? ReliOn Prime "calibration"

In the beginning of the month we took our ReliOn Prime BG monitor to the vet to be "calibrated" while we learned how to do home testing. Basically, all the vet tech did was compare her monitor's numbers (394) to ours (300), and told us to add 94 to all of our readings.

Since I've been lurking about on the boards, I'm seeing a lot of folks being told to get human meters and test using those, yet nobody suggests "calibrating" them.

Now I'm confused... which numbers are correct? Should I be telling the vet one set of numbers and recording the others in Boris' spreadsheet? And does this mean the vet has a different scale of what is okay and not okay?

 

Do you know if the vets meter is a pet glucose meter? I believe they read higher than human meters.

Great job on learning to test. One suggestion is if you need to increase the dose, only increase it by 1/2 unit. You want to find the optimal dose that works best for your cat and 1 unit may be too much of an increase. Also did your vet give you a "don't shoot" number? This is the number where you would skip the dose if it is this number or below. For newbies we recommend 200. However that can be lowered when you know how your cat responds to the dose. This is to prevent giving insulin when it is not needed and prevent hypoglycemia.

 

That is wrong. As already stated a human meter reads lower than pet meters/lab machines). At lower BGs the difference becomes less and thus adding 94 to all BG, even low BG is not correct. The accuracy of pet and human hand held meters is between 15 and 20%

 

just as ECID -- every cat is different --it appears that every meter is different too (EMID ?!) -- there have been tests using the same meter sequentially on the same sample, and they are only held to a 15% difference between the readings -- two meters of the same brand/style/type still only have to read within 15% of each other

add in the differences between meters targeted for humans, and meters targeted for pets (and dogs and cats test differently too) -- there's no magical conversion number, no mathematical multiplier -- at lower numbers, human and pet meters read close to the same, at high numbers they are considerably different

the few times I've read about using both types of meters on same sample (experienced it once myself at the vet) -- for 150 and below, pet meter will show about 20 points higher; in the 200s - 25 to 35; in the 300s - 50 to 70 or so; in the 400s, forget it, just call it HIGH .. the number itself doesn't matter precisely, it's the relationship to other test numbers using that same meter, and the trend or shape of the curve over time

almost all vets (including mine) will urge or insist that you use the Alphatrak, because that's what most of them use, and that's what they are comfortable with; mine will at least LISTEN to me, so we did a simultaneous test in her clinic, her techs drew the blood, I tested the sample with my meter, tech immediately tested with theirs -- plus she had a link to my spreadsheet and had looked it over -- at first she was quite skeptical until she saw the results in her clinic with her own eyes .. I think it opened her eyes a little -- particularly since she accepts quite a few patients/clients whose finances are tight

don't know if it helped or hurt that my AM injection was a "fur shot", so we were dealing with a +3 with little or no insulin modifying it -- if I'd gotten the insulin in correctly, our meters would have been much closer as far as numerical results -- I'm keeping a second spreadsheet with results from the vet

 

I'm curious what you meant by to get your meter "calibrated". Are you just referencing comparing readings? as I am not aware of a way any the commercial meters can be calibrated. I see that Boris is on Lantus. You should go to the Lantus board to post. Many very experienced contributors there. I am new to Lantus for 2 weeks and moved there. The protocols done by a group in Germany have stipulated that human meters be used. I was using the AT2 until moving to this new Lantus from Vetsulin which never really worked on Zoe. The strips for AT2 are about $1 each and if you are having to test frequently to get the right dose, it can be very expensive on top of the higher cost of Lantus over Vetsulin. I moved to the RelionPrime and oh what a relief on my purse strings.

I honestly think that Vets recommend AT because that is what they get discounts on for using just like pushing the Hills Science Diet or Purina DM because the reps visit them and push their product even though it is NOT the best for the cat. I ran out of strips and needed to get a new bottle because my Amazon order was not due until the next day. I called to buy a bottle from the vet. $98 is what they said they would cost. I was paying around $50 on Amazon. You see why they want you to use the AT2?

 

LOL -- as I explained to the vet -- I can pay you OR I can pay for the AT meter and strips -- not both ==

 

Good one!

I live in the states as I think learjetta does too. The cost of Lantus ($200-300/10 ml vial vs the $58 for Vetsulin) convinced me to quit with the using AT2, and buy Lantus from Canada where it was $112 (-$125 with shipping). I for one can not afford to keep throwing money out the window if I dont have to. I love my kitty dearly and am doing everything to do the best for her, but geez, most humans have insurance to offset the cost of medications. Wow.

 

Comparing readings, yes. I put it in quotes because, IMO, that's NOT what it means to calibrate something. Their word, not mine. If it were me, I'd tell the patient to do this to adjust the readings I get to more closely relate to the vet's meter, as all meters are different. And the vet didn't push their meter on us either, but it probably helped when I told them we already have a meter and that we plan to home test. I didn't really give them a choice.

This is part of the reason I asked the question I asked. The vet has not provided a don't shoot number (and I'm still coming up to speed on what we do for Lantus), but it begs the question... what is the don't shoot number? 200 on my BG meter, or an adjusted for the vet value?

This is incredibly helpful, thank you! So maybe I can add a sheet to my spreadsheet with numbers I can provide to the vet adjusted based upon an algorithm like what you provided above. Although, in rereading this, I find it interesting that the vet's meter read 394 while ours read 300... I'm pretty sure their meter was a pet meter, and should have read lower instead of higher. And when I get a reading below 200, it's a bit scary to think I may be adjusting it too high and inject when perhaps I shouldn't, or at least give a reduced dose instead.

The BIG reason I'm asking all of this is because we are leaving in 3 weeks for our destination wedding, and we will not be readily available for the people watching our cats... we need to leave instructions on how to handle possible situations so that we don't come home to find Boris went into hypo and died. I don't expect him to be regulated by then, so it's stressful. We will have cruise ship internet, but I don't expect it to be very speedy.

As if pre-wedding anxiety wasn't enough, we threw in a newly diagnosed diabetic cat!

 

I wouldn't "adjust" your readings, on a spreadsheet, to what you think the pet meter might show -- that's close to lying with statistics, LOL -- I'd suggest you do a spreadsheet, as I did myself, with the actual numbers you get -- because you are in control of your meter, and it's showing what is actually going on with Boris at the moment you take that sample and get a reading on your meter -- comparing the readings any time you and the vet both test, that's legitimate -- that gives the VET the numbers to "mentally" adjust what yours show -- remembering also that cats exhibit even more of the "white coat syndrome" at the vet -- so what you get there is most likely not indicative of what day to day and hour to hour reality at home, is

plus of course, most everyone here who might have opinions, support, advice, or experience to share, will have been using human-meter numbers themselves

you'll notice that I set up an additional spreadsheet for the vet's numbers, when she was taking the samples, and using her meter

her curve definitively showed that the insulin dose was too high, and that feeding only before the AM shot, and not anything later, was rougher on Catcat than I'd like; I asked her if she'd fed at nadir, she didn't, and I didn't think to ask her if she had furnished any supplemental carbs to keep him out of hypoglycemia, though I'm sure her employees were keeping an eye on him as soon as his values went subnormal

trying to make my words sweet and palatable, my immediate reaction was of the variety -- o h*** no !

 

The 200 would be on your meter. As you learn how your cat responds to the dose, you probably can lower that number. The way you will determine how the dose affects your cat is by doing several tests between shots to see what the glucose readings are. Usually they are taken every 2-3 hours. You are trying to determine how low the glucose levels get to. You should do a few curves, the series of tests, over several days, before lowering the don't shoot number. This also will let you know know if the dose needs to be adjusted. BTW curves done at a vets office are not really accurate. This is because cats are usually stressed and this causes glucose levels to rise.

 

I goofed -- originally I wrote that the pet meter would show a HIGHER number than the human meter
for some reason, I claim blonde, tired, and senior .... I went back and edited it to read "lower"
what was I thinking ????
just re-edited to say what I said to begin with, the pet meter number will be higher

 

Unfortunately, no algorithm can be made for the two meters (Pet AlphaTrak and Human meter). You'll drive yourself crazy comparing numbers . Pet meter's have like a 15% variation for readings while human meters are higher at 20% variations. The only guidelines we really use for each meter is the low's. You might need to steer kitty's BG if they test below 50 on a human meter and below 68 on a pet meter. And still Every cat is different . Best thing to do is pick one meter and stick to it for what it is .

Also, who recommended the 100% dose increase from 1.0U to 2.0U? Did they really start the first shot at 3.0U?? I hope that was just a typo...

Are the people caring for your fur babies, close? On a couple occasions we've had a sitter make a post on an owner's account while they were away. Stating they were posting on behalf of sugar kitty if they were in a pinch.

Lastly, you seem to be doing pretty well taking in all this new info and getting ready for a destination wedding cruise ! Boris reminds me of my boy when he was younger .

 

I'm thinking I'll just keep a separate sheet on the spreadsheet with vet adjusted numbers (adding 94), per the vet's request. That way they get what they asked for, and I'm maintaining both sets of statistics. Once we have a fair bit of data, I can go in to the vet with both sets of numbers in hand to hopefully show the vet that adding 94 to all numbers is a very bad idea, especially if the variance is more of a percentage.

Sounds good... thanks! Is there a "no shoot" number with Lantus, or is it a reduced shot? I'll head over to the Lantus forum and start a new thread there I guess... I want to make sure I'm not making a mistake as Lantus is long acting.

That makes better sense to our situation... thanks!!!

Agreed, but until I have the data to back up my decision to run with just my meter, I need to continue to provide the vet with what she requested. I'll be consistent for now and maintain two sets of numbers (which I've been doing on paper anyway for my own sanity), and just keep a separate sheet on my spreadsheet for vet adjusted numbers, per the vet's "calibration". Then the next time we have an office visit I can provide both sets of numbers to the vet, and hopefully between now and then I can find some study or other scientific data to bolster the need to switch to a single scale that better represents the data. Surely adding a static number to the BG values is a bad idea.

No, that's just where our home testing started. Boris was diagnosed in the middle of April while we were RVing in FL. He became lethargic, stopped eating and drinking. Took him to the ER and they found DKA, diabetes, pancreatitis, and a bladder infection. He was hospitalized for 2 days in the ER on a fast acting drip, and then spent 2 days on Lantus shots at a different vet hospital before coming home on 2 units BID. A glucose curve performed a week later saw his dose increased to 3 units. His BG curve 2 weeks after had us re-evaluate the dosage and basically start over at 1 unit.

That's a good idea! It's supposed to be my neighbor, but I'm having a hard time getting her over to the house to start learning the shots, so it may end up being a professional pet sitter with her own diabetic animal. The pet sitter may end up being the better choice regardless, as she's the daughter of a vet and is used to managing diabetics.

I've had low blood sugar issues in the last couple of years (suspect related to perimenopause and changing hormones), so the basic BG concepts, especially as they relate to diet, aren't new to me. That's why we already had the ReliOn meter. And I'm incredibly thankful that Boris is a laid back cat, which makes the entire thing less stressful for us all!

Your boy is handsome!

 

This depresses me. And you are correct, about comparing will drive you crazy. I am now officially crazy.

I have been trying so hard to get Zoe regulated. I switched to the Lantus board and have been using the relion prime and have felt good about her being in the yellows though I knew the readings were some what lower than the AT2, I figured the Lantus was helping and felt like I was on the right track towards a more stable acceptable BG until she might go into remission. Watching this conversation made me wonder because right before I switched to the Prime I checked both AT2 (w/Freestyle Insulinux strips, meter set at code 38) and got about a 60 point difference with Prime being the lower readings. I accepted it and went with the RP.

I bumped her to 3.25 units of Lantus from 3 yesterday.

I was checking a +2 just now and decided to pull out my AT2 to do a comparison. I had some AT2 strips which I had't used in a long while since switching to the FS Insulinux. So I coded the AT2 to the AT2 strips (7) and did the comparison. Ugh bad idea. Now I am feeling depressed. The AT2 read 437. The Prime read 302. Thats a 135 point difference. +3 AT2 =416, RP =291. (125 pt difference) I know all experienced members say to put the AT2 away and stick with the Relion and just go with it. I will still do that because it is so expensive to test as frequently as I need to as I push her Lantus dose higher. $50 AT2 strips for 50 doesn't even last a month testing just the standard twice daily. If you have to keep a closer watch and test more often as you try and find the right dose it can be $100-$200 just on AT2 strips for a month. But if I am more cautious about increasing the dose because I am getting lower and lower readings on the RP meter and she is really not in a lower range on her BG, am I not causing more damage to her system by allowing the high BG readings to continue longer and longer.

 

HAHA, I have been skirting prediabetes/diabetes and recently was dx with insulin resistance which is why I have my own Relion Prime
and a BG ketone meter and and doing a keto diet and checking my own BG/ketones trying to reverse the trend. (post menopausal). I decided after the last post to check my own on the AT2 and RP for more added anxiety. My prime read 123 and AT2 168. All I can say at this point is wtf on it all. I will say the prime is in line with serum BG I have had at my MD/lab. Geez.

 

may be an unnecessarily detail -- but was it the VET who suggested the +94 correction, or was it the TECH? might want to check directly with the vet to make sure; I think we have a member on the board, who works in a vet clinic, who was doing simultaneous BG checks with both the AlphaTrak and a ReliOn meter; if I can find out/remember who that was, I can tag the conversation so you can show that to the vet as well

sounds like your vet has had limited experience with those using human meters and may not understand how and why they have different readings -- this "correlation" idea is, as you say, a bad idea -- I'm concerned that this might be an issue with the tech rather than the vet

 

The 200 don't shoot number is a recommendation for any insulin. Unless you are doing your own curves, you do not know how low the glucose levels go between shots. The reason for this number is to prevent you from giving insulin that may cause the levels to drop so low that hypoglycemia can occur. It is better to skip a shot than become hypoglycemic. Hypoglycemia is dangerous and could cause permanent damage or death. When you understand how you cat responds to the dose, you may feel comfortable with lowering the number.

 

I'm so sorry... I didn't mean to add to anyone else's stress! But I do feel your pain... I'm feeling exactly the same way. Especially if we are given a single range of BG that is considered normal for cats. If human meters read differently than animal meters, then shouldn't there be 2 ranges? These are things that keep me up at night. HOWEVER, just remember, it takes a longer time on high BG to permanently injure your cat, whereas one hypo episode can kill. So try not to sweat the deltas on the higher numbers too much. High is high.

This is a great question, and I will try to find out. Thanks!!!

Agreed. Planning a home BG curve for this Wednesday, so I can call those number in to the vet on Thursday along with the requested nadir values. No need to do pay $110 for a curve in the office when I can do it at home.

That would be helpful. Thanks!!!

 

One can "calibrate" human meters that are manually coded (a lot of meters today are automatically coded my reading information from the strip) by changing the code. That is how the AlphaTrak meters works. Different codes are entered depending upon the species (the strip vial lists the code to use for different species). Except when using the AlphaTrak with AlphaTrak strips one really does not know what code to enter. Different species have different portion of the glucose in the liquid and in the cellular part (red blood cells). Lab equipment only measure the glucose in the liquid while hand held meters measure the glucose in an unspecified combination of the glucose in the liquid and cells).
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2769960/
http://www.advocatemeters.com/single-post/2016/01/18/Why-You-Need-to-Use-a-Pet-Blood-Glucose-Meter