Diabetes testing

[I Ratant]

I reuse lancets...some for weeks at a time. I've built up a year's supply of the things which come every 2 months from my HMO.
There's too much emphasis on the "pain" of the lancet, in my opinion, so people expect pain.
Doesn't seem that painful to me.
Even changing daily doesn't seem to be any different, one day to the next.
Sometimes I test 3 times a day.
And I use all the fingers over time.
I have found my favorite sweetmeats do make the sugar rise, but that's about the only positive change... exercise can make it higher, or lower.
After-dinner snacks may make it higher or lower in the morning at the first test.
There's little consistency.
As long as it's around 100 when I test in the morning, I'm happy.

 

[anor277]

The sweating is not caused by low sugar, but by DROPPING sugar. Depends on how high you started....

And most insulin users ARE type two. Due to insulin resistance, they may take 200-300 units per day. Too much exercise lowers the resistance, and BAM, hypo.

You don't need to ask me how I know, do you?

Sorry to take you up a on a point of nomenclature, but if you are an insulin user (i.e. you take bolus and basal insulin by subctaneous injection) are you not type 1? You might have started off as type 2, but once you begin injecting insulin you are type 1 - I believe this is what happens to all type 2 diabetics.

PS @ littleroundman "Injectable insulin" is a bit of a misnomer. As a hormone it will only function by injection. The assumption that an unconscious patient who has type 1 diabetes is suffering a hypo is usually the only one that can be made - you've got problems if (as likely) you've got no glucagon.

PPS Just back on topic, in terms of modern treatment of type 1 diabetes, I agree that the most painful, most uncomfortable part of it is finger tip pricking for blood glucose measurement. The 1st prick doesn't hurt, the 100th does.

 

[Skeptic Ginger]

I reuse lancets...some for weeks at a time. I've built up a year's supply of the things which come every 2 months from my HMO.
There's too much emphasis on the "pain" of the lancet, in my opinion, so people expect pain.
Doesn't seem that painful to me.
Even changing daily doesn't seem to be any different, one day to the next.
Sometimes I test 3 times a day.
And I use all the fingers over time.
I have found my favorite sweetmeats do make the sugar rise, but that's about the only positive change... exercise can make it higher, or lower.
After-dinner snacks may make it higher or lower in the morning at the first test.
There's little consistency.
As long as it's around 100 when I test in the morning, I'm happy.

You do know, I would think, that over time many diabetics experience increasing peripheral neuropathy. Maybe you no longer have sensitive finger tips? For kids, it might matter more.

 

[Skeptic Ginger]

Sorry to take you up a on a point of nomenclature, but if you are an insulin user (i.e. you take bolus and basal insulin by subctaneous injection) are you not type 1? You might have started off as type 2, but once you begin injecting insulin you are type 1 - I believe this is what happens to all type 2 diabetics.

PS @ littleroundman "Injectable insulin" is a bit of a misnomer. As a hormone it will only function by injection. The assumption that an unconscious patient who has type 1 diabetes is suffering a hypo is usually the only one that can be made - you've got problems if (as likely) you've got no glucagon.

PPS Just back on topic, in terms of modern treatment of type 1 diabetes, I agree that the most painful, most uncomfortable part of it is finger tip pricking for blood glucose measurement. The 1st prick doesn't hurt, the 100th does.

While type 2 is sometimes called 'non-insulin dependent', that is not the true difference, and the diagnosis does not change when type 2 progresses.

Mayo Clinic

Type 1 diabetes, once known as juvenile diabetes or insulin-dependent diabetes, is a chronic condition in which the pancreas produces little or no insulin, a hormone needed to allow sugar (glucose) to enter cells to produce energy. Type 2 diabetes, which is far more common, occurs when the body becomes resistant to the effects of insulin or doesn't make enough insulin.

Various factors may contribute to type 1 diabetes, including genetics and exposure to certain viruses. Although type 1 diabetes typically appears during adolescence, it can develop at any age.

Type 2

Type 2 diabetes, once known as adult-onset or noninsulin-dependent diabetes, is a chronic condition that affects the way your body metabolizes sugar (glucose), your body's main source of fuel.

When you have type 2 diabetes, your body is resistant to the effects of insulin — a hormone that regulates the movement of sugar into your cells — or your body doesn't produce enough insulin to maintain a normal glucose level. Untreated, the consequences of type 2 diabetes can be life-threatening.

There's no cure for type 2 diabetes, but you can manage — or even prevent — the condition. Start by eating healthy foods, exercising and maintaining a healthy weight. If diet and exercise aren't enough, you may need diabetes medications or insulin therapy to manage your blood sugar.

 

[Loss Leader]

Personally: 16 units long acting plus 4 to 6 short acting in the morning. 4 short acting at lunch. 10 short acting at dinner. 20 long acting at night.

I take no medications. They all seem to adversely impact my liver or kidneys and both systems are working at just about the outer boundaries of their abilities already.

Incidentally, I was born with a congenital heart defect and there is some indication of a higher rate of adult-onset diabetes among those who have survived serious heart abnormatities.

 

[littleroundman]

Sorry to take you up a on a point of nomenclature, but if you are an insulin user (i.e. you take bolus and basal insulin by subctaneous injection) are you not type 1? You might have started off as type 2, but once you begin injecting insulin you are type 1 - I believe this is what happens to all type 2 diabetics.

Not at all.

It is not rare for those diagnosed as being "type 2" diabetics to be prescribed insulin injections when all the "normal" treatments are proving inadequate.

The grouping together of "type 1" and "insulin dependent" and "juvenile onset" under the heading of "diabetes" is generally done, but is, in fact, unhelpful and inaccurate at the "pointy end" of the condition.

There is, for example, a separate condition known as ADULT ONSET/insulin dependent diabetes

What is often referred to as Type 1/insulin dependent/juvenile onset diabetes does NOT "evolve" from "Type 2" diabetes.

In VERY BASIC broad terms, type 1 diabetes can be described as being a failure of the pancreatic system at a metabolic level, whereas in VERY BASIC broad terms type 2 is a genetic/lifestyle related condition where inadequate amounts of insulin are produced.

Even using the term "metabolic level" can be challenged.

For example in the case of someone who has had his/her surgically removed.

 

[casebro]

So far as pain goes, it seems to be pretty random depending on whether you hit a nerve, lancet or needle. More nerves in fingertips, so more ouches than in the abdomen at injections.

Of course, nerves do seem to go hand in hand with blood vessels, so the injections that hurt are also the ones most likely to leave a bruise.

So far as t-1 vs t-2, t-1 equals low insulin production, giving insulin is treating directly at the problem.

T-2 is usually an insulin resistance problem. When the body's natural insulin doesn't work as well, giving more seems to help. So, a type II usually needs gobs more insulin than a type I.

There is a syndrome, "300 syndrome' (?) - 300 pounds, 300 triglycerides, 300 units of insulin per day. I was close several years ago, with two of the three, only 220 units. I quit eating wheat, worked off a few pounds, insulin needs dropped to zero for a while, as long as I kept pumping iron- restoring a truck. . Triglycerides to 120.

Gee, I sure like Lantus. I've been on it for a month or two. One shot per day at dinner seems to work just fine. Any quick acting stuff at all seems too much, at about 1 a.m. 130 at waking this morning.

 

[Beerina]

Not at all.

While hypoglycemic reactions in type 2 diabetics are far less common, hypoglycemic reactions in type 1 diabetics are of particular concern and potentially even fatal.

Even a 5 minute difference in returning an accurate BSL is unacceptable, thus the necessity for fingertip testing.

I assume tests have been done to determine these things. Yet the new diabetes testers show people using other body places. Aren't those manufacturers risking a lawsuit?

 

[Andrew Wiggin]

If it (a hypoglycaemic bout) has reached that stage, the priority is to consume some form of sugar not test your or the patient's blood glucose. Accurate (home) blood sugar testing has only been around for the last 20 years or so, and while it is extremely useful it won't do anything for hypoglycaemia except tell you that you have it (and when your sweating buckets and away with the fairies, DUUUUUUUH).

We test because the symptoms of really high sugar can look a lot like the symptoms of really low sugar. At that point, the patient isn't always making a lot of sense either, to tell us exactly how they feel, what they've had to eat, what they've taken to cover their sugar and their carbs. You could just as easily put sugar into a diabetic who was having symptoms from high sugar, except it wouldn't help. Test, then treat. It only takes a few moments, but it saves a world of trouble, when you find out you get around to testing and find that you just made a bad problem worse.

 

[littleroundman]

I assume tests have been done to determine these things. Yet the new diabetes testers show people using other body places. Aren't those manufacturers risking a lawsuit?

Alternate site refers to testing blood glucose on parts of the body other than the fingertip: most commonly the forearm, palm or thigh.

Testing somewhere other than the finger may bring a sigh of relief to many people with diabetes.

However, alternate test sites are not all the same.

With all meters, routine testing on an unrubbed forearm, upper arm, thigh or calf gives a test result that is 20 to 30 minutes old.

We will call these sites 'lagging' alternative test sites.


The fingertips and the palm hold the most recent 'memories' of your blood glucose. Fingertip and palm testing tell you what your blood glucose level is right now.

On the other hand, lagging test sites such as the forearm or thigh tell you what your blood glucose was around 20 to 35 minutes ago - not what it is right now. That difference can be crucial if your blood glucose is dropping fast --- a forearm test might tell you that the level is fine, because the forearm is a lagging test site, while a fingertip test correctly alerts you to a low number. Because of this, lagging test sites cannot replace the fingertip or palm completely for any person.

Several monitoring companies give people the choice to test their blood glucose using alternative sites. However, lagging test sites such as the forearm or thigh are only reliable when your blood glucose levels are relatively stable, such as fasting blood glucose.

So when is alternate site testing not recommended? The U.S. Food and Drug Administration gives these guidelines:

1. People with hypoglycemia unawareness should not use alternate site testing at all.

2. Don't use alternate sites when a seriously low blood glucose might go undetected:

* When you have just taken insulin, or any time during or after exercise.
* When there are unknown variables occurring in your day, such as illness.
* Any time you just feel "low".
* Whenever you are about to drive.


Talk to your doctor to see if alternate site testing is right for you. With a little bit of education, you can give your fingertips a rest and maybe test more often than you do now. For people with diabetes, more frequent testing is a good thing. Just remember: any time you want to be sure of an accurate, up-to-date blood glucose reading, test on your fingertip or palm.

http://www.bd.com/us/diabetes/blood-glucose-monitoring/how-to-test/alternate-site/

NOTE: (emphasis mine)

 

[Emet]

I assume tests have been done to determine these things. Yet the new diabetes testers show people using other body places. Aren't those manufacturers risking a lawsuit?

I would say unlikely. From Abbott Labs:

When using a FreeStyle meter, a blood sample test can be performed on the fingertips, forearms, upper arms, thighs, calves, and hands.3 However, it is always best to consult your health care professional for acceptable sites for your testing needs.
When Is Testing On The Finger Preferred?

It is important to note that when your glucose is changing rapidly, there may be a difference in the glucose readings between your finger and other test sites, like the forearm, upper arm, thigh, calf, and other areas of the hand.

Testing On The Finger Is Recommended:

If you think your blood glucose is low (hypoglycemia).

You can read this whole page here. At least as I read it, they've explained the differences well.

In the US:

Error range. Under FDA's current requirements for point-of-care meters, readings may err up to 20% when measuring standardized blood glucose concentrations of >75 mg/dL.

For blood glucose values of 75 mg/dL or less, FDA permits deviations of up to 15% from standardized concentrations. The error allowances adhere to International Organization for Standardization (ISO) standard 15197, "In Vitro Diagnostic Test Systems—Requirements for Blood-Glucose Monitoring Systems for Self-Testing in Managing Diabetes Mellitus."

http://www.ashp.org/import/news/HealthSystemPharmacyNews/newsarticle.aspx?id=3320


The FDA held a meeting about the issue of glucose meters in March, 2010:

http://www.fda.gov/MedicalDevices/NewsEvents/WorkshopsConferences/ucm187406.htm