“I’m High…Why?”

Report from the American Association of Diabetes Educators (AADE) annual convention in Washington, D.C., August 6 through 9, 2008. Marie McCarren attended “Brittle Diabetes? Myths and Realities,” presented by Cindy Young, RN, CDE, Maine Center for Diabetes, in Scarborough.

False high readings can lead to big problems. If you adjust your pre-meal dose of insulin based on a false high reading, your blood glucose level will probably drop too low after the meal. With an infection, even a minor tooth infection, you may see blood glucose levels in the 300s.

| Sep 11, 2008

Diabetes educator Cindy Young used case studies to illustrate the many little things that can have a big effect on your blood glucose-or just on the readings you get with your meter.

First up: Does it matter whether you wash your hands before you check your blood glucose? 

Young figured some people check their blood glucose levels in their kitchen after preparing meals. So she did an "unscientific study" in her own kitchen: She checked her blood glucose after handling various foods. Young does not have diabetes, so she expected her meter readings to be stable and in the normal range. 

When Young washed her hands with soap and water and then tested, the meter read 80 mg/dl. When she had lotion on her hands, the meter read 87 mg/dl. After she handled the following foods, the meter readings were all over the map: 

  • Milk: 92 mg/dl
  • Raspberries: 92 mg/dl
  • Peanut butter: 94 mg/dl
  • Red peppers: 117 mg/dl
  • Sweet wine: 122 mg/dl
  • Grapes: 447 mg/dl
  • Grapes, followed by wiping (but not washing) hands: 132 mg/dl

Young had a client who checked his glucose before lunch every day, but the readings he got at work were typically higher than the readings he got on the weekends. He and Young finally figured it out: At work, the client used a no-rinse hand gel, but on weekends, he used soap and water. 

False high readings can lead to big problems. If you adjust your premeal dose of insulin based on a false high reading, your blood glucose level will probably drop too low after the meal. 

Bottom line? Wash your hands or use alcohol wipes (and let the alcohol dry) before checking your blood glucose. 

Real Highs

Illness, infection, stress, and pain can raise blood glucose levels for real, not just on the meter display. 

A client of Young's had a disease that caused chronic pain. Young asked her client to keep a log of her pain severity on a scale of 1 to 10, along with her blood glucose levels. From those figures, they worked out a plan: The woman would use the temporary basal feature on her pump to increase her basal rate by percentages based on her rated pain and blood glucose response.  

Young warns that steroids can jack blood glucose up to the 300s to 400s. With an infection, even a minor tooth infection, you may see blood glucose levels in the 300s. A fight with your spouse or a conflict with your boss may also raise blood glucose levels.

If you are ill or need to take medication that raises blood glucose, you may require more insulin. If you have type 2 diabetes and don't use insulin, you may need to use insulin temporarily.

For stress-related highs, Young advises having a plan in place. Many people use exercise to reduce both stress and blood glucose. Others meditate or play a favorite game.  Identify whatever calms you ahead of time and put it in place when you're stressed.  

Marie McCarren is a medical writer who has specialized in diabetes for 15 years. Her books include ADA Guide to Insulin & Type 2 Diabetes and A Field Guide to Type 2 Diabetes.

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Comments

Posted by krissyd67 on 12 September 2008

Ihad this "grape" experience recently!" I tested by blood sugaar and it was in the 400s. I was horrified and tested again, thinking it must be a fluke. The 2nd reading was in the 300s. I then (stupidly) bolused. After experiencing a REALLY LOW low, it dawned on me that something must have been wrong, and that led me to the grape theory.

Posted by cde on 12 September 2008

Very true! I had a client (I am also a CDE) who was low (57 mg/dL) during an office visit, so she used one 4-gram glucose tablet to raise the blood glucose. In 15 minutes, we checked her blood glucose again, with the same finger she had used to put the glucose tablet in her mouth...230 mg/dL! I knew what had caused this reading, but wanted her to learn, so we discussed it, she washed her hands, and then re-checked: 71 mg/dL, which is within her target range. Learning by experience plays such a big role in DM. Dr. Stan De Loach, México, Distrito Federal. www.continents.com/diabetes1.htm

Posted by awestback on 12 September 2008

I had the same thing happen after eating some trail mix with dried cranberries. I was pregnant, so very cautious of my readings and tested 420 after eating the mix, then I bolused but wondered about the sugar left on my hands. I washed my hands and rechecked at 115. I was able to stop the bolus before it did too much damage. Now I try and wash my hands if I have eaten or touched anything prior to testing.

Posted by Anonymous on 12 September 2008

Whenever I test my BG, I have to be careful that my hands are clean, because sometimes I've had a few of the experiences described- correcting for a blood sugar that WASN'T high and then having a low.

Posted by Anonymous on 12 September 2008

it nevr haped to me

Posted by XoGinaXo on 13 September 2008

Sometimes you are in a situation where you cannot wash your hands. In these situations, what I do is I poke my finger and get a nice big drop of blood and wipe it off. Then I get another drop from the same poke and use that, the reasoning behind it being that hopefully the first "void" will help to clean off anything that may have been on my finger but then go wiped away and a new, fresh drop used.
Another good point to keep in mind: Never lick your finger thinking that will clean it. Keep in mind that there is sugar in your saliva, so if you lick your finger and then test, you might get a reading that has the sugar in the saliva as part of your result.
Also try to WIPE your finger with something clean/sterile after using alcohol or use the "void" method. Alcohol can affect readings.
To be honest, I use the "void drop" every single time I test, even if I do wash my hands first, etc.
Hope that helps someone :O)

Posted by Anonymous on 20 September 2008

The "Void" method works. Also you can let the first drop appear; wipe that drop off, then squeeze same location again for a second
drop to appear by squeezing location a little
harder for your second drop. Also, after using any alcohol, just blow on the puncture
a few times to be sure the alcohol is gone.


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