Poking Around

Today, testing your glucose levels is much easier with the use of meters that read the test
strip and display the result, often within only a few seconds, and lancing devices are
much smaller and gentler. Unfortunately science hasn't quite managed to find a way for
us to test our blood glucose levels without needing to draw blood, but hopefully in the
near future a way to do this that's available to everyone would be wonderful.

Why Test?

We test our glucose levels for many reasons. It allows us to take better care of ourselves.
For those who require insulin, it's important to be able to know whether their glucose
levels are too high or too low. As having too low a result can mean illness, coma or even
death, this is important to be able to check! Some people need to check their BGL (Blood
Glucose Level) before injecting insulin as they need to know how much insulin is required.

Another very important aspect of testing is to learn how our own individual bodies react to
the food we eat, or activities we participate in, stresses, and the medications we take.
Each person reacts differently to various foods. One person might be able to tolerate
having white bread or potatoes while others might have their BGLs go sky high after
eating the same items. It's important that we learn what works for us in keeping our levels
within the range specified by our doctors or within our own personal goals.

Benefits of Frequent Glucose Testing

One of the biggest benefits to testing our glucose levels often is being able to monitor our
own health. When we know what works for us and what doesn't in regards to the foods
we eat, medications we take, and exercise, we are able to manage our own diabetes
better than those who don't test or do so every now and then. It gives us an edge and
even though it may not be the most pleasant thing to do, it puts us in the driver's seat and
this can have a big psychological boost. When we become experts in our own personal
health care, we take better care of ourselves and can spot problems before they get out
of hand.

As an example, fever, infections and other illness can cause our BGLs to go higher than
normal. If we are testing on a regular basis, we can see these changes and if we haven't
had any dietary or medication changes that might account for the higher results, we can
be on the watch for other symptoms of illness so we can take steps to avoid problems by
visiting our doctor earlier.

Another situation where testing frequently is important is during any times that your
regimen is changed such as a change in your lifestyle or medication adjustments.

I test frequently because it's what keeps me on the right path. Knowing there's an HBA1c
test in a few months time is not enough to keep me from doing stupid things like having
donuts for lunch. However, as I test myself regularly, it keeps me eating the right foods as
I know if I don't, I'll see the higher results on my meter and this is what keeps me honest
with myself. I share my readings online, which is another way I keep myself in check. If it
weren't for being able to see the cause and effect of my actions by testing myself, I doubt
I'd have very good control over my diabetes, mainly because I know what my own self
control is like when it comes to some of my favourite foods!

When to Test?

When to test depends on your doctor's recommendations and your own requirements.
Some people test as often as 8 to 10 times a day which includes when you first wake up
(this is called a 'fasting' test), before meals, 2 hours after meals, at bedtime, and once or
twice in the middle of the night. Other times to test would be if you suspect your glucose
levels are low, when you're ill, before driving, during and after exercise or when drinking
alcohol.

Supplies

A. Glucose Meter

If you've been recently diagnosed or have never tested your glucose levels before, you'll
need a few supplies. Some items you will probably already have, other items you'll need
to purchase. First of course, you'll need a glucose meter (also referred to as a glucose
monitor) a lancing device and lancets for it. There are many types of meters on the
market. Some are able to record many of your readings, save comments with your
readings, show various averages, have a backlit screen or have a cable so you can
connect to a computer to download your results. Other features include requiring only
a small amount of blood and giving results quickly. The amount of blood required and time
it takes to give results varies greatly by monitor.When I was buying my first meter, I found
the reviews at Realitycheck.org.au very helpful. You can also search the ADI messages
archives for any mention of a meter that you're interested in purchasing. In the USA,
meters are sold in larger department stores such as Wal -mart and sometimes even come
free when you buy the test strips with them. Generally (in the USA), the meters are quite
inexpensive while the testing strips are the larger expense.

In Australia, most meters are purchased at the local chemist or pharmacy. If you're newly
diagnosed in Australia, you can save money on test strips and other supplies by
registering for NDSS (National Diabetes Services Scheme) benefits. The NDSS scheme
is free to join and only requires your doctor to fill out a form (which can be downloaded
and printed), it doesn't cost anything to become registered and it will save you a great
deal of expense over your lifetime. More information can be found here:
Diabetesaustralia.com.au

Glucose meters can also be bought online or through eBay and similar sites. I've owned
two meters so far in my diabetes journey, and both were purchased brand new through
eBay sellers at significant savings from what the same model would have cost me at the
Chemist. Before making any purchase, you should shop around and compare prices of
the same model glucose meter in local stores, Internet shops and auction websites like
eBay. Sometimes what looks to be a bargain in one shop might turn out to be much
cheaper elsewhere.

B. Lancing Device

Many meters are sold with a lancing device included in the package.However, what works
best for one person might not be what suits another. When first starting out with testing
your glucose levels, you probably won't be able to compare various types of lancing
devices personally, but this would be the ideal way to find what works for you and what
you are comfortable using. You might ask your diabetes education nurse to show you
different devices if they have these available. I'm sure they would at least have one
available for testing purposes. A few lancing devices are reviewed at:
Realitycheck.org.au

C. Test Strips

If you purchase a meter, generally about ten test strips are included in the package. In
some countries, you get a prescription for your strips and your insurance company pays
for them, or in other countries these are subsidised by the government (for instance, the
Australian NDSS scheme). You can also buy the strips in shops or even online. All test
strips have expiration dates so be sure to check the expiry date before purchasing.
Usually the type of test strip that you need depends on what your meter requires.
Apparently there are some generic type strips (not available in all countries) that work for
a few different meters so it may pay to find out which meters the generic strips will work
with before deciding on a meter.

D. Tissues or cotton balls

After you've drawn a drop of blood for your test, you'll need something to clean the blood
off your finger. I had been using a tissue for this, but cotton balls can also be used. Some
people prefer to suck their finger for this, but it's not something I can do or even
recommend, but that's my hang up.

E. Optional items

Having a few cleaning items on hand can also be useful. Wet wipes, a hand sanitizer
such as Aquium or Germ-X or alcohol wipes can be useful to have in your glucose testing
kit for those times when you're away from home and need to test. It should be noted that if
you do use any of these types of products, you must make sure that the area you will be
testing is completely dry before you lance the site. This is because the ingredients in any
hand cleaner you use could change the result of your test.

For accidental blood spills, hydrogen peroxide can be used to clean the area before the
stain sets into your clothes. I've heard of stain removing pens you can carry with you, but
haven't been able to try one yet. These would be a great item to have available in your
testing kit for accidents. Having a hand cream to use to moisturize your fingers after
testing might help you avoid calluses but if you use different areas and fingers for testing
you shouldn't have a problem with calluses. An empty test strip bottle or pill bottle can be
useful for storing used lancets and test strips until you can dispose of them safely.

F. Something to hold it all

Most glucose meters come with a case of some type that will hold the meter, lancing
device and a bottle of test strips. Some have additional pockets and other features that
come with them. For some reason these all seem to come in one standard colour - black!
You may find you love your meter but hate its case. The second meter I bought was
lovely and small, but the case seemed huge in comparison. So I went to the local
"cheap/dollar" shop and looked around for something more suitable. What I found was a
'generic' case for a Sony PSP (one of those hand held games). It has elastic bands inside
that are perfect for holding the glucose meter, lancing device and test strip bottle. On the
inside of the lid, there's a long mesh compartment with a Velcro strip at the top-perfect for
adding a few tissues, a small bag of lancets and a few small packets of wet wipes. The
best part was that it not only completely suited my needs but also only cost $2! Other
things that also make a good 'kit case' include make up bags (these come in varying
sizes), Xbox, Gameboy and other hand held games cases, camera cases and school
supplies such as pencil cases and pouches. You may even find small plastic boxes with
any number of designs on them in the toy or housewares department. Use what works for
you. Don't be stuck with what comes with your meter if you'd be happier using something
more practical or useful to you.

Preparation

Any residue of food or dirt could make your reading inaccurate so before testing, make
sure your fingers are clean and dry. The easiest way to do this is to wash your hands. If
you wash with warm water, it will help the blood flow in your fingertips and make it easier
to get a drop of blood. If you're out and about this is where having small packets of wet
wipes available comes in handy. If you have problems with cold hands and have trouble
getting your finger to bleed, some people suggest massaging your hand that you will be
testing with, and others warn against 'milking' your finger as you could end up with lymph
fluid in your sample. What I suggest is a compromise between the two. If you very gently
touch your hands together and rub them together lightly you'll find that the friction warms
your hand and fingers. Another technique when it's really cold is to heat up a wheat or
rice bag in the microwave -- careful that it's not TOO hot, and hold the bag in the hand
you plan to use for pricking your finger. If you can manage, you can do this while using
your other hand to prepare your meter. Other suggestions you can try are dangling your
hand at your side for a minute before testing, or try using a rubber band just below where
you plan to lance. Lance the area, then release the rubber band before squeezing your
finger. Be careful with this technique as it's probably more likely to cause problems with
spurting.

Testing Locations

Most of the time you will probably be poking your
fingers with the lancing device. However, if
you're just starting out, be aware that you don't
lance your fingertips - the top of your finger, or
the pad of your finger. The fingertip is the most
sensitive area on your finger and it'll hurt. The
fingertips and pads of your fingers are the areas
that get the most 'use' during the day so you
don't want to be lancing these places. You can use your fingers and your thumbs, but
instead of the tip or pads, instead use the sides. This area is less sensitive and doesn't
receive as much use. You can use both sides. Other areas you can use are the fleshy
part of your palm, just under where the little finger is, or the padded area underneath your
thumb on your palm. Another area that can be used is the fleshy area on the top of your
hand under your index finger and thumb. Hold your thumb close to your index finger and
you will see a small mound on the back of your hand. This area can be used for testing.

When I asked my diabetes educator about her own recommendations, she suggested
using the sides of the last three fingers on each hand. Her reason for this is that the
thumb and index fingers have more capillaries and there's greater chance of having blood
'spurt' with them than there is with the last 3 fingers. On the flip side of this reasoning, if
you have problems with getting enough blood, using your thumb or index finger (sides
only) may help as there are more capillaries in these areas, giving you a better chance of
getting enough blood for your test.

I've found that using any area other than my fingers can cause healing problems for me.
For some reason my fingers are less susceptible to infections. So if you have problems
with infections or have slow healing, it's probably best to stick with the sides of your
fingers.

If you're using alternate areas and have an unusual reading, it's best to follow up by
testing using a finger as this may give a more accurate result. Also, if you are testing for a
reason such as anything relating to a short time period, for instance checking to make
sure your levels aren't too high or too low, it's best to use your fingers instead of alternate
areas as this will give the most 'up to date' result.

Avoiding Pain

If you find that it really hurts when you lance your finger, some things to try include
changing the lancet inside the device more frequently as the lancet can become dull
(which makes it hurt more) or as they are very fine, they may even become bent (and this
would definitely make it hurt more). Some people change their lancet after every use,
others only change it when the notice a bit more pain. I try to remember to change
mine once a day.

If your lancing device has a depth setting, be sure to set it on the depth that's most
comfortable for you that also gives you a good blood sample to work with. Dial it to the
lowest setting needed in order to get a good sample.

Pay attention to how hard you press the lancing device against your finger. If you are
pressing it hard against your skin, try to use a lighter touch with it. Let the lancing device
do the work for you. This is probably a rather common problem when starting out as you
tend to press harder when first learning, and of course you're under a bit of stress too. So
try pressing lighter.

I've found that not all lancing devices are alike. I have one that I like it's shape and how it
works, but it hurts, consistently. My other lancing device doesn't hurt at all unless the
lancet has become dull. So naturally I use the one that doesn't cause pain!

Make sure you use different fingers and locations so that you're not using the same area
all the time. There are many different routines you can use for choosing which finger to
use. Some people alternate between left and and right hand. You could test top and
bottom on one finger, then move on to the finger next to it, etc and then the same on the
other hand until you come back around to the first finger on the first hand. This gives
several tests before you need to use the same finger again. If you have problems
remembering which finger you last used, you might find an adjustable ring to wear on that
finger (or the one to test next) might help.

Once you've done your test, press a tissue or cotton ball with firm pressure onto the
lanced area. This helps to prevent bruising and soreness, and also helps the blood to clot
faster.

Traveling and Public Testing Etiquette

You need to keep your supplies with you when out and about or when traveling. If
traveling, your supplies should be in your carry-on luggage as you may need to test while
in flight. Stowed luggage is susceptible to loss as well as temperature changes that could
affect your meter or strips. Be sure to have extra test strips, lancets and batteries when
traveling.

Should you need to test when away from home, some people might prefer lavatories but
considering the amount of germs in these areas, it's probably best to find a quiet area and
do your test as discreetly as possible. I've found that I can generally do my testing with my
purse in my lap or next to me and I use it as a 'shield'. The important thing is that if you
NEED to do a test because you're concerned you may be having a hypo (when your
glucose levels get too low), you NEED to do the test no matter where you are so you can
get on top of the problem before other symptoms arise. Don't be afraid to take care of
yourself!

Wrap Up

I hope this article has helped you learn a little more about ways to make testing your
glucose levels easier. Please remember I'm not in the medical profession, so my advice is
simply as a fellow diabetic rather than in any profession capacity. I've listed some helpful
links below for further reading, and hope to write future articles for ADI.

Useful Links

When writing this article, I found these sites to be helpful:
Underlined links are clickable in this article!

Meter and Lancing Device Reviews
Realitycheck.org.au

More information about glucose meters can be found here:
Mendosa.com

NDSS (National Diabetes Services Scheme)
Diabetesaustralia.com.au