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 does diabetes care cost so much?

Hey Dad,

It was good to get your feedback about the Affordable Care Act summary I wrote. I agree that it's still confusing, even with it broken down the way I have it.  I promise I will return to it and make it simpler as it becomes clearer to me.  I'm afraid, though, that it will never be simple enough because of the politics around making that legislation happen in the first place.  The bottom line for you will be that it means no change because you already have health insurance through your union that I'm positive covers the minimum that the ACA covers and you are not an hourly employee.  You might get even more preventive services with no co-pay because of the new regulations.


We talk a lot about why health care is so expensive and I'm sure we're not getting bored with it because it's very complicated.  I was pretty excited when I came across John Green's explanation of the system.  I think he's able to talk about it clearly in part because he's not a health care researcher.  Also, he's way funnier than I am when I talk about it.

So in the US, we spend about $245 billion per year just on diabetes care.  This is a lot, but it's especially a lot when we consider that in 2007 it was only $174 billion.  In contrast, in the UK diabetes care costs about £14 billion (about $22,400 billion USD), Canada spends about $12 billion CDN (about $11.6 billion USD), and Australia spends about $10.3 billion AUD (about 21.5 billion USD).  None of this should be surprising after hearing Green talk about the overall massive differences in health care spending.

The UK, Canada, and Australia all have some form of universal health care, which means that basic health care is funded through taxes and administered through a centralized system. Countries differ about how much people pay for medications and supplies, but since those costs are much lower to begin with, the out of pocket costs for people with diabetes is lower than in the US.  It is hard to pin down figures because the systems all report things differently, but considering that in the US individuals with diabetes incur about $7,900 worth of expenses directly related to the disease and that health care coverage is so varied, it is safe to say that it's a lot more expensive to live healthfully with diabetes in the US than other leading industrialized nations.


All of the issues that Green brings up are absolutely part of the problem of the expensiveness of diabetes care in the US.  Getting back to the question I raised last time about the effects that the ACA will have on out-of-pocket diabetes costs, I still don't think it will make any difference for people who have already been insured mostly because even with increasing access to health insurance, since the payors (private insurance companies and Medicare/Medicaid) are not centralized, folks who do not qualify for government benefits will not benefit from the economy of scale (negotiation of prices for massive contracts) that Green was talking about.  We will also continue to have huge inefficiencies in the system and high administrative costs because there are differences in billing, coverage, reimbursement, etc., so I don't think the ACA is going to do anything to reduce the cost of health care in the bigger picture, because it is not in the interest of the health care industry to cut its profits.

I'm glad that the out-of-pocket costs are manageable for you and that you have a union that has advocated for you and your coworkers.  Not all union members are in as good a position, though, since there are some unintended consequences that might hurt them.  As much as I hate to say this, I am grateful that your coverage is already through a for-profit insurance company.

Love,

Mel