Author Archives: Scott E
This is a deciliter (about 3.3 fluid ounces) of “blood”. Where I live, we measure blood glucose concentrations based on how much glucose is present in this amount of blood.
So, if I wanted to find out how much glucose was in the above sample of “blood”, I’d simply extract the glucose, put it on a scale, and weigh it.
(Your nation may vary, and if it does, I apologize in advance for not doing the conversion for you. But mmols involve counting molecules, not weighing them, and mmol folks base it on a full liter – or litre if you prefer – which is an order of magnitude larger)
104 milligrams of glucose in that deciliter of blood? Perfect. 104 mg/dl.
Except nobody in their right mind would want to draw THAT much blood – perhaps ten times a day – to keep tabs on things. So what do we do? We sample – we take a smaller amount and extrapolate the results.
For instance, instead of a full deciliter, we could take one one-hundredth of that amount of blood, extract and weigh the glucose, and take the result … times 100.
Of course, if our measurement is off by a little bit, that error gets magnified by a lot when you do the math.
But it’s still a lot of blood. So why not take one one-hundredth of THAT amount?
To get your blood glucose level, simply draw this amount of blood and multiply the weight by 10,000. If your weight is off by just 0.01 milligrams, your final result is off by 100 mg/dl. Unacceptable.
But even that blood sample is unacceptable.
According to this recent Diabetes Forecast comparison (pdf), some of the most popular meters use samples in the neighborhood of 0.3 microliters (Abbott Freestyle) to 1.0 microliters (OneTouch Ultra)
If I’ve lost you with the math, let me summarize: there are one hundred-thousand microliters in a deciliter.
This is one microliter, the amount of blood needed for a OneTouch Ultra meter. It’s mighty tiny – you might be able to detect it in the second photo.
You get the idea. Weigh the glucose, multiply by one-hundred thousand. A tiny error can make a big difference.
Now, of course, this isn’t how we really get our blood sugar readings. Not at home anyway (Maybe at a lab, I really have no idea). Modern meters mix the blood with a chemical, zap it with electricity, crunch it through a mathematical machine, and out comes mg/dl (accurate to 20 percent or so). To be honest, considering the size of the sample, they do it remarkably well.
Yet we’re still not happy, and justifiably so. Well enough is not good enough.
But is it realistic? Can we really get accurate blood sugar readings from such a small sample-size?
“But blood is not fixed. It’s liquid. It’s dynamic. [...] Your heart pumps it both upstream and downstream. [...] For our entire diabetic careers, we have been indoctrinated, trained, brainwashed, and bamboozled by our only available technology, the fingerstick meter, to view an inherently fluid part of our body as something static and fixed.”
-Wil Dubois, Beyond Fingersticks, Chapter 5
In other words, the glucose concentration at your fingertip is not the same as it is in your carotid artery, or your superior vena cava, or your forearm. (But you knew about the fingertip/forearm discrepancy. It’s in every standard disclaimer about alternate site testing).
I suppose it could even vary from one drop to the next. One microliter to the next.
The smaller the sample, the more room for variation.
But in the back of my mind, I still wonder — at what cost do we demand it?
Will accuracy-driven regulations mean we need to go back to a sample size of:
* * *
PS – That insulin pump I used above is an old, long-out-of-warranty pump that hasn’t felt the charge of a battery in years. The reservoir and tubing are the byproducts of a set-change a couple of days ago. And the syringe is about a decade old, purchased before I started using insulin pens and before I started pumping. I’ve got a ton of ‘em lying around. My own diabetes care (however unbalanced it has been as of late, though I understand there’s a book for that, which I fully intend to get my hands on) was completely unaffected in the writing of this post.
PPS – The wine was from a surprise 40th birthday party my wife threw for me last weekend (I’m really old). My own diabetes care was affected by that.
PPPS- Speaking of books, that edited paragraph I excerpted from Beyond Fingersticks: The Art of Continuous Glucose Monitoring came from a paragraph about expectations, and it totally changed the way I look at not only CGM, but blood sugars in general. If you haven’t read it, I highly recommend it. Brought to you by the author of Ask D’Mine.
PPPPS – Someone once said to be careful what you wish for, ’cause you just might get it. So when I make my demands known (do it here, do it now!), I’m not only asking for better accuracy, but no increase in sample size.
I will test my sugar. Scott’s-my-name!
Just watch! I’ll do it! Without shame!
And I would test it in a boat!
And at the zoo, next to a goat.
And I will test it on a plane.
And at my desk. And on a train.
And in a car; In a church pew.
It’s something I just have to do!
So I will test, not being rude.
Standing in line for some fast food.
And I will test it in the loo,
Or walking down Sixth Avenue.
And I will test it here and there.
Say! I will test it ANYWHERE!
I do not like
To hide my “D”.
Yes, I have tested in all of these places and situations … without shame.
Words and rhythm are a tribute to the legendary author Dr. Seuss, who would have turned 110 years old today. Happy Birthday!
“Statistically, just the rate at which diabetes is being diagnosed, you should be cautious of saying something like that [accusations of not knowing what life with diabetes is like]. Rashly assuming is a dangerous business.”
“That does not mean that it is our only defining characteristic or that we must live in a constant state of emergency. Were non-diabetics who know nothing about the disease to read some of the posted responses, they would conclude that diabetics live in a constant state of panic because the disease is unmanageable. That is not a good message for us to send to diabetics or non-diabetics.”
The first quote is from the elder Miss Manners; the second from the younger, the one with T1. (Excerpted from yesterday’s article on DiabetesMine, which had me captivated from start to finish.)
Now, you may not agree with everything Miss Manners says… heck, you may despise everything ever written in the column. But if you take some time to think about these two quotes and consider them in your own interactions with others, you just might be surprised on how well it works.
Wait a minute… the February blog carnival is about what it means to be an advocate. Didn’t I just write about that in January? Can I just submit that one? No? Darnit! Oh well, I suppose this will give me fodder for new blog material.
So here’s the deal. I still struggle with the whole advocacy concept. I’m still trying to break out of the constrictive definition of advocacy that I’ve formulated. A definition that includes words such as these:
Influential. Assertive. Vocal. Connected. Persistent.
What do these words all have in common? They imply a hierarchy. They suggest that we need to appeal to a higher authority (not THAT one) to influence change. That the targets of our efforts are limited to governments, suppliers, manufacturers, researchers, and insurers; and if they are to remain steadfast and inflexible, then all of our advocacy work will be for naught.
Read the rest of this entry
Have you ever applied blood to the test strip, and then in haste, removed and thrown out the strip before the countdown reached zero and the result was displayed?
Have you ever pricked your finger, then forgotten which one you chose, leaving you to squeeze three or four different digits looking for the surprise appearance of blood?
Have you ever harpooned yourself with a CGM sensor, only to have it fall right out again because you forgot to first remove the adhesive covering?
Have you ever lost your place while counting to four? (One glucose tablet.. chomp-chomp; two glucose tablets… chomp-chomp; four…no… wait…two…seven…eleventeen…?)
Have you ever tested your blood sugar… thirty seconds after testing your blood sugar…because you’d forgotten that you’d done it already?
Have you ever fasted for a blood-draw which, as it turns out, didn’t require you to not eat beforehand?
Have you ever awoken in the middle of the night, groggy and hypoglycemic, to find that you only dreamed of testing and treating the low, but never actually did it?
Have you ever confessed – publicly to the world – some of the absolutely boneheaded things you’ve done that left you feeling dumber than dirt?
I have. And I’m quite sure I’ll do all of them again.