Diabetes Self-Management Blog

There I was, at the American Association of Diabetes Educators (AADE) meeting in Indianapolis last month, when I started to feel kind of loopy. You know, fuzzy-brained and all that stuff.

“Oh, boy,” I said to myself, “I’m low!” And, because I was in Indy, I had cinnamon gummy bears on me! (You can’t get them where I live.) I love cinnamon gummy bears and had been waiting for just this excuse to eat some.

My inner child was chanting: “Gum-mee BEARS! Gum-mee BEARS!”

I salivated just thinking about it. My hand shook (from hypoglycemia?) as I took my meter out to check my glucose. How low was I? How many gummy bears could I justify eating to bring my sugar up? Three? Five? Ten?

The meter beeped and displayed the number. How many gummy bears could I have? As it turned out — none. I was 250 mg/dl.

Dang! Seventeen years of faithfully checking my blood glucose and I STILL can’t tell if I’m high or low by the way I feel.

Some people believe they can, however. A former colleague did. “I don’t need to test,” she’d say. “I can tell by the way I feel.” (Yeah, like I could tell I was low enough to eat cinnamon gummy bears.) I believe she has a few complications now. But she now uses a meter.

I was interested in the notion of knowing what your blood glucose is by the way you feel so, when I saw that Dr. Steve Edelman was doing a program on “Test, Don’t Guess,” I just had to go. You may know Dr. Edelman as the founder and director of “Taking Control of Your Diabetes (TCOYD).” If you’ve never attended one of the programs, I highly recommend doing so.

As it happened, lots of people — 71% in this study — believed they could tell what their glucose was without checking. And they made decisions about their diabetes management based on their “feelings.” Including insulin dosages. Yikes! And, as it happened, a lot of them were wrong. Participants had Type 2 diabetes, by the way.

Before I tell you what the results were, you need to know that current standards call for home blood glucose meters to be accurate within plus or minus 15 mg/dl at levels below 75 mg/dl and plus or minus 20% of meter blood glucose values of more than 75 mg/dl. Ninety-five percent of the time.

Edelman says proposed accuracy criteria calls for accuracy of plus or minus 15 mg/dl of values less than 100 mg/dl and plus or minus 15% of levels more than 100 mg/dl. Who knows when the US Food and Drug Administration will adopt the new criteria. Or if. I believe they were going to do that last year. Still waiting…

Also, results were adjusted by frequency of monitoring, when the person last ate, how long ago the person had done a blood glucose check, self-reported HbA1c, and stuff like that. There were close to 300 people in the study.

Overall, 46% of people failed to guess correctly based on current standards, and 58% missed the boat under the proposed standards.

Breaking it down, 43% incorrectly estimated their glucose at current standards for lows and 65% were incorrect when guessing their levels under the proposed standards.

On the high side, of people whose glucose was higher than 200 mg/dl, 63% guessed incorrectly under current guidelines and 78% got it wrong under proposed guidelines.

Well, after that little wake-up call, 99% of the participants allowed that maybe actually checking could help them make decisions in their diabetes management. (Ya think?)

Talk of current versus proposed guidelines aside, an article in the May 2010 edition of Clinical Laboratory News, a publication of the American Association for Clinical Chemistry, says many blood glucose meters (BGMs) already can meet the higher standards, according to the FDA’s data and reported during a meeting in March 2010. According to the article,

A recent FDA evaluation of glucose meters cleared over the past two years and discussed during the public meeting found that approximately 50% would meet ±15% at ≥75 mg/dl and approximately 72% would meet ±10 mg/dl at <75 mg/dl... These findings agreed with comments by several speakers at the meeting who noted that their own data indicated that BGM performance has been increasing, even though the FDA standard has remained the same for the past 8 years.

(Remember that the article is more than two years old.)

So. Do you guess or do you check? If you don’t check, why not? Will you after reading the results of this study?

If it’s a matter of affordability, check out store brand meters and strips. They tend to run a lot cheaper.

You can also check twice a day for the most part: Write “breakfast,” “lunch,” “dinner,” and “bedtime” across the top of a piece of paper. Check before breakfast and dinner one day and before lunch and at bedtime the next day. Keep alternating. You’ll soon begin to notice a pattern. Once in a while, check at 3 AM and check two hours after you take the first bite of a meal. You can use your meter to see how new foods affect you (check before the first bite and two hours after the first bite). Check before and after any physical activity to see how exercise affects you.

Off that subject, don’t forget to take time today to remember the events of September 11, 2001, those who lost their lives, and the family members who still miss their loved ones.

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