All posts in Ramadaan fasting and diabetes

Understanding insulin

Understanding insulin

There are many types of insulin each working in its own unique manner, some types of insulin are suitable  for one but not for another. Normally basal insulin acting for almost 24 hours is used once at night and rapid acting insulin used with the main meals is used thrice or twice as the case warrants. Most insulin preparations come either in pen delivery devices which are disposable or refill pens. Some preparations of insulin still come in vials or small bottles. The pen delivery devices are easy to use and for those who are visually handicapped there are audible clicks while turning the dose dialer to help know the dose. The basal insulin is clear looking insulin. This acts for 16 hours to 36 hours. Normally does not cause low sugar spells and can be taken before or after food. The dose is usually dependent upon the fasting sugar levels. There is also premixed insulin preparations available which is a combination of short acting and intermediate acting insulin.

The commonly available basal insulin ( long acting) preparations in Oman are: Insulatard®, Detemir ( under brand name Levemir®), Glargine 100 units/ml( under brand name Lantus®), ultra long acting Degludec (under brand name Tresiba®) and ultra long acting Glargine 300 units/ml (under the brand name Toujeo®).

The bolus insulin (rapid acting insulin) comes either in small bottles or vials or pen delivery devices (either as disposables pens or those which can be refilled with cartridges) This insulin is clear looking insulin. This is generally taken 15 minutes to half an hour before the main meals.

The commonly available brands in Oman are Human Actrapid®( which can also be given into the veins in the hospitals when sugar levels are really high) Humalog Lispro®, Novorapid ® and Glulisisne ( under the brand name,Apidra®).

The basal ( long acting) insulin is preferably injected on the thigh and the rapid acting insulin on the abdominal wall avoiding 2 finger breadths around the navel or belly button.

The commonly available premixed insulin preparations available in Oman are Human Mixtard 30/70®, Humalog Mix 25/75®, Humalog Mix 50/50®, Novomix 30/70® and Novomix 50/50®. Because there is a clear and a milky insulin as the constituents, the insulin preparation bearing vial or cartridge will have to be shaken before use.

There are some barriers facing the patients and the treating doctors when advising insulin. The fear of low blood sugar levels, the fear of the pain associated with the needle prick, the need for having to check the sugar levels frequently, the cost of the insulin, the possible negative impact insulin can have on ones social and married life, the scary feel associated with the insulin, the impact insulin has on ones friends are the common barriers. There are some who have seen their near or dear ones die or having developed a kidney failure or having amputated a limb after staring insulin. They feel the insulin was responsible for all this. The uncontrolled sugar levels can damage the eyes, the nerves, the blood flow to the legs, the heart, the brain, kidneys and once the damage has set in, insulin cannot help reverse the damage, but can help further worsen the damage. The insulin can cause weight gain, might cause allergy or numbness for some and episodes of low sugar when the patient has taken too high a dose and either exercised or taken less food.

Insulin is safe during pregnancy, in those with very advanced kidney failure and heart failure.

There are however some points to be considered while using insulin:

  • Insulin is to be stored either in a cool room. It is never to be frozen by placing in the freezer. If frozen by any chance, it cannot be thawed and is best discarded.
  • Insulin can be taken along while traveling by carrying it wrapped in between ice packs or by using cooled gel holders. Sometimes you might need a certificate while traveling to be allowed in the cabin bag.
  • Never leave insulin in the car especially during the summer as it can get damaged and lose its efficiency.
  • Always check the expiry date especially while buying large amounts of insulin.
  • Do not inject cold insulin. Roll the pen between the palms of the hand for six to seven times to lightly warm it.
  • Rotate the site every time you inject.
  • The site to be injected must be lightly cleaned with a swab. Check the site of injection for small swellings or bumps. These sites are to be avoided as the insulin will not act well if injected into those areas.
  • The dose to be injected is dialed if using a pen insulin delivery system.
  • Inject perpendicular to the skin after the needle is plunged fully. Plunge the dialer button to deliver the insulin.
  • After the dose has been delivered, count to five and remove the pen, lightly wipe the injection site and cap the pen again to place it back in the refrigerator or in a cool room away from direct sunlight. Sometimes a drop of blood is seen coming after the injection. Light pressure to that site for half a minute will help.
  • There is no need for a vigorous massaging of the site after the injection has been given.
  • You will need to have the food consumed within ten to fifteen minutes of the rapid or premix insulin shots to prevent low sugar levels.
  • Dispose the needles in a sharps container. It is advisable to change the needles after every injection.
  • Do not wipe the needles with an alcohol swab as it removes the silicone coating on the needles and makes the injections painful.
  • The dose of insulin will have to modified when traveling by long haul flights involving more than 15 hours either towards the East or the West.

 

Some precautions:

  • If going for a party at night, it is safe to take the long acting insulin before the party if the patient is on a mix of short and long acting insulin. Take the rapid acting insulin after you come back home, and checking the sugar levels. Taking the rapid insulin before the party can lead to low sugar levels as there will be a delay in eating the food. Moreover, one is not sure of the kind of food either and how much one would consume.
  • During Ramadan, please consult with your doctor on how best to take insulin.

Some myths:

  • The dose of insulin always remain the same. The dose of insulin depends upon the sugar levels while checking.
  • If I am sick and have not taken food, I do not need to take my insulin shots. When sick, though the appetite is compromised, the sugar levels will be high in response to the body`s defense mechanisms. Check the sugar levels and inject accordingly after consulting with your doctor. You might need either a smaller dose or higher dose depending upon the sugar levels.

Normally one unit of rapid acting insulin corrects sugar spike caused by intake of 10-15 gm of carbohydrate. (this is called the insulin to carbohydrate ratio) The carbohydrate content of food can be understood by referring to apps available on the smartphones or by checking on some sites such as www.carbsandcals.com

Another number to known is the insulin sensitivity factor. If you divide 1800 by the total dose of insulin taken in a day it will give the insulin sensitivity factor. Suppose you inject 50 units of insulin a day ( add all the insulin doses taken on a day), divide 1800 by 50 to get 36. This means by injecting one unit of insulin 36 mg/dL or 2 mmol/L of sugar comes down. This number will vary from person to person.

There are so many new insulin preparations and combinations being researched and soon to come into the market.

Points to consider while exercising if you are on Insulin:

Please check the sugar levels before exercising. If sugar level is < 5 mmol/L or 90 mg/dL, take 20 g carbohydrate, wait till the sugar levels reach 7 mmol/L ( 126 mg) . If sugar levels are between 10-15 mmol/L( 180-270 mg/dL) you can still exercise but be reminded that the sugar levels go up while exercising. If sugar levels before exercising are above 15 mmol/L (more than 270 mg/dL), check ketone levels in blood( there are blood ketone meters available with Freestyle® which uses a test strip for ketone like using the glucose test strip) If the blood ketone is between 0.6 to 1.4 mmol/L, you can do moderate intensity exercise and drink more fluids for half an hour. If the blood ketone levels are more than 1.5 mmol/L, you need to meet the doctor for correction of the sugar and ketone levels with insulin and IV fluids. Upper abdominal pain and nausea or vomiting can be sign of high blood sugar levels.

During the exercise you might need to snack in between depending upon the duration . An exercise time of not more than an hour needs no carbohydrate replacement, if the exercise duration is between an hour to 2 hours, take 30-60 gm carbohydrate snack and some water. If the exercise duration is more than 2 hours, take 30 gm carbohydrate every 20 minutes with water.

Prevention of low sugar levels after exercise : If doing exercise 2 hours after taking basal insulin, reduce the dose of basal insulin by 20%. If doing the exercise in the late afternoon or evening, reduce the dose of basal insulin by 20% at night to prevent low sugar episodes. A short sprint before or after the exercises causes a spike in sugar levels which prevent getting low sugar following the exercise regime. A proper cooling down after exercise can prevent the high sugar levels soon after exercising.

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Updates in insulin delivery devices and glucose monitoring

Updates in insulin delivery devices and glucose monitoring

New insulin delivery devices .

  • LifeScan One Touch Via®

index

This is a super slim pump device which delivers only bolus (rapid acting ) insulin. The cartridge can store 200 units which means less frequent refilling of the insulin. Squeezing 2 buttons simultaneously on the pump allows 2 units bolus dosing.

  • Companion Medical`s InPen®
  • In pen

This is the first insulin pen with in-built Bluetooth- sends the dose data to a phone and app automatically. This calculates and recommends the optimal dosing of insulin, tracks the history and timing of the dose, monitors the temperature of insulin, displays the last dose and insulin on board available. This can even send reports to the health care team if synchronized.

  • OneDrop Premium®-

One-Drop 2

 

This a Bluetooth enabled meter which helps in diabetes education by paying an annual fee besides monitoring sugar levels and administering insulin.

 

  • Tandems T Slim X2, OmniPod Dash System also are soon to hit the markets.

Image Slim X2     Omnipod 2

 

 

 

 

 

 

 

 

 

 

 

Some new glucose monitoring devices:

  • Abbots Lifestyle Libre Pro®-

LibrePro 1   LibrePro 2

 

After the sensor is applied on to the body, there is no need for the patient to interact with the system. There is no need for the finger stick calibration. This can monitor 2 weeks of continuous glucose monitoring.

 

  • Google Contact Lens®-

google contact

This is a contact lens with a reader device which can check the sugar levels from the eye tears. The lens has a wireless chip and a miniaturized glucose sensing device. A tiny pin hole in the contact lens helps the tear drop to seep in for glucose sensing. The electronic connections lie outside of the normal eye thus not harming the normal eye. There is a wireless antenna inside the contact which is thinner than the human hair and this helps to communicate the information to the wireless device.

  • Medtronics MiniMed Pro Infusion®-

MiniMed

 

This has a very small catheter and has lesser tendency for blockage. The tubing has a side port which be used for insulin delivery even if the main port is blocked.

  • Medtronics 630G®-

MiniMed 630

 

This calculates and recommends precise bolus dose. This prompts the patient to take action by predicting low levels. This has an inbuilt continuous glucose monitoring devise. The insulin can be delivered every 5 minutes, if set to deliver so.

 

 

 

 

 

 

 

 

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Fasting during Ramadaan

Fasting during Ramadaan

ramadaan feasting                                                                             ramadaan feasting 2

Fasting from dawn to dusk in the holy month of Ramadan for healthy adult Muslims has been ordained and physically sick Muslims are exempt from it. However many Muslims with mild to moderate Diabetes, Hypertension and other medical conditions do want to fast.

The purpose of this presentation is make some recommendations how one can fast safely in light of research on fasting. Many are concerned they cannot fast when they have diabetes mellitus . Please consult with your doctor.

Some people may need some tests to be done to assess fitness for fasting.
The salient features of fasting are :
 It is a voluntary undertaking rather than being ordered by a physician
 There is no selective food intake i.e. protein only, juice only, fruit only , water only etc
 There is no total calorie malnutrition i.e. it not a semi starvation diet.
 An exercise in self discipline i.e. from constant nibbling , drinking, smoking etc
 Psychological effect on the body and additional prayer give additional peace.
People who should ideally not fast, but can fast under supervision
 Diabetes Mellitus Type 1
 Those who get recurrent low sugar levels.
 Chronic Renal Failure including Renal Transplant
 Severe heart and lung conditions
 Severe Epilepsy
 Severe Migraine
 Physically sick ( Quran 2: 184-185)
 Traveler on a journey
 Women during menstruation
 Pregnant and lactating women
 pre pubertal children

Do you know?
 Blood glucose and Insulin levels will fall during the fast.
 The first few days will take some adjustment. If in doubt( headache, sweating, dizziness) check sugar or blood pressure.
What to do during the fasting:
 Beware the sweets and the fried food.
 Remember that by eating throughout the night will not help one tide over the next day. Instead indigestion and gas related problems may set in.
 Fluid intake must be adequate during the night to make up for the reduced intake during the day
 Having too much of sweets or fried food during the Sahoor can lead to dryness of the mouth which can be a cause of concern during the fast.
Points to remember while breaking the fast at Ifthaar:

  • Drink enough water, butter milk or juice. A glass of water melon juice, butter milk or tender coconut water will be a good option to break the fast. One need not add glucose. Water melon juice is sweet by itself and usually people add more sugar. Water melon has a higher glycemic index.
  • Try to be careful with the fried and sweet food. Take them in moderation.
  • Have a good Ifthaar or Isha meal. Have your prayers and then go for a walk to allow digestion.
  • Have some fruit at about midnight if need be. Have a good Sahoor of needed.
  • Avoid too salty food at Sahoor as that can make the mouth dry forcing more fluid intake.
  • Check the sugar level 2 hours after Ifthaar to decide whether  any additional dose of medicines is needed.

Exercise and Ramadhaan
 One can exercise during the month. Please check the sugar before exercise. One can exercise lightly before Isha or after the heavy meal.
 Try to avoid strenuous workouts as the body may be tired due to the lengthy fast.
 Those who want to exercise before Iftaar should check their sugar before exercise. If sugar is below 100mg(5.5 mmol/L) avoid exercising.
 Those with type 1 diabetes are exempt from fasting as their sugar levels are dependant on insulin. However, there are some who do fasting alternate days only. This is depending on your health status.

Some more tips

 Check sugar levels just before Ifthaar and before the Sahoor meal.
 One can check the sugar levels at 7 am before going to work. If the sugar levels are either too low or too high, it is wise to seek medical advice immediately. You may be advised to forego the fast that day.
 Time your medicines between Iftaar and 1am.
 If on long acting insulin such as Glargine or detemir, it is advised to take 20% less either at Ifthaar or Sahoor time
 Normally the doses of most of the medicines could be reduced during the month.
 The medicines have to be tailored in such a way that there is no hypoglycemia
 Be careful of sulphonyl ureas and rapid acting insulin
 Among the sulphonyl ureas, gliclazide is safe in that the chances  of hypoglycemia is lesser and the weight gain is minimal.
 Intermediate acting insulin are avoided during the month due to the 10-12 hour action which can go into the period of fasting

 

The essence of Ramadhaan is the same all over the world, but the flavors may differ.

Have a blessed Ramadhaan

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glycemic index

glycemic index

glycemic-index-chart

Glycemic index ( GI )of a food is the increase in blood glucose ( above fasting glucose) 2 hours after ingestion of a constant amount of food divided by a reference food( usually glucose).

To make this easy to understand, if the GI of a particular food is 72, this means that 72% of the ingested food is converted to glucose within the body after 2 hours of consumption.

GI reflects the rate at which carbohydrate is absorbed and digested by the body. Try to aim for low GI food combined with medium or high GI food rather than have more of high GI food. Whatever be the diet chosen, the dietary management has to be combined with physical activity for maximum benefit. A diet which suits one person may not suit all. It is advisable to see which food increases the sugar levels by checking the sugar levels after each food ( this is painful, but this can help to decide which food suits a person).
Low GI food stuff with the GI levels
Yoghurt low fat 14             Milk chocolate 24             Multi grain bread 48          Broccoli 15            Spaghetti 27              Parboiled rice 48                      Celery 15                              Skimmed milk 32                 Carrot juice 45               Bell peppers 15          Fat free milk 32   Jams and marmalade 49            Spinach 15                         Apple 38                         Low fat ice cream 50            Tomato 15                      Plum 38                   Orange juice 52                       Soya beans boiled 16             Pears 38               Kiwi 53                          Artichoke 15           Apricots dried 31                     Banana 54                            Asparagus 15

Black beans 41               Sweet potato 54              Cauliflower 15          Boiled lentils 29                  Egg plant 15                Boiled kidney beans 29      Lettuce 15                                 Green beans 15                          Peanuts 15                             Cucumber 15

 

Medium GI food with their GI levels

Oat bran 55                       Rye-flour bread 64                        Rice, brown 55                 Apricots (tinned in syrup) 64         Fruit cocktail 55 Raisins 64                          Spaghetti, durum wheat 55           Macaroni cheese 64        Popcorn 55                                             Beetroot 64 Muesli 56                          Mars bar 64                                          Mangoes 56                         Black bean soup, tinned 64         Potato, boiled 56

Cake , tart 65                  Mini Wheats (wholemeal) 57           Potato, steamed 65 *       Table sugar (sucrose) 65       Apricots 57

Barley, flakes 66             Potato, new 57              Pineapple 66         Digestives 58              Rice, white 58     Croissant 67         Pizza, cheese 60               Ryvita 67                          Hamburger bun 61      *Ice-cream 61 Whole meal bread 69     Shredded Wheat 69          Muffin (unsweetened) 62                Potato, mashed 70
High GI food with their GI levels
White bread 71                    Broad beans 79                     Golden Grahams 71                 Jelly beans 80                                               Millet 71             Pretzels 81 **                         Watermelon 72                     Rice Krispies 82                     White rolls 73                          Potato, micro waved 82    Puffed wheat 7                   Cornflakes 83                             Corn chips 74                      Potato, instant 83                                       Chips75

**Potato, baked 85             Rice pasta, brown 92             Doughnut 76                      Wafer biscuits 77 **                 Rice cakes 77

Dates 103
** low in calories and highly nutritious
* empty calories

 

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Hypoglycemia or low sugar levels

Hypoglycemia or low sugar levels

hypo 2                                          hypoglycemia-symptoms

Hypoglycemia or low sugar is one of the nightmares of the patients and the doctors alike. High and low sugars may both present with sweating , confusion and sometimes even unconsciousness.

The commonest causes being taking too much of insulin or some medicines or forgetting to take food, too intense an exercise, consuming alcohol and some tumors of the pancreas.

Symptoms

Generally sweating, shaking of the hands, irritation, craving for food, beating fast of the heart, headache, stomach pain (gastritis) and clouding of consciousness. The body tries to correct the levels itself by an in built mechanism.

For the elderly adults low sugar manifests as confusion, delirium and drowsiness.  Tremors and sweating are rare for the elderly with low sugar levels.These can mimic those with a fit or stroke and is, for that strange reason, often misdiagnosed.

For some people the body fails to recognize the features of low sugar. This is dangerous as very low levels are needed for the body to recognize it thereafter. This is called unawareness.

What can be done?

If low sugar happens, drink a can of orange juice or chew on some dry raisins or put some sugar into your mouth. If glucose tablets are available, that is a good option. Chocolates are not a good solution for low sugars as the fat content in chocolates delay the fast rise in sugar. Check your sugar level after 15 minutes and if still low, repeat the above. Get to nearest hospital and get this corrected if needed.

Categories of hypoglycemia:
• Documented hypoglycemia: typical symptoms of hypoglycemia and when the plasma glucose is ≤70 mg%.

• Severe hypoglycemia : An event which requires active assistance of a person to administer glucagon or carbohydrate or adopt any other resuscitative measure.

Asymptomatic hypoglycemia: An event that is not accompanied by typical symptoms but the plasma glucose ≤70 mg%.

Probable symptomatic: An event during which hypoglycemic symptoms are not documented with a plasma glucose determination, but presumed to be ≤70 mg%.

• Relative hypoglycemia: An event during which the diabetic patient reports typical symptoms of hypoglycemia, and interprets those as indicative of hypoglycemia, but the plasma glucose is ≥ 70mg%.

While driving if low sugar is encountered, drive off the road, put on distress signals, turn off the car, pull down the windows, remove the key from the ignition, take some sugar or orange juice immediately.( you must have a stock of this in the car always) . The brain takes some time to recover from the low sugar and impulsive driving may be initiated leading to accidents. Always check sugar levels before a long drive, break the journey in between long drives and carry an ID mentioning your diabetic status and contact numbers.

Sometimes hospitalization is also needed in serious cases.

The impact low sugars can have on life is very dramatic. For example, developing this while attending an interview or while at the exams or at an important meeting or while driving, can change the course of ones` life. People may then become introverts avoiding social functions for fear of low sugar. They are often mistaken for drunken behavior as well.

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Glucometers

Glucometers

glucometer 1 - Copy  glucometer 4

If you have diabetes, one needs a blood glucose meter — a small  device — to measure, store and display the blood glucose level. Glucometer is commonly used in emergency rooms in hospitals, ambulatory medical care services as in ambulances, helicopters or sea transport while shifting patients. The glucometer is used for analysing sugar leels and adjust dose medication with the help of the health care professional or diabetes educator. This is not used in the diagnosis of Diabetes.

Exercise, food, medications, stress and other factors affect the blood glucose level. Using a blood glucose meter can help better manage the diabetes by tracking any fluctuations caused by these factors.
Many types of blood glucose meters are available, from basic models to more-advanced meters with multiple features and options. The cost of blood glucose meters and test strips varies. Study all the options before deciding which model to buy.. As with any electronic device, this cannot be immersed in water, should not be stored in extremes of temperature and humidity which can affect the device or even the test strips. Most of the new model glucometer devices have an in built check that does not display readings at extremes of temperature. Using a glucometer at high altitude as when climbing high mountains can give erratic readings.

The glucometer uses an enzymatic portion on a test strip which is in a dehydrated state when packed and a detector. The glucose in the blood sample reacts with the enzyme to produce the level which is detected. The commonly used enzymes are hexokinase, glucose oxidase and glucose dehydrogenase

Basics while using any glucometer

 

  • Check the expiration date of the kit
  • Make sure the lancets, glucometer, test strips are available globally.
  • Make sure the warranty card is filled out and handed over.
  • Ask for a demonstration if need be.
  • Some meters need a code chip to be inserted with each new box of test strips.
  • Always clean the finger tip before pricking the finger tip for the sample of blood. The sides of the non dominant hand are used as the skin is thinner at the side of the fingertips.
  • The blood should be flowing well. Do not squeeze the finger tip excessively to get the blood out- this affects the reading.
  • Do not reuse the lancets or test strips.
  • Dispose the lancets in a sharps disposal bin.
  • Remember to use the glucometer often, say at least twice a week. If not used regularly, it may cause the batteries to wear off by discharging or the IC to burn off. It is similar to a motor car that is not used for a month or two. The battery will not work at that time.
  • Get the glucometer calibrated often as well as periodic testing of the control solution is necessary.

Choosing the right meter
When selecting a blood glucose meter, it can help to know the basics of how they work.

  • To use most blood glucose meters, first insert one end of a test strip into the device.
  • Then, prick a clean fingertip with a special needle (lancet) to get a drop of blood.
  • Wipe away the first drop of blood.
  • Carefully touch the other end of the test strip to the drop of blood and wait for a blood glucose reading to appear on the screen. There are meters which can determine the blood glucose and blood ketone levels as well. These meters are useful for type 1 diabetic patients. It is marketed by the Freestyle under the name Freestyle Optium Xceed.

glucometer 3 - Copy                                    glucometer 2 - Copy

Blood glucose meters are usually accurate in how they measure glucose, but they differ in the type and number of features they offer. There is a difference between the values obtained by the glucometer and the blood test done at the hospital. The glucometer checks the capillary glucose level. The hospital or clinic estimates the glucose from a sample drawn from the vein.

Here are several factors to consider when choosing a blood glucose meter:
• Cost. Meters vary in price, so shop around. Be sure to factor in the cost of test strips as the insurance doesn’t pay for them. Test strips are the most expensive part of monitoring because they’re used so often. A meter may be the cheapest one on the market, but may not be a good deal if the strips cost twice as much. Also, individually packaged strips tend to cost more, but you might not use all the strips in a container before the expiration date or within the required number of days after opening the container. Figure out which type of strip is most cost-effective for you. Remember that the strips have expiration dates on the cover. Please check it out.

• Ease of use and maintenance. Some meters are easier to use than others. Are both the meter and test strips comfortable to hold? Can you easily see the numbers on the screen? How easy is it to get blood onto the strips? Does it require a small or large drop of blood?

  • Also, some brands of meters need to be coded and others have no coding. Code numbers are used to calibrate your meter with the test strips for accurate results. Make sure the strips can be bought from other parts of the world as well so that travel does not be cumbersome.

• Special features. Ask about the features to see what meets your specific needs. For example, some meters are large with strips that are easier to handle. Some are compact and easier to carry. People with impaired vision can buy a meter with a large screen or a “talking” meter that announces the results. Colorful meters that give a quick reading are available for children. Some models have a backlight, which is handy for nighttime readings. Others are manufactured to withstand extreme temperatures, which may be useful for people who spend a lot of time outdoors, such as hikers or construction workers.
• Information storage and retrieval. Consider how the meter stores and retrieves information. Some can track all the information one would normally write in a log, such as the time and date of a test, the result, and trends over time. Some meters offer the ability to download your blood glucose readings to a computer or your cell phone and then email the test results to your doctor.
• Support. Many meter manufacturers include a toll-free number on the back of the meter or packing. Look for a meter that includes clear instructions that demonstrate the correct way to use the meter. Some manufacturers offer user manuals on their websites.

Although finger pricks remain the gold standard for blood sugar monitoring, researchers are developing products designed to take the “ouch” out of the process. You might ask your doctor about these alternatives.
Alternative site monitor Allows blood samples from areas likely to be less painful than your finger, such as your arm, abdomen or thigh Not as accurate as fingertip samples when blood sugar level is rising or falling quickly.
Continuous glucose testing Uses a sensor placed under skin to measure blood sugar level; transmits each reading to a small recording device worn on your body; sounds an alarm if blood sugar level becomes too low or too high Expensive; requires sensor to be replaced every three to seven days depending on the brand; must check blood sugar level with a traditional monitor when dosing for insulin or treating low blood sugar to confirm readings

• Infrared, laser light and electric current technologies are among a few of the possible offerings on the horizon for noninvasive methods of checking blood sugar levels. But, these may cause irritation to the skin where it is placed upon.
Consider these factors that affect meter accuracy and the steps to resolve or prevent the problem:

  • Test strip problems —Throw out damaged or outdated test strips. Store strips in their sealed container; keep them away from heat, moisture and humidity. Be sure the strips are meant for your specific glucose meter.
  • Extremes of temperature —Keep your glucose meter and test strips at room temperature.
  • Alcohol, dirt or other substances on your skin— Wash your hands and the testing site with soap and water before pricking your skin.
  • Improper coding— Some meters must be coded to each container of test strips. Be sure the code number in the device matches the code number on the test strip container.
  • Monitor problems —Fully insert the test strip into the monitor. Replace the monitor batteries as needed.
  • Not enough blood applied to the test strip —Apply a generous drop of blood to the test strip. Don’t add more blood to the test strip after the first drop is applied. Some meters do not need a large drop.
  • Testing site location — Blood samples from alternate sites are not as accurate as fingertip samples when the  blood sugar level is rising or falling quickly.

 

Blood glucose monitor quality control tests
When  starting a new container of test strips, occasionally perform these quality control tests before using them and when the results seem unusual.
To perform a quality control test, do one or both of the following:
• Test using a control solution. Follow normal blood-testing procedure, but use a liquid control solution instead of blood. These solutions usually come with the monitor and are available at most drugstores and pharmacies. Follow package directions.
• Match the reading with lab results. Take the blood glucose monitor along when visiting the  doctor or have an appointment for lab work. Check the blood glucose with the  meter at the same time that blood is drawn for lab tests. Then compare the meter’s reading with the lab results. The meter’s result is considered accurate if it falls within 15 percent of the lab test result.

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