OK, so question and i'm still trying to adjust my basal rates..ugh; I was feeling a bit shaky around lunch time but I'm also trying to get readjusted to 'normal' blood sugars. Of course, I'd taken a tylenol about 40 minutes prior so my CGM was way off and not working, I checked my BG's and it said 66 which didn't seem right so I rechecked on another meter and it said 119, went back and rechecked again and it said 137? Am I low or high..geez???
My question is, and I realize the variance with meters +/- 20%+, if my BG was 66 and maybe dropping, could that result in a liver dump bringing me up to 137 within a minute or two? Do liver dumps work like that or was it probably just a bad reading? It makes a difference because I was trying to basal test between breakfast and lunch so if I was low it would mean, maybe...still, basal off.
In my experience, it's most likely the meter. Especially with OneTouch meters, I'd find that the first result would be low and the second result would be normal or high--within the span of thirty seconds.
I know an endocrinologist who swears by Roche meters. Everything is different for everyone, but if it's something you see a lot, perhaps you'd consider switching? I have almost zero variability between results with the Accu-Chek Nano.
It's too bad our meters are not more accurate and precise. Given that, here's what I do to try and minimize that inaccuracy and imprecision. If I'm going to make a decision, whether it be to add insulin or fast acting carbs, I will do two finger sticks. If the finger sticks are near each other, like 120 and 130, I will average them and use that number.
If the numbers are further apart, like 90 and 140, then I will test a third time and use the middle number or average the two that are closest together. I have no study or science to back this up, just my personal experience that has served me well.
In your 66, 119, 137, example, I would have washed my hands after the 66 number and tested on the same meter with the same strip vial. I would then probably average the 66 with the second test provided it was not too far away. If the second number was 119 per your example, I would test a third time and average the second and third number and use that one for the decision. Again, this is my gut advising, not science. I see it as the "art" of daily diabetes management.
On the liver issue, I don't think that the blood glucose level responds to the liver in a minute, but in several minutes, yes. My personal experience with liver dumps and the effects of counter-regulatory response to low BGs, is that if I can keep the BG above 60 and for less than 20-30 minutes < 70, then my liver and other gluco-regulatory brakes don't seem to engage.
I think that the basal testing according to Gary Scheiner's protocol, does not recommend drawing any conclusion unless you can run the entire test within the 70-250 range. If you go below 70, he recommends aborting the test.
I'm the opposite: I prefer to keep it simple and use one meter and trust that reading.I had two meters once and comparing just drove me nuts. I work hard to not drive myself nuts. (One reason I have zero interest in a CGM) Fortunately, I seem to always have meters that feel reliable and accurate to me. Oh, and I don't usually consider 66 low or 137 high! The only time I would do anything about those numbers is if I were the former before bedtime, or the latter when I was ready to eat.
For what it's worth, I use the Accu-Chek Aviva. Dr. Berstein recommends the Abbott Freestyle Freedom Lite as the most accurate meter/strip combo.
Good to read that you get such consistent results with the Nano. My Aviva does not always give good consistency. I've been doing a lot of double tests for the last several weeks and have seen both close and disparate results.
I used to do the same thing with my old meters. It was usually wrong the first time, though. (Honestly, the second and third test were never low, even if the first one was normal and I was double checking because I felt low.)
yeah, unfortunately i have different meters because of different pumps..so sometimes i compare. 66 or 137, I was going to eat so am I low and need to eat before bolus or do a correction with food. IDK, ended up doing a correction after lunch anyway.
I would call the meter company and see if they will send you a new meter. While readings of 119 and 137 fit the +/- 20% requirement, 66 does not fit at all. Do you ever check your meters when you get blood drawn at the lab? I'm not sure from reading this if the 137 is from the same meter as the 119 (therefore within 20%) or the meter with the reading of 66, which would be more than 100% off. Either way, the meter with the 66 should be replaced.
I can feel a 66. If I got a 66 and didn't feel it, I'd test again. If I got 137, I might wait and do a 3rd test because it's hard to say. Or I might just skip lunch or wait a while and see what things were doing. I don't get as much problems out of Tylenol but I don't think a "liver dump" will work that quickly. I'm sort of dismissive of "liver dumps" as I've noticed that the night ones, when most of them are sort of suspected of happening, also happens to be the time when it takes my food like 6-8 hours to digest which seems to more reliably explain things.
Sarah, simplify. As Zoe said, stay with one meter. You don't need to use the ones that match your gear--use the one you trust.
Remember--the drug companies make a tons of profit on BG strips, so they give meters away (make them work with equipment they make) to make you feel you have to use them.
thanks, it's onetouch - ultralink, they've sent me a new meter already, so think it's the meter accuracy. yeah, 137 was from the same 66 reading meter..could i have gone low and then come back up so quickly. i just am trying to basal test..oh well, i'll try again tomorrow. THANKS!
tylenol effects the Dexcom readings. I'll chalk it up to a bad reading I guess and start basal testing again tomorrow. still think I need more levemir, keep going up in the evening even with corrections. damn this disease..ugh! i keep lowering my morning basal thinking i'm taking too much and having some weird counter reaction...but i'm not.
I don't think much about all this "liver dumping" and rebound stuff either, though I'm sure it happens. I'm a big fan of Occam's Razor for D happenings - the simplest explanation is usually the best. If I had a high and instead of worrying about what caused the high, wondered if it was a rebound from a low...I'd drive myself nuts. The main thing I'm not a big fan of. Keep it simple.
hey zoe, if on MDI, can one inject basal - levemir at any time? i.e., if i'm still high in the afternoons, bolus corrections barely touching because basal is off STILL, can i just give myself 1 or 2 more units of levemir in the afternoon (an additional dose)? it's not only not enough (my AM dose) but it doesn't seem to last more then 8 hours. Does an increase in levemir not only extend the time - duration of the shot, how long it lasts but also it's strength, do you know? THANKS
I can see your thinking on this, Sarah. But I wouldn't go that way, because that would be almost like using basal as a correction and it just isn't that efficient to do that. If you're high I would do a bolus correction according to your ISF (and make sure that is right, including different ISF for day and night if necessary.)I've said this before, long-acting insulin for basal needs is inexact at best. You seem to have different needs at different times of day, and long-acting just can't handle that. Maybe somebody else knows for sure if an increase in long acting increases duration, but I kind of doubt it. I don't think it's that your Levemir is running out in 8 hours, but that you have higher needs at that time of day. Some people do split their long-acting into three different doses.
OK, thanks. I do corrections but can't seem to get it below 150 after around 5pm no matter how much a correct, it will just go back up and then i'm high at bed. I'll add more levemir tomorrow with AM dose. I'm not restarting pump until July 30th so I have another frkcin month to go with this. It's not my I:CR, that stays steady but it's around the same time every day I go up...just keep thinking my basal isn't lasting. thanks!
So it's coming down to target and then jumping back up? Then that isn't an incorrect ISF, it's lack of sufficient basal for that time zone. You will do really well on the pump because you can specifically raise your basal for that time zone where you seem to have an increase in need. Keeping good records now will give you a jump start on your basal settings when you go on your pump. Meanwhile, yes, just try another unit of morning Levemir. Just out of curiosity, since you have your pump, why do you have to wait until 7/30? (You may have already said this, so sorry if I just forgot).
yes, it just keeps going back up. i did give myself 1 unit of levemir and another correction and it's starting to come down. i'll just wait and do another unit tomorrow.
waiting because i want to partner with a pump nurse; i've decided to go back to previous endo who has a dedicated onsite pump team/nurse and want to wait until my appointment with them. i'm so all over the place, still, that I don't want to just throw on the pump (not sure which one yet either probably back on pod) and get into another mess. you're a bit more skilled and/or courageous then I am.
