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Ground Control (Solution) to Major Tom.

Get in control.  Cheesy photo description, no?(That’s just a cool song and I’m in the mood for a little David Bowie.  Humor me.)

I’ve learned a lot in my frequent visits to the Joslin Clinic over the last six months or so, which just goes to show that it doesn’t matter how long you’ve had diabetes – there’s always something new to learn.  As I was preparing for pregnancy, there was a lot of focus on blood sugar control, and frequent monitoring.  That, I knew.

But what I didn’t realize was how often I should have been checking my meter with control solution.  

I have to be honest:  Before Joslin told me to get my act together re: using control solution, I never used it.  Ever.  It would come in the meter kits when I first opened them and it was the first thing I removed.  I ran on the assumption that my meter was the diabetes equivalent of “the customer” – it was always right.

The Joslin CDE disagreed.

“No, you need to be checking the accuracy of your meter with the control solution at least once a week, Kerri.  That’s important to make sure everything is in range.  Think about it – you’re dosing insulin based on these results, and you’re calibrating your Dexcom, too.  Don’t you want to make sure the numbers are accurate?”

Good point.  But how naïve am I to assume that the numbers ARE accurate?  Sometimes I get a result on the meter that I know is way off, and I usually test again to see what the deal is.  But I never thought to bust out the control solution to keep tabs on the accuracy, as well.  

Since I was (and am) trying to be Captain Compliance when it comes to Joslin instructions (thanks to the ever-growing BabySparl), I dug up some bottles of control solution and started double checking my meter.  And yes, I do feel soothed when the control test comes back right on target, because it reinforces my faith in the meter.  And no, I haven’t seen any wonky control results come back yet, but at least I’m looking out for them.  

If you’re already checking your meter with the control solution, bravo!   Just wanted to pass this info on, in case you were like me and tossing the control solution into a shoebox to reside with dust bunnies under the bed.  (Or with Siah bunnies, depending on how much your cat sheds.) 

As I’ve mentioned, I’m learning so much now that I’m in constant contact with my doctors, so I want to pass on all the tips I find to you guys.  Because it’s quite obvious that while I try pretty hard, the rules of the game seem to change overnight.

Comments

Okay, I have a question. I never use control solution either. My reasons are a little different - I have absolutely no idea what to do if the reading is "wonky." Do I toss the strips? Is the actual meter hardware to blame? Can I somehow calibrate it manually (tell it what it should be reading) to get it in range? You'd think after all the years of finger pricks, I'd have some idea what to do, but I'm totally clueless.

I'm guilty as charged on not using control solution. However, because the ranges on control solution are so large, I'm not convinced that weekly testing with control solution will show anything. It takes a hugely inaccurate meter to be out of range on a control solution test.

The thing that bugs me about the control solution is that you have to throw it away after like three months or something (I don't know, I haven't looked at a bottle of the stuff in years). It just seems like a waste since you'll never use it all before you have to discard it. Any suggestions?

I'm with Shannon ... what are you supposed to do if you get out of range numbers?? I have no idea.

I quit checking the meter with the control solution because each time I did, the meter checked out just fine.

The only time I check now is when the meter has been traumatized, i.e. it's been dropped on the floor or left out in a hot car or freezing cold car.

P.S. Everytime I hear "Ground Control to Major Tom" I think of Chandler singing it on Friends and it makes me laugh.

Same question: what do you do if it isn't within the range?

We joined the Freestyle Promise program which gives us a HUGE break on test strips (join if you use a Freestyle meter, the savings really are big- they'll pay up to $50 a month on your strips and you just have a $15 copay). I think that they will send you more control solution for free if you need it.

Alright, I'm going to check some of our meters this week.

I know you are supposed to use the SAME meter for accuracy, but it's not logistically possible for us. We keep one in the emergency bag at school, one in her lunch box, one in our "to go" kit, and one on the kitchen counter for most checks at home. (And yes, we grabbed a bunch of free meters at a walk.)

What about replacing meters? Are you supposed to replace meters frequently? Yearly?

Uhhh...crap. *runs to control solution stash*

I'm with the others - what do you do if the control solution says it's out of range? is it batteries? is it the vial of test strips? is it the lot of test strips?

I think if things seem way out of whack (like meter readings aren't matching up to what you're feeling on any given day or week), then yes, first thing would be seeing if the control test is off. Though I'm usually tempted to change the battery first :).

While I understand why you would want to make sure all is good, test strips are precious commodities and using one per week for control solution adds up when insurance covers so few for so many people (both type 1 and type 2).

I think I have used the control solution once.

I will get back on it. Once a week huh? Wow! I am way behind!

I usually just throw it in the trash but I had one in my extra meter at work and used it. It said 110. What should it say? The bottle did not have any instructions and the exp date is 10/2008. Can you buy extra control solution?

The instructions say you should use the control solution every time you open a new vial of strips; the manufacturers' reps say you should also use it any time you think the meter might be acting up (out in the cold or hot weather, humid, dropped, whatever). For me this comes out to about once every 10 days.

The acceptable range is pretty large, and sometimes it will affect my readings showing higher or lower. As a result, I mark the control reading on the strip vial with a Sharpie marker.

If the test is out of range, check to make sure you have the correct control code dialed into the meter. (Skip this step if you have a noncoded meter such as the Freestyle Lite or the Wavesense Presto.) If the control code is correct but the reading was out of range, you can: test again from the same vial to confirm (I usually find I just had one odd reading); if the second test comes back bad in the same direction (both higher, or lower, than the acceptable range printed on the vial), I would either test from a different vial of strips (preferably with a different batch number) to see if you had a bad vial of strips, or a new bottle of control solution. If the control test is still out of bounds after changing the vial of strips or the bottle of solution, I might try changing the second. If the control tests are still out of range, and nothing has been spoiled by heat, cold, age, or humidity, I'd call the meter company's tech support line and tell them what you've done so far...

hey let us know if it's ever out of range. That has never happened for me, which is why I stopped checking... Plus the stuff expires too quickly.

if it was so vital - why don't they put a vial of control solution in with the test strips? And not to disagree with your CDE Kerri, but the control solution is to check THAT vial of strips. Not the meter's accuracy.

Kerri,

I am with the others who have stopped testing because I have never had a reading out of range AND it's hard (for me) to find the control solutions. If I am getting really wonky readings, I try and match to how I am feeling.

While you probably don't want to get into a fight w/your Joslin CDE, I would ask for some stats - how often do they get out of range readings and what do they do? Also, you are on the Dexcom right? So how often do you find your meter and Dexcom readings at significant deviation. Sounds like they are feeding you the party line.

You could go on and on down this rabbit hole. What do the meter companies say about how often they expect you to get out of range readings, etc.

tmana - great post!

Fair Winds,
Mike

I've only ever used the stuff once...and ended up spilling the yucky sticky red liquid everywhere. Oops

When I was having big accuracy problems, I spent a lot of time on the phone with OneTouch. They said the vast majority of the time, the problem is with the test strips not the meter. The test strip is what determines the amount of sugar in the sample, the meter just displays to you the result that the strip finds (like a computer monitor). So the testing once a week thing doesn't make sense unless you're only going through one bottle a week of test strips.

Like other people said, I also don't know what to do about an out of range result. The strips? The meter? Then what?

Also, I don't think the control solution catches a lot of inaccuracy. When I was having really inaccurate results, getting MORE than 20% error if I would test my blood sugar twice in a row, the control solution would usually show an in range result. When my results were just under 20% off (like 19.5%), OneTouch blew me off and said that was acceptable - even though it is impossible to figure out how to correct when you don't know if you are 350 or 285, and whether to treat a low if you don't know if you are or 79 or 64. When the error was more than 20%, they would send me a new meter. But the problems continued.

I think unfortunately there is a lot of inaccuracy in test strips and there's not a whole lot we can do about it. My results seemed to get better when I stopped getting my test strips from mail order (I also stopped getting my insulin from them after the ice was totally melted once, I think they same temperature issues could have caused test strip problems).

I facilitate a diabetes education (type II) class at a clinic for uninsured low-income people and tell them to ignore the control solution. They receive enough strips to test once a day IF they are not absent to any of the classes (yes, this includes people on insulin). Those expensive strips are way too precious to waste for many.

Once a week? Seriously? Who knew?!

Everyone should use control solution every week, but no one's ever had their test out of range? Hmmm...

Kerri - first let me say I applaud your efforts in taking care of both yourself and bSparl. Then let me explain why I'm going to continue to pitch my control solution into the trash ; )

The way I see it, I have a limited amount of time and resources (I am including both strips and patience in "resources"). Yes, in an ideal world, I would be a perfect diabetic and test with control solution as I open every bottle (every 2.5 days).

But, realistically, I want the most bang for the buck in any above-and-beyond efforts I'm going to go for. Which means, that I'm far more likely to break out the scale to see that my typical "serving" of brown rice hasn't crept up, than to waste a strip every few days.

Also, given the accuracy of the strips themselves (ever get your two startup readings for the dexcom to be within ten points of each other?) and the wide range of acceptable control solution values, I figure oneTouch is already making enough money off me...

Again, I'm not picking on you (two!) but I may be picking on your endo a bit.

BTW, am I the only one who has ever obeyed the directions on the top of the insulin bottle - the ones that say "Flip off"?

I usually get the lab to check my meter for accuracy when I go in for an A1c. I ask them to do a 'random sugar' so i can check my meter's accuracy, then I test my sugar on my own meter while I'm there withing 5 miinutes of the lab tech drawing blood. Also, my D educator also told me to ALWAYS wash my hands before testing, as that can give an inaccurate result.... especially with all those oranges you're eating lately!! haha

I have not used the control solution since the very first two blood sugar meters ever made in the early 1980's, and even then it was a PITA.

I use the doctors 3 month A1c tests they perform to see if meter or test strips are off, and you can tell by normal results and numbers.

If they can get us to waste one more extra test strips, at over millions of diabetics testing, hey money maker.

I know you want ot take as best care as you can for your baby, but don't be too far from the judments and good calls you yourself already know about diabetes from having it. The doctors and educators are not always right and should be taken with a few grains of common sence as well.

I wish you well

Robert

I used to test my daughter's meter with each new bottle of test strips, but I recently stopped. I blogged about it on this post: http://pantsbeatsnopants.blogspot.com/2009/10/test-strip-rant.html
It just got too frustrating for me after awhile.

Does anyone know where my test strip are hidden????

I agree I used the control solution once and never again...I also have my endo test my meter the accu-check Aviva when I get my A1C done!

I can't believe how in the same boat we're all in... anyone bring drinks? umbrellas? seriously. I checked not long ago... I don't know why. Oh wait, I do. I was downsizing all my empty box storage stuff...trying to get rid of that HUGE pile in the back of my closet, and when I pulled the meter box out, I figured, what the hell. Might as well check it. :D and it read fine... even though I got that solution a while ago, and...I think it had been used before, so it was, for sure, over the 3 month limit. Where do I get more of that stuff, anyway? It should definitely be free.

kerri, i think that it is great that you are doing what joslin wants you to do. from my experience, joslin is really in no ones pocket, they usually do not tell you to do anything to pump up anyone else. i do have to say though, i agree with most of this here... what do you do if anything is off? what is it you are testing? and the error of margin is so huge anyway... does anyone go through all of the protocol? (i.e. alcohol swabs before injections, control solution, methodical site rotation, etc. etc.) my doctor is very good at telling me all of the things that should be happening, but that is what she does for a living, while i do something else for a living...

Ok...so I have NEVER used my control solution..I didn't even know it was red or what ever it was for. When I first got diabetes my diabetic educator told me it was for cleaning my machine...ok not to heap all the blame on them I should have read up on it or something...but thank you Kerri for teaching me something new....10 years and am still feeling like a a new-bie!

I normally check my machine accuracy when I go see my endo (once a month) and also when I do my A1c I also do a test with my machine.

I am a nurse. We are required to run controls on ALL glucose meters every 24 hours in the hospital. This is what I've been doing for over 12 years.

When I was pregnant and diagnosed with gestational diabetes, I was given a LOT of education about diet, how to use the meter, etc.

The one thing no one ever cared about was using the control solution. I asked my NP a few times if I should be testing the accuracy of the meter with something, and every time she said not to worry about it.

It made me batty!!

I just found it amusing that almost everyone commenting here is not all that interested in using controls... but I had the complete opposite reaction :)

One time, a long long time ago (about 2002), I had to call One Touch because of this. They ended up replacing my meter. The rep couldn't tell me if my strips were bad or the meter itself and she told me to throw away everything. Because the strips are soooo expensive, I kept them and they worked fine with the replacement meter.

The reason that I don't use the control solution is because I don't want to waste a test strip. If they want us to use control solution, then they should give like 5 extra strips in a bottle so we can use those "test" test strips for a control. If you use control solution once a week on a minimum that's one full box of 50 test strips you will have to use throughout the year. That's just my theory on "the man" trying to stick it to us. All that aside, it is comforting when the control solution actually works.

I'm with Chris Stocker, mostly, although several others here have made great points as to why using control solution seems like bunk. I'm too damn cheap to "waste" a strip on control solution.

I'm with Chris Stocker, mostly, although several others here have made great points as to why using control solution seems like bunk. I'm too cheap to "waste" a strip on control solution.

Ditto on the "not wasting a strip for it." I haven't used control solution since my first year as a PWD. That was a long, long time ago in a galaxy far, far away. If meters need that much frequent maintenance and attention that I need to be checking their accuracy that often, the companies can kiss my rear.

Here in New Zealand control solution isn't heard of. I know I can get it - though the one time I tried I gave up pretty quick, neither my DNE nor my chemist were interested so it would have taken a lot of pushing.
Instead of solution I just double check using 2 or 3 of my meters with the same drop of blood. Always with miserable results!

I've wanted more accurate meters since I started testing 5 years ago... I don't think it's going to happen :(

Belated congrats to you Kerri & Chris! Wow, a mini Sparling, how cool is that?! All the best for your journey, it's a wild one but so satisfying. If I can say that even when my son is a teenager who slams doors in my face, then it has to be true lol

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