Lies, Damn Lies, and Blood Glucose Meter Readings

My doctor had originally prescribed me the Accu-Chek Aviva Plus Glucometer to check my blood sugar. It's a good enough device, but with it, it didn't take me long to learn the dark secret of diabetes monitoring.

Namely, that these devices are sold under the Gillette model. Except rather than give away the razors and make money off the blades, it's glucometers and test strips. Same idea, though.

The Accu-Chek Aviva strips cost me $25 for 50. And that's after the insurance pays their share (whatever it is). If I want to get more, say, before a long trip and I'm not "due" for more, well, I have to fight with the insurance company to get them at that price or pay the out-of-pocket cost, which is a hell of a lot more than $25.

Needless to say, I was looking for a cheaper solution. Also, it'd be nice if I could get something that would also send the data right to my iPhone where I'm tracking it.

Enter iHealth Labs. They actually two Glucometers: one that is Bluetooth enabled, and one that just plugs into the headphone port on the iPhone (they also work with Android devices too). Since I didn't always want to be tied to my iPhone when checking my blood glucose, I opted for the slightly more expensive wireless model. 

That's all fine and good, but what really attracted me to these glucometers: the price of the strips. At $12.50 for a box of 50 (two vials of 25 each), it's half the price of what my Accu-Check Aviva strips cost. Better yet, I don't have to deal with my insurance company if I need more, I can just order them from iHealth Labs and they'll arrive in a few days.

I ordered a new iHealth Wireless Smart Gluco-Monitoring System and a couple boxes of test strips in early November. Given they are based in Mountain View, CA and ship UPS Ground, it only took a few days to ship once the items came in stock which I knew when I ordered. I ordered before my recent trip to South Africa, so the "extra long" shipping time wasn't an issue for me.

When the meter and strips arrived, I of course tested myself using both meters. The iHealth one was giving me very different results. When I looked at the strips a bit more closely, I noticed that the strips I had been shipped were going to expire on 2 January 2015--less than 60 days away. 

Another dark secret of blood glucose meters: they're not as accurate as, say, a blood test. They are good for getting a general idea of where your blood sugar is at, which is the reason your doctor tells you to use one. That said, different meters should give you similar results (within a few mg/dL of each other). When they're off by tens of mg/dL as I was seeing, something is probably wrong.

Given where my blood glucose is averaging, which is 117 mg/dL over a 30 day period, consistently higher test results could mean I test ok on the iHealth meter when, in fact, my blood sugar is actually at hypoglycemic levels. 

I contacted iHealth Labs customer service via email. I asked for a bottle of the control solution, which is used to verify the meter and strips are working correctly (it has a set amount of glucose in it) and a box of strips with a later expiration date since there was no way I could use the strips I had ordered before they expired. I got a return email saying both should arrive in a few days.

Meanwhile I continued to periodically test with both my Accu-Chek and the iHealth meter. The iHealth results were consistently at least 20 points higher than my Accu-Chek, sometimes much higher. 

I finally got the new box of strips in the mail today, but no control solution. My Accu-Chek strips are starting to run out and I really don't want to get another vial of those at $25 a pop, so I decided to test with iHealth using a strip from the new box I just received to see if it's a problem with the strips I had originally received.

On this test, the iHealth result was about 5 mg/dL lower than the Accu-Chek one. I tested with strips from both of the older boxes of iHealth test strips and the results were more than 40 points higher than the Accu-Chek number. This suggests I got a bad batch of test strips.

I just sent another email to iHealth Labs customer service. Hopefully they'll send me another box of strips and, this time, a bottle of the control solution.

Bottom line: if you're going to change blood glucose meters for one reason or another, make sure you test with both meters for a while to ensure the results are similar before completely ditching your old meter. Also, make sure to get the control solution for your meter.

I plan on doing a full review of the iHealth Wireless Smart Gluco-Monitoring System on a future episode of PhoneBoy Speaks.

Carry That Weight

Earlier this week, I went to the doctor to follow-up on the high blood pressure I had. Thanks to medication and the other changes I've made, it is now very close to the normal range. This is good news. 

The other change I've noticed is my weight. Since I started tracking a month or so ago, I've dropped about 15 pounds. Not that I'm trying to lose weight, but I guess with the dietary changes I've had to make, the natural result is: less calories consumed. This along with the increase in activity means I'm losing weight.

My blood sugar, meanwhile, has mostly settled into a normal range after returning from South Africa, with a 7 day average of 116 mg/dL.

Hopefully these trends will continue as we enter the holidays.

Different Strokes for Different Diabetic Folks

As I've been finding others on the Internet that also have Diabetes, I've got a few different observations. They're probably simplistic and obvious, but here goes:

  1. A lot of people have diabetes, including people I know. I keep finding out about more of them every day.
  2. There is no shortage of information about Diabetes on the Internet or from your doctor, some good some bad.
  3. There are a few different "types" of diabetes. It's not just Type 1 and Type 2. Regardless, of the reasons or the treatments used, it's ultimately about getting your blood sugar down to a normal level.
  4. What works for one person won't necessarily work for another. Everyone responds differently to different things (see previous point).
  5. A lot of folks have it way worse than I do. I'm on the Internet whining about numbers that are not that far above normal when some people have numbers that are downright dangerous, for example one of the comments on my last post on Facebook. 
  6. Diabetes is expensive once you find out you have it. I feel bad for those who don't have health insurance because even with insurance, the supplies you need to monitor and maintain your blood sugar gets pricey. 
  7. Monitoring, testing, and keeping track of your food intake and activity is the best way to figure out what's working for you and what's not. Right now, my doctor has me testing twice a day. I try to do it: in the morning before I eat, and two hours after some meal during the day. I'll either do it after dinner or, if I have something unusual for lunch, after that. On a few days, I've tested three times in a day.

I'm sure I'll have more to say on this. :)

Morning Has Broken...My Blood Sugar

You'd think when you wake up in the morning, wouldn't have above normal blood sugar readings when, the night before, they were normal. Unfortunately, it can and does happen, especially in people with Diabetes.

It's happened to me--the fasting numbers were higher than I went to bed with. You'd think I was sleepwalking down stairs, going into my pantry, and eating a slice or two of bread. Which actually sounds pretty good right now, but I know what it will do to my blood sugar.

Welcome to the dawn effect, caused by the liver dumping glucose into the blood overnight. The hormones that are believed to cause the liver to do this (including cortisol, glucagon, epinephrine) are also believed to give rise to insulin resistance. The end result: your body is unable to process the excess glucose in your blood stream, which of course means elevated blood sugar.

I do not experience this every morning. A diabetes site in the UK suggests this spike occurs 8 to 10 hours after going to sleep, which explains why on the mornings where I did observe this, I slept later than usual.

One of the possible solutions to this problem includes a late-night low-carb snack. Mixed nuts seem to be my go-to snack. We'll have to do some more science and see.

Feeling Groovy

Today, I went to go see the Diabetes Dietitian to learn what I need to eat. Seems kind of silly since I think I've figured out what I need to eat--and avoid--but I am satisfying my doctor's treatment plan. This visit included also had to share what I had been eating over the last week or so, what my blood sugar readings were, have I been exercising, how much how often, and so on. 

The prognosis: I could eat some more carbs--healthy ones, obviously--more green vegetables overall, and a little less fat. But so far, so good. I even had normal, non-diabetic blood sugar when I woke up this morning-100 mg/dl. I checked a couple of other times during the day. My numbers were 115 mg/dl mid-afternoon and 126 mg/dl a couple hours after dinner.

Clearly that's only one day, but it's a start. And overall, I feel better than I have in quite a while. I think I'm sleeping better, too. All of this has me feeling pretty groovy right now.

I Feel Like A Number

Like the old Bob Seger song, I have my moments where I feel like a number--insignificant in the grand scheme of things. Right now, however, how I'm feeling is defined by a number: my blood sugar.

As I'm trying to figure out exactly how to keep my blood sugar at an even keel in a world full of food that mostly puts it on a roller coaster, I've experienced a gamut of emotions. Happy that I know what's causing some of the issues I've experienced. Sad that eating bread, rice, or potatoes is something that I know will spike my blood sugar. Frustrated when I make a bad dietary choice and can see and feel the result.

I know eventually I'll get enough data--and experience--to know what works and what doesn't, which will ease some of the anxiety I'm currently experiencing. 

Sadly, though, this is not the only number I have to worry about. I'm also monitoring my blood pressure which is also high and likely related to the diabetes. Hopefully treating one, along with meds, will help the other. My numbers have gone down since my doctor's visit last month, which is a good thing.

The one number I am happy about so far is the amount of walking I've done: at least 30 minutes a day almost every day for the last week. This is going to get more challenging to do as the weather gets increasingly worse around these parts, but I managed to walk during a rain break this afternoon and thus stayed mostly dry. 

The other number I'm happy about is the number of calories I've consumed. It's not an exact science, but at least it doesn't appear I'm eating more than I should. Leaving out all the bread and rice has really helped my cause there.

Maybe all these numbers aren't so bad. I certainly didn't get this way overnight and I won't get better overnight either. I need to keep this in perspective.

Straightening the Curves, Flattening the Hills

The past couple of days, after lunch, my blood sugar spiked and crashed. Not to unsafe levels, mind you, but enough that I got really tired when my blood sugar crashed back down. 

Yesterday, I noticed it as I was sitting in a presentation at work after lunch and I needed help staying awake. Because I made some not wise dietary choices--having some sushi, which includes rice--I actually checked my blood sugar two hours after lunch. Sure enough: my blood sugar was higher than I expected. When I checked an hour later, it dropped 30 mg/dl.

Today, I had a similar experience. This time it wasn't due to my breakfast or my lunch choices, which were fairly low carb. But I'm guessing it's something that was in the trail mix I had been eating at the office the past couple of days: Raisins. The amount of raisins I ate over the past couple of days was not terribly excessive (1-2oz a day), but clearly it was enough to spike my blood sugar.

A quick look on the Internet suggests raisins both have a high glycemic index and a glycemic load, the latter of which is more important in that it helps determine how quickly the sugars will hit your system. 

Just to give an example based on recent dietary choices: An apple has a glycemic index of 36-40, but a glycemic load of 6. Meanwhile, raisins have a glycemic index of 53-75 and a glycemic load of 28. Rice is similar to raisins in this regard.

Bottom line: I need to avoid things that I know will spike my blood sugar.

Well, That Didn't Escalate Quickly

I just woke up in the middle of the night with one of those headaches. You know, the kind that, for the last couple of years or so, would quickly escalate to a migraine complete with nausea. It's something I mentioned to my doctor during my checkup and he confirmed its a likely symptom of the previously undiagnosed Type 2 Diabetes.

The good news is that the headache did not escalate into a migraine and the Excedrin I took did not come back up. The bad news is that it woke me up good and now I can't get back to sleep.

It's too early to say if the migraines are gone or not, but this appears to be a small step in the right direction.

A New Machine

Earlier this week, when I got my new medications, I also go this stuff:

Yup, it's a blood glucose monitor. There are many like it, but this one is mine. Fortunately I only have to use it twice a day: once in the morning before I eat and some other time during the day two hours after I eat. Some people, particularly those with Type 1 Diabetes, have to use it far more often.

My doctor sent me to a program where I had to get trained on how to manage my diabetes: using the equipment and how to eat so it doesn't get worse. My upcoming travel schedule made scheduling this in a timely manner difficult, but I did manage to get a session in with an educator before my next trip. The dietitian will have to wait, but I have a feeling the dietitian won't tell me anything I don't already know.

Mentally, I'm all ready to go down the low-carb road. Turns out I don't need to go quite that strict in terms of carbs, like I was on Atkins, but I think many carb-rich foods are "trigger" foods for me. In other words, if I have a little, I'll suddenly want to have a whole lot. They also want me to watch my fat intake because it apparently affects insulin receptors.

Using the machine to check my blood sugar is not that difficult. It is a lot of moving parts to manage: the lancer, the test script, and of course the monitor. Last night, I actually tried using it in my car--it was parked--and that was probably not the best place to do it, but I know I will have to do it on an airplane in the not too distant future.

When I got the results for my blood test back from my first doctor's visit earlier this month, my fasting blood sugar was 153 mg/dl. My first reading at the educator's office? A nice reasonable 114 mg/dl. The educator was suitably impressed. Quite honestly, I was amazed. When I did it in the car last night after watching the Gig Harbor Tides wallop the Olympia Bears 45-14 on the gridiron, I was down to 100 mg/dl. This morning before breakfast? 105 mg/dl.

I know it's early in this process, but so far, it looks like what I'm doing in terms of diet, exercise, and medication is having a positive impact. I even managed 9 hours of sleep last night, which is unheard of for me. I'll have to keep monitoring the situation, of course, but so far, so good.

The real test comes when I have to take this show on the road, which will be happening tomorrow.

Just Take Your Meds, Son

After receiving the news earlier in the week, I had a followup consultation with my doctor today to discuss the treatment plan for my diabetes.

The good news: he thinks it will be manageable. It's going to require some meds, dietary changes, and of course exercise. And monitoring my blood sugar regularly. No insulin, thankfully, which I imagine would make my travel just that much more challenging. 

The cocktail of drugs I now have to take meant, for the first time in my life, I had to get a pill minder. You know, a container that has several compartments--one or more for each day--that you fill with your doses of medications. You can tell at a glance if you've taken your pills or not and all the pills you need to take are in one place. I needed one for two different compartments per day. They also apparently they also make them with four different containers per day. That's quite a lot, but depending on the meds you're on, I could totally see that being needed.

New meds, of course, means I need to pay extra close attention to how I'm feeling for the next several days. Things have potential side effects and, while unlikely, I could be one of the rare ones that experience them. Reading the drug inserts the pharmacy includes with the drugs is always a scary experience. 

Next up is learning how to use the new hardware that I'll be using to monitor my blood sugar. That won't take place until Friday. I won't be able to meet with the dietician to set a diet plan until after I get back from California, but the basic idea appears to be: avoid carbs and sugar to keep my blood sugar low. The good news is that I did Atkins a decade ago so I have some experience with this, and was even successful at it for a time.

Earlier today, when my energy was at a particularly low point, I decided to take a walk around the neighborhood. I wish I had started doing this before the weather changed into the typical fall weather patterns around here: periods of sun and rain that, as fall turns into winter, gets colder and colder. I managed to get out during one of the sunny periods and walk around the neighborhood for a half hour or so. It felt pretty good. 

At the end of the day, I've taken the first steps towards getting healthy. I have awareness, I have a plan, and I've started acting on it. I just need to keep taking it day by day.