Winter 2010
Volume 19
No. 1

To Test, or Not to Test… That is NOT the Question

By testing your blood glucose (sugar) as prescribed by your doctor and using the results to make informed decisions, you may be able to avoid: kidney failure, heart attack, nerve damage, blindness, amputations or stroke. Regular blood sugar monitoring is like keeping track of how much gas you have in your car. You know how much gas you need to get where you are going. Similarly, by keeping within your target blood sugar range, you can continue enjoying your life. If you ignore it, like ignoring your gas gauge, you won’t be going anywhere.

Diabetes is a disease that causes higher than normal blood sugar. This high level of blood sugar may cause damage to the body’s blood vessels, nerves and organs. Over time this damage can become so severe that it leads to serious complications like those listed above. To have a fighting chance of preventing or minimizing complications from diabetes, you must monitor your blood sugar. Just simply checking and writing numbers down is not enough. To really make the numbers work for you, you have to know what they mean.

Meal Timing Blood Glucose (Sugar) Range
Before meals 70 – 130 mg/dL
After meals Under 180 mg/dL

Source: American Diabetes Association Clinical Practice Recommendations, 2009

The American Diabetes Association gives target ranges for blood sugar for people with diabetes, which are shown above. "Before meals" refers to right before you start eating, and "after meals" is about 1-2 hours after you start eating. It is important to remember that your doctor or healthcare provider may recommend a different range for you based on your specific situation, so make sure you know what ranges are right for you.

There are many things that affect your blood sugar – food, activity, medication, stress, alcohol, even illness – and each person is different. The only way to learn how these things affect your blood sugar is to test. This will show you, for example, if your meal size was appropriate, how much that walk with the dog did for your blood sugar, or that your dose of insulin may need adjusting. Finding these patterns will give you and your healthcare provider valuable information you can use to control your diabetes. By learning all you can about your blood sugar, you become a powerful self-advocate.

Without testing, you are ignoring your diabetes – and the consequences are far worse than running out of gas. R'ther than leaving it up to chance – get back in the driver’s seat and take control of your diabetes by testing your blood sugar!

From the desk of Nurse Lorraine

7 Simple Steps for Testing Your Blood Glucose

Dear Friend,

As a Certified Diabetes Educator, I know the importance of regular blood glucose (sugar) monitoring. With regular testing, you will gain information to help you and your doctor make decisions about your diabetes care and treatment. Following a routine for your blood sugar testing should be as much a part of your day as eating breakfast, lunch and dinner. This routine is key to successfully managing your diabetes and getting on with enjoying your life.

  1. Wash your hands with soap and warm water and dry them well. This improves blood flow, making it easier to get a blood sample. Do not use alcohol pads on a regular basis. Alcohol pulls moisture out of your skin. Over time this may cause your skin to dry out and crack. Clean hands ensure the most accurate result.
  2. Gather your supplies. Sit down in a comfortable, well-lit area, with all your testing supplies and blood sugar logbook within easy reach.
  3. Wiggle your fingers. Hanging your arm at your side and swinging it back and forth a few times will increase blood flow to your hand.
  4. One quick stick. Use a new, sterile lancet in your lancing device each time. You may stick the side of your fingertip or an alternate testing site such as the palm, forearm, upper arm, thigh, or calf. Refer to your meter manual and check with your doctor.
  5. Take your sample. Allow a small drop of blood to form on your finger, hanging your hand low if needed. Bring the test strip to your finger; don't lift your finger to the test strip. Press your fingertip firmly with a tissue to stop the blood flow.
  6. Use your meter. Follow the instructions in your meter manual to take a reading of your blood sugar levels.
  7. Record your results. Write down your results, along with the date and time. Be sure to take this information to each visit with your doctor. Need a logbook? Please tell your Customer Service Representative; they will be happy to include one in your next shipment!

Please carefully read this newsletter to learn more about how to monitor your blood sugar as well as many valuable tips to improve your testing routine. For more information, call 1-877-700-3800 to make an appointment to speak with one of our Certified Diabetes Educators, who are also Registered Nurses and Registered Dietitians. We are here to help you!

Best of health,
Lorraine Farrar, MSN, RN, APN, BC-ADM, CDE
Vice President, Education and Wellness

Ask Sandy

By Sandy Gaskins, RN, CDE Sandy Gaskins, AmMed Direct’s Registered Nurse and Certified Diabetes Educator, answers your questions and concerns about blood sugar monitoring.

Q: "I received a new meter and the blood glucose (sugar) test result showed a 15 point difference. Why does the new meter read differently and which is correct?"

A: Comparing two different meter results is frustrating. It causes doubt and worry; so avoid it. The accuracy of your test result depends on many factors: how you store and handle your test strips (check your manual) and how well you do the test.
3 ways to check your meter’s performance:

  1. Use electronic checks. Every time you turn on your meter, it does an electronic check. If it detects a problem you will receive an error code. Check your owner’s manual for a list of error codes.
  2. Use liquid glucose control solution:
    • Every time you open a new container of test strips
    • Occasionally as you use the container of test strips
    • Whenever you get unusual results
    Your shipment of test strips includes a small bottle of glucose control solution. A glucose control test is like a blood sugar test, except you use the control solution instead of blood. Gently mix the solution. Touch the test strip to a drop of the control solution (just as you would a blood drop). Your test result should match the result printed on the strip container. If it doesn't, repeat the test once more. Call Customer Service for additional help or refer to your meter manual. Mark the control test result in your meter so you won't confuse it for a blood sugar result later.
  3. Compare your meter with a laboratory analyzer. Take your meter with you to your next doctor appointment. Ask your doctor to compare the results with their lab.
Finally, be sure to discard unused strips and control solution when expired. As always, call your Customer Service Representative with any questions at 1-877-700-3800.

Simplify your life. . . with just a CLICK!

Now, you can authorize your next shipment of diabetes test supplies online. Simply visit www.AmMedDirect.com and click the Member Login tab at the top of the page. Answer a few questions and you’ll have access to reorder supplies, valuable diabetes management tools and much more. Check out some of these resources only available for our Better Care Program members:

Online Reordering
Health and Nutrition Tools
Member Only Recipes
Ask Nurse Lorraine

Good Things Do Come in 3s

See These Little-Known Facts about Blood Glucose (Sugar) Testing

Fact #1: Medicare reimbursement guidelines cover the batteries and strips for your meter.

Just ask your Customer Service Representative to include them in your order.

Fact #2: Test strips are like house flowers;

you have to take extra care with them. They cannot be exposed to excessive heat, cold or humidity. So, don't keep them in places like the car, refrigerator, freezer or bathroom. The vials they come in are specially designed to protect them. When you take one strip out of the vial, close the lid promptly. Never store strips outside of the vial they came in. Any of these actions can cause the strips to go bad. It could affect the accuracy of your test results. Check your meter’s instruction book to see if yours require special handling.

Fact #3: Lancets cannot be thrown away loose in your regular trash.

Used lancets and syringes are considered potentially infectious because of their ability to spread diseases like Hepatitis or HIV. They may cause injury to family members, housekeepers or municipal waste handlers. State and local laws vary. To find out proper disposal methods for your area, contact the Coalition for Safe Community Needle Disposal toll free at 1-800-643-1643, or online at www.safeneedledisposal.org

Less PAIN, More Gain!

When you have diabetes, testing your blood glucose (sugar) can be a real pain, but it doesn't have to be. The "pain" part of testing has nothing to do with the meter you use. All meters require a blood sample to give you a blood sugar reading. But, by making a few, simple, minor adjustments you can make a BIG difference in your comfort!

Try these easy tips for LESS PAIN:

Tip #1: New vs. Used:

Simply using a new lancet for each test greatly reduces the pain. Lancets are sharpened, polished and coated to glide through the skin easily. Would you use a dull knife to carve your turkey? After just ONE use, the tip bends back, like a fishhook, and dulls significantly, resulting in MUCH more pain going in.

Tip #2: Reduce your Depth:

Most lancing devices have adjustable depth settings to control how deep the lancet pierces your skin. The deeper the stick, the greater the chance the lancet will touch nerve fibers, which can cause throbbing pain. Use the lowest setting that allows you to obtain enough blood to test.

Tip #3: Replace your lancing device every 6 months.

The majority of devices sold are spring-loaded, which wear out after repeated use. A weak spring may require deeper or multiple sticks to get a blood sample. Medicare reimbursement guidelines cover one lancing device every 6 months for this very reason!

Tip #4: Lancet thickness can make a difference!

If the lancet is too thick, then tearing or bruising of the skin may occur and this causes pain. If the lancet is too thin, the lancet must go deeper to get a large enough drop of blood. Lancets come in different widths, called "gauges" (G). Common sizes are 28G, 30G and 33G. So, the thinnest gauge does not always equal less painful testing. Try different gauges to find the one that works best for you.

Tip #5: Location, location, location!

Fingertips are loaded with nerve endings – especially right in the middle. By testing on the side of your fingertip, you can minimize your pain. Another option, alternate site testing (AST), may be less painful. Sampling blood from alternate sites may be desirable but there are limitations. Your meter’s manual lists its approved alternate sites. Also, be sure to ask your doctor if AST is right for you.

Tip #6: Change is Good:

By rotating where you stick for your blood sample, you could ease your pain tremendously. Using the same 1 or 2 places causes the skin to form a callous, requiring a deeper stick for future samples which may lead to more pain. A quick rule of "thumb" is to start on one side of your left thumb, then go to the other side. Then use one side of your index finger. Use the other side and so on until you have used that entire hand. Then switch hands. When you return to your first stick site, it will have had lots of time to heal.

By following these 6 Easy Tips to Reduce Your Pain you will increase your gain – on living an easier life with diabetes!

From the Better Care KitchenTM - Cooking with Ken & Lori

No Crust Veggie Pie

Ingredients:

  • 1/2 cup chopped red pepper
  • 1 cup chopped broccoli
  • 1/2 cup chopped onion
  • 1 cup chopped tomato
  • 1/4 cup grated Parmesan cheese, low-sodium
  • 1/3 cup low-fat Cheddar cheese, shredded
  • 1 1/2 cups non-fat, evaporated milk
  • 3/4 cup reduced-fat baking mix
  • 1 tsp. parsley, dried
  • 1/8 tsp. black pepper
  • 1 tsp. garlic powder
  • Cooking spray with butter

Directions:

  • Preheat oven to 400 degrees. Spray a 10 inch deep-dish pie plate with butter-flavored cooking spray.
  • Layer the broccoli, onion, tomato and red pepper in the pie plate. Sprinkle the Parmesan cheese and Cheddar cheese evenly on top.
  • With a wire whisk, mix the milk, baking mix, parsley flakes, black pepper and garlic powder in a large mixing bowl.Pour mixture into the pie plate, over the veggies.
  • Bake for 25-30 minutes. Remove from the oven and let set for 5 minutes.

Sample Menu Using Maple Pumpkin Pie

  • 3 ounces roast turkey
  • 1/2 cup stuffing (1 carb serving)
  • 1/2 cup baked sweet potato (1 carb serving)
  • Skinny-turkey gravy (fat removed made with skim milk)
  • 1/2 cup green beans
  • 1 teaspoon margarine
  • Maple Pumpkin Pie (2 carb serving) SEE RECIPE

Yield

  • 6 servings
  • Serving size: 1/6 of total recipe

Nutrition:

  • Calories: 145
  • Carbohydrate: 29 grams
  • Saturated Fat: 0 grams
  • Cholesterol: 0 mg
  • Sodium: 350 mg
  • Fiber: 1 g
  • Protein: 2 g
  • Carb Servings: 2

Sample Menu Using No Crust Veggie Pie

  • 1 serving of No Crust Veggie Pie (2 carbs)
  • 1/3 cup cooked brown rice (1 carb)
  • Side salad:
    1 cup green leafy salad
    5-10 unsalted nuts
    1/2 cup pinto beans (1 carb)
    1/4 cup low-fat cottage cheese
    Sprinkle of alfalfa sprouts
  • 1 tbsp. Italian dressing
  • 8 oz. water