#and writes newspaper advice columns under your name and uses that act of giving advice from your perspective to pull himself together

[specialagentartemis]

Pack it in folks somebody tagged this with the ship that is so popular and so straightforwardly romantic somebody on twitter asked Richard Siken if his poetry was about it

“whatever the fuck these two characters had going on” is a vastly underrated character dynamic

[type2diabetestreatments-blog]

Ask D'Mine: Alternate Testing Sites, Bolus Timing for Exercise

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Ask D'Mine: Alternate Testing Sites, Bolus Timing for Exercise

Diabetes is complicated... Just look at today's post header! If you weren't a PWD, would you have any idea what that meant? No wonder we never run out of questions!

And thank goodness for that, we say here at Ask D'Mine, our weekly quirky diabetes advice column, hosted by veteran type 1, diabetes author and community educator Wil Dubois.

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

Kayla from Alabama, type 2 writes: I have a Freestyle Lite meter, but my fingers are getting really sore. I do alternate fingers, but I have no clue of where a good spot would be to test as an alternative. Any suggestions of where to get an accurate reading without too much pain?

Wil@Ask D'Mine answers: Diabetes isn't supposed to hurt. Actually, it's too bad it doesn't, because if it hurt when we didn't keep our blood sugar in control, we'd all be doing a lot better job!

But if your fingers are sore, there's a 90% chance that you're not pricking them right. So let me run though my sore finger checklist with you:

First, is the clear cap on the lancing device? The reason I ask is that the Freestyle lancing devices have two caps, one clear, and one either solid grey or solid blue. The solid cap is your fingerstick cap and the clear cap is your "alternate site" cap. Alternate sites, such as forearms, require deeper stabs by the lancing needle, so the clear cap is designed for deep stabs. If you use the clear cap on your fingertip it will always hurt like hell.

Next, there's a little wheel with numbers on it. In your case, they're 1 through 4. Some lancing devices run 1 to 8. Anyway, the higher the number the deeper the stab. The lower the number, the shallower the stab. The idea is to get a Goldilocks "just right" stab that's not too deep nor too shallow. Too shallow is detected by much finger milking and praying under your breath (please God, give me some blood, I don't want to have to stab myself again). Too deep is detected by significant use of language typical of sailors. So you should be able to easily get a small blood drop with a gentle squeeze, with little to no pain, and no swearing. Unless you just like to frickin' swear, damn it.

Be sure to hold the device against your finger with a steady pressure. If you sometimes mash it to the bone and other times hold it so it barley touches the skin, you'll never get the right number.

Play around with the bull's-eye. Some folks lance the center pad of their finger. Others the tippy-top, others still, the side. Any of those are fine, and most people find some areas more sensitive than others. Do not get a favorite finger (it'll be overused!), and be warned that for most people, the pinkie seems to be more pain-prone than the other fingers. I always find myself swearing when I prick my little finger.

Oh. Wait. I swear all the time anyway, don't I?

Now, the lancing needles that come in the device vary in size. The larger the number, or gauge, the smaller the needle. In theory, smaller needles hurt less, but they also get dull faster and need to be changed more often. The good folks at LifeScan recently introduced a new frontier in small needles with the ultra-thin Delica.

Speaking of which...When was the last time you changed your lancing needle? Oh really? Last year when you changed your smoke detector batteries? OK, here's the deal, the folks that make the needles tell you to change them every time you test, but that's not really necessary. On the other side of the coin, some of us are overly lazy about replacing them. After all, it takes so long to do (not). My advice is to change the needle when you notice it's starting to hurt you, bearing in mind that done right, this whole finger-stabbing thing shouldn't be hurting very much at all in the first place!

If all of those things check out, and you still have sore fingers, then you're in the 10% of people who just have super-sensitive fingers, and, yeah, you might need to use an alternate site. You should first try your upper palm, upstream from your thumb. Next, most folks prefer the forearm.

But be warned, it isn't that alternate sites aren't accurate, it's just that they're old news. The blood sugar there doesn't really reflect the level of glucose in the blood that's keeping the lights on in your head. This can be dangerous if your blood sugar is dropping rapidly.

Imagine the scene. You get that the-elevator-cables-just-snapped feeling. Your hands are a little shaky. You check your blood sugar. It seems fine, so you duck outside in your undies really quickly to grab the morning newspaper and wake up lying on the ground (still in your undies) surrounded by fireman and paramedics.

This kind of thing happens more often than you'd think. Just ask the next fireman you bump into.

Even the folks who make the meters have small print in their user guides that warns "be sure to not use alternate sites if you suspect hypoglycemia and don't sue us if you wake up in your undies surrounded by firemen," or words to that effect.

My feeling? We're creatures of habit in the best of circumstances, and when our blood sugar is dropping we're most definitely not in the best of circumstances. When the shit hits the fan, we tend to fall back on our established habits. If using an alternate site is your habit, then you'll do it the one time you really shouldn't.

And that can be dangerous.

Luke from Ireland, type 1, writes: I was diagnosed with type one just over 6 weeks ago. I am 18 and have just started college. I love to exercise and due to my schedule I tend to to exercise at around 7:00 p.m., usually halving my fast-acting insulin with my dinner two hours previous. I have noticed as I've increased the intensity of my workout that my BG is normal straight after exercise, so I will then have an apple. But later my BG is very high. I have been afraid to bolus for these highs so close to bed in case of going low during the night. How long after I exercise should I wait to take a correction bolus?

Wil@Ask D'Mine answers: So you're asking me how long after the barn burns down that you should wait to let the horse out? Is that it?

Sorry, I shouldn't be so snarky, I know you're new to the family. Here's the deal: You're off to a great start, and you understand that your workout could lower your blood sugar. The problem is that you're compensating for it twice. First you're under-bolusing your dinner, and then you aren't bolusing at all for your snack. That's putting way too many carbs in your system with no insulin to get rid of them. Which is why you're needing corrections by bedtime.

The question shouldn't be when to take your correction, but how to avoid needing a correction in the first place. That's the name of the game. (Oh, and before everyone flames me in comments, of course, corrections are part and parcel of juggling insulin, carbs, and life. BUT, if you need a correction at the same time everyday, you've got a therapy problem that needs to be fixed.)

What we're all trying to do is keep one step ahead of the blood sugar. We take insulin before we eat to try to keep the blood sugar from going up. We reduce insulin before exercise to try and keep the blood sugar from going down.

Looking at what you're telling me about the pattern of your blood sugar, it seems that cutting the dinner bolus in half is a great call on your part. Combined with your exercise, your blood sugar is nice and rock steady. But then you eat an apple with no insulin and your blood sugar goes through the roof. I think you should bolus for the apple. Even if your sugar is a hair low when you eat your snack, this is perfectly safe to do. The sugar in the apple will likely out-pace your insulin anyway. The insulin starts working in 15 to 20 minutes and won't peak for two hours.

I think if you do this, you won't be "very high" close to bedtime, and hopefully you won't need a correction shot at all — or if you do, it would be a lot smaller, and then you won't have to fret over the whole go-low-in-the-night thing, which is officially scary.

I wasn't sure exactly when you eat the apple, or when your bedtime is, but the first couple of times you try this, go ahead and set an alarm for the middle of the night to check your blood sugar. I'd choose about three-and-a-half hours after taking your snack shot. In most folks that's prime time for hypos. Modern fast-acting insulins pretty much run their course in four hours. If you're safely within target at that point, your odds of going low from the shot are pretty remote.

Yeah, setting an alarm will disturb your sleep, but you'll sleep a lot better knowing that you'll wake up the next day.

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.

Disclaimer: Content created by the Diabetes Mine team. For more details click here.

Disclaimer

This content is created for Diabetes Mine, a consumer health blog focused on the diabetes community. The content is not medically reviewed and doesn't adhere to Healthline's editorial guidelines. For more information about Healthline's partnership with Diabetes Mine, please click here.

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