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Shiftysdad 07-31-2019 03:36

new member, well not lurking now
 
Greetings. I have been a member her for a couple of years, but haven't posted anything. I like to read threads from time to time but have not been active.

I have been diabetic for probably 20 years. Lost weight when first diagnosed and eventually went off meds. Slid off the wagon with my diet and weight after awhile, started back on meds about 12 years ago.

My diabetes was complicated by a benign pancreatic tumor, IPMN, which continued to grow despite being drained once. I ended up in March of 2014 having a sub-total pancreatectomy, 2/3 of the pancreas removed where the cyst and a few smaller ones were located, so basically all I have now is the head of the pancreas. As part of the operation, they also removed the spleen, since blood supply is pretty tangled up with the pancreas', and in fact they tried to do it laparoscopically but ended up having to open my abdomen due to bleeding. Had several complications after that to boot, ended up being in and out of the hospital for a couple of months.

Fast forward a few years. I have now been on Lantus insulin at night for going on 5 years. Sugars fairly well controlled at times, and not so well at other times.

Lately I have been really wondering about the accuracy of my meter/strips. My meter is the One Touch Ultra. I used to be able to get strips from a friend who didn't need all the strips she was getting after starting an insulin pump. Now since that source has dried up, and I don't have traditional insurance to cover Rx, I switched to generic strips from Amazon and I thought they were pretty accurate. Tonight we had low carb pizza for supper, (yes there is such a thing, about 6 net carbs per whole pizza and I only ate 3/4. Made with low carb tortilla and toppings). I had mowed the grass today, so I always tend to run a little lower on days I do that since I walk about 4 miles all together. I took a Glipizide before eating, and 30 min after meal was 89. 30 min later was 102. I was happy with this. Then at 1:45 min, I was 141, tested right after and got 102, then again with same drop of blood 132. I know the glucose meters can have a certain variation but how much is normal, and how is a person supposed to accurately measure for insulin dose or other meds if there is that much variation. Or is that a normal amount of variance.

What do you all use and is there a more accurate meter out there or is the continuous blood glucose monitor that you put on your arm the best way to truly tell what your sugars are doing???

Thanks in advance for any help.

itissteve 07-31-2019 12:21

Welcome to the forum, 'dad!

U.S. regulations require meters to have 95% of blood glucose measurements accurate within 15% of true. So that 102 could show as high as 117 and the indicated 141 could have been as low as a real 120. In other words, no practical difference. Add in the variables introduced by testing site choice, testing site cleanliness, the age or storage conditions of the strip, and even blood itself (not being homogeneous), etc., and what you have is more of a guide than hard information.

How do you work with that information? That's the challenge. One way I deal with outlier readings is to take another reading right away; preferably after a washup and choosing a different finger. Most prevalent value wins.

Since I don't use insulin I will leave it to our insulin-using members to describe their technique in using readings. My sense, in reading posts from these members over the past year-plus, is that it's more of a navigation-made-good kind of thing with insulin injected to not overreact to a current reading. Sometimes you need to fine-tune things a little.

mbuster 07-31-2019 13:23

Hi Shiftysdad, welcome back.

Older meters have had allowable inaccuracies of 20% while newer meters have to have 99% of its readings within 20% of a lab quality meter and 95% of its readings within 15% of alab quality meter. Surely this means some improvement in accuracy for new meters, but I don't know how to g about proving it. Here is an article in Healthline about the standards.

Aside from the allowable inaccuracies of meters, there can also be inaccuracy in the strips we use, especially if they are third part strips made outside of the US. Looking at your numbers of 102 and 141, they are not within 20% of each other. We don't know if either one are right, but if it were really say, half way between both and 121 was accurate, then both of the numbers would be within the allowable 20%. It is only my opinion, but I think most meters read higher or lower than than what is real most of the time and any big deviation is usually a result of contamination of the strip or the blood sample.

I take my meter with me when I go to the doctor and get blood drawn for labs and test myself at the same time. Although it is not the same blood sample they collect and blood glucose is not homogenous (the same) throughout your body, my results have usually been very close to the lab results.+/-3 mg/dL. It is probably coincidental, because I can have some vastly different readings at home when testing and retesting, same or different fingers, same or different blood drops. I try not to retest unless I get a reading that is out of line of what I think it should be and I wonder if I might have contaminated the strip. I'll wash and dry my hands better and retest. I take that reading as what it is and don't retest again or compare with another meter.

I look at my numbers as trending in directions and not as a specific number. I don't take insulin, but if I did I would probably not rely on the exact number to base how much insulin I thought I should take.

Another thing to consider is that although low carb, the carbs may not always be converted to glucose immediately. Many things can slow the speed of digestion other than the complexity of the carb and it could take longer to see a BG rise.

Are you only on basal insulin, or do you take bolus insulin as well? You only mention Lantus.

Shiftysdad 07-31-2019 13:39

Thanks for your reply. Very interesting. I am only on the Lantus. I also take Metformin 1000 mg BID and the Glipizide 5 mg as needed before meals. I almost always take it before dinner, as later in the day I tend to run a little higher. I adjust my Lantus based on my sugars before bed, as I have occasionally had a hypo episode during the night. Not very often but I don't like to take any chances.

Shiftysdad 07-31-2019 13:55

Thanks, yes I retested again and got 132. I use my nighttime readings to adjust my Lantus dose so I don't get hypo in the middle of the night. I use readings before meals to indicate whether or not I take Glipizide before a meal, depending on what I'm going to be eating as well.

mbuster 07-31-2019 14:16

When you did have hypos were they on nights that you took glip? I could see the glip as being more responsible than the Lantus. Is there a reason why the doctor has prescribed glip? Just curious, because I don't know, it just seems that with an already compromised pancreas you wouldn't want to stress it?

Shiftysdad 07-31-2019 14:29

I take the Glipizide hours before I go to bed. Usually up til 11 or 12, and any Glipizide would be at 5-6. I have been on Glipizide for many years, pretty much since I started taking meds again. He continued it when I started going to him, just to control post-meal spikes. He has advised me to never take it any later than 6PM, which I do not. I think most often the hypos have been related to exercise. the more I walk or exercise the lower my sugars run later in the day.


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