July 9, 2012

Back to Diabetes Basics – Part 4

Proper Hand Care for Blood Glucose Testing

Hand washing is an important part of preparation for blood glucose testing. Laugh if you will, but about 95 percent of people testing blood glucose skip hand preparation over 50 percent of the time. I am also guilty as charged, but I calculate it is about 10 percent of the time that I don't wash my hands a well as I should. Being on insulin makes me more careful and much more concerned in obtaining the right reading before injecting insulin.

My eye opener was a reading before having my evening meal about two years after diagnosis. I knew what my carbohydrate count for my meal was and then added my correction to the reading. About three hours later, I was nervous, sweating, and wondering what was happening. I thought to test my blood glucose and it was over 200 mg/dl (11.1 mmol/l). I knew that was wrong as I would not be feeling nervous and sweating. I did think to wash my hands very carefully and dry them and retest. Reading then was 42 mg/dl (2.3 mmol/L). I grabbed three glucose tablets, started chewing, waited 15 minutes, and retested. Only up to 65 mg/dl (3.6 mmol/L), so had another glucose tablet and repeated. My blood glucose was 77 mg/dl (4.3 mmol/L) and I figured that I would wait another 30 minutes and test again. This time the reading was 81 mg/dl (4.5 mmol/L) and I knew I was okay.

Yes, the low reading scared me. I realized that I had eaten something with my fingers and one of them was the same finger I used for testing. From then on, I was careful about washing my hands and drying carefully. 

I had a very smart pharmacist who asked me why I was buying so many alcohol pads shortly after being diagnosed. I told her they were for cleaning my hands before blood glucose testing. She suggested that I put them back on the shelf and not use them. She examined my fingers and said no damage yet. She then said the alcohol pads would dry out my skin and the skin would start to crack. Since this was December, I knew what she was saying and when they did crack, my fingers would be sore. Testing would not be painless and I would dread doing it. Yet our companies still want us to use alcohol pads instead of warm water and soap to clean our hands before testing. Ignore their advice, please for the sake of your fingers and testing reliability.

One huge example of this appeared January 31, 2011 in Diabetes Care. The same study then appeared in Reuters Health on February 9, 2011 and is worth reading. If you needed to be reminded of the importance of washing your hands with warm water and soap, this should be a good reminder. So if you have a BG reading that seems too high or too low, please ask yourself if you washed your hands properly and thoroughly dried them (particularly the finger you will use for testing). If you are using insulin, this is very important. You want to inject the correct amount of insulin to prevent hypoglycemia especially, and you want to prevent your BG levels from rising into the levels for hyperglycemia.

Another good article with tips to make testing less painful is here. Please read tip number 8 because he does not mean the front of your fingertips so read the entire point.

Importance of Self-monitored Blood Glucose (SMBG) and Type 2 Bloggers

I started this topic in Part 2 of the series in “Some of the Testing Basics.” Knowing when, where, and how to test needs to be supplemented with the why. First, you should know where to test. Use the side of your fingertips. This has two advantages: there are less nerve-ends than on the pads, and it doubles the number of test-points so you can rotate through the positions. I also use the pads, which does get me to change the lancets a little more frequently, but you don't need to do what I do.

Alan Shanley has three blogs that are all on the topic of testing and for his perspective read his blogs – “painless pricks”, “test, test, test”, and “test, review,adjust.” You may use the search box on his site to search for and read his blogs on SMBG. Another website that should be on your listfor reading is by Jenny Ruhl. These sites cover the reasons, the why, how, where, and when.

You may also test on other parts of you body, arms being to next most popular area. If you are generally consistent in your blood glucose, you may be okay testing there. If you are inconsistent, please avoid other areas of your body. The blood glucose readings will be about 15 to 20 minutes behind your fingertips. When you are having hypoglycemia, you do not want this delay, as this could mean going lower than you want without treating properly. This is one reason many of us discourage using other body areas and staying with the fingertips.

When to test will depend on the number of test strips you are able to utilize. You should be able to test at least two times per day if on oral medications or no medications. If you are using insulin you should be able to use four test strips. Whether you are able to test more will depend on your own budget and possible assistance from the manufacturer of your meter and test strips. Some do have good assistance programs. It is generally suggested that one of the testing times be your fasting blood glucose test upon waking. If you are limited to two times per day and unable to afford additional test strips, then consider saving them for a needed time when you have messed up a strip, have an emergency, or need to use them to prevent them from passing the expiration date. You may also use them for testing after a meal. I suggest using them at the 1 hour mark after your heaviest meal, or the meal having the most carbohydrates.

Make sure you use a logbook or other form. I use a steno pad or wire spiral notebooks for recording my BG readings, the time, insulin injected, and food log and time of eating including snacks. Most meter manufacturers have software and cables available for use at a price. I do use mine and like the charts and graphs, which shows trends and readings in the hypoglycemia area and hyperglycemia range. Otherwise you have to chart your readings to see trends. This is the why, when, where, and how of testing for type 2 diabetes.

This is to inform you of the need for extra testing if you have an emergency and the doctor puts you on steroids. Make sure you know the name of the steroid to be used and discuss diabetes management with your doctor while taking steroids. I believe all steroids, and know most steroids cause blood glucose to be extremely elevated and make steroid use undesirable. However, they are often medically necessary. Do not be afraid of using insulin to assist temporarily in the management of blood glucose while on steroids. Oral medications can seldom manage blood glucose levels during steroid use.

For those looking for other good type 2 blog sites, David Mendosa writes here and here and the last one has pages and pages of excellent information. Gretchen Becker writes on the Internet here and here. Jenny Ruhl also writes here in addition to the above linked site. Tom Ross writes here and is not on medications as he has managed his diabetes with diet and exercise for ten plus years.

If you are looking for books, read my blog here. Check with your library to see if they have the book so that you may preview it. I own and have read all the books listed and own several more.

I have given you many links so that you become familiar with the sites and bookmark those that you enjoy, if you have not found them already.

Series 4 of 12

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