Wednesday, August 13, 2014

A foray into blood glucometers

After a whirlwind visit to Endocrinology, we found ourselves in possession of a slew of diabetic testing supplies, with instructions to test Aidan's sugars for the next few days as he comes off feeds to monitor for uncontrolled low blood sugar episodes.  I'm writing this post for me - because today, on day 1, I remember everything I've been told.  I may need to read this later.

Supplies - A grocery bag full of vampiric goodies.

We were given a Contour Next EZ Meter.  And no training whatsoever.  My wonderful colleague, Bob, took the time to show me what to do, and I felt at least seven hundred times better once he did. There is also a really helpful instructional video on Bayer's website.  A note - the meters should be operated in temperatures between 41 and 113 degrees (you'll get error code E1 if you're out of temperature range).

I also received a bottle of control solution - which contains a premeasured amount of glucose.  It's useful for practicing with the meter, on the off chance you don't want to stick yourself a few dozen times.  It's also used for testing the meter to ensure that the meter, test strips, and your technique are all working correctly.  It comes with instructions, but basically, you put a drop of control solution on a nonabsorbent surface (they recommend wax paper), and touch and hold the tip of a test strip to the control solution until the meter beeps.  You compare your result to the normal control range on the test strip bottle (and different bottles may vary - mine do).  If the results are questionable, the meter user guide should offer some suggestions regarding next steps.

I am nearly positive this is the wrong stuff.

Alcohol Prep pads - for cleaning skin before testing.  Self-explanatory.

Contour Next Test Strips - Obviously, for use with the meter.  They test blood glucose levels between 20 and 600 mg/dL - numbers I expect NEVER to see.  This should go without saying, but they're single use only.  Never reuse a test strip.  It's also important to keep the bottle closed tightly to protect the strips from humidity and contamination.  A nice feature that I think most test strips have now is the "sipping" technology - you just have to put the test strip up next to the blood and it draws it up into the meter - you don't actually have to soak the whole strip in blood.  Older meters/strips didn't work this way, and needed more blood to test.

Microlet 2 Lancing device & lancets - This is what you prick the skin with to obtain the blood for sampling.  The Microlet is easy to use - you just pull off the cap, insert a lancet, twist off the top of the lancet, replace the cap of the Microlet, and choose your endcap setting (tiny droplet for shallow puncture, big droplet for deep puncture) based on the patient and test area (fingertip vs. forearm, for example).  You press the endcap firmly against the test area and press the blue button, and it's done.  Like the test strips, you should never reuse a lancet.  Once used, they're no longer sterile and should be replaced.  To remove a lancet, you open the endcap, press the needle into the lancet cap you removed earlier, eject using the blue button and blue reset slider, and dispose as medical waste.

Not scary.

Even less scary.  Itsy bitsy needle.

Basic Use - We do not use any advanced features of this meter.  Aidan is not diabetic - he is experiencing hypoglycemic episodes that we need to monitor more closely.  The advanced features (reminders, meal markers, etc) look really helpful for diabetic patients, but that's not us.

- Load a test strip into the meter, gray square end facing up.  This turns the meter on.  You'll see a blinking picture of a test strip with a blood drop - this means it's ready to test.  If you've loaded it incorrectly, you'll get error code E4.  If you use the wrong test strip, you'll get error code E7.
- Draw a blood sample using Microlet and touch the tip of the test strip to the blood drop.  Hold it in place until the meter beeps.
- If more blood is needed, the meter may beep twice and show a picture of an underfilled strip.  You'll have 20 seconds to add more blood to the same strip - if you don't, you'll get an E2 error code and you'll have to start over.
- Once the meter has what it needs, it will evaluate the sample for 5 seconds and display your reading and store it to memory.
- Record your reading and remove the strip to turn off your meter.  And you're done!

My own testing efforts -

- Attempt 1 with control solution resulted in error code E3 - either the meter is sensing a used test strip, or the wrong control solution was used.  Ummm...  Everything is brand new, and this is definitely the control solution they gave us.  Wha??
- Attempt 2 - E3.
- Attempt 3 - After gently rolling the bottle around to make sure the control solution is all mixed up - still E3.  ARGH.
- Attempt 4 - After being ultra careful that no part of my fingers touched any part of the test strip sipping area - E3.
- Attempt 5 - The control solution is clearly broken.  I tried with my own blood.  I had chicken for dinner about 4 hours ago, and my blood sugar is currently 114.  Humm.  We'll call that "high normal" and assume my technique is okay.  And also, the control solution is broken.

Important points - these are what's important for us.  There are a million and one things that are also important for families managing diabetes.  Thankfully, we're not walking that road.

Normal non-diabetic values are between 70-110 when fasting.If Aidan's fasting blood sugar measures below 70, we are to report that to his doctor within the week so we can change his feeding strategy.  If Aidan's blood sugar measures below 50, we are to seek immediate medical attention.

Some symptoms of low blood sugar (hypoglycemia) are shakiness, sweating, fast heartbeat, blurry vision, confusion, lethargy, irritability, dizziness, and seizure.  Some symptoms of high blood sugar (hyperglycemia) are frequent urination, excessive thirst, blurry vision, fatigue, and hunger.  Some symptoms of ketoacidosis - a serious and dangerous medical emergency - are shortness of breath, nausea/vomiting, and very dry mouth.  All of these symptoms are a good prompt to check blood sugar for a patient with a known issue - and someone with a reading of less than 50 or more than 250 should call their doctor right away.  Again - not anything we ever expect to see with Aidan, but good to know and I figured there should be something informative in here somewhere.

After much reading and self-testing and worrying, I mustered up the courage to test Aidan for the first time.  I let him pick which finger he'd like to test, and he was awesome about it.  Didn't cry at all.  He just asked - are you done yet? The hardest part was getting him to hold still while I touched the test strip to the blood drop.  His reading was 74, while still on a feed, and it officially occurs to me that I never asked what a normal nonfasting blood sugar should be for him.Whoops.

More to come as we test and learn more.

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