Blood glucose testing: how I freaked myself out.

Hey Dad,

I'm glad to hear you're cleared to go back to work, and I'm still worried you're going to overdo it. I know that there really isn't any light duty without the company giving you a full-time helper, so they're not inclined to do it. It would be nice, though, since you've been there for such a long time. Mom said you're keeping a closer watch on your kidney function than you have in the past. I hope that if you see any signs of new problems, you'll see to it immediately. I know that's easier said than done since it's hard enough to keep post-surgical appointments!

Anyway, I think you'll get a kick out of this story:

OneTouch UltraMini kit.

One of the things I do as a part of my fieldwork is I talk to vendors at diabetes conferences, mostly to learn how they fit into the bigger picture of diabetes care and what sorts of new technologies are coming on the market. Sometimes I get free samples of stuff sent to me weeks or months later. Last year I had more cracked heel balm and nutritional samples than I knew what to do with. This seems to be the year of the blood glucose monitor. In case you were wondering, diabetes testing supplies are available over-the-counter. The only reason people usually get prescriptions for them is so that insurance might pay for all or some of the cost. Meters are pretty cheap (often free!); it's the cost of the test strips that's crazy.

As I was going through the most recent box of samples, it occurred to me that while I'd seen blood glucose testing done and had known the basic mechanics of it, I had no idea what it was like to experience it. Today was the day to change that.

So I opened up the meter. It looked pretty simple. On the box, it promised me that it would be fast and simple to use.

Those are just for the lancer!

I found the instructions and unfolded, and unfolded, and unfolded them for reading. Suddenly, it didn't seem so simple.

Once I got it set up, I learned that my cold fingers didn't want to give up blood, so it took multiple sticks.

And then I freaked myself out. I mean, I knew I hadn't had anything more than coffee yet, but 56 was alarmingly low. I ate immediately for fear I was gonna pass out. Was it safe for me to be home alone?! My cats just aren't useful in these situations.

Now panic!

It didn't take me long to realize that I wasn't as foggy, shaky, and acutely ill as I get when I usually go hypo. Besides, with a reading of 56, shouldn't I be dangerously so? I quickly read a different section of the meter instructions learned that if the blood gets smeared in the collection process, it might read artificially low. Incidentally, this isn't the only reason someone might get an incorrect reading.

I did manage to smear on my first try since I had so much problem getting blood, so I restarted the process. This time, I messed it up by not having the test strip all the way in place before the blood hit it. So I had to do it again. A couple of hours and more food later, I'm hanging out at a reasonable post-meal level.

I may not be a genius, however I am extremely literate and have good background knowledge for how to do this and I still messed it up. I initially failed at the finger stick, blood collection, and strip insertion--all points at which neuropathy, vision loss, and limited manual dexterity would have made it exponentially more difficult.

That's better.

Today, I went through about 7 finger sticks on 2 fingers (trial and error is painful!), 4 test strips, and 3 lancets. If I were just barely scraping by, the $4.00 those test strips cost (for my free meter) would hurt. I did the extra testing for science and because I was freaking myself out. It would be a hard sell if I knew I was going to keep having to do this a few times a day, every day--especially if the extra test strips had to come out of my food budget.

I promise I will be more understanding when you tell me you aren't testing as frequently as diabetes experts think you should.

Love,
Mel

My fingers do not consent to more testing.

P.S. My choice of the OneTouch UltraMini monitor was arbitrary. It was one of the four types of meters I've received from multiple manufacturers, which all claim to be fast and easy to use. After this experience, I have no desire to do comparison tests.

Did I mention that finger sticks hurt?

Why I'm in Orlando in August

Hey Dad,

It was disheartening to get the news last week that you were having more problems with your kidneys again.  It's so disappointing that after you've changed over to a kidney diet that you're still forming stones and getting infections more and more frequently.  Has it even been two months since the last round?  It's unfair and disappointing to see no benefit from making substantial dietary changes the way you have.  When I asked you about your diabetes care and you told me that you had bigger things to worry about, I couldn't argue the point. I'm so glad we had a couple of days together before I drove up to Orlando for the American Association of Diabetes Educators conference.

This AADE conference feels very different from the other two that I've attended.  I'm sure part of it is a matter of finding my own place in the diabetes world, but there's also been a huge political shift with the implementation of the Affordable Care Act and the ways it is changing reimbursement and the goals for health care organizations.  I've got a lot more information to share about this, but I have some questions to follow up on before I write a whole lot more about that.

What I can say, though, is this is an interesting time for health care professionals. Historically, nurses, dietitians, physicians and pharmacists, etc. have each had their own turf marked by the things they're licensed to do and the clear delineation of their roles in health care delivery.  Now, though, its in the best financial interests of hospitals, clinics, etc. to take a more collaborative team approach to patient care, such as in Accountable Care Organizations and the Chronic Care Model in patient-centered medical home organizations.  This is a hard shift for practitioners and the organizations they work for, much less for patients who are so used to dealing with the system the way it has been.

Diabetes educators have been doing collaborative work all along.  Because they don't have their own state licensure that's required for billing insurance for their services (generating revenue), they've had to work under the supervision of a recognized provider or as a part of an ADA recognized or AADE accredited program.  It makes a lot sense that the AADE is urging their members to become more vocal leaders where they work and to be more involved in the politics of health care in order to gain their own licensure and to exert pressure on states to expand Medicaid where it has not been expanded.  Basically, if diabetes educators gain recognition as providers, then they would be more valuable to health care organizations in terms of revenue.  This would theoretically expand access to diabetes education for patients through increasing the number of available educators and removing some barriers to accessing their services.  One hopes that this would actually improve the quality of care in the process, but in our patchwork health care system what matters most is revenue and cost containment.

I'm really enjoying that so much macro-level analysis is being presented and that so many sessions are dedicated to educating the educators about the new political and economic climate for their work.  I've talked to a lot of people outside of the sessions and very few had any idea about these issues or how their work fits into the larger organization of health care.  I don't usually talk about my own work as much as I have been this conference, but I think it's better understood on the tail of a macro-oriented session.

You asked me why I was going to this conference if I'm finished with data collection and well into the writing phase of my dissertation.  A few days ago I said something like "because this is actually the last of my data collection."  Today, though, I know that it's also because being at a conference full of people who are so committed to improving diabetes care reminds me that the type of research I do is important and can make a substantial contribution to the field.  I am definitely feeling recharged in my drive for this work even if I'm running short on rest.

Seeing you and being surrounded by diabetes care workers has made it okay that I'm in Orlando in August.  At least it's not supposed to rain for the next hour.

Love,

Mel

Catching up.

Hey Dad,

A lot has happened since I last wrote!

It's funny to be reminded that Chicago was having an unseasonably warm fall just before the polar vortex brought us to a halt.  I thought I wanted to hibernate before!  I realize that temps in the 50s are rough on Floridians, but I'm seriously reconsidering living in a place where the air hurts my face.  You might have been onto something when you moved down there.  I'm sure you don't miss digging out parking spaces, but I have to say you're missing out on some seriously amusing dibs activity!

http://www.businessinsider.com/dibs-season-chicago-2014-1
These folks are classing it up!

The Affordable Care Act went live despite the government shut down.  Unfortunately, there have been problems with the insurance marketplace website launch and a lot of folks are confused about what coverage is available to them.  I've been sitting back and watching the political drama unfold and I'm discouraged to hear folks I know personally having difficulty affording health insurance even with subsidies.  I am not convinced that health insurance reform is what we need.  Time will tell whether this actually helps folks.  I'm worried about what will happen with patient assistance programs from pharmaceutical companies since they typically only help the uninsured to afford medications.  The least expensive health insurance for folks above the medicaid cut-offs almost certainly won't give them enough coverage for their drugs and/or will have too-high deductibles.

Speaking of diabetes drugs, I'm worried about you.

It's been a rough several months for you with the shoulder surgery and now more kidney problems.  I know you hate being inactive and that has created some challenges with managingyour blood sugar.  We’ve talked about this before, but it bears repeating that you really do need to take it easy because diabetes can make the healing process take longer and having an injury or illness can make it even more difficult to control your blood sugar.  A lot of stuff can come up for people withdiabetes who are also recovering from a surgery.

Your most recent news, though, is the most troubling.  I am so sad to hear that you have new kidney stones.  I know you’ve been happiest eating a low-carb diet, but the high protein diet is really causing somedamage.  I’m glad that you went to the dietician to get some advice about how to eat a low-protein diet while managingtype 2 diabetes.  I hope that you are able to keep it under control with diet, but please reconsider taking medications if the doctor thinks you need them.

In the mean time, I’m looking into some food resources for you.  I know you are not a fan of most vegetables and you aren’t all that keen on expanding your palette, but maybe there are some ways to make it easier to try new foods so you aren’t stuck eating the same bowl of lettuce every day.

Love,

Mel