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Diabetes Care Tips Print version of the article by Lahle Wolfe, Islets of Hope, 02/24/2006 Contents Section 1
Section 2
Section 1About Glucose Monitoring and Glucose MetersBlood glucose monitoring is a way of testing how much glucose is in the blood (glycemia). Hypoglycemia means low blood glucose, hyperglycemia refers to high blood glucose, and normoglcyemia indicates normal blood glucose levels. In the United States, blood glucose is measured in mg/dL (miligrams per deciliter). In most other countries, blood glucose is measured in mmol/l. Blood glucose meters measure how much glucose is in a given blood sample. Where the sample comes from (fingers, toes, forearms, ear lobes) will affect test results. A test strip is placed inside a blood glucose meter (you can ONLY use test strips designed for your particular meter). A drop of blood is then placed on the strip. Blood reacts with hemicals in the test strip causing a small electronic pulse to be sent into the meter which then calculates the level of glucose in the blood sample and shows the result in a digital display. Lancet and Lancing Device Tips You do not have to use the lancing device that came with your test kit. As long as the lancing device you are using draws sufficient blood for your meter you can use anyone that you want. Not all lancing devices are equal. Generally, the smaller the drop of blood the less pain involved. If you choose one that does not draw sufficient blood you will have to squeeze (or "milk") you finger for more blood. Most people, children in particular, find the hard squeezing more painful than a larger needle, or slightly deeper setting.
IOH Tip: Almost all children (and many adults) fear needles of any sort. If your child is newly diagnosed it will take time to adjust to the many pricks each day. It is helpful if you practice on yourself first. Children may appreciate that you too are going through the same thing and it is a good way to see what hurts and what does not. (See "Less-Pain" Finger Sticks tips below.) You might also contact your local Juvenile Diabetes Research Foundation Chapter. Many of JDRF's chapters offer free meters, books, and even an adorable stuffed bear (Rufus of Rudy) to comfort children newly diagnosed with diabetes. The bears have hearts on their paws, bums and tummies -- places children have to take shots and finger sticks. "Less-Pain" Finger Sticks Once, my 10-year-old (who should know better) called me in a panic with a blood glucose reading over 400 mg/dL. But when she washed her hands, ridding them of the remains of a sugary snack she had eaten earlier, her glucose was normal. Because of the disparity between 400 and normal I did a third check which confirmed her blood glucose was in fact, normal. To have administered insulin to treat a 400 reading would have created a medical emergency. This brings me to my first tip (because repeating sticks causes more pain):
I keep small gauze pads in my daughter's test kit, insulin pump pouch, or in my purse to apply pressure for what she calls a "gusher." But Elizabeth much prefers to simlply apply pressure herself or (now mom cringes) plunging her finger into her mouth for a second. While this may work, it can be disconcerting to other people, especially to parents and school officials. Teach your child how to use a dry gauze pad (cut into small pieces) or cotton ball (which I find "shed" fibers that can stick to the skin) to stop bleeding and reassure other folks. Make sure anything with blood gets tucked away discretely or disposed of in a sanitary place like a sharps or biohazardous waste container. Quick Summary of Glucose Testing Tips
Important Tips for Accuracy
Always have a backup meter handy, and never, ever go anywhere without a meter, plenty of test strips, lancing supplies, fast-acting sugars, medical identification bracelet and information card for your wallet or purse, and, if you are on insulin, always carry a glucagon kit. Special Care Tips For Children Remember that most children are fairly resilient; they will adapt to their diabetes care program probably a lot faster than you will. Letting a child return to normal activities after diagnosis is scary for parents, but crucial for children's mental health. Here are some tips to help ease the transition from "everything's rosy" to dealing with a serious, and chronic illness:
If your child, you, or other family members are having trouble dealing with diabetes, seek counseling or therapy from a mental health professional because a chronic illness affects the entire family. Section 2 How They Work and Various Meter Features In the United States, blood glucose is measured in mg/dL (milligrams per deciliter). In most other countries, blood glucose is measured in mmol/l. Many meters can be set for either measurement so it is very important that you always make sure your meter is set to the measurement you are familiar with. Blood glucose meters measure how much glucose is in a given blood sample. Where the sample comes from (fingers, toes, forearms, ear lobes) will affect test results. Although alternative site testing is enticing (claiming to be less painful) I personally do not feel it is accurate enough for use on young children that cannot sense their own symptoms of hypoglycemia. Readings from forearm (or toe) blood lag behind fingertip blood and cannot accurately reflect rapidly changing glucose levels in the rest of the body. This means that a forearm sample could come back higher than is actually true and a person could really be suffering from hypoglycemia (low blood glucose) and need treatment. A test strip is placed inside a blood glucose meter (you can ONLY use test strips designed for your particular meter). A drop of blood is then placed on the strip. Blood reacts with chemicals in the test strip causing a small electronic pulse to be sent into the meter which then calculates the level of glucose in the blood sample and shows the result in a digital display. Different makes of meters offer a variety of functions and data management capabilities to match individual testing needs. Newer models of meters feature one-step sampling and readout. The chemically-treated strip is placed in the device and a drop of blood is placed on the test strip which acts like a straw drawing the blood sample into the strip. and the meter then gives a reading. Newer meters offer on screen averages for week or months at a time, can hold hundreds of previous test results with time and date, and may even have graphing capability. The new generation of meters may also have upload features so that a person or doctor can upload meter readings directly from the meter and into a computer for analysis and review. Some meters allow entry of additional data throughout the day, such as insulin dose, amount of carbohydrates eaten, stress, illness, or exercise data. Not all meters have these feature so be sure to talk with your doctor about what features are available and suit your needs best. Alternative Testing Sites Some meters offer alternate site testing, which allows a consumer to test on sites other than the fingertips, which can become sore and callused over time. However, alternate site testing is not as accurate as finger pricks. If your reading is low from an alternate test site (i.e., forearm), or you feel like you may be low, you still have to repeat the test on a fingertip. (I personally find finger sticks not only more accurate, but also less painful when done properly. The main drawback of alternative site testing is that they are not consistently reliable. A person may test higher on the forearm than if they had tested on their fingers. This can be a real problem if a person (especially child) is already on the low side. A false higher reading may prompt a parent to give a correction bolus when in fact, the child is already, or heading into, a state of hypoglycemia (low blood glucose) For now, finger tip testing is still more reliable than alternate site testing. Why Should I Test My Blood Glucose? The glucose meter is a key element of home blood glucose monitoring (HBGM, also called "self glucose monitoring") by people with diabetes mellitus and other disorders that require blood glucose monitoring. Since approximately 1980, a primary goal of the management of type 1 diabetes has been the achievement of closer-to-normal levels of glucose in the blood for as much of the time as possible, guided by HBGM several times a day. This has greatly increased the trouble and time spent in the daily care of this disease but has also reduced rates of long-term complications and improved the management of short-term complications such as hypoglycemia. It is estimated that approximately 85% of all diabetics do not adequately keep their blood glucose levels at, or near, their target ranges. This may be one reason for the high rate of associated diabetes complications. The best way to manage your blood glucose levels is simple: test regularly, and often. You cannot correct highs and lows if you don't know about them. Glucose monitoring is also an important tool for helping your doctor determine your best care plan approach. Readings can help determine what your basal (background) insulin should be, as well as your insulin-to-carb ration, correction factor, and how your blood glucose levels are faring during the night. Meter Use For Hypoglycemia Although the apparent value of immediate measurement of blood glucose might seem to be higher for hypoglycemia than hyperglycemia, meters have been less useful. The primary problems are precision and ratio of false positive and negative results. An imprecision of ±15% is less of a problem for high glucose levels than low. There is little difference in the management of a glucose of 200 mg/dl compared with 260 (i.e., a "true" glucose of 230±15%), but the difference between 70 mg/dl and 55 (i.e., 67±15%) represents a more unsatisfactory uncertainty. The imprecision is compounded by the relative likelihood of false positives and negatives in populations of people with diabetes and those without diabetes. People with type 1 diabetes usually have glucose levels above normal, often ranging from 40 to 500 mg/dl, and when a meter reading of 50 or 70 is accompanied by their usual hypoglycemic symptoms, there is little uncertainty about the reading representing a "true positive" and little harm done if it is a "false positive." In contrast, people who do not have diabetes but periodically have hypoglycemic symptoms, will have a much higher rate of false positives to true, and a meter is not accurate enough to base a diagnosis of hypoglycemia upon. Hypoglycemia (unrelated to diabetes) needs to be diagnosed by a medical professional. A meter can occasionally be useful in the monitoring of severe types of hypoglycemia (e.g., congenital hyperinsulinemia), to ensure that the average glucose when fasting remain above 70 mg/dl. When Should I Test My Blood Glucose? Your doctor will help you decide when to test and how often. However, the more often you test the better your chances of catching lows and avoiding highs; both important factors in reducing your risk of long-term complications of diabetes. Generally, most physicians will advise that you test:
Also, you need to RECHECK blood glucose levels anytime you have suffered a hypoglycemia episode (70 mg/dL or lower) that required treatment. Keep rechecking blood glucose until your levels have stabilized. Meter Accuracy Accuracy of glucose meters is a common topic of concern. Nearly all of the meters have similar accuracy (±10-15%) when used correctly. However, a variety of factors can affect the accuracy of a test including calibration of meter, ambient temperature, pressure use to wipe off strip, size of blood sample, high levels of certain drugs in blood, hematocrit (blood iron levels), dirt on meter, aging of test strips, and of course, wet fingers or fingers that are dirty or contaminated with food. Models vary in their susceptibility to these factors, and in their ability to prevent or warn of inaccurate results with error messages.
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