Info PSA concerning "AT" meters

Discussion in 'Prozinc / PZI' started by Carl & Polly & Bob (GA), Nov 19, 2015.

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  1. I'm posting this not as a PZI poster, but as a "Moderator". Earlier today, I saw a post by "Bandit" that caught my attention and that is what leads me to posting this.

    There continues to be some confusion on the whole FDMB board on occasion about the differences between numbers on a human meter, and what numbers on a pet specific meter like an AT meter "mean".

    Most of us, over the years have used human meters. Lately there seems to be a lot of people arriving with an AT meter already in hand. There have been threads in several forums about coming up with some sort of "conversion" chart, or a nice clear listing that shows what an AT number converts to on a human meter.

    I understand why people feel this might be a good thing to have around. But if you haven't noticed, the "moderators" have been unanimously opposed to advocating any such "conversion chart", and are not likely to ever endorse one that would be posted on the board for use by caregivers or anyone who advises other members. As a group, the moderators are even opposed to someone developing such a chart and "sharing it" with others by way of putting it in their signature, or providing a link to one in any manner.

    The reason for that is simple. There currently is no documented scientific study that supports such a chart. There may be people who have tested one meter against the other, and collected their data. And that's great for "individual" use if that's what they choose to do. But compiling data collected in a home environment is not a "lab study".

    The "thing" that gets tossed around a lot is "there's roughly a 30 point difference between an AT and human meter". That's what my vet told me. And I've seen it posted a hundred times at least, and I'm sure I've posted it myself before for that matter.

    But - this is one of those things that is said so often, that it has become "true" somehow.

    In fact, it isn't known to be true at all. The ONLY time it may have been valid information was in one specific instance.

    The Tight Regulation protocol for Lantus/Levemir, at one time, said that for users of a pet meter, the difference between it and a human meter should be considered as 30 points. But, it was only referring to "The Target Range", and only when considering a dose reduction when the nadir had dropped below a specific number. On a human number, FOR THOSE FOLLOWING THE TR PROTOCOL ONLY, the number that indicates a reduction being given is "50" on a human meter. On an AT meter, the number was "80".

    2 years ago, those guidelines were updated by the authors of the protocol. They revised the pet-meter "reduction" number to "68". The "human meter number" remains at 50. This still only applies to those that follow the TR protocol. And no other number, or range of numbers, was mentioned.

    Today, a caregiver here in PZI saw a 66 on an AT2 meter. In that thread, he commented that by adding 30 points, it was a 96, so still a safe number. I happened to stumble over the thread, saw that, and immediately posted in the thread. He had read the "add 30 points" at some time prior to today, and I guess misunderstood whether to add or subtract 30 points? I am not sure. But the point is, his cat had a below normal BG, only an hour after feeding and giving a dose of 2u. His cat was "in danger of hypo", but he didn't realize it at that point in time. The situation could have gone really badly, really quickly. Thankfully it did not do that.

    So please, everyone. Stop tossing the "30 points" thing out there. Nobody knows what the difference is. Each caregiver using a pet meter should talk to their vet, or to the maker of the meter, and ask them if there is a "conversion" number from your meter to human numbers. Even then, I would be skeptical about how they arrived at that conclusion.

    The majority of caregivers here use human meters. It's always been that way, and it will always be that way. All of our protocols and guidelines are set up using human meter numbers. The only people with experience with pet meters are those that use them. Our SS templates are set up to use human meter numbers. 90% or more of the people who look at questions, numbers and spreadsheets use or have used human meters. Our "mindset" is on human meter numbers.

    We ask people to put "AT meter" in their sig, and/or make it obvious on their spreadsheets, so that it can be seen by all who choose to offer advice or suggestions.

    The AlphaTrack meter is believed to run a little higher than human meters. When following the TR Protocol, Roomp & Rand have recommended adding a cushion for AT users dealing with lower readings on the lower end of the low range. Reductions should be taken at 68 (AT) instead of 50 (human meter).

    Users of other insulins and methods should consider an appropriate safety margin. That would apply to everyone here in the PZI forum.
  2. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

    Dec 28, 2009
    @Sue and Oliver (GA) : The information I've gathered below may offer you some of the references, frames of reference, and ranges you were looking for before you deleted your comments earlier today. At least it's a place for you to start. The bonus is the sources are all linked... no conjecture, misinterpretations, or misinformation coming from any of our members. I hope it'll help.

    Abbott claims their AlphaTRAK 2 meter measures closest to results from commercial labs and therefore is superior to that of human meters when measuring blood glucose in dogs and cats. They've illustrated this in their "Comparison of Three Portable Blood Glucose Monitors to a Commercial Reference Laboratory" graph in their veterinary brochure: AlphaTRAK_AT2-2063_VeterinaryBrochure.

    If that's the case, the following links using lab values should help to form guidelines for those using AT2 meters and Prozinc:

    From the Prozinc website:

    Hyperglycemia (high blood glucose) defined: This is blood glucose higher than 200-300 mg/dL.

    Hypoglycemia (low blood glucose) defined: The FDA defines this as blood glucose with a concentration of less than 50 mg/dL. A blood glucose level that drops to 80 mg/dL may be a safety concern.

    The initial recommended ProZinc dose is 0.1 – 0.3 IU insulin/pound of body weight (0.2 – 0.7 IU/kg) every 12 hours. The dose should be given concurrently with or right after a meal.

    ⦁ In the effectiveness field study, glycemic control was considered adequate if the glucose nadir from a 9-hour blood glucose curve was between 80 and 150 mg/dL and clinical signs of hyperglycemia such as polyuria, polydipsia, and weight loss were improved.

    The Prozinc website itself suggests veterinarians download the AAHA’s diabetes management guidelines for dogs and cats

    Note: Home BG monitors should be veterinary-approved products calibrated for dogs and cats (according to their guidelines). p. 9/223

    ⦁ In dogs and cats glycosuria typically develops when the BG concentration exceeds approximately 200 mg/dL and 250 mg/dL, respectively. p.2/216

    The panel recommends a starting dose of 0.25u/kg q 12 hours, based on an estimate of the cat's lean body weight. This equates to 1u q 12 hours in an average cat. Even in a very large cat, the starting dose of insulin should not exceed 2u per cat q 12 hours.,-28,738 p. 4/218

    Target results for nadir: 80 to 150 mg/dL.,-28,738 p. 8/222

    Action plan for cats,-28,738 p.8/222

    Initiating and on-going therapy and monitoring - includes feeding suggestions, precautions, management, and dosing guidelines,-28,738 p. 4/218 thru part of p. 6/220

    Hope this helps! :)
  3. Thank you Jill!
    I've been to the prozinc site many times before, mostly to learn about "how it works". (Duration, nadir, etc). I didn't realize that there was all the above information out there as well. Good to know for anyone who uses Prozinc.
    Seeing all those links, it's a shame that none of them are in the group stickies above. I'm wondering if it would make sense to put them in the stickies someplace?

    ETA - I've also looked at (and linked people to/ quoted from) the AAHA guidelines lots of times. I never actually noticed that they recommend the use of "pet meters" for home testing.

    Thanks again!
    Critter Mom likes this.
  4. Marlena

    Marlena Well-Known Member

    Nov 25, 2015
    Wow, I am glad I found this information, maybe it is a missing link to my problems with high BG.
    I have a gut feeling that 0.5u of Hypurin (PZI 100 percent bovine) is not doing anything for my cat who's recent PSAM were in range of 21 -24 (378 - 432) - even before starting this insulin and weighs 7 kg. I use Accuchek meter as I found it gives me similar readings as AT2, at least at high numbers. I have both meters (AT on lease from the vet) but I decided to use Accuchek as most advice is given based on human meters. Another thing I have noticed and it's not really mentioned much is that some human meters or test strips (as is the case with Accuchek) are plasma calibrated and others are whole blood. I had a few of them and there is a lot of difference. \whole blood ones were giving me lower numbers). So by saying that we use human meters do we mean plasma or whole blood calibrated? I have noticed that Accuchek was nearest to the AT2 and that was nearest to the lab work at the vets.
    Anyway, if some of you could have a look at my spreadsheet and give me some feedback (don't worry I am not going to say I was given wrong advice, in the end of the day it's me who makes decisions).
    I have a bit of a problem with this very conservative approach of some lovely people here but I personally prefer more aggressive approach and I like taking risks, I am refusing to be scared. But it is down to personality.
    So, if somebody could give me their opinion I will be most grateful.
    I have posted and had long conversations with very kind people on Feline Health Main Forum.
    Many thanks,
    Cara and Wynken (GA) likes this.
  5. Sue and Oliver (GA)

    Sue and Oliver (GA) Well-Known Member

    Dec 28, 2009
    Hi Marlena,

    I am reluctant to give you any advice as although your insulin is called PZI, the version that you use in the UK tends to last longer than ours, and there can be some carry over. I know Elizabeth has been advising you on Health and she has been using it longer than anyone on the forum. It looks like you have been on it about a week?

    If you want to be more aggressive, you can definitely raise the dose by small amounts. But with a insulin that acts more like a depot insulin, I would not want you to use our guidelines as the US version of PZI is definitely an in and out insulin. Have you said to your advisors on Health that you want to be a little more aggressive with dosing?

    I am not much help, but I do know you are in good experienced hands with the two ladies who are advising you on Health.
  6. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Feb 18, 2015
    @Carl & Polly & Bob (GA) Carl, this is an excellent PSA post and one I think is pertinent across the board. To that end, I would ask that it be posted in both Health and the Lantus/Levemir forums too. I have witnessed more than one occasion where a new member has used that erroneous 30 point difference with other insulins and in some cases come close to a disaster so getting this message across the boards would in my opinion be prudent.
    Critter Mom likes this.
  7. BJM

    BJM Well-Known Member

    Oct 6, 2010
    Where does the human glucometer reference of 40-120 mg/dL for cats not on insulin come from?
  8. Marlena

    Marlena Well-Known Member

    Nov 25, 2015
    thank you. Your explanation of American versus British PZI was very helpful.
    I told Eliz that I feel that the dose my cat is on at the moment is just to small and we agreed that I could increase a little. See what happens.
    I am grateful for any help, this is so difficult.
  9. Sue and Oliver (GA)

    Sue and Oliver (GA) Well-Known Member

    Dec 28, 2009
    It is difficult, @Marlena. But it is early days for your kitty and I hope lower levels are in your future, soon.

    @BJM, I first saw it here in the FAQs under Regulation. It looks like there are three different possibilities for the low range when going OTJ (from 40-70) but with cats off insulin, 40 seems to be the low end:

    Q6.1. What is regulation? A6.1. There are different definitions of regulation. As hometesting becomes more common, we've been getting a better understanding of what cats and their humans might be capable of. Janet & Fitzgerald propose the following "regulation continuum": Not treated [blood glucose typically above 300 mg/dl (16.7 mmol/L), poor clinical signs] Treated but not regulated [often above 300 (16.7) and rarely near 100 (5.6), poor clinical signs] Regulated [generally below 300 (16.7) with glucose nadir near 100 (5.6), good clinical signs, no hypoglycemia] Well regulated [generally below 200-250 (11.1-13.9) and often near 100 (5.6), no hypoglycemia] Tightly regulated [generally below 150 (8.3) and usually in the 60-120 (3.3-6.7) range, no hypoglycemia, still receiving insulin] Normalized [60-120 (3.3-6.7) except perhaps directly after meals -- usually not receiving insulin] There may also be an extra category of "mostly above 300 (16.7) but with good clinical signs" which occurs with some cats who are getting insulin. We don't know why it happens, but such a cat probably should not be considered to be regulated. On the other end of the spectrum, it is possible for a cat who is not getting insulin to have blood glucose as low as 40 mg/dl (2.2 mmol/L) on a home glucometer. If you have a non-diabetic cat, try testing her with the same meter to get a safe comparison figure.
  10. Who are you asking?
  11. BJM

    BJM Well-Known Member

    Oct 6, 2010
  12. I dunno. From day one, my vet told me 50-120 was normal, and unless Bob went lower, all was good. I never second guessed her, so it didn't phase me when I saw 40-120 stated on FDMB. I thought it was ridiculous to quibble over 10 points. Still do actually.

    I only saw 40's twice, and didn't do anything but feed Bob a half can of low carb and went on my merry way.

    Ignorance was bliss, I guess.

    More time and energy has been wasted over arguing BG ranges and meters here than on any other subject.
  13. Critter Mom

    Critter Mom Well-Known Member

    Jun 16, 2014
    @Carl & Polly & Bob (GA) -

    I agree that your opening post on this thread is extremely valuable and, as Linda suggested, would be beneficial to members right the way across the forum, not just on this board.

    As you note in your OP, Carl, there do seem to be more people here using Alphatrak meters nowadays. If there is a sticky created, I would like to suggest that, in addition to reinforcing the message to all members to put their meter type in their signatures (and ideally somewhere at the top of their spreadsheets, too) that the sticky include some sort of strong prompt or reminder to all members that there is a difference between human and pet meters, and to never automatically assume that a caregiver is using a human meter. Responders may not be able to give definitive BG guidelines to Alphatrak or other pet meter users, but at least if they check the meter type first then it could go a long way to reducing the potentially dangerous incidences of human meter guide BG numbers being dished out to pet meter users.

    Sharon14 and MrWorfMen's Mom like this.
  14. I'm not real big on creating yet another "sticky". The Issue is that there are already so many all over the board. And it's like the old adage about "leading a horse to water"....too many don't get read. A perfect example of that is this one:

    No thread in that forum should contain more than 4-5 posts. New members can't be blamed. They're new. They don't know what a sticky is, or what it's purpose is. But older members either haven't read the sticky, or the sticky is just wasted space on the board.

    I posted the PSA here because even though I did so as a moderator, PZI is like my "home forum".
    L & L already has a ton of stickies and info threads, and most people who advise there are well aware of the "issue" of AT meters being "visible" and are very good at making sure that "AT" is made obvious to new members posting in that forum.
    As far as Health goes, I would hope that those who offer help there are asking new members what type meter they use before offering one word of dosing advice.
    And as much as the "30 point difference" is concerned... that has been talked about in multiple forums in multiple threads.

    I guess I'd need to see evidence (links would be good) to threads where the incorrect info has been posted and nearly led to a disaster or emergency before posting a PSA in other forums?
    Given this is a peer reviewed board, I would hope that any errors in advice are being addressed by "peers" on a thread by thread basis.
  15. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

    Dec 28, 2009
    Links to any "near disasters" should be fairly recent... given the fact that this issue came to a head late this past fall. Prior to that the problem was widespread which is exactly why the issue had to be and was addressed.
  16. ELLIOTT & Fran Munschauer

    ELLIOTT & Fran Munschauer Member

    Jan 1, 2016
    Aside from the point of this post, WHY is Elliott on Lantus? I was told it was best for DVM's and others. It's all over the Internet....Then, I read on a forum here that specialist claim Lantus is NOT good for cats..PZI was never mentioned as a choice...until I specifically searched info on PZI...As far as Blood Glucose, I perform AlphaTRAK test but chart Relion for FDMB members, since most are use to human meters. The vast difference in readings is remarkable.Any good documentation on PZI vs Lantus would be greatly appreciated, even if I just purchased 5 vials of Lantus..Great site!
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