Frustrated and confused after vet visit. AT vs human glucometer

I just got back from the vet and she was very happy with the progress that Kyo has made and loves the spreadsheet. I brought in my human glucometer (ReliOn Micro) and told her that's what I was using and she wanted to do a side by side test with the Alpha Track. It read a whole 100 points higher which I expected from the information I've read on here. While she said she liked my meter she told me that I should be adding that 100 points to my readings. If that's true, then that means I have been UNDERDOSING my cat by a large margin! I have had 2 PJ parties where I stayed up all night thinking she would go into hypo at any moment..and now I'm just wondering if I have completely misunderstood calculations or what the heck.

*whew* I feel better after venting.

So my question is, is my vet right? Should I be adding 100-150 points to my human glucometer readings? If so my cat is not as close to remission as I thought and I've terribly upset about it..

 

No, your vet is not right. Oh bless them! I wish they would do more research before they scare people. If you run side by side tests, you'll find that both meters will vary quite a bit. Sometimes they'll read closer together, sometimes not so much. Plus, unless she did it right there in front of you, you can't be sure she even had her meter coded correctly (vets make mistakes too). It can be helpful during PJ parties to have both meters to try to get a sense of how low the kitty really is, but on a day-to-day basis, you just pick one meter, and take it at face value. You'll drive yourself nutty trying to second guess it. And again, adding 100 points each time would be wildly inaccurate since it won't vary by 100 points each time.

I'm sorry you're having to sort through this stress. A lot of us have had conversations just like this with our vets. My first time, my meter read 250, and the vet's read 375. Yikes. The next time I went in a couple of months later, still insisting on using a human meter, we did it again and my meter read 107 and the vet's read 95. Aside from the fact that they swapped places as far as which meter read higher, the obvious fact of Sam's health and improvement was enough to end the argument. Now he just takes my numbers at face value and we move on with the conversation.

 

NOOOOOOOOOOO! YOUR VET IS TOTALLY WRONG! Sorry for yelling but that is hogwash.

The AT2 meter will generally read higher and the difference in the readings will generally get larger the higher BG. At low range numbers the readings are much closer together. Cat blood and human blood carry glucose differently so there is no way to convert human meter readings to pet meter readings. There is also meter variance allowance of up to 20% which is just another confounding fact that means you can't do any calculation to convert the meter readings from one to the other. Even 2 AT2 or 2 human meters would not necessarily read the same and might have what seems like a significant difference.

Interestingly, if you graph comparison readings from a human meter against readings from an AT2, the graph will look very similar. Tell your vet to look at the pattern not individual numbers.

 

sorry your vet doesn't understand the difference between the readings on pet-specific meter vs human meter ..
perhaps she also doesn't realize how much the stress of the vet's clinic will spike the BG

she's wrong (don't tell her I said so ) -- at the low end there is very little difference between the readings for the two types; well within the expected variance of the meters (they're allowed a 15% difference according to one standard)

at the high end there is quite a difference -- my vet and I did a simultaneous test too -- her reading on the AlphaTrak was 70 points higher than mine on the Confirm (the bigger twin to your Micro), but she also looked at my spreadsheet, asked about Catcat's behavior at certain times, and realizes now that each type of meter will wind up with results showing the same curve, but the numbers will be different

there's no numerical correlation, no algorithm to translate one meter reading into another -- high is high, low is low, in between it's like a pair of parallel ziplines

actually, pet specific meters are a fairly new invention -- vets used the same meters as humans for years -- and almost all the advice here was generated by people using human-targeted meters .. they're easier to come by, as are the test strips, they're more economical, and they're held to the same criteria -- the big difference is that the official AlphaTrak strips are rigidly quality controlled and optimized for a particular code for the machine .. perhaps one reason they're $$

 

Oh my goodness, I'm so glad I asked this question. I was so upset to hear that news with all the positive progress I made. It just didn't sound right with the way Kyo seems to be improving. I'm glad she didn't try to get me to up the dose at least. I'm going to have to figure out a way to explain to her in a month how I didn't add the 100 points like she asked me to, but that's another can of worms for later. Thank you everyone for reassuring me that we are on the right track. It's unfortunate that even the nicest and most understanding vets still might not have the best information about everything related to FD. And as much as I wish I could afford the AT2, until I finish college I'll have to work with what is economical for me. I hope this may clear up any future concerns for other people who get this news from their vets as well.

 

I was curious, looks like the original AlphaTrak was released for sale in 2006 -- doesn't seem like a long time ago TO ME -- but many vets have been trained since that time, and taught that the AT, and later AT2, are the "gold standard" for pet testing

not to mention that Abbott, the developer and manufacturer, badmouths human glucometers as being inaccurate in their "release notes" -- and it could be that the meters available in 2006 WERE less accurate --- technology has resulted in newer meters, perhaps more accurate strips too

it's more complicated than that of course, we are dealing with the practicalities of day to day living with our sugarcats, not experimental scientists

 

I'm not a fan of when companies fund their own studies only to come out with a list of reasons why their products are better than a competitor. Could be that it's true, but unless it's information from an independent study, I tend to take what they say with a grain of salt. There's too much money involved at that point. Thanks for that info @CandyH and Catcat ! Love the cat name btw, what a cutie!

 

I’m really new and had your same concerns. I was looking for all the mathematical conversions that didn’t exist. I started with the ReliOn Sunday June 9th. Because of my vets concerns I purchased the AT 2 and did my first test with it Friday 14 June. We are still trying to determine if Pinot is going to need insulin. Because of this I decided to us the AT2. He had a total of 4 insulin shots and none since Sunday 9 June. Here are the readings I received on each meter. If we require insulin I plan on using the ReliOn for daily use and the AT2 for vet updates. I think the best advice I read was pick a meter and stick with it.
06/09/2019. 62 ReliOn
06/10/2019. 31 ReliOn 79 ReliOn
06/11/2019. 74 ReliOn
06/12/2019. 96 ReliOn
06/13/2019. 64 ReliOn
06/14/2019. 92 ReliOn 120 AT2
06/15/2019. 59 AT2 119 AT2
06/16/2019. 79 AT2 102 AT2
06/17/2019. 94 AT2 103 AT2
06/18/2019. 82 AT2 76 AT2

 

While it is perfectly fine to use a human meter, and most people here do, the AT2 is for pets, and when used with AT strips and properly coded is generally going to give the more accurate reading, meaning closer to professional vet equipment. So, it is understandable that a lot of vets want to 'push' it on people. In an ideal world, if cost was not a factor, it probably would be best if everyone used one. Since it is not an ideal world, human meters are widely used. Again, that is perfectly fine, especially since patterns, danger ranges and target ranges are really what is important, but I get why vets prefer the AT2. And, if a vet is on board with testing (for which they get a lot of points since so many vets are strongly against it) but is hung up on seeing AT2 numbers, it seems to me like a great compromise to do as Robert mentioned, use a human meter for daily testing but use the AT2 if you ever need to do a curve for the vet.

 

I totally agree @FurBabiesMama ! I guess I'm kind of hung up on it because if Kyo's blood glucose levels read blue to green ranges and I try to take her off the insulin at some point for an OTJ trial, her actual BG levels will be higher when tested at the vet and she may actually need insulin still? If a human meter reads lower than a pet specific monitor then doesn't that mean I should be giving more insulin? My vet recommended a frutosamine check in a month, do you guys only do an OTJ if their BG levels test well at the vet?

 

@Robert Vittetoe Wow Robert! I wish I could get Kyo to those levels! Hopefully Pinot stays able to to handle the diabetes through diet alone! That would be amazing! That's what I'm trying to work towards as well so I'm trying to wrap my head around how to get that to happen without having to buy an AT2 meter!

 

No. This would be dangerous for your cat.
The numbers used on FDMB for safety are *for human meters* and are not meant to be used with pet meters. Because the AT reads higher, a higher cut off (danger) number is used for safety for pet meters.
I really may not have explained that well, sorry, I'm very tired lol. @MrWorfMen's Mom , could you possibly explain better?
With love, nikki

 

OK, I'm not familiar w prozinc but apparently it follows SLGS. So from the Lantus info sticky:


"Many here choose one of two methods to hopefully achieve regulation: Tight Regulation Protocol with Lantus or Levemir or a less intense method with fewer blood glucose tests required called Start Low, Go Slow (SLGS).
Note: Lantus and Basaglar are brand names for insulin glargine.

Bothapproaches were created and developed by laypersons using human meters. Reference numbers given for blood glucose numbers are from blood glucose meters calibrated for human use."

And from the prozinc protocol sticky:

"If you encounter numbers under 50 on a human meter or under 69 on a pet meter, post on the PZI forum and Health to get advice. "

Hope that's a bit clearer. Just scared me that someone whose cats numbers were low enough for pajama parties might increase a dose based on misunderstanding meter comparisons. With love, nikki

 

Don't worry! I do not intend to increase Kyos dose in any way right now as I would love to get in some good rest finally l forgot about those ranges being based on the meters, and yes that's exactly what I've been following. I think my vet just left me more confused than anything, maybe I should try to not worry about what she told me and carry on doing what we are doing. My birthday is coming up soon, maybe I can get away with asking my boyfriend for a AT2 starter kit and use it every once in a while to get a more "vet approved" reading

 

Nope for both those questions. We know "normal" BG for a cat using a human meter is 50-120. On a pet meter it is 68 to 150 (some labs say up to 175). The methods and protocols here are based on human meter readings but the only time those readings are of paramount importance is when kitty is heading into low territory. High is high no matter which meter you are using. So for example if you give kitty 1u of insulin and their nadir is 50 using a human meter, on a pet meter that nadir would be roughly in the neighbourhood of 68. Same dose of insulin, both normal safe readings but the BG readings differ because the are different scales of measure.

Most of us do not get fructosamine testing done when we are routinely testing several times daily. It serves no useful purpose when you have the data to back up that kitty is doing well on your spreadsheet.

 

Thanks for that info @MrWorfMen's Mom ! That might save me a good 100 bucks!!

 

Lauren I agree with what the others have said. You definitely do not add 100 points onto the BSL result. Yikes where do these vets learn this rubbish. Yes,the Alphatrak tests higher than a human meter, but you don't change the numbers......it is just two different methods of testing. We just know that normal human meter numbers for cats is 50 -120 and numbers for a cat with the Alphatrak 68-150.
And it is worth noting that our dosing methods are all based on the human meter BSL results not the Alphatrak meter.
You and Kyo are doing really well..
I agree a fructosamine test is not necessary. It is just an average of BSLs over the previous couple of weeks. No indication that the BSLs might have been high, low, or all in the middle, whereas you have in your SS an hour by hour documentation of the BSLs which is a far superior document.

 

I posted something very similar here when I first joined FDMB. For a while I tried to maintain numbers like the vet wanted (even going so far as adding a second sheet on my spreadsheet labeled "Numbers for Vet" that automatically adjusted the numbers), but since have just decided to run with the RelionPrime numbers. I'm following the FDMB protocol, and those numbers are based on using a human meter.

Kyo's numbers are beautiful! I'm hoping to get Boris down into that range soon!