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What a strip of paper can tell you
Self-testing of your blood glucose levels is an important part of controlling your diabetes. Electronic glucose monitors are accurate and reliable, and they play center stage in your self-monitoring routine. They also have an insatiable appetite for test strips, so your biggest expense is an ongoing supply of strips to use with your meter. The type of strips you use will depend on your type of meter. Photometric meters detect color changes and use test strips coated with glucose oxidase. Other meters detect electronic currents and use strips coated with an enzyme. Either way, the meter reads the strips and gives you a precise value for your blood glucose level. Another type of blood glucose strip is designed to be read by the user, rather than by a machine. These visually read strips provide less accurate results than those used with meters, since they can only provide a range for your glucose level. However, they can be an excellent backup when your meter is not working properly, or for times when you don't have your meter with you.
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Shopping Around for the Best Deal
- Blood glucose test strips are available at pharmacies.
- Visually read blood glucose strips are about the same price as the strips required by blood glucose meters.
- The cost of using strips adds up quickly.
- Purchasing in bulk may save you money, but be sure you can use the quantity of strips by their expiration date.
- Check with your insurance company to see if it they will cover your strips.
Do I Need to Recalibrate My Machine?
- Each new batch of strips requires a new calibration.
- Use the check strips or control solutions that came with your machine. If the result does not fall within the specified range, either the strips are bad or the machine needs cleaning or is broken.
- Periodically take your blood glucose meter to your local diabetes center. They can compare the results of your monitor with those of more sophisticated machines.
The Accuracy of Visually Read Blood Glucose Strips
- Like blood glucose meters, visually read blood glucose strips give you your present glucose level and are preferred over urine glucose strips.
- Visually read glucose test strips give readings in 20 mg/dl to 30 mg/dl intervals.
- Some people can assess their blood glucose as accurately from strips as they can from meters; however, this is not the case for most people.
- To maximize accuracy, preserve your strips by keeping them clean and fresh to avoid damage.
- The accuracy of strips is also dependent on the ability of the person to match the color indicated to the chart provided by the strip manufacturer.
Never Share Equipment
- Never share diabetic equipment that penetrates your skin or comes into contact with bodily fluids like blood or saliva (e.g., syringes, auto injectors, catheters, glucose monitors, lancing devices). This reduces the chance of transmitting and/or contracting an infectious disease like HIV, hepatitis, or syphilis.
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Visually Read Blood Glucose Test Strips
- Visually read blood glucose strips should not replace blood glucose monitors.
- They can give you a range in which your blood glucose level falls.
- Visually read blood glucose strips can provide you with an estimate of your blood glucose level when you don't have your electronic blood glucose monitor with you.
- The blood glucose test strips are coated with glucose oxidase, an enzyme that reacts with the glucose in your blood and causes the strip to change color. A chart is used to match the color of the strip to the corresponding blood glucose range.
Blood Glucose Monitor Strips
- These strips can be used with electronic blood glucose meters only.
- Strips are coated with different materials, depending upon the type of meter used.
- One type is coated with glucose oxidase and changes color based on the blood's glucose level (much like visually read blood glucose strips). But unlike visually read glucose strips, the strips are placed in a meter to get a reading. Meters can read subtle changes in color much better than the human eye, providing more precise values of blood glucose level.
- Another type of strip is coated with an enzyme that pulls electrons off glucose and onto the strip. The movement of electrons from glucose towards the enzyme embedded on the strip creates a current. The strip is placed in the meter and the meter measures the current. A weak current signals a low blood sugar level, whereas a strong current signals a high blood sugar level.
Before Sticking
- To wash or not to wash your hands? Studies have been done that indicate no difference in the instance of infection between people who wash before sticking versus those who don't.
- If hands are excessively dirty or infected, wash them.
- If you do decide to wash your hands prior to sticking, remember to dry your hands completely. Excess water can dilute your blood sample.
- Make sure your lancing device is fitted with a sterile lancet.
- Be sure to have your strips nearby so that you can place the droplet on the strip immediately.
- A number of ways exist to prepare your hands and fingers so that you get the maximum amount of blood flowing in them:
- Run warm water over your hands to stimulate circulation to your fingers.
- Swing your arm in a circle so blood can pool in your hands.
- Hold your hands below your waistline and shake them vigorously.
- In extreme situations, you can use a rubber band as a tourniquet. Just remember to remove it once you have collected your sample!
- Some believe that alternating fingers will prevent soreness. Others believe that using the same finger causes a callus to build up, causing less discomfort but still allowing enough blood for each test.
Drawing Blood for a Blood Glucose Test
- Place the lancing device next to the skin.
- Depress the button or release the lever.
- Remove a strip from the bottle.
- Close the bottle immediately, as strips are sensitive to humidity.
Performing the Test on a Visually Read Strip
- Place the blood droplet on the blood glucose/reagent strip.
- If your lancing device has a cap, recap it immediately.
- Important: dispose of the lancet properly. Used lancets are considered a biohazard.
- Wait 30 to 60 seconds. Consult the manufacturer's directions for the ideal time.
- Wipe or wash off any excess blood.
- Wait about one minute.
- Compare the color result to the chart that comes with the strips.
- Record the results.
Performing the Test on a Machine-Read Strip
- Place the blood droplet on the blood glucose/reagent strip.
- If your lancing device has a cap, recap it immediately.
- Important: dispose of the lancet properly. Used lancets are considered a biohazard.
- Do not smear the blood. Do not add more blood.
- If you have not provided a sufficient amount of blood, start over with another finger and another test strip.
- If you are using a blood glucose meter that reads color, wait the amount of time instructed by the manufacturer before wiping off the excess blood.
- If you are using a blood glucose meter that reads currents, do not wipe the excess blood.
- Carefully place the strip in the meter. You should have your reading in anywhere from a few seconds to a few minutes, depending on your meter.
- Read immediately and record the result in a logbook, even if your meter has a memory feature.
Read the Directions
- If you have a glucose meter, periodically re-read the manual that came with it. After you've been testing for a while, you might be surprised to find that you've been overlooking something.
- If you are using visually read strips, follow the instructions provided. Different strips may have different instructions.
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Treat Test Strips Carefully
- Blood glucose/reagent strips are sensitive to humidity and excessive heat. Store them properly.
- If you suspect that a strip is defective, do not assume that the rest of the strips from that batch are OK. Often, whole batches are defective. Contact the manufacturer.
- At this time, there are no drugs known to interfere with the accuracy of blood glucose/reagent strips.
Remember Your Medical Identification
- Always wear an emergency information bracelet, necklace, or other form of identification to inform emergency responders and others that you have diabetes. This helps emergency responders deliver appropriate care.
Hypoglycemia Happens
Hypoglycemia, or low blood sugar, is going to be a reality if you have diabetes, no matter how well you control your blood sugar. Don't immediately blame yourself for episodes of hypoglycemia; in managing your diabetes, you are attempting to control a very complex, intricate, and inconsistent system. One or two hypoglycemic episodes per week can be expected, even if you are managing your diabetes effectively. If you are experiencing more than two hypoglycemic episodes per week, contact your healthcare provider to see how you can bring the number down.
Generally, if your blood sugar drops below 50 mg/dl to 55 mg/dl, you are considered hypoglycemic. But studies indicate that glucose-level drops from 70 mg/dl to 72 mg/dl can affect brain function. Before you decide to treat your hypoglycemia with glucose tabs, gels, or other sugars, you must take (if possible) a blood glucose test to determine how much sugar you need. Finding out just how much sugar you need relative to your blood glucose level reading involves trial and error. No hard and fast rules apply, since people differ so much. Symptoms will vary from person to person, but here are some hypoglycemia warning signs to watch out for.
Symptoms caused by rapid release of epinephrine:
- Rapid heartbeat
- Excessive sweating
- Muscle tremors
- Anxiety
- Hunger that can be extreme
Symptoms caused by unavailability of glucose to the brain:
- Irritability
- Vertigo
- Headache
- Blurred vision
- Confusion
- Convulsions in extreme cases.
- Unconsciousness in extreme cases
- Lethargy
- Fatigue
Hypoglycemia Unawareness
- It is possible to have hypoglycemia and not experience any of the early warning symptoms. You may experience only the mental symptoms, and none of the physical symptoms.
- Hypoglycemia unawareness was originally thought to be caused by nerve damage from living with diabetes for many years. This causes an absence of epinephrine release in response to low glucose levels.
- It is now thought that hypoglycemia unawareness may be caused by frequent episodes of low blood glucose, without pre-existing nerve damage. Episodes of hypoglycemia seem to lower the glucose levels at which epinephrine release, causing hypoglycemia without any of the physical symptoms.
- Hypoglycemia unawareness tends to affect people who control their glucose levels stringently. It also tends to affect pregnant women.
- An interesting comparison occurs in people who do control their blood sugars poorly. These people experience physical symptoms of hypoglycemia at much higher blood glucose levels than the average diabetic person.
- If you have hypoglycemia unawareness, you need to consult your healthcare provider. Together you can develop a treatment regimen to ensure that you have adequate blood glucose levels and avoid situations where you might have low blood glucose. Keeping blood sugars at adequate levels to avoid hypoglycemia for days to weeks has been shown to restore sensitivity to hypoglycemia.
How to Treat Hypoglycemia
- Get carbohydrates immediately. Carbohydrates can come from glucose tablets, soda, candy -- anything rich in sugar. Do not use carbohydrate sources that are also high in fat such as ice cream, chocolate, or cake. The excess fat can inhibit the absorption of carbohydrates.
- Keep your convenient glucose sources in your purse, pocket, car, or any other place that is quick and easy to access.
- Treat hypoglycemia correctly. Do not overeat carbohydrate sources or eat too little carbohydrates.
- You should consume about 10 to 15 grams of carbohydrates. Look at the nutritional labeling of the products you buy to determine how much you should consume to get 10 to 15 grams of carbohydrates. Do this ahead of time, not when you are experiencing hypoglycemia, because you might be tired and not thinking clearly.
- Below are some food equivalents for 10 to 15 grams of sugar:
- Six large jelly beans (not the tiny gourmet kind)
- Four to seven Life Savers
- Two tablespoons of raisins
- Two teaspoons of table sugar or honey
- Six to eight ounces of skim milk
- Half a can of soda (not diet)
- Remember that it can take up to 20 minutes before carbohydrates are efficiently absorbed into your bloodstream. If after 30 minutes you still feel symptoms of hypoglycemia, take another 10 to 15 grams of carbohydrate. Repeat this process until your symptoms are gone.
- If after three attempts of consuming sugar your symptoms have not disappeared, seek medical attention.
- It may be difficult, but you must resist the temptation to eat more carbohydrates. Overeating can lead to hyperglycemia.
Educate Others
- Please educate your friends, family, and co-workers about what to do if you become unconscious.
- If you do become unconscious or so debilitated that you cannot ingest glucose tabs or food, you need glucagon, an injected drug that counteracts hypoglycemia.
- Instruct friends, family, and co-workers to take you to the hospital and/or call for an ambulance. Remind them that these are life-and-death situations.
- If you cannot receive medical attention immediately (in the case of a long ride to the hospital or a wait for an ambulance), instruct friends, family, and co-workers to place some glucose gel or cake frosting between your cheek and gums and to massage the outside of the cheek to help the gel or frosting dissolve.
- Make sure friends, family, and co-workers do not attempt to force sugar or food down your throat. You can choke!
- No matter how well you manage your diabetes, always carry glucose tabs, gels, or their food equivalent with you at all times and let those who are around you know exactly where they can find them.
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Websites, Organizations & Manufacturers
Sources & Further Reading
Books
- 1. American Diabetes Assocation. American Diabetes Association: Complete Guide to Diabetes. New York: Bantam Books, 1996.
- 2. American Pharmaceutical Association. Handbook of Nonprescription Drugs. 11th ed. Washington., D.C.: American Pharmaceutical Assocation, 1996.
- 3. Fauci, Anthony S. et al. Eds. Harrison's Principles of Internal Medicine, 14th ed. New York: MacGraw Hill, 1998.
- 4. Saudek, Christopher D. et al. The Johns Hopkins Guide to Diabetes for Today and Tomorrow. Baltimore: JHU Press, 1997.
Find more books on health and wellness at  barnesandnoble.com.
Articles
- 1. American Diabetes Association. "Buyer's Guide to Diabetes Products '98." Diabetes Forecast; Vol. 52 10/1/1997.
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