Ask D’Mine: Sleazy Advertising, Insulin Embarrassment

Welcome back to our spankin’ new diabetes advice column, Ask D’Mine. We just kicked off this series last week, and we’re already getting lots of queries — so thank you, Curious PWDs! As a reminder:

This is a place to send all your quirky or potentially embarrassing questions, behind-the-scenes curiosities, lifestyle queries, or even ethical dilemmas related to life with the Big D.

“Need help navigating life with diabetes? Email us at AskDMine@diabetesmine.com“

And now, to your host, veteran type 1, diabetes author and community educator Wil Dubois:

Frank from Arkansas, a type 2, asks: I saw on TV that there is some sort of meter that can check your blood sugar without poking your finger. Is this for real? I pray so! Poking my finger hurts so much I hate to test!

Wil @Ask D’Mine answers: Sorry. You’re the victim of sleazy advertising. The dream of “non invasive testing” has cast dozens companies onto the rocks of bankruptcy. Testing blood sugar while leaving the skin intact, while theoretically possible, is proving darn tricky. Bottom line, today there’s no meter available that doesn’t require poking a hole in your epidermis.

So what about the ad you saw? Well, it’s a half-truth. You don’t have to tear a hole in your finger. Instead, you have to tear a hole in your arm. Lately, especially on late night TV, Medicare suppliers of various stripes have been stretching the truth to gain market share. The fact of the matter is that most meters in the US are FDA approved for what is called “alternate site testing,” which allows for taking samples from the forearm, upper arm, thigh, calf, or palm all of which are supposed to be less painful because these areas have fewer nerve endings.

Some caveats, however. First, alternate site testing is old news. For reasons too obscure and complicated to detail here, the blood samples in the alternate sites reflect where the blood sugar in your brain was about 20-30 minutes ago, and it’s the flow of sugar to the brain that keeps the lights on (or shuts them off). This is why all the meter makers urge you to check using your fingertips if you think your blood sugar is low or dropping. My feeling is why get into bad habits in the first place?

Alternate site testing can also be a figurative pain in the ass, even though it saves you from having a pain in the finger. Testing on your forearm requires a ritual that vaguely resembles the Macarena dance. You need to briskly rub your skin to develop friction, bringing blood to the surface. You then poke a pretty deep hole in your skin with a lance that has a clear cap. You pump the lance up and down, like milking a cow, until you see a large enough blood drop to test from. Then you lift the lance straight up being careful not to smear the blood drop.

Oh. And you’ll most likely get a bruise. If you test a lot the cops will be checking your car for illegal drugs when you get stopped for speeding. You know, ‘cause of the track marks on your arm.

But, before we run out of space, let’s switch gears and talk about the pain you are suffering. Done correctly, fingertip testing really shouldn’t hurt that much, and there are three things that are responsible for 90% of testing pain.

One. Is the clear cap on your lancing device? If so, put the solid one on right now. The clear one is for those alternate sites and it lets the needle go waaaaaaaaaay deeper than you need on your fingertip.

Two. The lancing device has some sort of dial or a twisty cap with numbers. The higher the number the deeper the needle goes. “1” is for little children or well-to-do heiresses who’ve never worked a day in their lives. “8” is for Canadian Lumber Jacks. I’m guessing you might not fit into either category and need to be in the middle somewhere. Choose a number that gets you a nice blood drop with a gentle squeeze of the finger. If you are pumping your finger and praying for blood, you need a higher number. If you are using language that would make a special forces commando blush you need a lower number.

Three. Sooooooooo….. When was the last time you changed the lancing needle? Oh really? The same day you changed your smoke detector batteries? Well here’s the deal. You don’t really need to change them every time you test, like the folks who want to sell you more lancing needles advise. But neither should you over-use them. Skin is tough. It will make the needle dull over time. Me? I change my needles when testing starts to hurt just a little bit. Then I know the lance is getting dull. Some folks get a day out of a lance. Some a week. Some a month. It depends on how tough your hide is and how many times per day you test.

So bottom line, there’s no magic meter that you can wave at your skin and divine your blood sugar. Not yet. Sorry, you’re a person with diabetes. Ya gotta test. But that said, it shouldn’t be torture. Work with your gear and find the settings that get you the best results: tiny bit of blood for a tiny bit of pain.

Jennie from New Jersey, a type 1, asks: I’m embarrassed to take my insulin in public. Does Ask D’Mine have any suggestions?

Wil @AskD’Mine answers: First off, who gives a s—t what other people think? If someone looks at you funny because you took a shot that’s THEIR problem. You are doing what is necessary to keep yourself healthy. There’s nothing wrong with that, and you should be proud that you have your priorities straight. If you were skipping your insulin in public because you worry about what strangers think, then YOU have a serious problem.

But I do have a few tools for you to employ. In a perfect world, you’d recall that as a PWD you are also an ambassador and you’d embrace the opportunity to educate the ignorant fool that looked at you funny, so that person would leave educated about diabetes and improved as a human being. But of course, your soup is getting cold.

You can always fall back on humor. If someone sees you inject and looks at you funny, make eye contact and just say “I’m just having the worst time kicking this heroin habit.” That’ll pretty much be the end of the conversation.

If neither of those suggestions feel like a good fit for you I want you to ask your doctor for an insulin pen. Lots of insurance plans don’t like to pay for pens ‘cause they cost, I dunno, like 25¢ more than a vial, but you can probably get at least partial coverage—enough for public injections.

All the various fast-acting insulins for meal coverage are available in disposable pens. The business end of the pen uses a pen needle—a tiny little screw-on hub with a short thin needle. The back end of the pen has a dial to select the appropriate dosage. The whole thing is pre-filled with 300 units of joy juice and is disposable. To inject, just pull the cap off, screw on a needle (you can do that part in advance at home), dial your dose and shoot up. It’s even safe to shoot through your shirt. The whole operation can take place under the table with no one the wiser. Even your table mates will likely miss the action.

So eat, drink, and be merry. But take your damn insulin.

Disclaimer: This is not a medical advice column. We are PWDs freely and openly sharing the wisdom of our collected experiences — our been-there-done-that knowledge from the trenches. But we are not MDs, RNs, NPs, PAs, CDEs, or partridges in pear trees. Bottom line: we are only a small part of your total prescription. You still need the professional advice, treatment, and care of a licensed medical professional.