Meter Accuracy

Probably preaching to the choir with this post, but still:

I test twice with my meter every time I have a result >250. Sometimes the variations are huge, one example from last week: 428 mg/dl vs. 303 mg/dl. In this case, the deviation from the true value (which of course I don't know) has to be at least 17%. (Interested in the math? See below*.)

Meters in Germany, as well as in the US, need to have a deviation of no more than 20% (only ~60% of the approved meters on the German market even fulfill this standard).

Edit: Somebody pointed out to me, that this sentence is contradictory in itself. (Thank you, Holger.) So let me elaborate: Meters in the EU need to have an CE certificate, which officially requires the fulfillment of the ISO norm 15197:2003 (deviations <20% or <15mg/dl for BS <75 mg/dl). But this certificate is merely a statement by the manufacturer (or the importer), that the meter fulfills the standard European regulations. Nobody checks who checked for the fulfillment of the ISO norm (e.g. the manufacturer). The CE certificate can be issued by a lot of so-called Notified Bodies in the EU.
A study by the university of Ulm lead by Dr. Freckmann and published in 2009 showed that actually only 60% of the meters in Germany fulfill the ISO norm.

The manufacturers argument to legitimate low meter accuracy usually is, that with this deviation no decisions in your diabetes therapy change, and that for high blood sugars usual correction scales can't be used anymore anyway, due to changed metabolic processes. (Or at least that's what meter company representatives told my at an expo.)

Well, I still use my usual correction scale and it works fine, as long as I use the average of my two tests to calculate it! If I know that my high reading is due to a miscalculated meal or a skipped bolus, there is no reason for ketones or anything else which would give reason for a different correction scale. And even if there was, does any of you have one??? I certainly don't.

Using the normal correction scale on a reading that might be easily 60 points above my actual blood sugar, means that I will most likely end up with a reading 60 points below my aim. So at 40 mg/dl!

Dear pharmaceutical industry: A low like that can be life threatening, so don't tell me a 20% deviation does not lead to changes in therapy decisions! Even smaller deviations do!

With the tight control a lot of diabetics try to obtain, 15% or even 20% deviation are too much to fit our needs. I don't care whether my meter needs only small drops of blood, is quick and small, can be attached to an ipod, sends data to my pump, has background light, comes in pink or can sing songs: If it doesn't fit my needs of accuracy, it's not better than its predecessor! You are producing meters for 20 years now, and there is hardly any real progress in this area.

Also keep in mind, that the guaranteed deviation only has to be kept in 95% of the tests. So in the other 5% my values can be of by 30% or whatever.

And don't you dare shifting the blame to the patients for not washing their hands and whatnot! A lot of the patients are very thorough with their testing routine and it would be a shame not to improve meter accuracy because of the patients who wouldn't make use of it. Also, if your meters don't pass the on-road test that's not the patients fault but something you should put some serious R&D into.

As said before, I'm probably preaching to the choir here. But in my opinion it can't be stressed enough: Something has to happen in terms of meter accuracy, otherwise all of the other diabetes gizmos are useless!

15 years of developement and I don't see a difference.

Fine-tuning my pumps basal rates? Ha!

Hopefully I can follow-up this post with another one about meter accuracy soon, but I first need to find some additional information about the subjact-matter.


*If 428 is 12% above the true value, the true value is 428/112*100, because 428 are 112% of the original value. True value: 382
If 303 is 12% below the true value, the true value is 303/88*100, because 303 are 88% of the original value. True value: 344
As you see, the upper value is still above the lower value, after calculating in a 12% deviation. This means, the deviation has to be larger. As you can see in the small table below, I tried this for increasing deviations, and only at 17% deviation the upper value matches the lower value. This means, I might have had a blood sugar of 365mg/dl. 
With a deviation of 20%, my bs could have been between 357 and 379.

upper lower deviation
382     344    12%
379     348    13%
375     352    14%
372     356    15%
369     361    16%
366     365    17%
  ⁞          ⁞        ⁞
357     379    20%

Mostly about thigh sites

I don't want to use a bullet list, but I want to talk about different things today. Here we go!

First of all, thanks to Karen for the wonderful DBlogWeek! I had a lot of fun and remembered why writing is fun in the first place. Also I read a lot of blogs I wouldn't have come across otherwise. You'll probably see some of seem in my blogroll soon (that is, when I update it, which will be after reading a lot more posts from last week).

Secondly, I was thinking about changing my insulin pump site to my thigh today. I've never done it before, but I know a lot of PWDs have made good experiences with them. And I feel I run out of space on my belly, hipps and lower back. I change my set about every three days and I use about *gets up, undresses half, tries to count the last little red spots and favorite places for cannulas around her body middle, redresses and continues to write* 16 or so different places, rotating counter-clockwise, so every spot is used only about every 48 days. But I can see a little red dot left behind for two weeks after I removed the cannula. And that has me wondering how much damage it does to my tissue. Long story short: I'd like to conquer new areas in my body for sites. And I wanted to try my thighs today. But I was hesitant - there are so many blood vessels in my legs, that I can see shine through my skin. I also like to place a set where I can take a skin fold between my fingers - heritage of old school MDI days - and for me that's difficult with my thighs, for some reason (which is not me being skinny). It feels more secure to me. I did shots in my thighs too, but that's a long time ago and they always had the tendency of bleeding more often then belly or buttock shots.
In the end I choose to use my belly again, because there'll be a performance of my jazz dance group tomorrow and I don't want the set to show through the leggings of the costume and I wanted to be on the save side with moving and all that jazz. But I still want to give thigh sites a try. If any of you could dispel my doubts or has words of encouragement to offer, they are greatly appreciated. I'd love to be able to bring myself to try thigh sites.

Third, my outfit today. If that isn't advocating for diabetes, I don't know what is. ;-)

Yeah, that's right. You see a belly site there. 

And yes, I made the pic standing in front

 of a mirror which is not entirely clean.

DBlogWeek - One Thing to Improve

There are certainly a lot of things I could improve in my diabetes management. For example, I really should start logging again. I know I do better when I have the feedback and the "stick to it!"-reminder from my small, blood stained, number filled ring binder.

But Karens description of the topic also says "Why not make today the day we start working on it". Therefore I think I should pick some smaller improvement, something taking less effort, so chances are higher I don't give my resolution up next time it gets difficult to stick to it. One small step at a time, you know.

So let's see, what else have we got:

• Not eating between meals. Cause eating between meals leads to bloodsugar spikes between meals, which are not good for my A1c. 
• Bolusing well ahead. Instead of bolusing while I'm already eating. If I would do that, I probably would have way less problems with the bullet above. It's those spikes, that I never catch with my meter (one of the things for which a CGM would be great) and which have my A1c above 7 in the end, I'm sure.
• Changing out my lancets more often. Haha.
• Changing my sets every three days instead of "every three or four days, depending on my mood and remembering the date".

Ok, I think that's enough for today. Now let's pick the one I want to start changing today, because it's easy enough and has the most impact and is checkable (doesn't help when I start slacking off again, just because I have no means of controling myself).

...

Ah, screw it, I'll start logging again. I know it's a pain in the behind, but for goodness sake, it's the easiest way to controll all of the other stuff! How else would I go through with them, if I didn't log?
Also, I've done it before. Can't be that hard. What do they say, 30 days to make or break a habit? Let's see, if I can do it. Ehm, I mean of course: I can do it!

DBlogWeek - One Great Thing

Today the DBlogWeek topic is one great thing we are good at concerning diabetes.
I think I do well with most of the diabetes stuff, really - except I freak out to often -, but in all aspects of my diabetes management slip-off's happen from time to time. So there is probably nothing I will do right all the time.
The one thing I do great about diabetes is thinking of everything. When I want to bolus for a meal, I think about

•  carb count, 
• bloodsugar, 
• most probable blood sugar trend at the moment, 
• insulin on board, 
• basal rate glitches during the last few days, 
• possible and/or planned exercise/action of any kind coming, 
• most recent/next to come set change, 
• fat-protein-units, 
• possible sickness and/or menstruation,
• ...

Okay, maybe not all of them all the time. But a lot of them often enough. And then I try to weight them. How large will the impact of this and that be? Will those two effects just take the mean, or will they take hit at different times?
Of course, all this considerations do not necessarily lead to the desired result. But sometimes they do, and this is what I call success.

133

Parties always wreck havoc on my bloodsugars. I try to guestimate carbs, but I usually loose track or underestimate the amount of carbs and then end up around 300. Always. I don't really get why, because I try every single time to make it better than last time, but it doesn't work out. So in this respect, parties are no fun for me.

Yesterday I came back from a birthday party at around 2 a.m. and tested before I got to bed. 133. And half a unit of IOB to bring me right back to my target of 100.

I'm speechless. This is huge! I'm still dancing through the flat singing "133! 133!" :D

Plan of Action needed

My A1c has been in the high sevens for quite a while now and while I am overall satisfied with my "compliance" and control, I'm eager to get to the next level of blood glucose control. Especially with my eye doctor appointment coming up in January, I want to be able to say "I really am doing everything that's possible". Because in case of a discouraging result I don't want to have to start working on my control when I am scared and frustrated already.

I think that a large part of my A1c has to be accounted to post-prandial spikes as those high's are the ones I don't catch. Unfortunately, before I can get started on tuning the distance of the space-time events "bolusing" and "eating" to give my insulin a head start, I have to guarantee that my basals are ok and that my bolus factors and correction factors are ok. (I think they are, but I need to check.)
My next blood work is scheduled for mid November. I guess I can figure out the prerequisites until than although I hate basal testing.

So the plan of action is as follows:

1. Check your basals. Check your factors. Tweak if necessary. Complete task until November 16 (date of blood test).
2. Vary time delay between bolusing and eating until post-prandials are in range. Complete task until January 26.

But this planning is of course the easy part. Everything's easy in theory. The hard part is: Start logging again. Be disciplined. Don't guestimate. Eat regularly. Try again, every day. Start now.

Hopefully this decleration of my goals will help to keep me accountable. I'd like to have smaller steps in my plan, like things to do or to improve for every week or so, but I'm not sure how to do that.

By the way, does any of you have experiences with fat-protein units? Is it worth the effort?

...and I am not going to write fail

Ok, so yesterday was a good day, today is a crappy one. Maybe that's poetic justice or something, but I don't like it.

My BS today: 248 - good night!, I correct of course. 224 - good morning!, I correct. 306 - maybe a miscalculated cocoa, but that bad? I correct. 286 - an hour later, also moderate ketones, I get kinda panicky and change my pump site, but considering the insulin on board only give a tiny correction. 272 - I start correcting and test ketones again. My ketone meter (sic) says LO and for some reason that makes me check my BS again, which is 165 - I immediately stop the pump from delivering the rest of the correction bolus - and, check again, 159. WTF?? That's what you call off by 20%?? So glad I double checked that reading! Finally have dinner. I'm 145 just before writing the post.

Sometimes diabetes sucks. There is no way denying it. But I'm not going to consider this day a fail on my part. I did everything to the best of my knowledge, and that is all I can do. It might seem a little awkward and double standard that yesterday I claimed the credit but won't accept todays readings as the results of my doing. But I work every day to manage this disease, every friggin' day. No matter what my results are, I should get rewarded for this work. And if diabetes decides to throw stones in my way, I'm neither going to thank it for that nor will I take responsibilty for the resulting stumbling.

Success

If I had a CGM (which I don't) yesterday would have been a no-hitter, I am sure. My bloodsugar read 90, 121, 96 and 74. Ok, I now it's only four readings (I usually take more readings per day, I swear!) so there was a lot of time when I don't really now what was going on. But it was a slow day where nothing out of the ordinary happend and my basals seemed to be quite ok the last time I checked.

The biggest hassle for me are meals out. I'm a big SWAG boluser. And as those things usually go - I end up not in range. Sometimes not anywhere near range. But I have really gotten better during the last year. Yesterday I also had a meal out, and it seems I guestimated it correctly for once. Woohoo!

So for me yesterday was a success. I painted a WOW! into my log, as a little reward. Yes, I log. Yes, it's a pain in the butt, but for some weird reason it helps me to gain better controll. Fact is, without my log I never would have realized that yesterday was a good diabetes day. And I think it's important to see little successes like this once in a while, because they show that all the work we put into our diabetes management is not in vain but indeed does make a difference.

On a completely unrelated subject, I realized that the term diabetic, which I used, is officially political uncorrect. I understand why, but personally was never offended by the term. I'm a physicist but that doesn't mean I am defined solely by that. The same goes for being a daughter, sister, girlfriend, collegue, for being an agnostic, for being gothic or for being diabetic. But I also do see that recreational dancing doesn't make my a dancer. So I'll try to remember to use "person with diabetes" (PWD) instead.