Tag Archives: blood glucose

This movement is gaining momentum. Climb aboard the steamroller NOW.

August 20, 2013 – 12:01 pm

If you’re a Person With Diabetes, you know the importance of seeing accurate readings on your glucose meter. In a public meeting last May, officials from the U.S. Food and Drug Administration admitted that there are some glucose meters and test strips out in the marketplace that no longer meet the standards that they were approved for in the first place.

What were they approved for in the first place? In testing with the FDA, test strips are required to meet an accuracy of +/- 20%. That means if my meter says 180 mg/dL, it could actually be as high as 216 and still pass the test. Or it could be as low as 144… and still pass the test. That’s a 72 point difference! That’s a window big enough to drive a truck through. And that’s what is required to pass the test and win approval.

To their credit, the FDA is working to lower the threshold and make test strips even more accurate. So what’s the problem?

Well, once the test strips are approved for use in the USA, they aren’t subject to further scrutiny. In other words, there is no program in place to ensure the continued accuracy of test strips once they’re approved. So the test strips I’m using, that met a 20% standard of accuracy when approved, might now have an accuracy of +/- 40%, according to some experts. At that measure of accuracy, my 180 mg/dL reading might actually be 252. Or 108. A difference of 144 mg/dL.

Since dosing insulin is dependent on my blood glucose reading and how many grams of carbohydrates I’m eating, if there are 45 grams of carbs in my meal:

– That 20 percent standard means a dose as low as 3.3 units. Or a dose as high as 5.1 units.

– That 40 percent deviation could mean a dose of 3.0 units. Or a dose of as much as 6.0 units of insulin.

Imagine if my dinner bolus is 6.0 units, but it should have been 3.0 units. Since my target is to get back to 100 mg/dL, and one unit of insulin should drop me about 40 mg/dL, an over-bolus of 3 units means I could drop 120 points lower than expected, resulting in severe hypoglycemia or even death. Are you with me so far? Do you understand how critical test strip accuracy really is? Good.

This is why the Strip Safely (http://www.stripsafely.com) campaign is in full force, helping to spread the word about the importance of test strip accuracy. You can do your part too, by sending a letter, either by snail mail or by e-mail, to your elected officials in Washington. Need a little help getting started?

– A sample letter you can use is available here.

– You can find your elected officials HERE.

Hint: Our elected officials have Twitter and Facebook accounts too. So does the FDA. In fact, they have many Twitter handles, including @US_FDA, @FDADeviceInfo, and @FDAMedWatch. If you decide to send something via Twitter, be sure to include the hashtag #StripSafely.

You might be saying, “Hey Steevo, you wrote about this before… why bring it up again?”. Because it’s that important. Let’s keep the momentum going. Let’s help improve the safety of people living with diabetes, and improve the peace of mind of our loved ones affected by diabetes. It’s that important. And your help is needed and appreciated and keeps the momentum going.
 
 
 

By StephenS | Posted in Diabetes | Also tagged , , | Comments (0)

Sometimes, I just hate getting blood drawn.

June 5, 2013 – 10:37 am

Excuse me while I vent a little…

I had to get blood drawn today for the clinical trial I’m participating in. Instead of going all the way down to Virginia to get it done, the team there sent me a lab slip so I could get the work done here. Fine so far, right?

So I go into the local corporate-owned lab processing place (are there any mom and pop lab processing places?) and gave them the lab slip that had been scanned and e-mailed to me. In the office there was me and three lab technicians. That’s where the trouble started.

“This says ‘Virginia’ on it… I don’t know if we can do that here”. Well, yes, you can. You’re a multi-state organization, which is why they chose you to do the work (I live in Maryland, for those who don’t know).

“This doesn’t have your name on it, just your initials… I don’t think we can do this without your name on it.” They’re trying to keep the study participant information as private as possible, I think, and I just let you look at my driver’s license, and by the way, the form says “patient’s initials” where my initials are.

“Okay, we just need your name, date of birth, your phone number, and your address.” Really? Do the words “Patient Privacy” mean anything to you? Actually, that’s only what I was thinking, it’s not what I said. I eventually gave it to them to keep the process-at-a-snail’s-pace moving.

What I said, eventually, was: “Look, I’m not going to come in here out of the blue with a forged lab slip because I like going around and getting poked in the arm all the time. No one would do that.”

Ten minutes later, the blood was drawn and I was on my way. After answering questions like “did we get your date of birth?” (Yes) and “This goes to Johns Hopkins, right?” (No, University of Virginia). Start to finish the process took about 50 minutes. And I was the only patient in the place.

I was a retail manager in a previous life, and I know this is a different setting, but let me put it this way: I never believed in the notion that “The customer is always right”. My feeling was, the customer should never be made to feel that it’s their fault if they’re wrong. If I hand you a piece of paper that doesn’t look like every other piece of paper you receive (even though it does have your company’s logo at the top), let’s work together so I can ease your fears and you can ease mine.

If we had worked together, the whole episode would have taken less time, and you and I probably would have had smiles on our faces at the end of the process. If you even care about that kind of thing. Which, maybe, you don’t.
 
 
 

By StephenS | Posted in Random Glucose | Also tagged , | Comments (3)

Highs vs. Lows.

May 23, 2013 – 9:30 am

Seems to me there’s a disparity in dealing with high glucose versus dealing with low glucose. Okay, maybe it’s not as serious as a disparity, but I’m trying to keep this light here, okay?

When my BG is low, I find that there are many things that I can use (read: ingest) to get myself back into a safe range. Among them:
 
 
– Juice

– Glucolifts (Cherry… yum)

– Honey

– Goetze’s Caramel Creams (addictive)

– Fruit

– Level Life Glucose Gel (kinda like the Mandarin Orange)

– Smarties (which are Rockets north of the border)

– Rockets (which are Smarties here in the USA)

– Insert your favorite here (Nutella, Maple Syrup, etc.)

– And, as a last resort, Glucagon
 
 
That’s at least nine items that I can use to bring up my glucose from an unsafe level. Having low BG is no picnic, of course. But those options almost feel like a reward for suffering through hypoglycemia. Almost. But not quite.

But what if my glucose is high? What if my pump has an issue delivering insulin, or it’s a hot day and the insulin loses its effectiveness, or I under-bolus for lunch? Now, I’m hovering near 300 mg/dL and I only have three options available to combat the high BG:
 
 
– Insulin

– Drink lots of water

– Exercise (while drinking lots of water)
 
 
That’s not a lot of options. And they’re not very appealing either. Also, if you have Type 2, you may not be on insulin therapy, so you may be left with only two options. Woo-freakin’-hoo.

In a way, having fewer choices when you’re high takes a lot of the guesswork out of what you need to do. You’ve just gotta do it, right? Using one, or two, or three methods. And it’s likely that you’ll have to wait to get yourself back into range. I mean, when you’re low you drink some juice, pop some glucose-laden product, and you’re often back in range within minutes. When you’re high, you can give a correction bolus of insulin, drink lots of water, and go for a run, and you’ll still have to wait some time before your BG comes back down.

I think this disparity in available options and time needed to correct explain why I absolutely hate being high, and why I try to do everything I can to avoid it. That doesn’t mean that I’m doing everything I can to be low. It just means that I don’t worry about being low as much as I worry about being high, if you know what I mean. Plus, I’ve got to admit, I hate how it makes me feel.

I suppose I could use this discussion to push for development and approval of faster-acting insulin. But I’m not thinking about that right now. I’m thinking about how high BG makes me feel, physically and mentally. And how that’s completely different from how I feel about low BG.

What about you? Do you worry more about high BG than low BG? Do you still worry about low BG, but secretly like the fact that it allows you some seemingly guilt-free indulgence? I’d love to hear what you think about both ends of the glucose spectrum.
 
 
 

By StephenS | Posted in Random Glucose | Also tagged , , , | Comments (11)

#DBlogWeek – Day Six. Time for a wild card.

May 18, 2013 – 4:25 pm

diabetes-blog-week

We’re near the end of Diabetes Blog Week! Myself and many others are posting for 7 (seven!) straight days. Haven’t heard of Diabetes Blog Week? Get the lowdown by clicking on the banner above.

We’re up to day six now. And to be honest, I am the Worst.Artist.Ever. That means it’s time for a wild card subject:

Back by popular demand, let’s revisit this prompt from last year! Tell us what your fantasy diabetes device would be? Think of your dream blood glucose checker, delivery system for insulin or other meds, magic carb counter, etc etc etc. The sky is the limit – what would you love to see?

I know I’m not going to give this subject justice today, but here’s a little of what I’d like to see:

– A device that delivers insulin and measures glucose through the same infusion set.

– It would be nice if said device would be 100 percent accurate. Always.

– And can it deliver data real-time to mobile devices and the internet?

– While we’re at it, can we make the data readable by Macs and PCs and Androids and iPhones and Samsungs, etc.?

– Let’s give it an alarm that will wake the dead in the middle of the night.

– What if it sent data to your endocrinologist on a regular basis, whether they want it or not? And then what if it held them accountable for helping you and kept them from saying stupid things, like “non-compliant diabetic”? (I’m not talking about you, Dr. P)

– Oooh… Let’s give it a feature that will taser the Diabetes Police whenever they get out of line (maybe with cupcake frosting).

– And finally, I need my Dream Diabetes Device to pick the winning Powerball numbers tonight. ‘Cause 600 Million Dollars would buy a lot of test strips.
 
 
 

By StephenS | Posted in Diabetes Blog Week | Also tagged , , , | Comments (5)

Sometimes the highs are worth it.

March 11, 2013 – 10:39 am

I have a lot to talk about this week. But first, I need to get this thing out of my head from yesterday. It’s about a low. One of those nasty, thrashing around, call 911 hypoglycemic events that we all hate to think about. Or talk about. I’m fine, no real harm done, and the EMS people were only at the house for about five minutes because I’m always better by the time they get there anyway, though the thing I hate most about those times (which have been very infrequent) is that they have to be there at all instead of being out helping someone who really needs to be helped.

The thing about the situation yesterday is that it could have been avoided. There are two ways that I could have avoided such a low. And I have a real point to make at the end, I mean it.

The first: I should lay the groundwork here by saying it was around five o’clock, it was already a full day, with a warm afternoon which included my first outdoor bike ride of the year and catching up on cleaning the kitchen within an inch of its life, cleaning the bathroom within an inch of its life, and doing the laundry. I had just come up from the basement after switching over the laundry for the third time, and Maureen said “Whoa, slow down, come sit down, you look pale”. I could feel myself getting low downstairs, and I took an extra couple of minutes (7? 8? 10? Who knows?) to finish everything down there before going back upstairs. You can see where this is going, yes? So I knew I was low when I came up. But I sat down anyway without getting anything or even grabbing my meter. Maureen is like, “You look low… I’m getting some juice and something to eat”. I told her not to, I have a tube of Glucolift tabs in my pocket, and if she could, please get my meter. I didn’t want to overtreat and kill my appetite for what was shaping up to be a nice Sunday dinner. I wanted to know where my BG was so I could ingest an appropriate amount to get back up to an appropriate range.

So in about two seconds (she’s superhero fast like that) she brings me juice, honey, and my meter. “Here, drink this before you test”. “No, I want to test first”. “No, drink this first”. I had to move her hand away from trying to hand me juice while I tried to get a drop of blood to my test strip. And now, with my brain turning to mush, each attempt by her, each word by her, meant that I had to start at zero again and concentrate from the beginning to inch my way toward that strip. And in the end, that drop of blood never made it there, and the meter, myself, and Maureen all made it onto the floor.

If I would have been left alone for just a few seconds, I probably (probably…) would have gotten that reading and then started treating right away.

The second reason: Of course, the worst could have been avoided if I would have just obeyed orders and immediately started drinking juice and eating honey. And popping Glucolifts like they were candy (they do taste like candy, I confess). But I didn’t. And that’s what brings me to the crux of this post.

Here’s what I learned from this experience: Sure, if I would have been on my own, I probably would have tested first, and I’m pretty sure everything would have been okay and there would have been no need for EMS intervention or anything like that.

But the thing is, I wasn’t by myself. There were two people in this scenario, and other than physically, the other person was affected just as much or more than I was by the whole episode. People With Diabetes: Do you think that the other people in your life aren’t affected at all by what you go through? Do you think that they don’t feel for you at these moments? Do you understand that they feel responsible, sometimes guilty for not helping you enough? If I can help it, I do not want to be responsible for heaping more on my loved ones than they already have to endure.

What I learned from this is that sometimes, it’s just better to risk overtreating and suffer the high BG later in order to save your loved ones the unbearable and unnecessary grief, guilt, and fear of the next time. Holy crap, I would give anything to erase that now. Including a little bump in my A1c or a CGM graph or a downward-carb modified dinner.
 
 
 

By StephenS | Posted in Lows | Also tagged , , , | Comments (7)