human meter? It may be that the relion is more prone to bad readings ("wonky strip") due to the small sample size.

    It's definitely true that some cats will regularly run in the 40's (or even the 30's!) while not on insulin. We set the safety cutoff at 50 for two reasons: first, there's a lot of variation among cats in terms of their tolerance for low glucose, and although some cats normally run low naturally, many others will show at least mild external hypo symptoms in the 40's (or be biochemically hypo but not show external signs). Second, it's not just the current number that is the concern when a cat has been given insulin, it's where the numbers are going. With insulin in the picture, downward trends have extra momentum behind them, and you want to put the brakes on early in the process to keep the cat safe. The 50 take-action cutoff was set in order to ensure safety in these situations.
     
  27. Critter Mom

    Critter Mom Well-Known Member

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    Jun 16, 2014
    Hi,

    I'm a bit concerned about the above. Do you mind sharing where this information came from, please?


    Mogs
    .
     
  28. Badtux

    Badtux Member

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    Dec 9, 2017
    My cat and comparing the Relion Confirm with the Contour Next One. Two different batches of Confirm strips from sealed bottles. The Confirm seems to read about 10-12 lower than the Contour Next One. Repeat: Two different bottles of Confirm strips. I see occasional readings in the high 40's *without* any insulin in the picture, so that validates what I saw when doing the comparison, that this is a normal number for a cat on the Relion Confirm.

    Went back through my logs. Lowest number I hit was 43. No symptoms of hypoglycemia. It was outside the trend line so I shot him anyway. Do note that I was using Lantus on a low 1u dosage. If you're using a fast acting insulin or a higher dosage obviously don't shoot when you see something that low.

    Caution: I had enough data to fairly accurately predict what my cat's blood sugar was going to do and how the Lantus was going to affect it. If you don't have that data, the cautious and correct thing to do is don't shoot.
     
    Last edited: Jan 20, 2018
    Reason for edit: Add caution
  29. Nan & Amber

    Nan & Amber Well-Known Member

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    Yes, shooting numbers in the 40's really isn't recommended. I'm glad Tux was fine, but honestly, I wouldn't do it even if I had years of data on my cat, it's just too risky. I'm emphasizing this point for anyone reading this thread, especially any newbies. Getting that kind of number at pre-shot warrants, at best, a stall, but most likely means skipping a dose and reducing the dose at the next shot time.

    Sure sounds like the Relion you have runs consistently low! Good to know. Meters are allowed a 20% variance, which I usually think of as an error allowance, but it's definitely possible for some meters to be biased up or down. I use a Contour meter and my cat who is off insulin sees numbers in the 40's regularly, while the CVS-branded meter I have as a backup tends to run a bit higher.

    With all of the variables involved, though, I do think it's better to stick with 50 as the general cutoff number. FD is complicated enough already, if we start having different cutoffs for different brands of meter (other than, of course, human vs. pet, which really do work differently), we'll all go (even more) crazy!
     
  30. Critter Mom

    Critter Mom Well-Known Member

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    @Badtux -

    First up, I hope you will read the following post in the spirit with which it's meant, namely that of keeping kitties safe and helping new members to learn more. I say this because I'm always very conscious that text-only communication has little to no tone or nuance and I don't want to cause any upset or misunderstandings. :)

    [Emphasis mine]

    Not quite so. This is a 'normal number' for your cat using your Relion Confirm meter and therefore not a sound foundation upon which to base generalised statements. In comparison, the guidelines for human meter use at FDMB are based on evidence from scientific studies of a statistically significant population and are intended to be safe guidelines for caregivers using *any* brand or model of human meter (faulty or design-flawed meters excluded, obviously).

    As Nan comments above, it is possible that a different Relion Confirm meter might, on average, tend to give higher readings than the meter you are currently using, just as your Contour Next One meter did (hence the reason why manufacturers can only claim accuracy of their meters to within the specified tolerance and why you see frequent advice here to just stick with one meter to track a kitty's BG; using different meters at different times would add an additional variable element to test results, making gathered data less reliable).

    Your experience with your meter is helpful in that it raises the issue of whether individual meters may have a slight bias. In addition, it is helpful because it is a perfect example of why it's important to set a hypo threshold at an appropriately high level - and also why it's important to follow well-established safety guidelines. To wit, consider the situation where a cat's 'actual' BG level is 39 but a caregiver is using a Relion Confirm meter which tends to read slightly higher than the 'actual' BG value (unbeknownst to the caregiver). For the sake of argument, let's say that in this hypothetical situation the meter reads '49'. If the caregiver follows the FDMB guidelines and takes action to raise BG upon seeing the '49' reading then the cat will have been prevented from dropping to a more dangerously low BG level. However, if that caregiver were to follow a recommendation that 40 is a safe number when using a Relion Confirm then by the time that cat's BG registered at 40 on their particular meter its 'actual' BG would be even lower than 39 and the cat would be at greater risk of harm.

    One of FDMB's greatest strengths is the sharing of individual experiences in order to broaden the knowledge of all readers. That said, when it comes to safety matters it is critically important to qualify certain of those shared experiences and to explain to readers the basis upon which any generalised statements are made, hence my earlier enquiry about the source of your information.


    Mogs
    .
     
    Last edited: Jan 21, 2018
  31. Critter Mom

    Critter Mom Well-Known Member

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    Ditto, and risk analysis seconded.


    Mogs
    .
     
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  32. Larry and Kitties

    Larry and Kitties Well-Known Member

    Joined:
    Dec 28, 2009
    That is not unexpected at all. The "20%" is made up of different parts like:
    - Error in the strips. Having different codes for different lots of sstrips helps reduce the error
    - Error in the method used to determine the BG value
    - errors in the meter. This is made up of a constant error and variable error like how good the strips contacts make contact with the contacts in the meter.
    Thus, the constant meter error can result in a meter that tends to always read high compared to either another meter of same design.

    I agree that it it no recommended but I do it occasionally, especially with my Patches II. On the PM of this month I gave her a reduced dose (1 unit vice about 1/8)) of Levemir with a PS of 42 (human meter). The next morning's PS was higher than normal, as expected wojh the reduced previous dose. Patches tends of have lower PMPS tyhan AMPS.
     
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