Good morning and a little help please!

[Simpo]

Good morning all!

I'm undergoing the joys of steroid induced diabetes post liver transplant.

The regimen isn't too bad apart from the conflict between transplant diet requirements and diabetes diet requirements.

My problem is trusting my glucometer.

Can anybody tell me where I can source the control solution for the contour plus blue meter? All the ads return the contour next system or have no stock.

Any info appreciated

 

[MrsMonty]

Hi Simpo,
I'm fairly certain if you phone the company helpline, they will send you out some. The number is 0345 600 6030

 

[Lucyr]

Can anybody tell me where I can source the control solution for the contour plus blue meter? All the ads return the contour next system or have no stock.

Phone the company

 

[Docb]

If you cannot find any test solution then don't fret about it. Worrying about the accuracy of your meter is the least of the problems when it comes to making sense of meter readings. They are brilliant things and can be invaluable when it comes to sorting out diet but the errors in sampling will outweigh any fundamental errors in the kit.

 

[Proud to be erratic]

Good morning @Simpo, Welcome to the Forum.

I can't help you with any specific knowledge about your glucometer. But in general the permissible tolerances for glucometers is +/- 15%. When I first read this I was surprised, it seemed pretty poor. But a hasty reflection made me adjust that initial thought. These devices are made in bulk, to meet a price point that keeps them affordable for domestic use by a lot of people and the science is actually pretty remarkable - creating a reading on a screen from a drop of blood onto a test strip. There is a lot going on behind the screen!

I've also come to realise that each of us has very different outcomes from what is medically summarised as metabolism. How our bodies respond to a food type and convert that into blood glucose can be very different from person to person. So when a Health Care Professional (HCP) or this Forum advise us to stay above a particular number from a finger prick test, I think we have to be realistic that the whole process is fairly approximate.

So I try very hard to not allow myself to get too close to that hypo figure of 4.0 that is quoted to us and to stay somewhere above 6. Then my risk of going hypo is low and damage to me in the long term form that sort of BG is negligible.

I am T3c, after surgical removal of my pancreas after getting pancreatic cancer. Your steroid induced Diabetes fits the definition of T3e:

Type 3e diabetes. This form of diabetes is any diabetes that has been induced by chemical or drugs. For example, high doses of steroids, taken for an extended period of time, can lead to diabetes developing. Steroid-induced diabetes is therefore a form of type 3e diabetes.​

All of the T3(a-h) definitions are part of a distinct recognition that some Diabetes is "Secondary", neither T1 nor T2. We have damage to our pancreas from some other cause (my pancy damage was extreme and abrupt, yours from a steady accumulation of essential steroids for a different medical reasons) (damage from excessive alcohol is another cause, along with genetic issues that affectthe pancreas, ot different genetics that affect insulin production). Those of us with one of these "Secondary" types of T3 have a couple of things in common: there aren't many of us perhaps at most 2% of all people with Diabetes; our treatment and management's of our D is usually Secondary to the original cause of our pancreatic damage. Your liver transplant is blatantly your first concern.

May I ask how long ago you had your liver transplant? What medications, if any, are specifically for Diabetes management? What guidance have you been given so far for your BG management? If you are happy to share such personal info, perhaps members of this Forum can share their tips and tricks for how they manage any issues they might experience in your context. I certainly recognise the conflict you talk about in relation to dietary contradictions (but such a conflict wasn't a big issue for me, other than during my chemo phase). I feel sure there will be others who can offer their thoughts and suggestions.

 

[Simpo]

If you cannot find any test solution then don't fret about it. Worrying about the accuracy of your meter is the least of the problems when it comes to making sense of meter readings. They are brilliant things and can be invaluable when it comes to sorting out diet but the errors in sampling will outweigh any fundamental errors in the kit.

My concern on accuracy is it's direct effect on medication again because of the link across to transplant medication.

 

[Simpo]

Good morning @Simpo, Welcome to the Forum.

I can't help you with any specific knowledge about your glucometer. But in general the permissible tolerances for glucometers is +/- 15%. When I first read this I was surprised, it seemed pretty poor. But a hasty reflection made me adjust that initial thought. These devices are made in bulk, to meet a price point that keeps them affordable for domestic use by a lot of people and the science is actually pretty remarkable - creating a reading on a screen from a drop of blood onto a test strip. There is a lot going on behind the screen!

I've also come to realise that each of us has very different outcomes from what is medically summarised as metabolism. How our bodies respond to a food type and convert that into blood glucose can be very different from person to person. So when a Health Care Professional (HCP) or this Forum advise us to stay above a particular number from a finger prick test, I think we have to be realistic that the whole process is fairly approximate.

So I try very hard to not allow myself to get too close to that hypo figure of 4.0 that is quoted to us and to stay somewhere above 6. Then my risk of going hypo is low and damage to me in the long term form that sort of BG is negligible.

I am T3c, after surgical removal of my pancreas after getting pancreatic cancer. Your steroid induced Diabetes fits the definition of T3e:

Type 3e diabetes. This form of diabetes is any diabetes that has been induced by chemical or drugs. For example, high doses of steroids, taken for an extended period of time, can lead to diabetes developing. Steroid-induced diabetes is therefore a form of type 3e diabetes.​

All of the T3(a-h) definitions are part of a distinct recognition that some Diabetes is "Secondary", neither T1 nor T2. We have damage to our pancreas from some other cause (my pancy damage was extreme and abrupt, yours from a steady accumulation of essential steroids for a different medical reasons) (damage from excessive alcohol is another cause, along with genetic issues that affectthe pancreas, ot different genetics that affect insulin production). Those of us with one of these "Secondary" types of T3 have a couple of things in common: there aren't many of us perhaps at most 2% of all people with Diabetes; our treatment and management's of our D is usually Secondary to the original cause of our pancreatic damage. Your liver transplant is blatantly your first concern.

May I ask how long ago you had your liver transplant? What medications, if any, are specifically for Diabetes management? What guidance have you been given so far for your BG management? If you are happy to share such personal info, perhaps members of this Forum can share their tips and tricks for how they manage any issues they might experience in your context. I certainly recognise the conflict you talk about in relation to dietary contradictions (but such a conflict wasn't a big issue for me, other than during my chemo phase). I feel sure there will be others who can offer their thoughts and suggestions.

Transplant was 10 weeks ago with no problems, back in the game 6 days post op with prescribed glycizide.

Unfortunately I have developed some rejection.

This meant a course of high dose steroids which led to being put on iv insulin sliding scale for a week to combat bg in the mid 30s.

On release I'm on humilin and novorapid.

I was a medical engineer for 30 years and +/- 15% is not calibration to me and is nothing more than a vague guess. I would never have released equipment at that level of error non life vital or otherwise.

If your only interest is trend monitoring then ok your looking for dips and raises, but no use when you're after a target.

This also feeds into my RAF Engineer OCD.

Guidance wise I've been given take the medicine and send us the results.

Using a control reagent at least allows me to apply a consider offset to my readings.

 

[helli]

Those of us with Type 1 diabetes use the accuracy of these meters to calculate the dose of insulin - a potentially fatal decision if we get it wrong. But the meters' accuracy are "good enough".
I always think about the other inaccuracies - our insulin dose calculation is also based on the inaccurate statements of carbs in the food we eat. We assume all apples have the same carb density regardless of variety, ripeness, growing conditions. We assume each slice of cake has the same number of currants in.
On top of that, BG is affected by more than just what we put in out mouths - it is also affected by weather, stress, how well we sleep, how much exercise we do, .. some even say the colour of our socks can make a difference.

I appreciate your transplant medication is not insulin and maybe not all of the "inaccuracies" I have mentioned are relevant. But if you are deciding upon your medication based on a single (or even multiple) finger prick at a moment in time without knowing what is going to happen in the next hour or while you are sleeping, I would be very surprised if the accuracy your comments suggest you are wanting are relevant.

If you think your meter is out by a long way, you could do a "in the right ball park" check by testing someone who definitely does not have diabetes. My partner occasionally does a finger prick and unless he has just eaten a bowl of sugar (or a big breakfast of pancakes swimming in maple syrup) or done intensive workout, his BG is in the 5s.

 

[Simpo]

Those of us with Type 1 diabetes use the accuracy of these meters to calculate the dose of insulin - a potentially fatal decision if we get it wrong. But the meters' accuracy are "good enough".
I always think about the other inaccuracies - our insulin dose calculation is also based on the inaccurate statements of carbs in the food we eat. We assume all apples have the same carb density regardless of variety, ripeness, growing conditions. We assume each slice of cake has the same number of currants in.
On top of that, BG is affected by more than just what we put in out mouths - it is also affected by weather, stress, how well we sleep, how much exercise we do, .. some even say the colour of our socks can make a difference.

I appreciate your transplant medication is not insulin and maybe not all of the "inaccuracies" I have mentioned are relevant. But if you are deciding upon your medication based on a single (or even multiple) finger prick at a moment in time without knowing what is going to happen in the next hour or while you are sleeping, I would be very surprised if the accuracy your comments suggest you are wanting are relevant.

If you think your meter is out by a long way, you could do a "in the right ball park" check by testing someone who definitely does not have diabetes. My partner occasionally does a finger prick and unless he has just eaten a bowl of sugar (or a big breakfast of pancakes swimming in maple syrup) or done intensive workout, his BG is in the 5s.

It's my background that will not accept 15% as adequate.
All the monitors I've serviced in the past shipped with at least high and low reagents or an electronic test strip to validate readings.
I'd already noted a disparity between my meter and the hospital ones.
If I'm measuring 30mmol and I'm in reality 20 this represents a concern that could be avoided even though the level still needs attention.

 

[Docb]

My concern on accuracy is it's direct effect on medication again because of the link across to transplant medication.

I see what you are getting at. If your medications do influence blood glucose or vice versa then you will see it I would guess by looking at trends rather than trying to react to individual readings.

To illustrate what I am trying to get at. Some time ago I did 10 finger prick tests in rapid succession just to see what the reproducibility was like. I found a range of about 2 units which I put down to sampling errors rather than instrument error. To this day I only report finger prick readings to the nearest whole number. The number after the decimal point is meaningless.

In terms of what I think you are trying to do, I have a lot of data in my database and I can see the effects of changes in T2 medication but only if I look at trends over a couple of weeks or more.

Are you any good with a spreadsheet?

 

[helli]

It's my background that will not accept 15% as adequate.

As a fellow engineer, I can empathise with this.
Maybe that is why I have needed to "justify" the inaccuracy. I have drawn graphs in my head of error bars on top of error bars on top of error bars and finally realised how little impact the 15% meter accuracy error bar has on the total.
Added to that is the people receiving medals for surviving diabetes for 50, 60 and 70 years when finger prick meters have been common for less than 30 years. The treatments we have today are so much better than these people have used for most of their lives and they survived.
I am a relative new-comer with only 20 years under my belt. But, by accepting these inaccuracies, I have lived a very full 20 years (and expect to live many many more) with no complications with my diabetes and no major hiccups along the way.

Until we can accurately measure stress and carb contents without weighing the ash left after burning food, up to 15% inaccuracy on a meter is something I can accept, especially if it lets me get on with the rest of my non-diabetic life.

 

[Simpo]

Certainly am

I see what you are getting at. If your medications do influence blood glucose or vice versa then you will see it I would guess by looking at trends rather than trying to react to individual readings.

To illustrate what I am trying to get at. Some time ago I did 10 finger prick tests in rapid succession just to see what the reproducibility was like. I found a range of about 2 units which I put down to sampling errors rather than instrument error. To this day I only report finger prick readings to the nearest whole number. The number after the decimal point is meaningless.

In terms of what I think you are trying to do, I have a lot of data in my database and I can see the effects of changes in T2 medication but only if I look at trends over a couple of weeks or more.

Are you any good with

I see what you are getting at. If your medications do influence blood glucose or vice versa then you will see it I would guess by looking at trends rather than trying to react to individual readings.

To illustrate what I am trying to get at. Some time ago I did 10 finger prick tests in rapid succession just to see what the reproducibility was like. I found a range of about 2 units which I put down to sampling errors rather than instrument error. To this day I only report finger prick readings to the nearest whole number. The number after the decimal point is meaningless.

In terms of what I think you are trying to do, I have a lot of data in my database and I can see the effects of changes in T2 medication but only if I look at trends over a couple of weeks or more.

Are you any good with a spreadsheet?

I certainly am, already written a monitoring program to produce graphs etc.

 

[Martin.A]

But in general the permissible tolerances for glucometers is +/- 15%.

And even then only 95% of the time?

I've used test solution and it confirms that I'm getting a result within the range quoted on the tub. I've taken this as confirmation that I have a good batch of test strips. I didn't think it told me anything about my meter's accuracy.

Mike @everydayupsanddowns has often posted a table of the upper and lower levels for a specific test result.

 

[everydayupsanddowns]

Welcome to the forum @Simpo

Edit: posted at the same time as @Martin.A

In case it is helpful I thought I’d post this section from the ‘useful links’ page, which explains the ISO standards of BG meters in more detail.

BG meter accuracy
It can be quite disconcerting for members new to self monitoring of blood glucose to get different results from BG readings taken close together, even when carefully following manufacturers guidance (washing hands etc). All meters for sale in the UK should comply with the following ISO standards 95% of the time, which allows a degree of variation (and 5% of results can read anything at all). If in any doubt, or if a reading doesn’t match how you are feeling, you should check again with a fresh strip.

I can completely understand why the extremes of variability at the outer edges would be a concern for you, especially with your background. Pragmatically, my experience has been that once levels get above the high teens, their meaning begins to coalesce around Urgent Action Required, and the specifics of exact correction dose seem to become less crucial. Particularly as for me at higher levels I seem to observe a degree of insulin resistance so my standard insulin sensitivity factors become less applicable, and a gut-feeling guesstimate is a better initial response, followed by tracking its effect over the following hours and adjusting as necessary.

Good ole Diabetes Maths eh? Never happy to abide by its own rules!

 

[rebrascora]

I was surprised how wide the range is for the test solutions when I used to use them. I think there would be something like 2 whole units range for the test solutions.
I just checked my current test strips and the pot says the low control solution should read between 2.1 and 3.8 and the high solution should read between 12.3 and 16.6. To my mind the control solution is not really going to set your mind at rest about accuracy with those ranges for what should be a known test solution.

Getting too caught up in the accuracy of these meters will do your head in and cause stress. They are amazing bits of kit, just like Constant Glucose Monitors (CGMs) are great bits of kit but you have to put aside your scientific mind a bit and take them more on faith. Once you can do that and gain experience with how your body responds to certain situations and how that pans out with readings, you develop more confidence in the results they give you and learn when there is a potentially rogue reading that needs a double check. You are using physics and chemistry in the form of a somewhat inaccurate meter to measure biology, which is rather unpredictable and variable. There are always going to be error margins that you have no control over.
There are plenty of us here on the forum using insulin who have scientific minds and have had to wrestle with this issue and you can drive yourself mad with it, but the truth of the matter is that the meters give a ball park figure which is close enough to calculate doses from and get it right most of the time. Yes you will get it wrong from occasionally and end up hypo or hyper but there are so many factors which can cause those situations aside from the meter inaccuracies that you learn to accept the meter inaccuracy as the least of your worries. If you get a CGM and you could apply to Abbott for a free 15 day trial of their Libre 2+ you can drive yourself mad all over again, but it is an amazing bit of kit once you understand it's limitations and has been a game changer for many of us on insulin, but it is more inaccurate than finger prick meters and there are certain circumstances where it is unreliable. Once you understand that and accept it, the data from it is amazing and life changing.

I wonder if you had to go back to boiling up a sample of your urine with a reagent to get a ballpark reading from a colour chart of what your BG was about 3 hours previous, as people did whether you would find it easier to accept BG meters for what they are. A bit of kit which helps us enormously. It doesn't need to be really accurate to enable us to keep ourselves safe and well managed. You just have to learn how to respond to the data it gives you.

 

[rebrascora]

I should say that I stopped using control solution to check each pot of test strips after my first year and with hindsight it was a waste of time. Never had one that was outside range, probably because the range is so wide.

 

[helli]

you have to put aside your scientific mind a bit and take them more on faith.

As someone with a scientific mind, I have never put it aside but used it to understand the limitations and consequences.
Telling me to take something on faith would never work. I need to understand.
There is science (including economics) behind the inaccuracies not voodoo.

 

[Docb]

I certainly am, already written a monitoring program to produce graphs etc.

I preferred a database! Either way up, you will no doubt get to understand what is going on under your circumstances as you build your data set.

@rebrascora has articulated how to put the meter into context very well indeed.

 

[Martin.A]

For me it's more about the trend line on my graph.

 

[harbottle]

I emailed ascencia customer services and they sent me a bottle of test solution for my Contour.
I used it and got a number, but not entirely sure what that number meant and how it related to accuracy.