December 16, 2013

Problems with Test Strip Accuracy

I hate to say this, but a large percentage of people with diabetes do not read or are afraid of reading. Why do I make this statement? I am constantly surprised what people do with their test strips. A few days ago, I was invited to a get together for several people that I knew were people with diabetes. The person being surprised was a type 1 (Lilly) and her parents had planned this.

I knew most of the people present, but I was in for a few surprises myself. We had been in the game room when we were asked to come to the dining room for some treats. I was not planning on food and let the hostess know this. I had thought to wash my hands and used paper towels to dry them. I had not seen Max and Allen arrive, but I was not surprised to see them as we came through the kitchen.

After we were all seated, the food was explained to us and we could tell that the mother had done the preparation as each was labeled with the grams of carbohydrates. For those that had doubts, the recipe was listed and the servings for each and the nutrition data. The mother said that the serving size was accurate to the gram so they knew that the carbohydrates were also correct. Max said he could vouch for them, as living across the alley; they often compared notes on recipes. He added that they had borrowed his gram scale for this as well.

At that point, we were given permission to test and go to different areas if we wanted privacy for injecting insulin. Out came the testing supplies. Allen and I both looked at each other as we watched some of the testing. We were done before most and Allen asked me if we should comment. I agreed and said to wait until we had finished at the table.

When everyone was finished, one fellow that had heard Allen and me talking asked what we had to say. I said that we had noticed habits that we felt should be educated for, if they had no objections. No one objected and Allen asked if anyone had read the instructions that came with their test strip box. No answers and Allen asked me to explain part of what we had noticed. I commented that I had not witnessed anyone washing their hands. Several said they had not seen me wash mine. I said that I had used the washroom on the lower level and Allen said he had washed his before arriving. The daughter said she had seen me use the washroom before coming upstairs to the kitchen.

Allen commented that several had test strips in unapproved containers or in paper towels. Others had dumped several test strips onto the table before testing. I continued that several had been eating fruit before being called up for the food and before testing. If they had cleaned their finger with alcohol pads as we had seen several do, we would bet that they would have hypoglycemia shortly. One of the people with type 1 diabetes laughed and said listen to the type 2's talk.

Allen said he knew that he had an insulin pump and a continuous glucose monitor (CGM) on as his equipment. I asked him to look at his CGM for about 20 minutes earlier and compare this to his meter reading. The other person with type 1 diabetes did look at his CGM and commented that he would probably have a low, as his meter was higher by quite a bit than his CGM. This caused the second person to look and he admitted that was the case for him as well.

I said that the alcohol pads did not remove the fruit sugar from their fingers and that was why they should have washed their hands with soap and water and dried their hands carefully. Allen has the same meter as I have and had just opened a new box, took his instructions out, and asked the daughter to read some of the instructions. She read the part about washing the hands with soap and water.

Next, Allen asked her to read the instructions for keeping the test strips in the container they came in and she read this. She knew to continue reading about using the test strip removed from the container as soon as possible, keeping it out of direct sunlight, and not handling it with wet hands. It also said to close the lid after removing a test strip.

Allen commented about those that were used from other containers and paper towels could not be relied on as being accurate and people were wasting money when they dumped three or four test strips on the table and did not return them to the container as soon as possible, but did after they were done with testing. The daughter continued reading about this and carefully read the part about not damaging test strips by removing too many and putting them back in the container or transferring them between containers.

One of the people with type 2 diabetes had his instructions for his test strips and read them to himself while we were discussing our instructions. He commented that his instructions were almost the same, but said to only remove one test strip and close the lid immediately, carefully insert the strip in the meter, and then prick the finger.

The one person with type 1 diabetes said he had never read about washing with soap and water and had been taught to clean his fingers with an alcohol pad. I asked him if he had trouble with his fingers cracking and having pain in testing. He said he always wears gloves when outside and used a lotion to keep his fingers from cracking. Allen suggested that he take time to read the instructions that come with his test strips and the instructions with his meter if he still had them.

The rest of the party was rather somber, but when I said something to the mother, she said that was why she enjoyed having people with type 2 around. Her daughter always learned more from people with type 2 diabetes than from the people with type 1 diabetes. Her husband said we always seemed more concerned and caring than the few with type 1 diabetes. He realized that there was a difference between the two types, but the members of the type 2 group were always willing to advise her to talk with the endocrinologist for most things instead to saying his daughter must do this or do that. He said he and his wife always appreciated that.

Allen stated this is always best and their daughter needs to trust the endocrinologist. Then Allen added that we may know some things, but if we speak out against something the endocrinologist says we are undermining the endocrinologist. The mother said that is why when we have parties, we make sure that several of you are present. She said that her daughter learned quite a lot today and said that with her being the one reading the instructions, and having the same meter, she knows that you are right. Today was a good lesson for her and she will remember that you were not putting the rest down, just correcting their poor examples. With her about ready to have a pump, she said I am happy you took the time to point her in the right direction.

With that I needed to go home and Allen was ready to leave.

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