Tuesday, May 10, 2011

Statistically Significant

The second prompt for Diabetes Blog Week asks us to write some kind of letter. The recipient can be real or fictitious - an endocrinologist, a pump or meter company, diabetes itself - or you can write a letter to yourself as a younger diabetic.

You know, my very first venture into the D-OC was my husband emailing me the link to Amy Tenderich's Open Letter to Steve Jobs in 2007.

I was in righteous agreement with her, shaking my head affirmatively as I considered how out of date and out of touch the technology behind our insulin pumps and meters and continuous monitors was.

Just last year, in a dinner with some engineers from Abbott concerning the Freestyle Navigator CGMS, I remarked how important I felt a dedicated backlight button was to a device like a CGM. The engineers seemed puzzled.

"How would you like it if every time your phone rang in the middle of the night, you had to sleepily figure out a complicated key sequence to get the backlight to turn on so you could see who was calling?" I asked.

"Oh," they answered.

Similarly, I described all of the other user-friendly options we wish we could see in our devices and they seemed dumbfounded. Timestamped data on the onboard graphs, a test strip port light, range enough that you can use a device while naked, battery life meters that actually measure actual battery life, and...most importantly...meter accuracy. Yes, meter ACCURACY - something companies compromised over a decade ago in the name of faster testing results.

I'm fed up with meter companies' mediocre attention to detail and lack of empathy for their patient customers. (Probably doesn't help my mood that I was on the phone fighting with Abbott yesterday morning about the Navigator CGMS's interminably indefinite "inventory interruption" that has had my transmitter backordered for over a year.)

So here is my letter.

Dear CGMS and meter engineers,

Do you know that I take a different dosage of insulin for a blood glucose value of 136 mg/dL than I do for a 145 mg/dL?

But that's not statistically significant, you reply.

Not to you maybe.

If your meters can be as much as 20% off of lab values (and more in some cases) and I have to base my dosing decisions upon incredibly loose data, how can I ever hope to achieve "normal" control?

If my blood sugar is actually 120 mg/dL and your device tells me that I'm 161 mg/dL, I inject insulin into my bloodstream that my body can neither use or dispose of and then I go low.

Will my medical team blame the meter I used? No. They will tell me I must not be reporting something or that my basal rates might be off or that I didn't wash my hands thoroughly before I tested. They will actually seem puzzled and ask, "Why did you go low here?"

It's never your fault, meter company, is it? You fly your little butterflies and American flags across my tv screen, brag of faster (but less accurate) results and new bright color options for my meter, tell me that coding is my biggest annoyance (really?), and that I can test from my arms (MUCH less accurate). You have smiling rock climbers, fishermen, grandparents...all with blood sugars of 104 mg/dL.

But you and I both know we can't rely on that number, don't we?

Sweetly Voiced


  1. AMEN! Love the butterfly comment too. :)

  2. Love it and totally agree! *nodding head in agreement* ;)

  3. Ha...coding isn't my biggest annoyance either. My dexcom going all ??? for 8 hours while I sleep is near the top though. Actually, the MM cgm saying I was 300 when I was 38 would be at the tippity top of the list.

  4. Having a hard time getting beyond the "range while naked" concept! lol it just made me giggle.

    Otherwise - right on! That we spend countless hours analyzing results which are so faulty to begin with defies reasoning, but it's all we have.

  5. Ha! How true. I hate issues with meter accuracy. Just yesterday we had a 350 which seemed very off, and upon retest, she was 202. Big, BIG difference. I want my $1 back, please.

  6. I hate testing Cara twice and getting 2 completely different numbers. which one is right? do I treat or not?

    I hear ya!!

  7. 4 strips in less than 4 minutes.

    I have tested my daughter when I got her up from her nap at 2pm for a late lunch. I wiped and dried her hands as I usually do. The the reading was 2.8 (50), I checked again 16.6 (299). They couldn't both be right. Yikes. So I tested again and again 3.7 & 3.5 (67 & 63).
    So she was low. Not too low. But the difference between the first 2 readings threw me.
    I don't know if she put her finger on or in something when my back was turned between the first 2 tests but it was weird. The other 2 tests were on her other hands.
    But even so I treat a 2.5 (50) differently from a 3.5(63). Not much but there is a difference.

  8. preach on, sister, preach on!

  9. I really really really hope at least one, if not all, of the meter companies read this awesome letter!!!!!