The Diabetic Handyman
To take care of diabetes, you need good tools and a good foundation
By Wil Dubois
I'm not much of a handyman. Most of the things I've ever fixed, assembled, or built break again, disassemble themselves, or fall apart.
My wife avoids buying anything that says "some assembly required" on the box.
But I've learned a thing or two from watching real handymen—when I finally throw in the towel and pay one of them to clean up my latest mess—and it's this: You need good tools and you need a good foundation.
Now, don't take insult at the analogy, but our diabetic bodies are the ultimate fixer-uppers in the classic sense, and to do the necessary repairs and maintenance on them we need both a good foundation and good tools.
Let's start with the tools, because tool-less, there's really no way to build a strong foundation, is there? And what's the diabetes equivalent of the all-important power screwdriver? Yep! Your blood glucose meter, also called a glucometer, blood testing machine, blood sugar meter, or "maquinita" if you speak Spanish. It's the indispensable tool for diabetes blood sugar testing.
There are more brands and styles of meters than I can count. There's a virtual diabetes blood sugar testing equipment superstore out there! Meters come in a dizzying array of sizes, shapes, and colors, with a stunning variety of features. Some have strip port lights. Some have attached lancing devices. Some hold the strips in drums. Some are tiny. Some are flatter than a pancake. Some have big numbers. One even plugs into the bottom of an Apple iPhone. But they all have one thing in common: They don't have to be very good.
Yeah. Once again, I am here to ruin your day. For Food and Drug Administration (FDA) approval here in the USA, a meter can be up to 20% off from the reading a professional clinical reference laboratory would get from the same drop of blood, and still be approved for use. This "standard" has not changed since 2003. Really? How many people do you know who are using a cell phone or a computer from 2003? You would expect blood sugar-testing technology would have improved enough since then to require improved accuracy standards.
How big a difference does 20% make?
How big a deal a 20% error is depends on where your blood sugar really is. If you are cruising at a perfect 100 mg/dL, the meter would tell you that you are anywhere between 80 and 120 mg/dL. Hardly perfect, but all things being equal, pretty harmless mis-information. Of course, I don't know about you, but I'm rarely at 100 mg/dL, despite my best efforts. If I were at… say… 200 mg/dL, now my meter could give me "results" ranging anywhere between 160 and 240 mg/dL. And if I were having a really bad day, like I did yesterday, when I was at 300 mg/dL, the stupid meter could give me "results" ranging anywhere between 240 and 360 mg/dL. That's a 120-point spread! The higher your blood sugar is, the worse the error becomes, because 20% of a Ben Franklin is a hell of a lot more pocket change than 20% of a George Washington.
But wait. There's more. Once on the market, the strips are never checked again by our Federal regulators. There's no review process. No post-market surveillance. No follow up of any kind whatsofrickinever. For some time now, patient advocates have suspected that the strips we pick up at the corner drugstore are routinely "worse" than the already unacceptably bad 20% standards that they were approved under, and recently the FDA has confirmed that this is true.
This strip accuracy and reliability problem is about more than just diabetes control. This is about safety. People can and do get hurt by bad strips. Everyone on insulin is using the information from their glucometer to make "informed" therapy adjustments. But if the information is bad, so is the adjustment. And a bad insulin adjustment can be fatal.
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Well maybe not so much a furor as a controversy. The question, bluntly put, is whether or not a single HbA1c reading should be sufficient and adequate to diagnose diabetes — and whether the conditions under which the test was conducted should have any bearing on the diagnostic or non-diagnostic value of the test. The lede from