Glucorx HCT meter showing low hemocrit and its impact on accuracy

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sugarislifeanddeath

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Type 1
Hi all!
Just a brief one really - I just last week moved to the GlucoRX HCT meter, given I recently was in hospital for dka and scared the bejesus out of myself, so I wanted something that can do blood ketones as well. I test 10x daily (I know this sounds excesssive but I'm a taxi driver, hypo unaware, & so up and down it's ridiculous) and I have noticed a trend of my hemocrit on the meter showing as continously low, often under 20%, with an average of 14% over a week. Two questions:
  1. Is this worth a call to the GP? Or should I ignore it? Or do I bring it up at the next appointment in 6 months?
  2. How will this affect my readings? Will they be inaccurate? Can I do anything to compensate?
 
I know this isn’t your question but do the DVLA know you are hypo unaware and are they happy for you to be driving? Normally you wouldn’t be eligible for a licence in hypo unaware so concerned you could be driving illegally.
 
sugarislifeanddeath said:
Hi all!
Just a brief one really - I just last week moved to the GlucoRX HCT meter, given I recently was in hospital for dka and scared the bejesus out of myself, so I wanted something that can do blood ketones as well. I test 10x daily (I know this sounds excesssive but I'm a taxi driver, hypo unaware, & so up and down it's ridiculous) and I have noticed a trend of my hemocrit on the meter showing as continously low, often under 20%, with an average of 14% over a week. Two questions:
  1. Is this worth a call to the GP? Or should I ignore it? Or do I bring it up at the next appointment in 6 months?
  2. How will this affect my readings? Will they be inaccurate? Can I do anything to compensate?
Click to expand...
I would most certainly contact your GP as it could indicate anaemia as that does sound particularly low but of course a monitor would not be as accurate as a proper blood test.
I don't think it would affect your spot glucose level test but could well affect an HbA1C test result.

Make sure you have checked the DVLA regulations as Lucy says, you don't want to find yourself driving illegally and putting yourself and passengers at risk.
 
It sounds like you need more support with your diabetes management, including education and better tech. As someone who has lost hypo awareness a Libre sensor would be a simple step and you already fit the previous guidelines for prescription on the NHS with testing 10x a day and not having hypo awareness, but the new guidelines mean that all Type 1 diabetics should be offered it, so do get in touch with your diabetes clinic and ask about it ASAP.
As others have said, you really are putting yourself and others at risk by driving when hypo unaware and it will invalidate your licence and insurance if you haven't declared it. Testing 10x a day is not enough to mitigate that risk, especially when you say your levels are erratic. It sounds like your livelihood depends on good diabetes management (as well as your health) so please spend some time and effort improving it. We can point you in the right direction but it sounds like you need some in depth support from a DSN to improve things.
My guess would be that your basal insulin isn't right if your levels are unpredictable.
Which basal are you on and when was the last time you adjusted it?
Many people seem to think that once your basal dose it set, that is it, but many of us here find that basal doses (or even the type of basal insulin) needs changing to suit the individual's body and environmental factors..... the change in seasons being a prime factor... longer days and warmer weather can both impact basal needs quite significantly and most of us have to reduce our doses for that. Freestyle Libre will help you to see when your levels are drifting in the absence of food (and bolus insulin) and indicate whether your basal insulin is holding you steady or needs adjusting. It also has high and low BG alarms and trend arrows which show if your levels are rising or falling. It is not a perfect system but if you understand it's limitations it is a game changer for better diabetes management, so do ask about that at the earliest opportunity.
 
Lucyr said:
I know this isn’t your question but do the DVLA know you are hypo unaware and are they happy for you to be driving? Normally you wouldn’t be eligible for a licence in hypo unaware so concerned you could be driving illegally.
Click to expand...
They're happy if I test every 30 min, and follow the whole 2 hour rule if i go below 6.
 
rebrascora said:
It sounds like you need more support with your diabetes management, including education and better tech. As someone who has lost hypo awareness a Libre sensor would be a simple step and you already fit the previous guidelines for prescription on the NHS with testing 10x a day and not having hypo awareness, but the new guidelines mean that all Type 1 diabetics should be offered it, so do get in touch with your diabetes clinic and ask about it ASAP.
As others have said, you really are putting yourself and others at risk by driving when hypo unaware and it will invalidate your licence and insurance if you haven't declared it. Testing 10x a day is not enough to mitigate that risk, especially when you say your levels are erratic. It sounds like your livelihood depends on good diabetes management (as well as your health) so please spend some time and effort improving it. We can point you in the right direction but it sounds like you need some in depth support from a DSN to improve things.
My guess would be that your basal insulin isn't right if your levels are unpredictable.
Which basal are you on and when was the last time you adjusted it?
Many people seem to think that once your basal dose it set, that is it, but many of us here find that basal doses (or even the type of basal insulin) needs changing to suit the individual's body and environmental factors..... the change in seasons being a prime factor... longer days and warmer weather can both impact basal needs quite significantly and most of us have to reduce our doses for that. Freestyle Libre will help you to see when your levels are drifting in the absence of food (and bolus insulin) and indicate whether your basal insulin is holding you steady or needs adjusting. It also has high and low BG alarms and trend arrows which show if your levels are rising or falling. It is not a perfect system but if you understand it's limitations it is a game changer for better diabetes management, so do ask about that at the earliest opportunity.
Click to expand...
Thank you. Please do not worry; the DVLA is aware.

On the note of a libre - My team have (just this past week, actually) always stuck by not allowing people who aren't children and don't live alone to have cgms/ flash libres. Even with guidlines changed they're adament it's just a suggestion, not a requirment, and they won't be changing thier policy because they're cost ineffective when you can just prick. Or that's what they're saying anyway
 
Once you are finger pricking more than 8x a day Libre are cost effective as that is why the previous guideline was brought in.
If you are having problems with your team, then I believe Dr Partha Kar is prepared to fight individual cases as he is very passionate about this and I am pretty sure in your situation he would have ample ammunition.... especially in view of your recent DKA.... An emergency admission costs the NHS far more than a few sensors!.... so well worth contacting him.
I think @Bruce Stephens has a link to Partha Kar's contact details. He is our guardian angel fighting our cause with the powers that be, at the top level.
 
sugarislifeanddeath said:
and they won't be changing thier policy because they're cost ineffective when you can just prick
Click to expand...
I confess I didn't really follow the economic modelling that NICE give, but it looks to me like they think CGMs are generally good value for money.

I'd have thought that would be especially the case for a taxi driver (presumably testing well over 8 times a day). (The evidence is here https://www.nice.org.uk/guidance/ng17/evidence (it's the "Economic model report" I'm thinking of), but I think understanding it needs some familiarity with the relevant economic models which I just don't have.)

If it were me I think I'd contact Professor Partha Kar and (quite likely) he'd email your team and suggest they stop being silly and just follow the guidelines.
 
rebrascora said:
Once you are finger pricking more than 8x a day Libre are cost effective as that is why the previous guideline was brought in.
If you are having problems with your team, then I believe Dr Partha Kar is prepared to fight individual cases as he is very passionate about this and I am pretty sure in your situation he would have ample ammunition.... especially in view of your recent DKA.... An emergency admission costs the NHS far more than a few sensors!.... so well worth contacting him.
I think @Bruce Stephens has a link to Partha Kar's contact details. He is our guardian angel fighting our cause with the powers that be, at the top level.
Click to expand...

Bruce Stephens said:
I confess I didn't really follow the economic modelling that NICE give, but it looks to me like they think CGMs are generally good value for money.

I'd have thought that would be especially the case for a taxi driver (presumably testing well over 8 times a day). (The evidence is here https://www.nice.org.uk/guidance/ng17/evidence (it's the "Economic model report" I'm thinking of), but I think understanding it needs some familiarity with the relevant economic models which I just don't have.)

If it were me I think I'd contact Professor Partha Kar and (quite likely) he'd email your team and suggest they stop being silly and just follow the guidelines.
Click to expand...

Thank you, both of you. I will reach out to him tonight
 
Good luck and do let us know how you get on.
 
For those interested, I recieved a prompt reply from Glucorx today:

"...
GlucoRx HCT meter's Heametocrit Correction Technology makes it one of the most accurate meters on the market.
HCT Glucose Test Strips measure the haematocrit and glucose levels in blood (no algorithm involved). Factors which cause low haematocrit include age, exercise, nutritional deficiencies, pregnancy, underlying medical conditions etc which you can talk to your healthcare professional about.
In order to enhance the accuracy of your HCT meter reading, please repeat glucose testing ensuring you routinely discard the first blood drop about lancet skin puncture and test the purer blood which emerges from underneath..."

They went on to say they don't currently offer a way to test the accuracy of the hct number, and according to them I'm doing everything right. I've called my gp, who seems unconcerned, but this is the person who told me that my (T1) diabeties was my own fault for eating poorly (I eat extremely well) & would go away if I lost weight and stopped eating carbs altogether as all of them were "pure surgar". (He refused to entertain the idea of complex carbs, the glycemic index of foods, and the concept of eating a balance of all macros in a meal) So I think I'll watch and wait.

In any case I think we can rule out pregancy
;)
😛
 
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