December 13, 2014

Assisting a New Member with Testing

On Tuesday, Allen called and asked if I had time to help the newest member to join, Albert, as he had an A1c that was much higher than he had anticipated. Allen asked me to stop by his place and we would go to Albert's apartment. When we arrived, we parked behind his car and as we passed Albert's car, we could see a meter and test strip container lying on the passenger seat. I commented that I could already see problems. Allen then looked and said he hoped not that.

When we were greeted at the apartment door, Albert invited us in and after we were in the kitchen, I could see other potential problems. A meter was lying on the counter and another meter was lying on a kitchen stool. I asked how many meters he had. He said seven that he uses and a few others he has lost. He said they were all the same meter brand and he didn't need to worry about test strips that way. None of the meters was in a case and the test strip containers were setting around the kitchen.

Allen suggested we talk about his meters and where he was storing them. After Allen explained that he had some serious concerns about the accuracy of the equipment, Albert asked why. I explained that the kitchen was not the best place to keep the containers of test strips and that applied to the bathroom as well. Albert then showed us the bathroom where there was another meter and two containers of test strips setting on the counter next to the sink.

I asked Albert to select the bathroom meter and one container of test strips and then when we were back in the kitchen, to select another set. Then we adjourned to the living room and we asked Albert to test with each meter and a test strip. Allen and I both had our meter and test strip and we took them out. We used an alcohol pad to clean the lancing device and put new lancets in the device. When Albert was ready, we asked him to test using each meter.

Before he tested, Allen and I asked when he had last eaten and he said about three hours earlier. Allen said he would use his meter and test him first. After Allen had tested him, the reading was 184 mg/dl. I then used my meter and the result was 182 mg/dl. Albert then set his up and tested with the bathroom meter and the reading was 116 mg/dl and the reading from the kitchen meter was 102 mg/dl. Albert asked to look at our meters and when he saw that they were the same, he asked why our meters were so much higher than his were.

Allen nodded at me and I said because our meters are kept in the case when not in use and not laying around catching dust and lint. Allen then said we also keep our test strip container in the case along with the lancet and lancing device. This minimizes the dust and lint from getting in the meter and keeps our test strip container protected.  I continued that with the test strip containers setting around and in high moisture areas, which was probably why he was not getting near accurate blood glucose readings. I said that I keep all of my test strip containers in a zip-lock bag in a room that is fairly dry and not receiving direct sunlight. Plus this, I cover the bag with a dark washcloth to protect them.

Allen asked where he had obtained the meters and test strips and Albert said from the supply outlet that Medicare had told him to use. I had never heard of the meter brand and Allen had not either. We told Albert to attempt to obtain a test solution to be able to check his test strips, but added that he may have no luck in obtaining the test strip solution.

Allen then stated that the test strips were probably all unreliable and his meters not being properly protected could also be adding to the problem of his blood glucose readings being low and his A1c much higher. I asked Albert if he used the meter and test strips we saw in the car. He answered yes when he feels low. I stated that both the meter and test strips had temperature ranges for storage and use and keeping them in the car during the summer and winter and in direct sunlight would make both unreliable and basically unusable.

Next, I asked if he had read the instructions that came with his meter and the instructions that were in the box with his test strip container. He said he had never read them. We asked if he had any of the instructions around and he said he always takes the test strip container out of the box and throws any papers away as soon as he receives them in the mail.

Allen and I just looked at each other and shook our heads. We knew we had some educating to perform and soon. We asked when he would receive this next order and he said after the first of the year on the day following New Year's or on Saturday. Allen emphasized to him that he should not open all the test strip boxes immediately and if he needed to open one, to keep the instructions and read it. I asked if he would be receiving a new meter then and he said no, but he would in the July order of next year.

We said we would talk after he received his new supply and cover the proper use of the meter and test strips. Allen told him that he had an extra case for the meter and test strips and he would give him one if he would use it and not leave everything lying around and exposed to the elements. Since he was on metformin, we did not understand why he would feel a low since metformin did not cause them. He may have a false low when his blood glucose dropped quickly, but with his meter and test strips being stored where they could freeze, they would not be reliable. He said if he would carry the case next to his body when outside, he would supply him with a case he could use if he would promise to use it. Allen said he would see him the next day and we left.

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