How do i know if my diabetes is under control?

You make tests. There are three kinds of tests you can make in your own home. We'll list them the way some mail order catalogs list their products: good, better, best.

Good urine testing

For years this has been the way most diabetics have checked on how well they were managing their diabetes. You test the amount of sugar in your urine. If you have no sugar, then the assumption is that your blood sugar has remained normal, because if it hadn't, sugar would have spilled over into your urine.

If there is sugar, the assumption is that your blood sugar was above normal at some time during the previous hours. The test shows the amount of sugar and this is supposed to indicate how high your blood sugar was and may still be.

Urine testing for insulin dependent diabetics is usually recommended four times a day before meals and at bedtime. Other diabetics can often get by on one test two hours after the largest meal of the day.

There are three products you can use for urine testing:

1. Clinitest. 

These are little tablets you put in a test tube. You collect a specimen of urine and put in two or five drops (there are two methods to choose from) with an eyedropper. You add ten drops of water. Then you drop in a tablet. After the liquid finishes boiling, you wait fifteen seconds before comparing the color with a chart. The color remains dark blue (negative) or changes to green or gold or orange, depending on the percentage of sugar in the urine. If during the fifteen second wait the color passes through the entire spectrum and ends up a dark greenish brown, the percentage of sugar is greater than the test can measure. The two drop method is more accurate for higher ranges of blood sugar.

Clinitest is the most troublesome but also the most accurate way to test for sugar in your urine. It is most often recommended for insulin dependent diabetics (the two drop method).

2. Diastix. 

These are plastic sticks with a chemical testing area at the end. You can either dip the stick into a sample of urine or hold it in the stream of urine. Wait thirty seconds and compare the color of the stick tip with the color blocks on the container. The colors change from aqua (negative) to brown.

3. Tes-Tape. 

This is a roll of chemically treated tape. You tear off a piece and either dip it into a urine specimen or hold it in the stream. In one minute the strip either stays yellow (negative) or it changes to darkening shades of green, depending on the amount of sugar in the urine. If it stops at one-half percent (3+) at the end of this minute, then wait another minute before deciding on the amount of sugar.

The advantages of urine testing are its relatively low cost and its convenience. It's by far the least expensive of the testing methods. With Diastix and Tes-Tape you can make the tests quickly and easily whenever you're in a restroom.

The disadvantages of urine testing are several. The testing materials can give inaccurate results if affected by moisture or certain drugs you may be taking, such as vitamin C, some types of antibiotics, and aspirin. Even the amount of water you've been drinking can affect the reading. If you've been drinking a lot of water, the percetage of sugar in the urine will appear to be less than it really is.

Also remember that we said that many people, especially older people, have a high renal threshold. Their blood sugar has to be extremely high before the kidneys let sugar spill into their urine and register on a urine test. Conversely, children often have a very low threshold, and it looks as if they have very high blood sugar, when actually it's only slightly high or even normal.

Another main problem with urine tests is that they can only tell you if your blood sugar is high. If no sugar shows on a urine test, you don't know if your blood sugar is normal or low. With insulin dependent diabetics it's just as important to know if blood sugar is too low as it is to know if it's too high. As a matter of fact, urine testing doesn't even show you what your blood sugar is at the moment that you make the test. If you have a positive test for sugar, you only know that your blood sugar was high. You only know past history. Naturally, it's good to know whether you've been in control or not, but, especially for insulin takers, the information can be deceptive and dangerous. They might assume their blood sugar is high after a positive urine test, when in reality it could have already fallen low and they could need to eat something to bring it up.

Some doctors and nurses believe that if you take what's called a second void, the urine test is more accurate. A second void means you urinate once without testing and then half an hour later you urinate again and do the test from that. This test usually reflects blood sugar one half to one hour before. Recent studies, however, have somewhat discredited this theory. They show that accuracy is improved very little, if at all, by the second void method.

Another disadvantage of urine testing is that people don't enjoy fiddling around with their urine. It's just not an aesthetically pleasing activity and some diabetics find it positively degrading. At best, you have to keep your sense of humor operative.

Better home blood sugar testing with Chemstrips bG or Dextrostix 

The new, improved way of finding out if you're in control is by testing your blood sugar. The advantage of accuracy in this is obvious: The test tells if your blood sugar itself is low or normal or high, and it tells you what it is at the very moment you take it. As San Francisco diabetologist Dr. Michael Rubin says, it's the difference between a person and the shadow of a person. The blood sugar test is the person, the urine test merely a shadow.

We ourselves are more enthusiastic about home blood sugar testing than we are about any recent development in diabetes care. We agree totally with Dr. Michael Etzwiler, Director of the Diabetes Education Center in Minneapolis, Minnesota, who considers home blood sugar testing such an important tool in the management of diabetes that ". . . we can anticipate that perhaps by 1985 urine testing by diabetic patients will be a thing of the past."

Previously the only way you could have a blood sugar test was in a doctor's office or hospital. Now it's possible to do it at home by pricking your finger to get a drop of blood and putting it on a chemical agent at the end of a stick. You read the results by matching the color on the end of the stick to a color chart printed on the side of the container of the sticks. The two kinds of sticks currently available for this purpose are Chemstrips bG and Dextrostix. Chemstrips bG (Figure 1) are easier to read since they have two colors to match (beige and turquoise) instead ofjust one; and Chemstrips bG, unlike Dextrostix, are wiped off with cotton instead of being rinsed with water so you can test yourself anywhere. (June has done it sitting in an airplane or riding as a passenger in a car.)
You can easily see one of the disadvantages of testing your blood sugar getting the drop of blood from your finger. Nobody likes to jab a finger with a needle or one of those little bloodletting blades called lancets. Fortunately, there is a new device to help get the blood. It's called the Autolet (Figure 2). Using it, you can press a button and automatically and almost painlessly get the sample of blood you need.
Another disadvantage to home blood sugar testing is the cost. As of this writing Autolets cost $25.00 and each time you use a stick it currently costs between forty two cents and seventy five cents, depending on where you buy them. And even at high prices, it's not always easy to find blood sugar testing sticks and Autolets.'(If your pharmacy doesn't stock them, they are available from the Sugarfree Center.)

It's also difficult for some diabetics, especially those with vision problems, to read the colors accurately. (With Chemstrips bG we suggest you judge primarily by the bottom color, turquoise, for below normal blood sugars and by the top color, beige, for above normal blood sugars because it is easier to distinguish the variations in those colors in those ranges.) Generally, however, you have no problem deciding whether your blood sugar is low or high or in the normal range, and that's usually enough to know. If you need to know your exact blood sugar, say within five or ten points of accuracy, you have to use the best way of testing.

Best home blood sugar testing with sticks and a meter 

It's possible to buy a meter into which you insert a stick after putting a blood sample on it. The meter then gives you a specific readout, the kind you formerly could only get by going to your doctor's office or a hospital laboratory. With a meter you can know exactly what your blood sugar is at any given moment and you can gear your management plan to the facts rather than to guesswork. For pregnant diabetics, for diabetics with high or low urine thresholds, and for insulin dependent diabetics who have mysterious swings of blood sugar, or, as a matter of fact, for any diabetic, the meter can make the difference between feeling good and feeling bad, between feeling defeated and feeling victorious, and as more and more doctors are coming to believe, between developing complications and being free of them.

The meters now available are manufactured by the same firms that market the sticks, the Ames Company of Elkhart, Indiana and Bio Dynamics of Indianapolis, Indiana. There are now three generations of meters in the Ames family but still only one in the Bio Dynamics family.

Ames meters

Eyetone reflectance colorimeter. This is the first generation and the one that June first owned. It weighs 23/4 pounds and measures 71/4 inches long, 41/2 inches wide, and 2 inches high. This machine served June well. Though plugged into the electricity for over two years, it was still going strong when June switched to a later model.

Different bottles of Dextrostix have slight variations in how they react to the blood sample, so for accuracy, each time a new bottle is opened, the machine must be calibrated (adjusted) to that particular bottle of sticks. A simplified and accurate way to calibrate it is described in Richard K. Bernstein's book, Diabetes: The Glucograf Method for Normalizing Blood Sugar. The Eyetone is no longer being manufactured, but you may be able to locate a used one through your Ames representative or an individual, and at a price considerably less than the later models.

Dextrometer. 

This is the second generation and the machine that is currently on the market. It weighs 131/2 ounces and measures 61/4 inches long, 31/8 inches wide, and 11/2 inches high. It has a battery pack, which allows you to carry it with you and use it when you're away from home. The problem with using it on batteries is that it must be calibrated each time you turn it on. This means using two Dextrostix for each blood sugar you take. If you keep it plugged into the electricity, this disadvantage is overcome. The Dextrometer costs $275; the battery pack is $35 extra. (See Figure 3.)

Glucometer. 

This, the third generation, is now available only in England, but will be coming onto the American market in 1982. It is only 31/4 inches long, 65/8 inches wide and 15/6 inches high and weighs 12 ounces with batteries. (It operates only on batteries; you can't plug it in.) You can carry it in an overcoat pocket or a purse. And best of all, it can store its calibration in its memory even when turned off. (See Figure 3.)

According to an Ames representative we talked with, the Glucometer is the first meter truly designed with the diabetic in mind instead of laboratories and doctors' offices. June has been using an English model of it and considers it a marvel. It beeps to tell you when to put your drop of blood on the strip and beeps again to tell you when to wash it off. It's such a perfect gem of a little machine that she thinks she'd like to marry it. In fact, in a sense she already has.

We'll let a diabetic laboratory technician we know, Dixie Starkovich of Redondo Beach, California, have the final word on blood sugar testing. Dixie did a comparison of home blood sugar monitoring methods. She took thirty blood sugars using Chemstrips bG and compared her results with readings on a Dextrometer, a StatTek meter, and the Coulter serum blood testing method used by laboratories.

Dixie told us that she is extremely impressed with how accurate and close to each other all methods of checking blood sugar are. Her conclusion is that if you have good color vision, you can do just as well with Chemstrips bG as with meters. You have to remember, of course, that Dixie has a laboratory trained eye for reading color changes. She also has scientific objectivity. Some diabetics, when dealing with their own blood sugar, tend to invariably read Chemstrips bG higher or lower than they really are, either out of worry or wishful thinking.

Bio-dynamics meter

StatTek. 

This meter is made by the same firm that makes Chemstrips bG, but it cannot give readings from them. Special strips called "StatTek glucose test strips" are required. The StatTek has been used by laboratories for many years, but only recently was its price lowered enough to put it in competition with the Ames meters. It now costs $375. It weighs 21/4 pounds and is 81/2 inches long, 53/4. inches wide, and 4 inches high. There is no battery pack available. Calibration is simple, but without a special adapter kit the meter only registers blood sugar from 40 to 350. (The Ames meters register to 400.)

We have heard that Bio-Dynamics is about to burst onto the scene with a new machine comparable to the Glucometer. Watch for it.

What June does is test her blood sugar with her meter at home; she uses Chemstrips bG without the meter when she's away from home. That way she has the best of both worlds.

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