January 8, 2013

Tips for Glucose Testing – Part 2

Part 2 of 4 parts

Information that is important for all people with diabetes.
If you are newly diagnosed or an old hand, please take time to read or reread the instructions that come with your meter and the instructions in the box with your test strips. Instructions do change and I am of the habit of trying to read mine on at least a yearly basis. Every now and then, I learn something new or find that instructions for the test strips have changed. Example, it used to say to clean your finger to be used for testing with an alcohol swab and let air dry. Recently, this instruction change to wash you hands and thoroughly dry. Even I know this is better, and would add to wash with warm water and soap and thoroughly dry. It is important not to handle the test strips with wet hands as you could cause problems and receive an incorrect reading.

Learn How to Test Almost Pain Free
At first, pricking you finger to get blood for your test strip can be intimidating. With practice and knowing your equipment, this will become almost second nature. Unless you can prove that testing on the tip of your finger is painless, learn not to test there. Learn to test on the sides of your finger. About an eighth of an inch below your fingernail and on each side and for about three sixteenth of an inch is the best area for pricking your finger. Also use the area just behind where the nail extends (area you trim) to about where the nail emerges from your skin for the boundary front to back within the area in the previous sentence. The below image shows the appropriate pricking area.
Some people are able to test like in the picture below, but not many. There are more nerves in this area for most people. I know that this area does not work for me. However, that does mean that you can’t experiment.

Next, examine your lancet device. In the picture above near the left area near the lancet area and look for a dial or adjusting slide and select the lightest setting (usually the lowest number) and start with this. The above shows the dial area, which is on the reverse side of the lancet device. Then take a lance from the box and insert it in the correct area for holding it, then carefully twist off the round-like tip and you are ready to go.  One the above lancet device, just pull of the dial and you will see the insert for the lancet.

If you have not been shown how to do this, ask a pharmacist, or if you have one, a diabetes educator for instructions. Then press the top (on most devices) until the device is cocked. (See the right side of the Softclix picture above.)   Holding the device firmly against the side of one finger, press the release button (the button to the left of the Softclix name in the picture). If there is no or very little blood, move the dial or slide to the next higher number and repeat. There is no need to change lancets yet. If there is sufficient blood for the test strip, then this is the setting to use. Repeat the above until you have sufficient blood. Most of the time nearly enough blood could be enough if you gently press your finger and move the pressure toward the area of the blood. This is what we term as milking the finger to obtain sufficient blood. Do not use a lot of force, but set the depth of the lancet deeper.

A word of caution, please. Please know that if you hand write a lot, you may have some calluses on the finger you use the most for holding the pen, pencil, or other writing tool. If you want to use this area, you may need to adjust the lancet depth more and then reset it for the rest of your fingers and thumbs. Rotate finger sides and fingers for each time you prick for blood. The strategy for using the sides of the fingers is these areas contain fewer nerves and the sole and fingertips have many more nerves.

Now about changing your lancets. You may have been told to change for each finger prick. This is true and probably a good habit to get into. However, after using a single lancet for several months, I have gotten into the habit on only changing mine about every three months. Some people change weekly, biweekly, or even monthly. In other words, we don't change lancets for every use. I do change lancets if I use my lancet device on my wife or any other person and change it when I use it again on myself. I do keep alcohol pads around to sanitize the area of the lancet device that presses against the skin when testing on others. I also adjust the depth setting, as I don't normally need as deep a setting for people that do not test.  Read this by Alan Shanley for another viewpoint on painless pricks and then one from Jan 5 that covers much the same ground as mine.

Do not use alcohol pads to clean the area that you will prick. Alcohol pads will dry your fingers and during the winter, they will crack, becoming very painful. It is better to use warm water and soap to wash your hands and dry thoroughly. Read this for more reasons to use water and soap.  Also, David Mendosa has a blog on Health Central about operator error that is worth reading.

Learn and know the why of testing
Yes, learn about testing and the why of testing. There are many sources for this information. Don't be like many people and think you are doing the tests for your doctor. This is a fallacy and needs to stop now. Many, if not most, doctors outside diabetes offices, never look at the data or blood glucose reading log.  Most are only interested in your A1c.  Many diabetes clinics do download the readings from your meter, print out logs, and review them with you to ask questions and give you assistance in interpreting them early on. Then they expect you to know what the readings mean and how to use them.

The best reason for testing is helping you effectively manage your diabetes. Without testing, how are you going to be able to know what is happening, what needs to be changed, and if the change was even the right change? No, you will be in a fog with no direction and cannot even know what is happening.

Test with a Purpose
One of the best blogs about testing is this one by Alan Shanley. Although this blog may suggest testing more often than many people can afford to test, it is still applicable in learning the why of testing. Once you have read that blog, I suggest reading this blog, also by Alan. What I like about Alan's style is that he can be very insightful and lead to an understanding. In addition, he is not afraid to say that you need to find what works for you and not follow what works for him. For some, following his suggestions will work and for others they will need to read for understanding and find what works for them. Do not hesitate to bookmark anything you may want to review later.

Testing is important to know what your body is doing and what food is doing to your blood glucose levels. Testing gives you what your blood glucose is at that time. Therefore, I would encourage you to read this by Jenny Ruhl – here and here – to get some guidance also in testing. You may notice that the first link is the same information as the first link for Alan. This is because this is excellent information and important to know. There is also excellent information on Jenny's site.

No, this is not what the American Diabetes Association (ADA) preaches. The more you read and learn, the more likely you may find that the dogma preached by the ADA does not work for you. The levels they suggest using are in the range that encourages diabetes to progress and does not prevent complications from developing. Management of your diabetes is the goal to prevent or slow the progression of diabetes and prevent the complications from developing. Yes, it is possible and this should always be considered a goal of diabetes management. Many of us use this from William Polonsky, “Diabetes causes nothing! It is the lack of diabetes management that causes the diabetes complications.” This means that if you don't manage your diabetes, complications are quite likely.

Yes, there is a purpose behind testing your blood glucose. You are doing the testing for your benefit and to measure your blood glucose to know that at the one or two hour time after eating that you have achieved your goals. Intensive testing to find your general time of high blood glucose after eating, start testing about three fourths of an hour after eating (use first or last bite, but be consistent), and test every 15 minutes or every half hour until the three hour mark. If you notice the reading going down, stop testing. If you have learned from intensive testing that you reach your high blood glucose level about 90 minutes after eating, then you will generally desire to test at the 90 minute mark to make sure that you haven't exceeded your goal. No, I did not use the one or two hour mark to show you that these can hold true for some people and other people can vary when they reach their high point. Many people do reach their high at the one hour mark and some studies show for many people, the the high is reached at about the 78 minute mark.

Know What to Do With the Numbers
Numbers are just numbers unless you know what they mean. To start with, most normal people without diabetes the range for blood glucose is between 70 and 120 mg/dl (milligrams per deciliter - the American measure), or 3.9 to 6.7 mmol/l (millimole per liter – as the rest of the world measures). This is what the “experts” don't say after the previous statement. Most normal people without diabetes can have readings above 100 mg/dl, but they don't stay above 100 very long and are back below 100 quickly. This can happen after a very carbohydrate heavy meal and is not the normal happening. They also don't say that readings of 100 to 125 mg/dl are the range of people that have prediabetes.

If you have morning fasting readings of over 120 mg/dl, you need to consider making some food changes the evening before. Maybe a smaller snack (less grams) before bedtime or not eating for longer before bedtime other than the snack. If this does not help, then you need to discuss the dawn phenomenon with your doctor. This is or can be caused by the normal wake up reaction of your body and your liver dumping glucose into your blood in preparation for waking up.

Some people notice that after an evening meal that their blood glucose levels are elevated over 180 mg/dl. This may mean that the evening meal was too large or carbohydrate heavy and the number of carbohydrates need to be reduced. Or, it is possible that an evening walk will help bring blood glucose numbers back in range. Other people will notice that after exercise that they are low, (below 70 mg/dl) and need to consider having as least a 15 gram (or larger) snack before exercising.

By knowing your blood glucose numbers, this will help you adjust your food intake and possible changes in your exercise regimen that will help in maintaining lower blood glucose levels. This in turn will help return a lower A1c reading and help in your diabetes management.

Know what your blood glucose numbers are will also help you know if you need to talk to the doctor about reducing your carbohydrates or if the doctor will need to consider, reducing medications, adding   additional medications, a change in medications, or even the need for insulin.

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