?? Re:New(er) ranges for Alphatrack -vs- Human meters-

I am not new, but I am also not on the board all the time as my kitty was OTJ for years and has now GA. (still cannot say this- first time I used those letter just now) Anyway, from the information I had when we were actively on the board a few years ago, the disparity was +/- 30 points. SO in Lantus Landm you would subtract/add 30 points accordingly to adjust dose as per protocol, or guiding a bean for steering a cycle with food, etc..
SO i JUST learned yesterday that that is an antiquated information and the latest school of thought is to add/subtract 18 points to alphatrack numbers to 'convert' to a human meter number, which most of us here use.

I had no idea this had changed, but apparently there is a blurb in Romp & Rand, I have no idea the date. So I have a question. If you are charting your numbers on a SS..the SS default is to color code based on human numbers. Since this is a critical distinction if they ARE using alphatrack, should they be manually going in to color their entries correspondingly so the color patterns "read' clearly? For those that pop on and glance at someones SS to advise them, they might not catch that they are AT users, especially if that person is posting needing hurried advice for a low number they don't know what to do with.

When newbies are trying to figure out what it all means, what 'normal' ranges are etc..I just think it is scary that they may be getting information that is disparate and all over the place. I am experienced and I did not know the interpretation had changed. Is there a way the distinction can be made automatically?...like converting WORLD #'s to US....is it overkill to have them change the color manually?
and at what number.
Is there a chart somewhere to say what GREEN, BLUE, YELLOW, RED, BLACK should be if using alphatrack. Just seems if someone steps in who is not familiar with a particular cat and only glances at a SS- and only glances and sees the default...advice could be skewed as a result.

 

I would just use one meter and stick with one meter.
Here is one daya pointy for mmy cats:
9-14-2014
I just did two tests with my original AlphaTrak and my human Easy Gluco Plus meter. Both comparisons used same drop of blood from two different cats
Dulce OTJ
AT = 72
Easy Gluco Plus = 54

Badgar
AT = 377
Easy Gluco Plus = 331

 

Hi Larry-

The meter question was not for me personally. Someone using AT was being given advice and I (being old school) thought the numbers was getting were really low...thinking it was 30 points lower if it were ahuman meter. But I was corrected by someone that the ranges are now considered to be 18 points apart.
Where this especially comes into play is if you are following Lantus TR/Romp & rand...and when do you raise, lower, etc.. if ALPHATRACK.
Also at which point would you stall before shooting, intervene with food, etc... OR recommend to a Newbie, same.

But the other part of the question has to do with whether to manually color code the chart to GREEN, BLUE, YELLOW, etc.. to correspond with the AT 'conversion' so those advising dosing or otherwise, don't confuse at a glance what those numbers are. IE: some blues are actually greens, etc...

You want the folks reading someone's spreadsheet to have a true sense of what is going on at a glance.

 

The accuracy of the meters, both human and AT, are only +/- 20%. Thus it is really hard to get enough data from different strips, different meters at different BGs to get a good picture of the difference. But in any event, the +/- 20% will likely overwhelm being able to say add X valve to compare different meters.

 

I'm really glad that you raised this topic, Betty. I've seen different versions of the TR protocol with different Alphatrak adjustment numbers/ranges and I've found it confusing. I customised the colour coding on Saoirse's spreadsheet, but I think after reading your opening post I've calibrated the sheet using the out-of-date ad justments (i.e. adding 1.7 / 30 to the BG dose adjustment threshold numbers defined in the protocol. It sounds like I should adjust my colour coding.

 

Please see my signature link Glucometer Notes for some details on glucose measurement.

 

Betty,

As far as the "18 points" issue...

When the protocol was updated, the only range of BG numbers that was changed were the "target range" numbers. That would be numbers at the lower end of "normal".

The old standard used to be " a 50 on a human meter was an 80 on a pet meter". The updated adjustment is "30-40%" added on to that 50. That became "18 points" because 35% of 50 is 17.5. So they rounded up to "18", and 50+18=68.

The only time that really matters is if you are following the guideline that says " reduce the dose is a cat falls below 50" on a human meter. Users of AT meters used to reduce if they got under 80 on their meter. Now they would reduce if the BG dropped below 68.

The updated protocol says NOTHING about converting AT numbers to human meter numbers at ANY other range of BG numbers.

It doesn't say that we should always use "18 points" as the difference. It doesn't say that the variance is always "30-40%" at other BG ranges. We simply don't know for sure what the difference is or could be at a BG of 250, 300 or 400.

The update was intended for people using a pet meter AND following the TR protocol, which is why that protocol was updated specifically.

Any other use of the "30-40%" or "x number of points" by us is purely guesswork on our part.

 

Doesn't the issue also arise when deciding on TR phase 2/3 dose adjustments as well?

 

What do you mean, exactly?

The 65 mg/dL is the lowest you want your cat to go when using an AlphaTrak. Any lower than that risks hypoglycemia.

High is high and the actual specific number is irrelevant if it isn't in the target range.

 

You're referring to increasing (phase 2) and/or holding (phase 3) the dose based on the nadirs, right?
Then yes, I can see what you mean about what the difference between pet and human meters might be in the 200-300 range.
Unfortunately, that isn't addressed by the recent update to the protocol as far as I can see. :?

 

To estimate (as in, it won't be exact, nor precise due to the inherent +/- 20% variance in what meters are allowed to read):

Human meter estimate = 0.65 * AlphaTrak
AlphaTrak estimate = human meter / 0.65

 

That's what I was thinking about, Carl. Below is the version of the TR document I saw posted on a recent thread and I was confused about which version I should be using. The Rand document I had been working to advised users of mmol-calibrated Alphatrak meters to add 1.7 to the human meter threshold numbers defined in that version of the protocol. The target range worked out the same, but the higher defined numbers were different.

http://www.felinediabetes.com/Roomp_Rand_2008 dosing_testing protocol.pdf

It's also a bit confusing to a novice such as myself to find the higher dose adjustment thresholds defined in the document above are identical for both human meter and Alphatrak users.

 

There's a pretty good discussion over in the Think Tank

http://www.felinediabetes.com/FDMB/viewtopic.php?f=22&t=123130&start=50