The ablity to have an instant snapshot inside our children is nothing short of amazing. Testing blood sugar is such a relatively new technology. Fifty years ago, testing urine was the standard. Today, the selection of blood glucose meters available is almost overwhelming.
On a separate note, I'd love to just once see a meter in an advertisement that doesn't have a perfect number. Seeing 250 on the screen would just make it more realistic for me.
Testing
Blood Glucose Meters
Blood glucose meters and their test strips come in so many different shapes and sizes. They vary in colors, sample size, coding, accuracy, etc. Many people simply use the meter the hospital gave them at diagnosis or what insurance will cover. If your meter breaks or you need an extra, you most likely don't need to buy a new one. The meter companies make their money on the strips, so they're pretty free with the meters. Just call and ask the meter manufacturer--the worst they could say is no.
Recently, there has been some buzz about the degree of inaccuracy of certain glucose meters. You can take three different samples at the same time and have three different results from any meter on the market today. That is unsettling given you are dosing your child with insulin from a number you trust to be accurate. The following article discusses this issue.
Lancing Devices and Lancets
Just about all glucose meters come with a lancing device. And every company has their own particular style. Most are the single-use lancet variety. Accu-Check® Multiclix is unique in that it employs a drum filled with six lancets. It is very convenient not to be constantly loading the lancing device. It also offers many depth settings. Of course, no matter the lancing device, the biggest concern is the gauge of the lancet, especially where children are concerned. The higher the gauge of lancet, the smaller the poke. The highest gauge I have found is manufactured by Tiniboy. The company advertises a 36-gauge lancet. It claims to be virtually painless and will draw blood on both adults and children. I plan on getting a sample!
Toes vs. Fingers
No one enjoys poking their child until they bleed several times per day. It hurts our kids and parents find it just as painful watching them go through it. The diabetes educators at the hospital insisted I only use my two-year old son's fingers for blood glucose checks. According to them, the reason was twofold: the feet do not have the blood circulation of the hands, which therefore could lead to inaccurate blood samples and possible amputations later in life.
Then the nighttime nurses advised me I could indeed test his toes and said it would spare him pain and yield numbers with reasonable accuracy. They, in fact, tested his toes at night when the diabetes team went home. And my son never even flinched when they did. Since the day we left the hospital, we have primarily tested our son's toes without a single whimper from him about the pain of poking. And during our son's last endocrinologist visit, the doctor observed me poking his toe and asked if I saw a difference in the numbers between his toes and fingers. I replied that I didn't see much of one. And he said he tested toes on burn victims. I was so relieved that he didn't balk at my use of toes and simply let the issue go. He did not seem concerned by it.
You will meet medical professionals who split on this issue. Some say the risks of inaccuracy and amputation are overblown and others would say I'm risking my child's health and toes. Speak with your trusted medical professionals about the subject. And keep testing, no matter which digit (or appendage) you decide to use. Managing your child's diabetes depends on it.
Continuous Glucose Monitoring (CGM)
CGM is a relatively new technology that has come a long way since its first introduction in the late 1990's. Just as it sounds, the blood sugar is monitored continuously and every few minutes displays a blood glucose number on a small screen. It also plots the trend of past numbers in the form of a line graph. Overall, miles better than just blood glucose testing, but far from perfect. For parents of children who are über-sensitive to insulin and carbs and/or are hypoglycemic in the night, CGM is a godsend. It gives the parent a clue as to what is happening inside their child without poking them every 30 minutes. For older children, it is nice that they can see what's happening inside their body and warn a parent, school nurse, or caretaker that their blood sugar is in need of some attention.
Currently, there are three CGM manufacturers:
- FreeStyle Navigator® (Stand alone)
- DexCom™ Seven® Plus (Stand alone)
- Medtronic Guardian® REAL-Time (Stand alone)
- Medtronic Guardian® REAL-Time (Integrated with the Paradigm insulin pump)
There are many differences among all of these models, not the least of which is price. A comprehensive comparison and description of these systems can be found at the following website:
Warning: Insurance companies are not keen on paying for these systems and for replacement sensors. Read your provider's Diabetes Policy Bulletin to find whether or not CGM is covered in your plan. CGM is considered "experimental and investigational" by many providers. Be prepared for at least 2-3 rounds of the appeals process and maybe even a call to your congressional representatives.
Ketone Testing: Urine vs. Blood
The most widely used method to test for ketones is through the urine. One of the biggest complaints from parents, though, is that the urine may not reflect the presence or absence of ketones because you don't know how long the tested urine has been in the bladder. Further, for the very young, peeing on a test strip and on command is not going to happen. For the little ones in diapers, you just need some cotton balls placed in the diaper to absorb the urine and then squeeze it out onto the test strip (or into a small cup first). I was relieved when our toddler became enthralled with peeing in a cup. For him, it was almost as fun as peeing on a tree.
Some of the best advice I received was from a seasoned T1D mom. She insisted that I switch to a blood ketone meter. She said the more accurate and instant reading was worth the cost. And to make it even easier to switch, she advised me to call my insurance company because they would probably give my son one for free. I made the call and our new Precision Xtra® blood glucose/blood ketone meter arrived compliments of the insurance company. The meter can test both glucose and ketones, with the use of different test strips. Make sure you are prescribed/buying ketone strips. The only drawbacks I found are the price of the test strips, coding, and large sample size.
The ketone strips range from $3.50 to $5.00 apiece. Ouch! If your insurance covers the strips (and they should), you'll pay a portion of that amount. For us, we figure it costs just over $1 per strip out-of-pocket. And the truth is, I would pay double. It's worth every penny for the accuracy and not needing to force your sick child to pee on a stick every hour. And if your child wears diapers, it gives you the information you need in an instant.
Your child's endocrinologist may not be aware that blood ketone meters exist. Read the instruction booklet to guide you with the results and especially when to seek immediate medical attention. And if during the illness you are speaking with the endo, tell them that the meter is measuring Beta-Hydroxybutyrate Dehydrogenase. Or just spell it. The meter results will read just like from a lab sheet. For the endo, the same numeric threshold for DKA should apply to your child's blood ketone meter results.
