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What do blood glucose numbers mean? – with Marilyn Konezny, February 29, 2012
 Marilyn@Unity:
 Welcome to the Unity Diabetes Online Community! I’m Marilyn Konezny. I’m glad you could join us for our latest online chat today. I’ll be examining what blood glucose numbers mean and pattern management.
RULES
Before we get started let me just tell you how we’ll address your questions and comments today. I answer questions one at a time, in the order that they are posted to the site, and there might be a slight delay as I respond to each question.
 
 Marilyn@Unity:
 It may take a few minutes for me to type answers to your questions, so please stay logged-in to the chat to see my response, even if it takes a few minutes. And you might need to refresh every few minutes to keep up with the latest posts in the chat if you switch to another application on your computer. Also, if you have questions not directly related to tonight’s topic, feel free to ask – we want this session to benefit you in any way possible! Let’s get started.
 sassy35:
 Is it better to test on your arm or fingertip? I've been told to do it both ways.
 lucyblue:
 Hi Marilyn, when should I be checking by blood sugar and what are good numbers?
 Marilyn@Unity:
 You can test either site. The arm is known as "alternate site.” There is a LAG time between the arm and the fingertip, so if BGs are changing – i.e. after a meal, after taking medication, after eating, etc., the arm and fingertip reading may be significantly different.
 Marilyn@Unity:
 If you routinely test the arm, but are having low blood sugar symptoms, you MUST test fingertips as this is more accurate. The arm reading may show a higher BG result because of the lag time.
 lucyblue:
 Sometimes when I check my blood sugar I get one number and if I check a minute later in the same finger it is significantly different, is my meter working properly?
 Marilyn@Unity:
 Follow your doctor's recommendations for testing. Testing before meals may be important if you are using insulin and need to determine how much to inject. Some people like to test after the meal to see the effect of the food they ate; some test at bedtime and then in the morning before breakfast to see what is happening overnight with the BG.
 Marilyn@Unity:
 BG goals according to the American Diabetes Association are fasting (before meals) 70-130 and 2 hours after the meal 70-180. Before bed BGs should be 100-140. BG goals are very individualized to the person and should be discussed with your doctor.
 sassy35:
 I'm just curious – why do they tell you to test your arm if it's less accurate that the fingertip?
 Marilyn@Unity
 Hi Lucy – Remember your blood constantly moves through your body so you are not testing the same blood every time. We get 'pockets' of sugar in the blood – kind of like when you were a kid in the swimming pool and walked around to find the warm spot of water to stand in. The blood flowing through us is sort of the same thing.
 Marilyn@Unity
 Meters also can vary in results so don't compare results between meters. Meters are currently allowed to have a 20% variability; this can be a significant difference, especially if the BG is high. Test on the same meter and preferably on ONE meter.
 Marilyn@Unity
 Most meters have download capabilities and the chart information available can be very useful in looking at the overall BG control, showing patterns or trends, to help manage BG control. This is why the recommendation to use only 1 meter. You can't see the overall BG pattern if several meters are used.
 aaron:
 Most meters come with a test solution to check your meter’s accuracy.
 sassy35:
 What's the best kind of meter to use?
 lucyblue:
 I always wondered about the test solution – how does it work?
 Marilyn@Unity:
 Hi Aaron! Yes, some meters do come with control solutions. If your meter comes with solution, it is recommended you check the first strip out of a new bottle before using those test strips. The control solution checks the validity of the strips. If your control result is not within range, most meters rec. checking 2 additional strips; both have to be in range or do not use the bottle of strips. Call the meter company – # on back of meter and discuss with them.
 Marilyn@Unity:
 Sassy35 – All the meters are good; they usually will have specific features that may be better for you – larger test strips, brighter screen, talking meter, etc. Lancing devices can also vary.
 aaron:
 Love my freestyle lite!
 sassy35:
 Aaron – what do you like about it?
 Marilyn@Unity:
 Aaron – good meter!
 Marilyn@Unity:
 Good question. Aaron – can you tell sassy why you like it?
 aaron:
 Small, downloads info, no codes, lance device works great on my "testing calluses" and only a small amount of blood needed for a test.
 Marilyn@Unity:
 Thanks Aaron. It is a nice meter for all the reasons Aaron stated. My question is why do you have testing calluses? Do you change finger sites?
 sassy35:
 Thanks – that's helpful!
 Marilyn@Unity:
 While we're talking about finger testing, here are some helpful tips (no pun intended).
 aaron:
 I have been type 2 for a little over 10 years. I test on both hands and rotate fingers but I test at least 6 times a day.
 Marilyn@Unity:
 Tip #1: Always clean your hands with soap/water, alcohol or hand sanitizer. I don't like to rec. the alcohol always as it tends to dry out the skin; sanitizers can leave a film and may interfere with the reading.
 lucyblue:
 Wow Aaron – that's a lot of testing. I am also type 2 and only test twice a day. Why do you test so often?
 Marilyn@Unity:
 WOW Aaron – I'm impressed!
 aaron:
 My average daily BG according to my meter is 118.
 Marilyn@Unity:
 Tip #2: Do not test fingertips or center of finger pads. Test on either side of the center where there are less nerve endings and hopefully less pain!
 aaron:
 When I stop testing my BG on a regular basis they trend up.
 lucyblue:
 That is an enviable avg. daily BG Aaron.
Marilyn@Unity:
 Good control Aaron!
 aaron:
 Keeps me honest.
 lucyblue:
 :) Yes, those numbers can't be ignored...
 Marilyn@Unity:
 Keeping focus on BG control is very important, I like to tell my patients that even though testing is a 'pain,’ it is your ROADMAP that tells you what is working and the effects of everything in your life – food, meds, stress, exercise...
 aaron:
 AMEN!
 lucyblue:
 That makes sense to me but sometimes my numbers sure don't make sense!
 aaron:
 My numbers will go up if I am sick or I eat simple carbs.
 lucyblue:
 I often wake up with too high BG in the morning, even if I ate well the night before – that doesn't make sense to me.
 aaron:
 Dawn effect?
 Marilyn@Unity:
 That is why you need to look at the patterns or trends. I am not as concerned about occasional 'hit or miss' #s that you can figure out a reason for – ate too much, no exercise, meds, illness, etc. It is the overall pattern that we need to address – maybe portions, timing of meals/meds, etc.
 lucyblue:
 What is “dawn effect”?
 aaron:
 Marilyn?
 Marilyn@Unity:
 Yep – "dawn phenomenon" – your brain cells constantly need glucose to function. Since you are sleeping and not eating (and please don't eat through the night unless treating a low BG!), your liver puts out stored glucose into the bloodstream.
 sassy35:
 I had that too – I finally had to start insulin at night before bed.
 Marilyn@Unity:
 You also have other hormones working in the early morning to help you wake up but these hormones work against insulin and BGs go up.
 Marilyn@Unity:
 Many people are insulin resistant in the early morning and need to limit their carb intake at breakfast. The other hormones wear off and by mid-morning your insulin is working better.
 sassy35:
 How many carbs do you recommend at breakfast?
 lucyblue:
 Is there anything I can do to bring my morning BG down?
 Marilyn@Unity:
 Sometimes I tell people to have a smaller breakfast and then include an AM snack.
  Marilyn@Unity:
 Sassy35 – that is very individualized. Bottom line is to try a small amount of something and check your BG either 2 hours later or before lunch and see if you are within goal range.
 aaron:
 Food log!
 Marilyn@Unity:
 @lucyblue – Some find if they add a higher fat (heart healthy) at bedtime snack, that will last longer through the night and help lessen the amount of sugar the liver puts out. Ideas are peanut butter on crackers or a small handful of nuts.
 aaron:
 Also help show how different foods affect BG.
 Marilyn@Unity:
 Food logs are great – keeps us honest but also helps with overall BG control.
 lucyblue:
 That sounds good.
sassy35:
 How close to bedtime should you have the snack?
 Marilyn@Unity:
 Foods affect everyone differently. Also, some brands of foods may give different BG results; combinations of foods, etc. Keeping track of the BGs and food log help you to modify diet if needed. 
 Marilyn@Unity:
 Sassy35 – Depends on your schedule/routine. I usually like a snack around 10PM if your schedule if "normal" – is there such a thing??
 Marilyn@Unity:
 Any other questions before wrap-up? Good luck to all of you in your BG control!
 aaron:
 Thanks Marilyn!
 lucyblue:
 Yes, Marilyn, very informative!
 Marilyn@Unity:
 You’re welcome! Thank you for joining in the chat. Keep up your food efforts and your great focus!
 Marilyn@Unity:
 That’s all the time we have for today. I’ve really enjoyed our conversation and hope that I was able to provide some insight for you. If we didn’t get to your question today or if you think of another question later on – feel free to jump into the conversation in the forum, or submit a question using our “Ask an expert” feature. Be sure to join us for our next chat Wednesday, March 14 at 7 p.m. with Joy Valvano and Sharon Spear who will discuss the benefits of exercise as it relates to diabetes.
 
 
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