Editor’s note: This is the third in a series of updated posts on living with diabetes and blindness or low vision, written by Audrey Demmitt, RN, BSN, a Diabetes Nurse Educator and APH VisionAware Peer Advisor. Audrey discusses the importance of developing regular and accurate blood glucose monitoring skills, which are essential for people with diabetes. As Audrey says, “With practice, blood sugar monitoring can become a quick and routine procedure that helps manage blood sugar and avoid the complications of diabetes.”
Self-Monitoring Is an Essential Skill
Self-monitoring blood sugar is an essential skill for people with diabetes. The information obtained from regular and accurate finger-stick testing gives you and your doctor the ability to adjust your diet, exercise, and medications so you can achieve your blood glucose control goals. People with diabetes know that monitoring blood sugar is important, yet they resist doing it and for valid reasons. Here are some common reasons people give for not testing as often as the doctor recommends:
- It hurts to poke my fingers.
- My fingers get sore and calloused.
- It is difficult to get a good drop of blood.
- I have trouble finding the blood drop.
- I waste a lot of test strips trying to get an accurate reading.
- The test strips are expensive. My insurance will pay only for so many strips.
Monitoring: the First Steps
As with learning any new skill, it is important to have the right equipment, instruction, and support. With practice, blood sugar monitoring can become a quick and routine procedure which helps manage blood sugar and avoid the complications of diabetes.
Selecting an Appropriate Glucose Meter
Begin by asking your doctor or diabetic educator which glucose meter would be best for you. There are many models available that include accessibility features like larger screens, tactile buttons, speech output, and lighted backgrounds.
Insurance providers have “preferred” equipment lists. Sometimes, your doctor can write a letter of “medical necessity,” documenting reasons you may require a certain type of glucose meter and insurers will make an exception. For instance, if you have vision impairment or neuropathy of the fingers, you may need a specialized model. Learn more about glucose meters and their accessibility features at ADA Consumer Guide (diabetes.org).
Learn Techniques for Self-Monitoring
Next, you want to be sure you have learned proper techniques for self-monitoring and that you have not developed bad habits over time. Ask for instruction when you visit your doctor’s office. Ask your doctor to evaluate your technique and compare your result against the blood draw that is sent to the lab to check your meter for accuracy. I have heard of newly diagnosed patients who were handed a glucose meter in a box and sent home without any instruction. This is unacceptable. Patients need to ask for proper instruction.
While you are learning this new skill, you may need support from family, friends, or other caregivers. It is a good idea to have someone learn along with you so they can give assistance while you perfect your method and act as a backup in times of illness, stress, or when troubleshooting is needed. Contact a vision rehabilitation therapist to learn ways to adapt your technique if you are experiencing vision changes. Consider reaching out to your local American Diabetes Association (ADA) office to inquire about workshops, events, and check out support groups in your area. Good Rx also offers a list of where to find support groups.
Find Step-by-step Instructions and Comprehensive Overview of Blood Sugar Monitoring:
Tips to Help Make Blood Sugar Testing More Successful
- Choosing the site. Develop a method of rotating your fingers so they do not get poked as often. One method is to begin with the left first finger on Monday, second finger on Tuesday and third finger on Wednesday. Move to your right first finger on Thursday, second finger on Friday and third finger on Saturday. For Sundays, use the baby fingers. You can also rotate the sides of the fingers; the side facing the thumb for morning and the pinky side for evening. This gives your fingers a chance to heal, avoiding soreness and callouses.
- Getting the blood drop. Increase the blood flow to the site by washing your hands with soap in warm water. Then hang your hand down and shake it a couple of times. Massage your finger to warm it up. This helps bring blood to the fingertip so you can obtain an adequate blood drop to test. If you still have trouble getting a good-sized drop of blood, you may want to try wrapping a rubber band around the middle joint of the finger, holding the band in place with your thumb – like a tourniquet. After poking the finger, release the rubber band so blood will fill the fingertip and the site will bleed. Don’t squeeze the site; “milk” the finger gently instead.
- Finding the blood drop. Poke the finger along the sides, avoiding the finger pads. There are fewer nerve endings and more blood vessels on the sides. If you have trouble seeing the drop of blood, it will be easier to find if you use the sides of the fingers and visualize where the puncture site is in relation to the nail bed. Usually, a slow scooping motion, with the strip in the meter, along the side of the finger will find the drop of blood. Check out the Thumb Guide Technique to learn another method to find the drop.
- Using the right lancing technique. Adjust the lancing device to the right depth and purchase lancets with the smallest-sized needle that gets the job done. The larger the gauge of the needle, the smaller it is in size. Most blood glucose strips now require micro amounts of blood, so there is no need for large, deep sticks. Ask your pharmacist or diabetic educator for a few lancet samples so you can experiment to figure out the best size and depth for you.
- Knowing when to test. Talk with your doctor about how often you need to test your blood sugar. Since not everyone needs to do it as frequently, determine “the bare minimum” of tests you need to perform. You may also want to “pair the readings,” such as before and after meals or an activity, so the results give you more information about how your blood sugar responds to various factors. In this way, fewer tests may be needed.
- Ensuring accuracy. Meters are designed to detect errors in testing and give feedback. Be familiar with your meter error messages so you can correct them. Avoiding errors means fewer finger sticks and fewer strips wasted. The Food and Drug Administration offers information about meters and the most common testing errors at Blood Glucose Monitoring Devices.
- Working with Your Insurance Provider. Insurers cover blood sugar testing supplies under the durable medical equipment policy. This includes prescription items ordered by your doctor for home use. If you require a special type of meter and strips, or more strips than are allowed monthly on the policy, you can ask your doctor to fill out the medical necessity form and send documentation as evidence to support your request for the insurance to make an exception. Generally, insurance companies have rules to provide what is “medically necessary” or an appropriate substitute. Also, co-pays for test strips are often less if you use a mail-order service instead of a retail pharmacy. Check with your insurer about this option. Supplies are conveniently delivered to your home and are cheaper.
- Getting help through Accessible Pharmacy. Accessible Pharmacy is a mail-order pharmacy designed for blind or low vision individuals. They provide phone and video education/ medication identification through the Be My Eyes app, packaging options, and can supply continuous glucose monitors (CGMs) (Freestyle Libre and Dexcom 6) and Prodigy talking glucometers as well as service animal medications. Contact them at 215.799.9900.
Saving Money on Supplies and Insulin
During the past few years, the burden of diabetes expenses has increased for the patient in the form of higher co-pays and higher deductibles. Though testing supplies are a smaller expense in comparison, there are ways to cut costs. Check out CDC’s recommendations and what Medicare will cover with its new benefit for insulin: “Plans can’t charge you more than $35 for a one-month supply of each Medicare Part D-covered insulin you take, and can’t charge you a deductible for insulin.”