From Buffalo, New York, USA:
A new student in my school has an insulin pump, tested his blood sugar this morning because he was "not feeling well", and told me his numbers were 260-375 mg/dl [14.4-20.8 mmol/L] even after a bolus of 5 units of Humalog. When I checked the memory in his meter I got very different readings. I checked the meter when he brought it in this morning, and the number in the memory was 127 mg/dl [7.1 mmol/L]. The numbers after that were 123 mg/dl [6.8 mmol/L], 132 mg/dl [7.3 mmol/L] and 245 mg/dl [13.6 mmol/L], so I know that these were the numbers he got after he arrived in school today. Could there be a problem with the meter memory? I know there is some kind of test to check the accuracy. Could you refresh my memory?
Well, offhand I can think of several possible explanations, in no particular order:
- This student is lying -- the trick is to try to understand any secondary gain he might get for providing false information;
- Meter problem: Some meters must have the day and date reset after a spent battery. Values appear, but they are not "correlated" to a specific day and time. The value is probably correct, but you have no way to trace the specifics. The strips for the various meters come with some sort of "control" to assure proper calibration. Some meters have a special code to punch into the meter with new strips; others have a special computer chip; other meters have a testing solution. I can't give better advice without knowing which meter and strip the student uses, but there is likely an 800 number on the back of the meter to call with questions.
- Sample problem: Too little blood, excess alcohol on finger, and other issues can corrupt the glucose reading.
I'm sure there are other possibilities. When faced with these types of dilemmas, I find it best to review the basics, with attention to completely proper technique and avoiding any "short-cuts."
Additional comments from Dr. Larry Deeb:Interesting. I did some of the original work with memory meters. Then we had problems with patients writing lower numbers in logs, only to discover higher numbers in the meter. Here they were trying to please the doctors. I wonder if the child is high that he/she might get special attention/favors etc at school.. Not surprising that could happen. My best guess is the meter memory is correct and the truth is there just not in the verbal reports. I still see computer downloads that disagree with the patient log, especially when the patient doesn't realize I can see the data. This is one of the major advantages of the pump. I can see every insulin dose...surprising the "forgotten" boluses. I shudder to think of the forgotten shots. Diabetes is a difficult and non forgiving partner...always there and always demanding attention.
Additional comments from Stephanie Schwartz, diabetes nurse specialist:I doubt it is a meter problem at all. My guess is that this young man, if he is new to the school, is feeling very lost and insecure in his new environment. I'd take time to talk to him and find out what's really on his mind.
Last Updated: Tuesday April 06, 2010 15:09:40
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