Washing hands—it’s not just a bathroom activity
“J” works for me. He’s a T-2 who was originally one of my patients. He came to me from a extraordinarily wealthy part of Colorado known for it’s good health care. He came to me as a total train wreck. He suffers from every known diabetes complication except death.
As I got to know him and study his medical history, as I better understood his intelligence and personality, a radical idea came to me. I went to my medical director and told him, I think we should treat this guy like a Type-1. After lengthily discussion I was given leave to “promote” J to a T-1 and I started MDI therapy on him. For those of you who don’t know the slang, MDI stands for Multiple Daily Injection. A person on MDI takes one or two daily basal insulin shots to hold the line at night and between meals, and then must take a fast-acting shot every time they eat anything. It is the only way a non-pump T-1 can stay alive. It is a lot of work, but you can get some stunning results control wise. MDI is best for control enthusiasts who have embraced their diabetes as the interesting and time consuming hobby that it is. On top of fast-acting for food or drinks with carbs, you must also take fast-acting to correct for high blood sugar when you’ve been ambushed by lurking carbs. Advanced users can also adjust on the fly for high or low blood sugar by increasing or decreasing the amount of insulin taken with a meal.
Jim took to MDI like a fish to water. His control is now better than mine, and we now have a number of motivated T-2s on MDI. All doing really, really well.
About the same time that J became both a born-again-diabetic and in great control, we had a booth at the “Diabetes Day” in the rotunda of the state capital. I had gotten my paws on one of the 10 booths available to all of the diabetes programs in the state back when I was still the super-driven religious zealot of diabetes education. Three months later, I was a cynical burn-out with a booth and no clue how to use it.
We decided on a public screening. My Executive Director suggested I take along a few patients to talk to people about their experiences at the clinic. She quickly followed that suggestion with a not-so-short list of…. difficult…. patients that I was not to take.
Any way, J was one of four who spent the day with me. We screened 350 people. It was crazy. I couldn’t keep up and he jumped in to help with the fingersticks. He came to life. At that very moment, our Peer Educator program was born.
J is now paid by the clinic and is my left-hand-man. That’s because I already had a right-hand-woman. He works the Thursdays that I’m gone and he fills in for me when I’m sick or Rio has a day off school. To keep his education curve moving upwards he also works with me half day Mondays.
So this Monday J had a low.
He felt it coming on as he left the pharmacy with some insulin samples. On the way past our Executive Director’s office he spied a birthday cake on the carb counter (out boss has a sweet tooth and enables herself by sharing with the staff). Figuring he needed sugar anyway, and figuring that birthday cake sounded like more fun that glucose tabs, he snatched a piece and ate it on his way across the parking lot to the Annex.
When he got to my office he reported in and told me what was going on. “I’m still feeling symptomatic,” he told me.
Do a fingerstick, I said, handing him a meter and a disposable lancet.
His hands shaking, he slipped a test strip out of the vial and slid it into the meter. I twisted the safety off the lancet for him and he held it against his finger. Snap! A small squeeze and a fair-sized drop of blood appeared. He held the tip of the strip to the blood droplet and the strip wicked in the sample. Tick-tock. Tick-tock. Tick-tock.
157.
Huh. “That doesn’t seem right,” said J.
Test again.
“Let me wash my hands first.”
Jim stepped out and washed his hands in our wheel-chair accessible bathroom.
He came back and we repeated the process. Snap! Tick-tock. Tick-tock. Tick-tock.
56.
Holy crap! Here, I handed him a three-pack of glucose tabs. Eat them all.
It was a bad ride. We had a hell of a time turning around the hypo. (Later his wife reported to me that at breakfast J couldn’t remember if he’d taken his bolus or not and apparently double bloused. He now has a Lilly Memoir pen that keeps track of such minor details for him.)
After the glucose tabs we did dried banna chips. Then an entire bottle of Oral Glucose Tolerance Test solution.
You’ll be glad to know J is still alive. I just read about a guy who was given U-500 insulin at a Wal-mart instead of his usual U-100. He wasn’t so lucky.
Any way, back to the WHOLE POINT of this post, which is the 157 fingerstick followed by the 57. WTF? you may be asking. Here is what J and I think happened: there was still sugar on his finger from eating the cake, probably from the icing. When he lanced his finger, the sugar on the surface mixed with the blood and gave him a false high. Crazy!
So, do what we are all supposed to do, but we never do: wash your hands before you test. If you are where you can’t wash at least lick off your finger.
Unless your mouth is full of cake.
As I got to know him and study his medical history, as I better understood his intelligence and personality, a radical idea came to me. I went to my medical director and told him, I think we should treat this guy like a Type-1. After lengthily discussion I was given leave to “promote” J to a T-1 and I started MDI therapy on him. For those of you who don’t know the slang, MDI stands for Multiple Daily Injection. A person on MDI takes one or two daily basal insulin shots to hold the line at night and between meals, and then must take a fast-acting shot every time they eat anything. It is the only way a non-pump T-1 can stay alive. It is a lot of work, but you can get some stunning results control wise. MDI is best for control enthusiasts who have embraced their diabetes as the interesting and time consuming hobby that it is. On top of fast-acting for food or drinks with carbs, you must also take fast-acting to correct for high blood sugar when you’ve been ambushed by lurking carbs. Advanced users can also adjust on the fly for high or low blood sugar by increasing or decreasing the amount of insulin taken with a meal.
Jim took to MDI like a fish to water. His control is now better than mine, and we now have a number of motivated T-2s on MDI. All doing really, really well.
About the same time that J became both a born-again-diabetic and in great control, we had a booth at the “Diabetes Day” in the rotunda of the state capital. I had gotten my paws on one of the 10 booths available to all of the diabetes programs in the state back when I was still the super-driven religious zealot of diabetes education. Three months later, I was a cynical burn-out with a booth and no clue how to use it.
We decided on a public screening. My Executive Director suggested I take along a few patients to talk to people about their experiences at the clinic. She quickly followed that suggestion with a not-so-short list of…. difficult…. patients that I was not to take.
Any way, J was one of four who spent the day with me. We screened 350 people. It was crazy. I couldn’t keep up and he jumped in to help with the fingersticks. He came to life. At that very moment, our Peer Educator program was born.
J is now paid by the clinic and is my left-hand-man. That’s because I already had a right-hand-woman. He works the Thursdays that I’m gone and he fills in for me when I’m sick or Rio has a day off school. To keep his education curve moving upwards he also works with me half day Mondays.
So this Monday J had a low.
He felt it coming on as he left the pharmacy with some insulin samples. On the way past our Executive Director’s office he spied a birthday cake on the carb counter (out boss has a sweet tooth and enables herself by sharing with the staff). Figuring he needed sugar anyway, and figuring that birthday cake sounded like more fun that glucose tabs, he snatched a piece and ate it on his way across the parking lot to the Annex.
When he got to my office he reported in and told me what was going on. “I’m still feeling symptomatic,” he told me.
Do a fingerstick, I said, handing him a meter and a disposable lancet.
His hands shaking, he slipped a test strip out of the vial and slid it into the meter. I twisted the safety off the lancet for him and he held it against his finger. Snap! A small squeeze and a fair-sized drop of blood appeared. He held the tip of the strip to the blood droplet and the strip wicked in the sample. Tick-tock. Tick-tock. Tick-tock.
157.
Huh. “That doesn’t seem right,” said J.
Test again.
“Let me wash my hands first.”
Jim stepped out and washed his hands in our wheel-chair accessible bathroom.
He came back and we repeated the process. Snap! Tick-tock. Tick-tock. Tick-tock.
56.
Holy crap! Here, I handed him a three-pack of glucose tabs. Eat them all.
It was a bad ride. We had a hell of a time turning around the hypo. (Later his wife reported to me that at breakfast J couldn’t remember if he’d taken his bolus or not and apparently double bloused. He now has a Lilly Memoir pen that keeps track of such minor details for him.)
After the glucose tabs we did dried banna chips. Then an entire bottle of Oral Glucose Tolerance Test solution.
You’ll be glad to know J is still alive. I just read about a guy who was given U-500 insulin at a Wal-mart instead of his usual U-100. He wasn’t so lucky.
Any way, back to the WHOLE POINT of this post, which is the 157 fingerstick followed by the 57. WTF? you may be asking. Here is what J and I think happened: there was still sugar on his finger from eating the cake, probably from the icing. When he lanced his finger, the sugar on the surface mixed with the blood and gave him a false high. Crazy!
So, do what we are all supposed to do, but we never do: wash your hands before you test. If you are where you can’t wash at least lick off your finger.
Unless your mouth is full of cake.
posted by Wil | 9:39 AM
8 Comments:
Oh yes, clean hands are a must!
I had a similar incident while out for a walk with my hubby one day. I'd grabbed a handful of raisins before we headed out and when I tested 30-40 minutes later I got a reading over 200 mg/dl. It didn't seem right so I was frustrated and gave a pretty aggressive correction bolus, only to reconsider a few minutes later. I cleaned my hands, retested and was perfectly normal (90-110s). Darn!
What a silly thing to have to remember, but sticky, sugary fingers can play tricks on you!
We run into this all the time at diabetes camp for kids w t1. I sound like a freak telling all of the other med staff to focus on clean hands... alcohol swabs don't do a damn thing to get rid of the sugar goo left over from a day at camp. Night time checks are especially vulnerable to the sugar on the finger scenario and I've had to step in more than once to recheck after cleaning the fingers of the already asleep kid.
Wash your hands everyone and not because of the 'germs'. Sugar on your fingers is hazardous to your health.
It's not just sugar you have to worry about. My 10 year old T1 daughter is very hypo aware. One morning she came to me saying she felt low. When she got a 200+ reading she insisted that wasn't right. I suggested she wash her hands and test again, 69! She hadn't eaten anything lately but she had put on some hand lotion. I don't know if it was that particular brand or not, (I tossed it immediately), but now I insist on a thorough scrub with an alcohol swab before every stick. I don't even trust the sweet smelling soaps or instant hand sanitizer. Children are too prone to hypos to be accidentally over bolusing.
Another reason to test on your arm. But that has to be free from sweat.
Her endo says children should not test on the arm unless it's too traumatic to test the fingers. Alternative site testing is slow to pick up on the hypos.
Family member has been testing on forearm for 5 years. We do use fingers for verification. The numbers have not been far off. His job and extracirricular activities make fingersticks contraindicated. Of course everyone is entitled to their opinion and preference, professional and personal.
Please comment on this Oct 12, 2007 entry on this blog. Is it fact? Someone told him the pooled blood in the extremities is not as accurate as the second drop from a finger or the arm. http://canddbishop.com/blog/
the last couple weeks or so , i've been getting high readings( 150 fast which is high for me) . i work in the health field and use hand sanitizer alot. today i scrubbed my hands with just soap and water rinsing really good came back 107. anyone else find this with hand sanitizer?
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