BG testing with OneTouchUltra2 and GlucoPet

[CarolW]

I said OneTouchUltra2, but actually, i started yesterday with my brand-new OneTouch UltraMini meter, which I got free by buying 100 test strips (this deal has been going in Canada for some time).

I had inquired of animaldiabetes.com about maybe testing their GlucoPet meter, after somebody on a Yahoo Group said it was a superior meter for testing animals (say, cats and dogs). I heard nothing back for months; wasn't planning to buy the meter, nor test strips - asked for a donation (meter and test strips) for testing purposes; said if I liked it, I'd feature it on my web site.

Since then, I've learned stuff that indicates to me it's probably no more use than is a meter intended for humans, even when you use these human-meters on dogs. All the same, I intend to proceed with the comparisons, to see what I can learn.

Three months after my initial inquiry, I heard back, and they did send me a meter, with 150 test strips, which was wise, because that would give me more leeway for testing; I'm bound to waste a few strips.

Meantime, I'm having some thoughts about testing BG levels (at home, of course), and about learning.

I talked to OneTouch Customer Care eight times at least, on the phone. I found them very helpful, each time. They DID tell me their meter is "not recommended for use on animals." I pressed with further questions, and they said that is an industry standard. They are not allowed to encourage such off-label use! Their meters are, I believe, FDA approved - for humans.

It seems the animal-validated meters, such as GlucoPet and AlphaTrak are NOT FDA-approved. Interesting.

The web site for GlucoPet:

http://www.animaldiabetes.com/

has some information on it, but a lot of it seems to me a bit vague; it's a little hard to track - unlike the information that Natalie and Kathy post here!

I'm here because of the excellence of communication here. I tell ya, friends; it's a joy to be here!

So, here I am, doing spot-checks on Kumbi. His next BG curve isn't due for another six weeks or so, but I didn't want to wait that long before trying the two new meters, the OneTouch Ultra-Mini, and the GlucoPet. I seldom do spot-checks on Kumbi; I prefer to watch him for clinical signs, and test only if I become really concerned; then I would certainly do a proper curve, perhaps after a few spot-checks the day before.

As probably most of you know, BG levels can fluctuate for many reasons. Sometimes we just can't identify a reason. At other times, we can notice the dog has an infection; my vet says, BG levels fluctuate unpredictably in the presence of infection, so, apart from any need to avoid a possible hypo, she doesn't recommend testing BGs till any infections are cleared up.

Kumbi is very cooperative about testing, probably because, it's very clear, the Lip-Stick method I use (inner, upper lip) is completely painless for him. Kumbi always lets me know if something hurts. But he doesn't like Procedures, so the testing IS a stress on him. When I first started out, I did an awful lot of curves, with lots of readings, and one of my two main vets suggested I let up some - she thought there's no need to stress Kumbi that much, and it's not all that good for him. But now, I have two New Toys!

With the numbers so low yesterday, I tested again 1.5 hours later, half an hour before Kumbi's supper. He does tend to run at his lowest in mid-afternoon, but sometimes, right before his supper! To my relief, though, when I did the second spot-check, his numbers were on the way back up - before his supper.

I would like to know, though, when, likely, Kumbi was at his nadir (lowest BG level for the day). Yesterday, might it have been when I took that first set of spot-checks - or might it have been before that? I don't know! If it was before that, his numbers might have been too low for comfort!

So today, I'm trying to figure out Kumbi's approximate nadir time. That's a bit silly of me, because it does vary some. Sometimes it's around 2 p.m; sometimes, as late as 6 p.m.

I feed at 6:30 a.m. and p.m., and give 6.75 units of Novolin NPH insulin at 7 a.m. and 7 p.m. (It was 6.5, but I nudged it up recently.)

Actually, yesterday's readings were excellent, but they were as low as my vet ever wants to see. Kumbi has been very stable the last half-year, no clinical signs, no problems apart from his near-total blindness, which we just accept (Kumbi handles it fine). Typically, all my curves on Kumbi have had the numbers running somewhat high, and I'm reminded of Marion and Cara! (Keep up the good work, Marion and Cara!)

Also, today we had a sort of run-in with roaming neighbor dogs; Kumbi and Kwali got very excited - so I had another excuse - wanted to see what happens to Kumbi's BGs when he has a sudden big stress.

Managed to test half an hour after the initial encounter. Again, his numbers were on the low side, compared to what I've usually seen. What I think is really going on is that with his current insulin dose, and food, and scheduling, and freedom from infections, Kumbi's BGs are basically very stable. He had smply been running slightly on the high side, till I did that last tweak up to 6.75 from 6.5 units of Novolin NPH insulin.

But! I do NOT want to see anything below 6 mmol/L (108 mg/dL). And Kumbi's readings yeserday at 4:30 p.m. were, on the UltraMini, 5.9 mmol/L (106 mg/dL) and on the GlucoPet, 6.0 mmol/L (108 mg/dL). So I'm continuing today. Another test in about 10 minutes, then I hope for one more, about 6 p.m., half an hour before his supper, 11 hours after his morning insulin shot.

I didn't care that much for the Ultra-Mini meter; I find it a little hard to see the time correctly, as the display window is slightly small, and I like the Ultra2 because it prompts you for everything, so I never have to look at the manual!

I started out with a FreeStyle Freedom meter, which was okay, but it seems I had some of the test strips that were later recalled, which might explain partly why I later deserted it in favor of the OneTouch Ultra, which was the model they were sellng at the time. They're no longer selling that one; the Ultra2 has taken its place - and the UltraMini is just a nice, small meter convenient to carry around. I guess if you're using it most days, you don't often need the manual!

I test so seldom, I have to rely on help from somewhere.

Yesterday, then, I used the ULtra-Mini; today, I've gone back to the Ultra2, and I'm doing double-prick, double-readings, so each meter - the Ultra one and the GlucoPet gets its own blood drop. I have to throw out my GlucoPet reading, though, for earlier today, as I flubbed it a bit - touched the lip with the test strip before I touched the blood sample. It did give a reading when I touched the blood sample, but it was enough lower than the Ultra2 so I don't trust the reading. Doesn't matter, because I do trust the Ultra2 to be consistent.

I'll post readings later, perhaps with more comments - yesterday's, nad today's.

You can see I'm a BG-testing NUT, but not at Kumbi's expense! Or, I TRY not to make Kumbi pay for my slight obsession.

Back later. Readings due in a few minutes!

Sat, 4 Oct 2008 15:56:17

[CarolW]

To continue, here are the readings I got. This is to compare the two meters - well, three. Yesteday, the One-Touch Ultra Mini, with the GlucoPet. Only two comparisons.

Today, the One-Touch Ultra2 with the GlucoPet - I got two good comparisons, a third shaky one, and on the fourth reading, couldn't get a GlucoPet reading at all, because poor Kumbi had reached his pricks-limit. He was getting restless and uncomfortable, and I don't blame him.

Two pricks per spot check or BG test is perhaps excessive, when HE doesn't need them. And he doesn't.

He was a very good sport though.

I'll put the Kumbi-related stuff in the first thread I started when I joined up here, and leave the meter-related stuff here.

Here, then, I'll list my readings, with a enough commentary to indicate their likely reliability (as far as I can figure it out).

The technique I used here was:

prick, prick (two pricks, fairly close together, and one immediately after the other)

sip, sip (apply the test strip from the One-Touch first, because it shuts off after two minutes; apply the GlucoPet second (to the second sample), because it shuts off after three minutes).

I set date and time on the meters by my computer-clock, which shows seconds, as close as I could; the two meters were set to within one minute of each other, I believe. Same goes for the OneTouch Ultra2 meter I used instead of the One Touch Ultra Mini I used yesterday.

Friday 3 Oct 2008: OneTouch UltraMini, GlucoPet

16:27 - 5.9 mmol/L = 106 mg/dL - OneTouch UltraMini
16:28 - 6.0 mmol/L = 108 mg/dL - GlucoPet

18:01 - 8.4 mmol/L = 151 mg/dL - UltraMini
18:02 - 8.8 mmol/L = 159 mg/dL - GlucoPet

Comments:

Since there's a plus-or-minus 20% margin for error on any one reading, I consider those readings functionally equivalent - in each pair.

But I'm interested that the readings were so similar, when it seems to be said that the OneTouch meters read about 30 mg/dL low! - suggesting, lower than the GlucoPet.

Compare with today's readings!

Saturday 4 Oct 2008

OneTouch Ultra2, compared with GlucoPet; again, both with date and time set to be about the same.

11:31 - 12.4 mmol/L = 223 mg/dL - OneTouch Ultra2
11:31 - 12.7 mmol/L = 229 mg/dL - GlucoPet

14:01 - 10.6 mmol/L = 191 mg/dL - OneTouch Ultra2
14:02 - 8.1 mmol/L = 146 mg/dL - GlucoPet

Comment: Kumbi was a bit squirmy by the second reading (GlucoPet); I touched his inner lip before touching the blood sample, and the sample was just a bit small, but the reading took anyway (no Error message on the GlucoPet)

16:09 - 5.5 mmol/L = 99 mg/dL - Ultra2
16:10 - 6.2 mmol/L = 112 mg/dL - GlucoPet

17:56 - 7.4 mmol/L = 133 mg/dL - Ultra2
No reading on the GlucoPet. Kumbi was fed up with pricks by then; too squirmy to use the small blood sample I got in the second prick.

I have a question for those of you who know.

Is my idea of

prick, prick
and
sip, sip

reasonable? assuming the pricks are close together, and nearly simultaneous?

Or would it be better to "prick harder" (or deeper, but that's unlikely to be possible, because I sink the lancet, by hand, to its full depth - I use 25-gauge lancets) - anyway, would it be better to use the SAME blood sample (one prick only) - to compare the two meters?

I keep feeling that once you sip a sample, its glucose (and whatever else is taken into that test strip - leaving the sample not all that useful for a second test with another meter-and-strip.

Unless, of course, the blood keeps welling and welling, which Kumbi's usually doesn't. I thought it would be a more valid comparison to do the double-prick.

And no, I'm not gong to ask Kumbi for double-pricks very often!

Anything I have to say about these readings and Kumbi, I'll put in that other thread - you know; one dog, one thread! (I just LOVE this organization! - it works so well!)

Sat, 4 Oct 2008 20:07:21

[We Hope]

Carol,

First of all, what you are seeing re: Kumbi's nadir or peak is entirely possible.

So today, I'm trying to figure out Kumbi's approximate nadir time. That's a bit silly of me, because it does vary some. Sometimes it's around 2 p.m; sometimes, as late as 6 p.m.

There are a lot of variables that go into each and every insulin injection--where it's given, how it's absorbed, and so on.

It's very difficult to be able to "reproduce" how the bg's ran yesterday, last week or last month because we also have variables as activity or lack of it, possible stress and so on. Bg's taken on a very busy or stressful day are going to look a lot different than ones that aren't either of them. When you evaluate bg's and curves, you need to consider them "snapshots" of bg levels.

But--when you have enough "snapshots" in your "diabetes photo album" that appear to be similar, this is when you see that whatever is happening is a trend and you either jump for joy if it's good or sit down to figure out what's not right and how to make corrections.

You'll need to use the same blood sample, though, for a comparison of the two meters. The best way to tell is to take them both to Kumbi's next appointment for blood testing and ask the vet to use some of the drawn sample on them both. This will tell you which meter is closer to lab values and also how much each of them vary from that.

Re: running low from excitement--some dogs, like people, run high from it while others run low--it depends on the individual.

There's also this PubMed abstract re: NPH/isophane insulin which indicates that it may have more variance in dogs than was previously believed:

http://www.ncbi.nlm.nih.gov/pubmed/3333933?dopt=Abstract

Absorption kinetics of regular and isophane (NPH) insulin in the normal dog.
Domestic Animal Endocrinology 1987

"Absorption kinetics of regular and isophane (NPH) insulins were evaluated in seven normal fasted dogs by measuring serial serum concentrations of insulin and glucose following the subcutaneous administration of regular and NPH insulins. These results were compared to serum insulin values determined after injecting similar doses of regular insulin intravenously. Regular insulin was better absorbed than NPH insulin (mean bioavailability index 64.6% vs. 41.1%, P less than .01) resulting in a significantly greater maximal increase in mean circulating insulin concentrations above baseline values (362.2 microU/ml vs. 147.8 microU/ml, P less than .05). The time interval between insulin injection and return of serum insulin values to basal concentrations was also significantly shorter for regular than for NPH insulin (4.9 hr vs. 8.6 hr, P less than .05). However, there were no significant differences between regular and NPH insulins in time to reach peak serum insulin concentrations, maximal reduction in serum glucose concentrations, or time of lowest circulating glucose levels. The results of this study support previously accepted values for time-action characteristics of regular insulin, but suggest that NPH insulin may have an earlier peak and shorter duration of action than has previously been proposed in the dog."

Kathy

[CarolW]

Wow; a ton of information there, Kathy; I'll get back to you later! Neeeed some sleeeep! (haha; surely many here do!)

THANKS!

Sat, 4 Oct 2008 21:15:30

[CarolW]

Hi Kathy,

I guess I can't change the title with an edit, but it should be:

venous/capillary blood / field/lab tests (calibration, comparison)

or something like that (Note added Sun, 5 Oct 2008 07:32:53 - Carol)


You'll need to use the same blood sample, though, for a comparison of the two meters. The best way to tell is to take them both to Kumbi's next appointment for blood testing and ask the vet to use some of the drawn sample on them both. This will tell you which meter is closer to lab values and also how much each of them vary from that.


I see; you're talking about actual calibration, where I'm talking about "comparing in the field" - that is, how do the two meters produce readings compared to each other when used as I mentioned - prick, prick (pricks fairly close together and close to simultaneous) - and then sip, sip - take up one sample into one meter, and the other into the other.

This would only give you a comparison of that exact situation, and you'd get no information about accuracy - but at least the test-conditions would be similar, and you'd be working with "fresh capillary whole blood," which is what (I understand from the manuals and OneTouch Customer Care) is what the meters-with-test-strips are designed to measure.

I'm sure I have lots of other questions, but this is one of them: in talking to OneTouch Customer Care, I got the idea their meters (Ultra; Ultra2, Mini - all using the same test strips: OneTouch Ultra strips) - are intended to measure "fresh capillary whole blood," and I also got the impression that a venous blood draw would produce somewhat different results!

Do you know anything about that?

I'll come back later with other relaetd questions. Thanks!

Sunday, 05 October 2008; 06:24:25, PDT

[CarolW]

Kathy - you mentioned that with some dogs, stress raises BG levels; with others, it lowers them. That is big news to me; I never heard of it! I did see somebody mention that somewhere.

However, as I understand it, stress always raises BG levels. Then the dog's response to the stress affects how the levels get lowered - how fast, and how soon. The more frantic a dog gets, the more the dog will excrete glucose, and then, use up the glucose.

Maybe I'm understanding that all wrong; that's entirely possible!

To put it simply (which is what my understanding is - very simple, and surely not complete):

A stressful event occurs (stressful to the dog - or whatever other animal with adrenal glands). The animal gets an immediate surge of adrenalin (assuming the adrenals are healthy). This surge is followed by various other stress hormones - I believe, called glucocorticoids, and/or cortisols.

The adrenalin in the bloodstream subsides after, say, 15 minutes or so, and is mostly gone after half an hour. The other stress hormones enter the bloodstream a bit later, and more slowly than did the adrenalin. These other stress hormones take a variably long time to subside. This can be anywhere from two to six DAYS; sometimes, even longer.

And they can only subside to base level (to a level normal to the animal), if other environmental triggers - external (perhaps internal as well), if no OTHER stressful event starts the sequence off again.

This is stuff I picked up from international dog-trainer Turid Rugaas. Turid probably knows as much about dogs in general - coordinated information - as anybody on the planet (that's why I mention her often on my web site - she's completely unpretentious, but also, very, very knowledgeable - much like you and Natalie.

There's a book that's just a bit hard to read; however, it's very entertainingly written, and, I believe, very much worth the effort. You wouldn't have any trouble with it. I have some, but I'm very experienced in being willing to be confused, and that aids me throughout - so, I can read this book without necessarily being able to track to perfection everything it says, and I can still get a very good idea of what is going on.

I recommend this book very strongly (I should add it to my web page on reducing stress for dogs; probably will do that).

Here's the book:

Sapolsky, Robert M. _Why Zebras Don't Get Ulcers: The Acclaimed Guide to Stress, Stress-Related Diseases, and Coping._ 3d ed. Henry Holt and Co., LLC, 115 West 18th St., New York, NY 10011, 2004. ISBN: 0-8050-7369-8

It should be in most libraries of any size - including public libraries.

Reading his Preface is a fabulous way to comprehend how people share information, and contribute to growing bodies of knowledge in a field!

But - to come back to stress levels and testing, what I believe is that if you test while the BG levels are rising, you'll see the levels that way. However, you might be testing when the BG levels are falling, a short while AFTER the stressful event - the dog is using up the glucose.

In short, I think what BG levels you get depends on individual timing in the dog.

Any comments? Thanks!
Sun, 5 Oct 2008 07:48:02

[CarolW]

To clarify my last post - some dogs respond to stressful events with heavy physical activity; this would use up the extra blood glucose. But others might shut down in the presence of triggers that raise glucose levels - that is, they'd reduce their physical activity; this would leave the glucose levels somewhat raised, and it would take quite a while for them to subside.

Anyway, I think the physiological process is quite reliably similar, but what happens to the BG levels - what the timing is - depends on the predilections (and actual physical activity) of the dog in question.

So, it's a matter of timing of the BG measurement, as well as the dog's predilection - and what the dog actually does. That's how I understand it, anyway.

Sun, 5 Oct 2008 08:36:49

[We Hope]

Carol,

Stress does activate the counter-regulatory hormones which raise blood glucose. But we also need to consider the idea that there's only so much glucose "on board" and that when the system gets the "nod" for additional glucose, it first goes into its stored glucose.

The system does go into its "produce glucose" mode, but glucose production doesn't happen instantly. It's a bit like a checking account in that if a check clears before the deposit you've made has been credited and that check is for more than your balance before the deposit credits, it will bounce.

The counter-regulatory hormones are sending out the word to both make the stored glucose available to the body and for the system to produce additional glucose when it senses that the blood glucose levels are getting too low--they are the same "folks" who activate during stress.

After the body has used up whatever extra store of glucose it has and more is still required, while the system is busily producing glucose, it becomes a supply and demand situation. The system is simply demanding more glucose than the body can turn out after its stores have been temporarily depleted--this is where hypo comes in and there's a need for some external source of glucose to see the body through.

The external source of glucose and the addition of carb-rich food (for people, they suggest a sandwich because of the carbs in bread) shortly thereafter, is what gets one through the hypo event while the body produces glucose to be stored for later needs.

If glucose production was quicker after the activation of the counter-regulatory hormones for whatever reason, there would be no need to promptly treat a hypo--the problem would resolve without any outside intervention.

Basically, it's like banking except it's more difficult to know how much glucose is in one's "account". :)

Kathy

[We Hope]

Hi Kathy,

I guess I can't change the title with an edit, but it should be:

venous/capillary blood / field/lab tests (calibration, comparison)

or something like that (Note added Sun, 5 Oct 2008 07:32:53 - Carol)

This would only give you a comparison of that exact situation, and you'd get no information about accuracy - but at least the test-conditions would be similar, and you'd be working with "fresh capillary whole blood," which is what (I understand from the manuals and OneTouch Customer Care) is what the meters-with-test-strips are designed to measure.

I'm sure I have lots of other questions, but this is one of them: in talking to OneTouch Customer Care, I got the idea their meters (Ultra; Ultra2, Mini - all using the same test strips: OneTouch Ultra strips) - are intended to measure "fresh capillary whole blood," and I also got the impression that a venous blood draw would produce somewhat different results!

Do you know anything about that?

I'll come back later with other relaetd questions. Thanks!

Sunday, 05 October 2008; 06:24:25, PDT

Let's look at capillary whole blood versus venous plasma blood first:

http://petdiabetes.wikia.com/wiki/Glucometer#Whole_Blood_vs_Plasma_Readings

"Glucose levels in plasma (a component of blood) are generally 10-15% higher (even more after eating) than glucose measurement in whole blood. All of our home devices actually measure the glucose content of whole blood. Most lab testing measures the glucose content of the plasma.

"Many currently marketed meters automatically display their readings (through a math algorithm built into the device) as plasma equivalent. Thus allowing one to better compare their meter results to those of lab testing. It's important that you know whether the meter you're using displays readings as whole blood equivalent or plasma equivalent."

http://www.lifescan.com/pdf/AW_06397301A_EN.pdf

From the OneTouch UltraMini (US) Users' Booklet-Page 48

"Test results with the OneTouch UltraMini are plasma-calibrated. This helps you and your healthcare professional to compare your meter results with laboratory tests."

And then it goes on to explain that if you've been using a meter that doesn't give you the plasma-calibrated results, but instead gives a whole blood readout, you'll note that your readings with the plasma-calibrated meter will be about 12% higher than the readings from a meter using whole blood measurement only.

"OneTouch UltraMini meter test results and laboratory results are expressed in plasma equivalent units. However, your meter may differ from your laboratory result due to normal variation. Meter results can be affected by factors and conditions that do not affect laboratory results in the same way."

So we see that the meter is geared to provide us with a reading which is similar to that of a lab test result--most to all meters currently on the market do it like this now.

I went to US Diagnostics for some information on their EasyGluco meters, which is what the GlucoPet and GlucoVet really is, minus the animal-valdated test strips.

http://www.usdiagnostics.net/

I see no tech information on their site for the EasyGluco G1 and G2 meters. This would lead me to believe that EasyGluco might be in the process of being phased out in favor of their newer Maxima and Control models. What I did see is information about the EasyGluco test strips; these are not animal validated but the basics should apply since it is the same strip:

http://www.usdiagnostics.net/index.php?section=professional&page=professional_technology.htm

Here you see a comparison of the strips against those for OneTouch Ultra.

I'm going to go with the idea that the EasyGluco meter is also plasma-calibrated even though we can't find that information on the US Diagnostics website.

Kathy

[CarolW]

Kathy - thanks so much; I find your explanation truly helpful. I seem to have lost my place on the page, so I"ll combine a reply to both your posts in this one reply.

Your glucose explanation is wonderful! I'm tracking better now; I need more time to study; I'll get there!

About the GlucoPet meter; I went to the U.S. Diagnostics site, and it showed the Control meters there. The one I got in the mail says "Control" on its backside, but its front says "GlucoPet." (haha!)

I also noticed that the "validation" page on the animaldiabetes site is very vague, and very limited.

Somewhere in the GlucoPet manual, I noticed it said it IS plasma-calibrated. Same with all the OneTouch Ultra meters I have - now, three of them; one Ultra, one Ultra2, and one Mini. I REALLY don't care for the Mini much - too small a display, too much manual-reading, for me. The Ultra2 is an absolute delight! I wlil keep the Mini around, in case I need to carry one around!

As for the GlucoPet, I don't know if my vet would be willing to put it through its paces. It's a bit hard with Kumbi, because he's so stable right now, I'm unlikely to get any particularly high readings (say, much over 300 mg/dL. Well, I could get close to 400 in some conditions, but that's not common. My vet is a bit short-handed right now, with one vet off (a locum is helping, though - nice guy! - I've met him several times) - and the office manager - a total gem! away for a bit of a vacation, I think. So I'm holding off on email to my vet, as the office manager, Pam, does the email.

I can tell I need to go to bed - when I start rambling like this. Cannot resist the temptation to come read here on my way to bed!

Thanks for all the help! I know I'll have more questions, and will ask along the way.

Sun, 5 Oct 2008 21:42:52

[k9diabetes]

16:27 - 5.9 mmol/L = 106 mg/dL - OneTouch UltraMini
16:28 - 6.0 mmol/L = 108 mg/dL - GlucoPet

18:01 - 8.4 mmol/L = 151 mg/dL - UltraMini
18:02 - 8.8 mmol/L = 159 mg/dL - GlucoPet

11:31 - 12.4 mmol/L = 223 mg/dL - OneTouch Ultra2
11:31 - 12.7 mmol/L = 229 mg/dL - GlucoPet

14:01 - 10.6 mmol/L = 191 mg/dL - OneTouch Ultra2
14:02 - 8.1 mmol/L = 146 mg/dL - GlucoPet

16:09 - 5.5 mmol/L = 99 mg/dL - Ultra2
16:10 - 6.2 mmol/L = 112 mg/dL - GlucoPet


Your tests so far looked about the same as ours. When we tried GlucoPet, a few years ago now, it read actually somewhat lower with Chris' blood than the OneTouch Ultra. Around 10 points lower than the OneTouch.

We did one-stick tests on Chris' lip. Prepped the meters before hand, waited for a good-sized drop of blood, and then pulled that blood into two or three meters at a time. I don't think you'd find a lot of variation in blood glucose levels with this method or the way you've done it.

At the vet we had a few opportunities to test the stress issue as well.

I checked Chris' blood in the waiting room before he went into the exam room. They did their blood draw for lab analysis and then I took a second test of his glucose on my meter after they handed him back to me. That way I knew that there wasn't a huge change in his blood glucose levels from vet stress.

Chris was one of the dogs whose blood sugar drops at the vet - I think anxiety/activity and perhaps stress. We always had to make sure his blood sugar was high enough for it to drop some at the vet.

Natalie

[eyelostit]

I'm glad you guys posted all of that, seems the mini is close to the glucopet.


with my tests with glucopet and reli on ultima the Reli on is close to glucopet only when BG is 225 or under, if BG is high the Reli On will give 100 pts higher the glucopet

I;ve noticed with the glucopet lately strips coded with 23 and 24 are not drawing up blood I wasted 10 strips today.

I find this odd, with the Reli On I never had trouble drawing up blood, but could not trust it with high readings.

[CarolW]

Natalie - from all I read about Chris, he never went by the book; ha! I think my Kumbi goes much more by the book than Chris ever did. I'd frankly be terrifed to use any R insulin on Kumbi, since the Novolin NPH seems to work very well for him (and Kathy, your information about the workings of Novolin was great).

Again, I've lost my page-place; not understanding the Quick Reply too well, but I can at least see enough to reply in general!

About the GlucoPet strips I have - they are coded #23. I did have trouble with one reading, but can't attribute that to the strip's sipping function at all; the sample was just a bit small, and also, Kumbi was getting squirmy, as apparently I hurt him a bit with one of the pricks. The other GlucoPet readings I got, the strips worked fine.

And about my prick-prick; sip-sip idea - I really think that gives both meters a fair chance, where taking everything from the same sample (at least, on little Kumbi!) risks drawing up enough to leave the sample too sparse for the second meter-test-stirp combination.

But testing this way does nothing to determine the accuracy of either meter! At least I'm aware of that. It will take me some practice an study and time to figure out how each of these meters behaves. I'm thinking likely, the Ultra-Mini, the Ultra2, and the Ultra behave quite smilarly; their differences, at least theoretically, shouldn't be more than what you'd get with two different meters of the same model, as long as the manufacturer is the same - at least, for a manufacturer as apparently reliable as LifeScan. Am I silly to believe that? Could be!

Last time I had to reinstall Windows (last December), I left my OneTouch Diabetes Management software uninstalled - I had it backed up, had my laboriously hand-entered data for over a year also backed up - but it took up a lot of room, and I didn't want to reinstall it. But now, with remarks about the importance of looking at TRENDS, I want it back, so I reinstalled it today. Must check in case there are updates to the software.

But a trends graph from MY data doesn't work very well, because my curves are too far apart, and I don't have enough spot-checks to fill in the interim areas. Eventually, I'll sort out how to get a decent trends graph with it - I hope!

Haven't tried the Excel thing Kathy posted, yet. Will try that too.

I'll report back with anything I notice. Today was a miserable computer-day for me - desperately needed to do maintenance, and must back up my hard drive, too. (Did the necessary pre-backup maintenance, at least.)

Hope to be back sometime tomorrow!
Mon, 6 Oct 2008 22:08:28

[CarolW]

....
We did one-stick tests on Chris' lip. Prepped the meters before hand, waited for a good-sized drop of blood, and then pulled that blood into two or three meters at a time. I don't think you'd find a lot of variation in blood glucose levels with this method or the way you've done it.
....
Natalie

I'm thinking out loud here; all comments welcome.

When I sent my results to Karen Dahl (six spot-checks, two last Friday, four last Saturday),. she replied to my question on this, saying use the two different pricks. I think it's probably "safer" to do it that way, but let me look at what variables we're dealing with, when using two different meters on the same dog, same date, same time, same general prick-site (so if you do double-prick, as I did last Friday and Saturday, the pricks need to be close together, but not so close the samples would run together).

I'm not sure just how much of what fluid the test strip sips up! Ideally, it should sip a perfect sample- round drop of blood that's welled up from a prick site. I can't help but think that after the first sip, the rest of the sample, even if it's still welling up some, could be somewhat depleted. That's why I plan to continue with the

prick-prick
sip-sip

technique.

Kumbi will accept that if none of my pricks hurt (usually they don't), and if I can be quick with the meters (comparing my trusty One-Touch ULtra2, which I've been using about a year, with the new GlucoPet).

Kumbi's mouth is small, so I'm limited in just how many pricks I can fit in there without making him uncomfortable, and I'll have to play this by ear; I had hoped to compare the two meters throughout a BG curve test, of, say, minimum, 7 (double-) sticks. But whether I have room for 14 pricks remains up in the air - that is, 14, all of which will deliver, on first prick, a perfect sample; ha!

But let's assume that at least for some of the readings, I can get two good samples.

Now what are the variables? I keep in mind that this is a FIELD test; it says nothing about the accuracy of either meter. All this can possibly show is a difference between how each of the two meters reads on something RESEMBLING similar samples, taken at approximately the same date and time, from the same approximate prick-site.

Is such a comparison of any use? For ME, it is, if I'm working on deciding which of the two meters I'd like to use as a matter of course. The other meter, I'd likely set aside, and if I'd use it again (which I might), I'd do another of these prick-prick, sip-sip comparisons before depending fully on the results of the readings - just in case something in a meter - or test strips - had changed in the interim. So, also, I'd do control tests before beginning; I generally do that if there are long pauses between my tests - usually, there are.

Variables: The dog is the same; date is the same, prick-time is very closely (not exactly) the same.

Test strips- for either meter, there's no way to know! That is, assuming you follow all the manufacturer's recommendations - do the control-testing (there's one strip) - but then you have some idea. (The GlucoPet also has a Check-strip - interesting! - I think what it tests is just basic meter-functioning).

I should also remark that the GlucoPet I have appears to be their latest model; it says "Control" on the back; it's from U.S. Diagnostics; I think Kathy posted their site.

Taking everything into account, then, the most stable element is the dog. Now combine with that the date and time, which should be very close (time, that is), and - if the reading is to be any use at all to get any meaningful results on comparing the meter-readings - the two blood samples that result from the initial prick-prick should, ideally, well up similarly, and fairly easily - and shouldn't flood, nor run. And need to be pretty close together, so the prick-site is about the same.

When all that falls into place, AND on the sip-sip, each meter-test-strip combination picks up the sample easily and quickly, THEN, I think, you have something that compares how the two meters read.

This is in no way any kind of calibration, but it does allow you, if you're used to using one of the meters, and you're considering maybe changing to the other, to make decisions based on how the readings you get compare with the dog's current condition (clinical signs and so forth would be your guide there).

And there's another rub - the dog's current condition. Kumbi has been in glowing good health the last half year (I'm hoping that will continue!) In this good condition, I can't compare, with Kumbi as the stable variable, how the meters would read if his BGs were, say, too low, or higher than is comfortable.

If Kumbi were to start running uncomfortably high numbers, then, I'd probably do another set of comparisons, before depending solely on the GlucoPet. He's had high numbers in the past, that I picked up with my earlier meter, the OneTouch Ultra (that model is now replaced by LifeScan with the Ultra2).

Karen Dahl told me the GlucoVet meter is more accurate for higher readings than is the GlucoPet, and offered to let me try the GlucoVet instead of the GlucoPet. But I said, I'm not going to ask Kumbi to give me 3 microliters per sample; he has a hard enough time with the 1 microliter. Also, there are other factors to consider - and it's there, I think, that could help us interpret results (from this field-testing only) in any kind of useful way.

I already mentioned that if the two samples are less than ideal, a comparison-reading may need to be thrown out - it's not a useful data point. Also, if my technique is faulty, as in the time I touched Kumbi's lip instead of the sample, when he moved suddenly, that reading needs to be discarded (unless I can replace the test strip in a hurry, and prick again as well)!

I figure if I do have trouble, and need to re-prick re-sip, that if I can do it within one minute or so, the results are probably good enough to make some kind of comparison - that is, the conditions remain approximately the same as before, apart from possibly a sudden stress to Kumbi - but BG levels shouldn't change drastically within one minute, I think! - not enough, anyway, to affect a Lip-Stick reading much.

I'm keeping careful records, as I always do. I have no idea which meter I'll end up using as my primary meter for Kumbi. I do know I could use the Ultra2, which appears to function similarly to my older Ultra, though again, I should compare THOSE two. My vet uses OneTouch Ultra meters.

Which brings up one last consideration. LifeScan - OneTouch Customer Care - tells me their meters are "not recommended for use on animals." I went over this with them, several times. They said, this is the industry standard - in meters made for humans. They also said, there's a margin for error of 20% either way, on a SINGLE reading - and that would be on humans! Which surely means, on dogs, as well.

And perhaps one test strip, even from the same vial, could differ from the next (of course, that is, even from the same manufacturer and with the same code-number).

About the test strips - the only way to guess the strip is okay is, seems to me, to believe that the result of the reading really makes sense. If it doesn't make sense at all, best take a second reading with a fresh test strip.

If all goes perfectly well on every prick-prick, sip-sip, at least I'd have a day's worth of readings, where one set (the Ultra2) should resemble my previous curves, or at least be somewhat meaningful related to my previous curves, and the other set (GlucoPet) should at least make sense; for instance, it should have a curve somewhat similar to the one the Ultra2 produces.

That is, I think usually, my technique is good enough, and Kumbi is cooperative enough, so that I can get a reasonable curve on him with the ULtra2. Are the results accurate? Surely not to the single-number-value, whether reading in mmol/L (as I do) or in mg/dL (and I always convert the numbers, and write them down in both units of measurement).

So if the resulting curves are similar in shape, and the high, low, and interim readings are somewhere near each other, I think it's a safe assumption that both meters are working pretty well. Then I would still have to make my choice about which to depend on to guide my vet and me in dosing decisions, not to mention, in sending results to my vet!

Currently, Kumbi's numbers were low enough on my first set of spot-checks, so I nudged his dose down by a quarter-unit (Novolin NPH). Kumbi is looking fine. I probably won't take more readings for a time, because he really does stress with them, though I'll always do a spot-check if I think it's necessary!

I'll continue my reports when it makes sense to.

Thu, 9 Oct 2008 08:52:16

[k9diabetes]

Especially for folks new to home blood glucose testing, I want to point out that the kind of comparisons Carol is doing with meters are more of a scientific exercise than related to how you manage your dog's diabetes on a day to day basis using a blood glucose meter.

This is important because it's easy to get lost, when you're working with real world regulation, in tiny differences in numbers.

Say you do a spot check today and the BG is 320 and tomorrow you do it and it's 280. Functionally, those aren't significantly different readings. Blood glucose varies naturally and with the same diet and the same insulin and even all the same conditions, if that was possible, you could easily see this much variation from one day to the next.

UGA discovered, thanks to the Continuous Blood Glucose Monitoring System, that BG varies constantly, moment to moment.

So the goal of curves is to capture trends.

This is also why it doesn't really matter whether the OneTouch Ultra is meant to be used with dogs. Say the OneTouch Ultra, as ours did, runs a pretty predictable average of 30 points lower than a lab value.

If I get 320 on the meter, it doesn't really matter, in terms of what I'm going to do about insulin, whether the BG is 320 or 350. All I really need to know is that it's in the 300s, probably the lower half of the 300s, and act accordingly. If the meter reads 50, even then I don't really need to know if it's really 50 or if it's actually 80 - I know my dog is at risk of hypoglycemia since the BG could drop further and need to act accordingly.

This is why so many of us - with feline and canine diabetics - manage very nicely with regular meters meant for people and skip the expense of the animal-adjusted meters. (Also have to consider that the animal-adjusted meters are not necessarily more accurate.)

I do very heartily recommend comparing your meter - regardless of the type - in tests against some lab values so you have an idea of how far off it is (or isn't). More knowledge is always better.

But if all you ever use your meter for is to determine whether your dog's stumbling and lethargic behavior is high or low blood sugar, you will have put the meter to good use.

Meter to meter comparisons are a lot of fun and provide a lot of useful and interesting information. But don't get mired in trying to monitor your dog's blood sugar to minute degrees of difference - you wind up "chasing numbers" and missing the trends, which are the important thing long-term in determining whether your dog's diet and insulin dose are working properly.

I will be very interested to see how Carol's comparisons turn out.

In general, Carol, my guess is that the amount of variation allowed in the meters and test strip function is large enough that one prick versus two won't make any difference - there's variability inherent to the meter process. I believe the strips screen out the red cells anyway so how many of those get into the meter shouldn't make much of a difference.

Chris was a very good bleeder on the lip. He put up a nice big drop - no milking or smearing required to test as many as three meters. And he wasn't at all wiggly either, which really helped. We had him lie on his side so he wasn't a moving target (he was lying upright in the video but that isn't normally how we did it - just easier to capture on camera) and he didn't mind the testing at all.

Looking forward to more results.

Natalie

[CarolW]

Natalie - thanks so much for your remarks, with the perspective you include. I always work this way! But I had also intended to say much the same as what you just said, about using glucometers. Maybe with very rare exceptions (which would be on the low side, rather than high, 50 points (mg/dL) here, there, would hardly make a difference. A rough estimate of low, medium or high would usually be enough - along with the shape of the curve, and trends from one curve to another.

Just as you say, put the margin for error in there, add the constant changing of BG levels through a day (and night) anyway, and the way I do it begins to look awfully silly!

But it DOES give me some idea of what the readings on one meter might mean with respect to the readings on the other - with the stablilizing (central) factor being Kumbi and his current condition. In effect, it is Kumbi telling me about the meters!. More than that, I couldn't say. (I do tend to use empirical methods in my studies, and there are times when that's useful.)

I expect you're right about the blood sampling - for a dog who "gives easily," as Chris did, the one sample for two or three meters seems workable. Kumbi hoards his blood [grin]

Gee, just think, if Kumbi gave as Chris did, maybe I could have used the GlucoVet instead of the GlucoPet! (But I don't think it matters that much, because my main concern for any possible accuracy is in the lower numbers. Kumbi has never had a hypo. and I don't want him ever to have one!

I've heard of meters that are just all over the place, so you'd get very disoriented if you tried something like this with one of those. Worse, if you used the meter without being aware it does that!

It's a privilege to post and to have your so-well-educated comments, Natalie! That goes for you, too, Kathy.

If I have anything more to say in this series, it's like to be reports of comparative readings.

Thu, 9 Oct 2008 11:17:34