December 19, 2013

User Errors in Blood Glucose Testing


User errors are very common for people with diabetes. The equipment that helps us measure our blood glucose and manage our diabetes is delicate and deserves our care to function as intended. Yet, I see people doing the wrong things and wonder why the readings they receive from their meters are unreliable.

This is not a comprehensive list, because when I think it might be, I always discover another error or watch people abuse their testing equipment in a new way. I do wish people would read the instructions that are contained in the box with the container of test strips and read the instruction manual that comes with their meter.

The list of user errors that I have seen to-date:
#1. Not keeping the test strips in the container they came in. I have seen people take them out of purses, wallets, zip-lock bags, and other containers. Some even have them in tea bags holders or folded paper towels to protect them from the light, but this is not the correct way to carry them. The container you receive them in is the only proper container to carry them in as this container is manufactured to protect them from light and moisture. If you will be spending the day on the water, then you may wish to put the container and your testing equipment in a zip-lock bag.

#2. Not carrying the meter in its case. Using the case that came with the meter is best, but will not prevent lint and dust from getting in the meter if the case is left open when not using the meter. Lint and dust are often the culprits that cause a meter to not read the test strip properly. I have seen people carry the meter in purses, pockets, and backpacks or fanny packs and not in the intended carrying case. I have even watched people search through their purses, backpacks, and other places for the different parts to the lancet device while dust was blowing onto their meter. One of our support group members commented about people handling their test strips and meters with wet hands after getting out of the swimming pool to test their blood glucose levels. If you want accuracy in testing, this is not a good practice.

#3. Keeping the container of test strips and meters on the car dashboard, in the car glove box, or even the seat of the car in the summer or winter. This delicate equipment has temperature guidelines for storage and use. Baking them in the car or freezing them will not produce accurate test results. Yet this seems to be a favorite place for people to carry them.

#4. Using test strips in direct sunlight. This is a big no no, but I see people do this quite frequently. Not too many days ago, my wife and I were in a restaurant, and a couple was sitting in the sunlight. I watched the wife take her meter out of the purse and sit it in direct sunlight, then dump out a few test strips, pick one up, and insert in her meter. Then she needed to hunt up the parts of the lancing device from her handbag, assemble it, and then prick her finger and wick the blood into the test strip. I could see her pull out the test strip, insert another from the pile on the table, and repeat the process. This happened two more times before she gave up. The first error was not having the lancet device ready for use. Then she should have only taken one strip from the container and kept the meter and inserted test strip behind something to prevent the direct sun from shining on it while pricking her finger.

#5. Most people do not take time to read the instructions that come in the box with the test strip container. I admit I did this for a few years until instructions started to change. Until about four years ago, instructions seldom changed. Now they change at least once a year if not more often. Maybe not much of a change, but changes nonetheless. Some have been important, such as the change from using alcohol pads to wipe the finger to using warm water and soap to clean your fingers and then drying your hands thoroughly.

#6. Many people are not aware of using the second drop of blood or when this should be used. Read my blog here for when to use the second drop of blood.

We as patients can make many more errors in testing our blood glucose levels. For the errors David Mendosa covers, read his blog here. David has a better grasp of some of the mistakes we can make when we don't respect the delicate equipment we have to use.

I have also written other blogs about errors we make. The first is about the importance in hand washing that is here and the second is about the needless ways we find to waste test strips and this blog is here.

For those that have problems getting a single test strip out of the container, my suggestion is obtaining a plastic tweezers for use. I have two that I use when I open a new container. I have taken both and glued a quarter of an inch length of a three eighth inch wide rubber band on the outside of the tip of one side of the tweezers and then wrap it slightly around the tip.  The second tip as a quarter in of a thin rubber band glued to the inside of the tip.  To pull out a test strip, I insert outside of the first part into the container very carefully and once I have it far enough in to pull out a test strip. I have the container tilted enough to pull one strip out and then when it is far enough out to rotate the tweezers to grasp with both tips, I lightly squeeze and extract the test strip. Still holding the test strip with the tweezers, I set the container down and close the lid. Then I grasp the test strip with my fingers and set the tweezers down. I then pick up the meter and carefully insert the test strip in the slot in the meter.

Granted, this did take some practice to do this without damaging a test strip. It is better than dumping a few test strips out and then risk damaging them when putting them back into the container. I don't know that the manufacturers of the test strips would approve of this, but it works for me. Never, I repeat, never use a metal tweezers. The metal will damage the test strip and some have been magnetized and this will damage the test strip.

And with many of the errors I witness, I ask myself why these people are even testing. They create a climate that wastes test strips and do not receive readings that are reliable. It is bad enough that there is a built in margin of error, but to needlessly add more error margin with the mistakes many people add to the built in error margin really is a waste of money for the results they receive.  If you are using insulin, these errors can create hypoglycemia that you don't want.

2 comments:

davidmendosa said...

Dear Bob,

Thank you for your excellent post and for linking mine. Another user error that one reader recently brought to my attention is using expired test strips. He was complaining about the Accu-Chek Aviva, which won't let you use one that is expired and he couldn't even find a workaround. I had to tell him that using expired test strips is a very bad idea.

Namaste,

David

Bob Fenton said...

Thanks for the tip. A member of our support group did find a workaround, but when he used it and then used my meter with a good test strip, the 40 mg/dl difference convinced him that the error was not worth it. His reading was 140 mg/dl postprandial and using my meter the reading was 99 mg/dl. Same meter and he could see what his insulin injection would have caused. For the carbs he had consumed for breakfast, he knew his reading should not have been that high. He then changed his key card and inserted a new test strip and obtained a reading of 102 mg/dl. This convinced him no to use his workaround. An episode of hypoglycemia was not what he wanted.