if one looks at the example we think what is the big deal I could count the number of letter in" Norwegian blue but what about the pledge of allegiance or the paragraph below
parrot = "with a scheduled visit to the doctor approaching, will improve their eating habits so that their blood sugar records improve. I have seen several teenagers whose falsified blood sugar data were discovered by this test. I, therefore, suggest that HgbA lc be measured at regular visits every two to three months. This test costs about $60.Ideally, the other blood and urine tests should be performed before attempting to normalize blood sugar and annually thereafter. If an abnormal value is found, your physician may wish to repeat that test and related tests more often. The exception is the fasting C-peptide test, as there is little value in repeating it except to see if the pancreatic function is deteriorating or improving. I certainly like to repeat the thrombotic risk and lipid profiles about two months after blood sugars have been normalized. The improvement that I frequently see tends to encourage patients to continue their efforts at blood sugar normalization. The R-R interval test should be performed every eighteen months. J consider it the second most important test I perform on my patients after theHgbAC.A final note: Dietary vitamin C is important to good health. In doses above 500 mg/day, however, vitamin C supplements can destroy the enzymes on blood sugar test strips and can also raise blood sugars. Finally, in levels higher than about 400 mg/day, vitamin C becomes an oxidant rather than an antioxidant and can cause neuropathies. If you are already taking supplemental vitamin C, I urge you to discontinue it or lower your dose to no more than 400 mg daily. Only use the time-release form.Your DiabeticTool KitSUPPLIES YOU WILL NEED AND WHERE TO GET THEM In order to monitor and control your blood sugar levels, you're going to need certain tools. This chapter lists and describes them; you'll learn more about them in later chapters. Also included are supplies for foot care and for treating dehydrating illnesses. For most items, approximate costs are listed. Some expenses will be onetime outlays, such as for your blood glucose meter outfit. Others will continue on an ongoing basis.The tools that all diabetics will need are listed first. Tools that only insulin users will need are listed separately. Some are necessary, and some are optional. You can show your physician the list and he or she can decide which items are appropriate for your needs.Following the tables of supplies is a brief description of each, what it's for, where you can purchase it, whether you'll need a prescription, and Where in this book you'll find a complete description of its use.If you can't locate some of these supplies in your area, all prescription items and most nonprescription items can be ordered via telephone and credit card, check, or money order from Trotta's Pharmacy at (877) 987-6882.Your Diabetic Tool Kit 65SUPPLIES FOR ALL DIABETICS For measuring and recording blood sugar Is On 6 w with a scheduled visit to the doctor approaching, will improve their eating habits so that their blood sugar records improve. I have seen several teenagers whose falsified blood sugar data were discovered by this test. I therefore suggest that HgbA lc be measured at regular visits every two to three months. This test costs about $60.Ideally, the other blood and urine tests should be performed before attempting to normalize blood sugar and annually thereafter. If an abnormal value is found, your physician may wish to repeat that test and related tests more often. The exception is the fasting C-peptide test, as there is little value in repeating it except to see if the pancreatic function is deteriorating or improving. I certainly like to repeat the thrombotic risk and lipid profiles about two months after blood sugars have been normalized. The improvement that I frequently see tends to encourage patients to continue their efforts at blood sugar normalization. The R-R interval test should be performed every eighteen months. J consider it the second most important test I perform on my patients after theHgbAC. A final note: Dietary vitamin C is important to good health. In doses above 500 mg/day, however, vitamin C supplements can destroy the enzymes on blood sugar test strips and can also raise blood sugars. Finally, in levels higher than about 400 mg/day, vitamin C becomes an oxidant rather than an antioxidant and can cause neuropathies. If you are already taking supplemental vitamin C, I urge you to discontinue it or lower your dose to no more than 400 mg daily. Only use the time-release form. Your DiabeticTool Kit SUPPLIES YOU WILL NEED AND WHERE TO GET THEM In order to monitor and control your blood sugar levels, you're going to need certain tools. This chapter lists and describes them; you'll learn more about them in later chapters. Also included are supplies for foot care and for treating dehydrating illnesses. For most items, approximate costs are listed. Some expenses will be onetime outlays, such as for your blood glucose meter outfit. Others will continue on an ongoing basis. The tools that all diabetics will need are listed first. Tools that only insulin users will need are listed separately. Some are necessary, and some are optional. You can show your physician the list and he or she can decide which items are appropriate for your needs. Following the tables of supplies is a brief description of each, what it's for, where you can purchase it, whether you'll need a prescription, and Where in this book you'll find a complete description of its use. If you can't locate some of these supplies in your area, all prescription items and most nonprescription items can be ordered via telephone and credit card, check, or money order from Trotta's Pharmacy at (877) 987-6882.Your Diabetic Tool Kit65SUPPLIES FOR ALL DIABETICSFor measuring and recording blood sugar credit card. They work quite simply: with one drop of blood from a finger stick, the instrument gives you a reading of your blood sugar. (See Chapter 4,\"How and When to Measure Blood Sugar.\")-For small children and for people who develop calluses on their fingertips from frequent blood sugar testing, try Vaculance (Bayer), which can secure a drop of blood from arms, legs, buttocks, or abdomen. I use it myself for about one-third of my measurements.Blood sugar meters are available at most pharmacies and chain drug stores. Some are more accurate and reliable than others. Because of the rapid advances in technology, it would be counterproductive to recommend a particular meter in this book. If you want our current recommendation, please call our Diabetes Center at (914) 698-7525, Monday through Thursday, 9:30 a.m. to 3:30 p.m. Eastern (U.S.) time.Disposable 30-gauge lancets. These are used with or without your finger-stick device to puncture your skin for glucose testing. I reuse mine until they become dull. The small supply packed with the various meter outfits should easily last a year.* For people with severe gastroparesis (see Chapter 22).Blood sugar test strips. When you stick your finger, you'll put the drop of blood on or into one of these. They work with your meter to give your blood sugar readings.Glucograf II data sheets. See Chapter 5, \"\Recording Blood Sugar Data.\" These are essential to record properly your blood sugars and other important data. They are available from Trotta's Pharmacy and Bayer Corporations. These are the only data sheets that I recommend.-Hydrogen peroxide. Now and then, when you're sticking your fingers or injecting through your shirt, as I do, you may get a little blood on your clothing. Hydrogen peroxide is an effective way to eradicate it. You can get small bottles for home, office, car, or travel. Available at any drugstore and at many groceries. (See Chapter 16, page 250.)For dehydration. Dehydrating illnesses, such as vomiting, diarrhea, or fever, are potentially fatal for diabetics. If you become dehydrated, these products can help you replace lost electrolytes. Look for potassium chloride on the list of ingredients. These should be available at the supermarket or grocery store. Their use is covered in Chapter 21, \"How to Cope with Dehydration, Dehydrating Illness, and Infection.\" They should be used as directed by a physician.\For diarrhea. Diarrhea can cause dehydration. The one product that appears always to Work is Lomotil (diphenoxylate HCl with atropine sulfate). This is a prescription drug. Generic versions are available at lower cost.For vomiting. Vomiting can also cause dehydration, which, as noted above, can be life-threatening for diabetics, Tigan suppositories (trimethobenzamide HCl) are for vomiting and should be used for no more than 1-2 days at a time, unless directed\" lubricant. Don't use mineral oils or petroleum-based products, as your skin will not absorb them. Do not use products containing urea or mostly glycols. Available at Trotta's Pharmacy, drugstores, and health food stores. Olive oil is available at most food markets.Bath thermometer. Many diabetics have impaired sensation in their feet. Without knowing it, you can scald and seriously injure your feet if showers or baths are too hot. Don't take foot care lightly, Poor foot care for diabetics can lead to amputation, especially if you have poor circulation. Available at most pharmacies.Books and publications. There are many books of food values available that can be helpful in trying to figure out your meal plan (see Chapter 11, \"Creating a Customized Meal Plan\"). They are optional, but the table lists a few I think are valuable. They are all available at most bookstores and on the Internet.Artificial sweeteners. As we will discuss in Chapter 10,\"Diet Guidelines,\" the little packets of artificial sweetener you see on restaurant tables in the United States are predominantly glucose. Stay away from powdered sweeteners (except stevia extract), and always scan the lists of ingredients for any word ending in -ose. Also, avoid maltodextrin. In the United States, use only the tablet form or stevia liquid or powder. You can get saccharin or Equal (aspartame) tablets in any drugstore and in many groceries. Stevia is sold at health food stores. If you have a sweet tooth, there is no restriction on how many or how much of these you use. Cyclamates are available in Canada and elsewhere outside the United States. These won't affect your blood sugar.For Insulin-Using DiabeticsInsulins. The types of insulins I recommend are Humalog (lispro insulin); Humulin R or Novolin R (regular human insulin); Humulin L or Novolin L (Lente human insulin); and Humulin U (ultralente human insulin). A new, clear, long-acting insulin, Lantus, is comparable to ultralente. I recommend it as a fully equivalent alternative (see Chapter 17). In the United States, many states require a prescription for the purchase of Humalog or Lantus.You should keep at least two vials of the insulins selected by your doctor on hand at all times. You may need a prescription, and your physician will select the insulin(s) appropriate for you. A thorough discussion of their characteristics, use, storage, and administration appears in Chapters 16-19.Frio. This very clever product, a wallet-style cooler activated by immersion in water, will keep insulin cold when you are traveling in hot climates. For periods shorter than six weeks, insulin need not be kept refrigerated but should not be exposed to high temperatures. Frio is available in the United States from Medicool, Inc., (800) 433-2469 or WWW.medicool.com/diabeteSy and in the U.K. from Totally Cool (+44-1437-741700) or WWW.friouk.com.Insulin syringes. Any 25- or 30-unit short-needle insulin syringe, preferably with A-unit markings, should be satisfactory. They come in boxes of 100, and you should get at least 200 to start. They are available with a prescription at most pharmacies. Their use is covered in Chapter 16,\"Insulin: The Basics of Self-Injection.\" Syringes with longer needles for more rapid correction of elevated blood sugars should also be considered after reading Chapters 16-19.action, exercise, and any other pertinent data that affect blood sugar, is best recorded on the Glucograf III data sheet, illustrated on page 82.How Frequently Are Glucose Profiles Necessary?If your treatment includes insulin injections before each meal, your diabetes is probably severe enough to render it impossible for your body to automatically correct small deviations from a target blood glucose range. To achieve blood sugar normalization, it therefore may be necessary for you to record blood glucose profiles every day for the rest of your life, so that you can fine-tune any out-of-range values. If you are not treated with insulin, or if you have a very mild form of insulin-treated diabetes, it may only be necessary to prepare blood glucose profiles when needed for readjustment of your diet or medication, Typically, this might be for one to two Weeks prior to every routine follow-up visit to your physician, and for a few weeks while your treatment plan is being fine-tuned for the first time. After all, your physician or diabetes educator cannot tell if a new regimen is working properly without seeing your blood glucose profiles. It is wise, however, that you also do a blood glucose profile for 1 day at least every other week so you will be assured that things are continuing as planned.Selecting a Blood Glucose Measuring OutfitThe measuring system usually consists of a pocket-sized electronic meter with a liquid crystal display. The outfit will include a spring-driven finger-sticking device and a supply of lancets. The meter is designed for use with disposable plastic strips, onto or into which a drop of blood is placed. Some brands of strips change color when exposed to glucose, and the accompanying meter measures color change. Other strips contain electrodes that-conduct or generate more or less current depending upon the amount of glucose in the blood.About twenty different blood glucose metering outfits are presently being marketed in the United States. Only one or two of these currently have a degree ot accuracy acceptable for our purposes. Some Systems routinely report blood glucose values that are 40-100 percent in error. This can be very dangerous to the user. How these have secured approval from the Food and Drug Administration FDA I is a matter of conjecture. Usually the problem involves poor quality control or poor design of the plastic strips, or inability to calibrate the meter accurately for different batches of strips,Although your supplier should be in a position to advise you properly on the selection of systems for blood glucose monitoring, this is almost never the case. Even physicians and educators specializing in diabetes rarely conduct the studies necessary to evaluate these products. Reports in medical journals that purport to be evaluating different blood glucose self-measurement systems are frequently financed by one of the manufacturers and often present grossly deceptive conclusions. All this puts you, the consumer, in a difficult position.Designs advance so rapidly that it's impossible to predict what will be available when you read this book. I frequently compare new meters for accuracy versus a major clinical lab. I also check the reproducibility of results. You can call our Diabetes Center at (914) 698-7525 Monday through Thursday between 9:30 a.m. and 3:30 p.m. Eastern time (U.S.A.) to find out what system we currently recommend for our patients.Accuracy is the most important feature to keep in mind when selecting a meter, so do not be seduced by low cost, size, appearance, or special features, such as built-in memory, built-in lancet, or built-in insulin injector. Buy from a dealer who will refund your money if the system is inaccurate. You can get a rough idea of the precision or reproducibility of results of the system by performing four blood glucose measurements in succession at the dealer's store. They should be within 5 percent of one another when blood sugars are in the 70-120 mg/dl range. Ask your physician about the systems he has evaluated. He can secure virtually any system from its manufacturer for study at no cost.A number of my patients have been tempted by advertising for blood sugar meters that contain a built-in device to puncture the skin at sites other than the fingertips (arms, buttocks, abdomen), where the puncture causes absolutely no pain. I have tested several of these products and found their blood sugar readings to be inaccurate. Far superior to these is the Bayer Vaculance for painless punctures of these alternate sites. I use it myself and a separate, very accurate meter. If blood sugar is changing rapidly, these alternate test site results may lag behind fingertip tests by as much as 20 minutes.MEASURING YOUR BLOOD SUGARS: IMPORTANT TECHNIQUES Many instruction booklets give inadequate or erroneous instructions for preparing thefinger or putting the drop of blood onto or into the test strip or electrode. If the instructions that follow conflict with what you ve been told, believe mine.."
len (parrot)
print len(parrot)
parrot = "with a scheduled visit to the doctor approaching, will improve their eating habits so that their blood sugar records improve. I have seen several teenagers whose falsified blood sugar data were discovered by this test. I, therefore, suggest that HgbA lc be measured at regular visits every two to three months. This test costs about $60.Ideally, the other blood and urine tests should be performed before attempting to normalize blood sugar and annually thereafter. If an abnormal value is found, your physician may wish to repeat that test and related tests more often. The exception is the fasting C-peptide test, as there is little value in repeating it except to see if the pancreatic function is deteriorating or improving. I certainly like to repeat the thrombotic risk and lipid profiles about two months after blood sugars have been normalized. The improvement that I frequently see tends to encourage patients to continue their efforts at blood sugar normalization. The R-R interval test should be performed every eighteen months. J consider it the second most important test I perform on my patients after theHgbAC.A final note: Dietary vitamin C is important to good health. In doses above 500 mg/day, however, vitamin C supplements can destroy the enzymes on blood sugar test strips and can also raise blood sugars. Finally, in levels higher than about 400 mg/day, vitamin C becomes an oxidant rather than an antioxidant and can cause neuropathies. If you are already taking supplemental vitamin C, I urge you to discontinue it or lower your dose to no more than 400 mg daily. Only use the time-release form.Your DiabeticTool KitSUPPLIES YOU WILL NEED AND WHERE TO GET THEM In order to monitor and control your blood sugar levels, you're going to need certain tools. This chapter lists and describes them; you'll learn more about them in later chapters. Also included are supplies for foot care and for treating dehydrating illnesses. For most items, approximate costs are listed. Some expenses will be onetime outlays, such as for your blood glucose meter outfit. Others will continue on an ongoing basis.The tools that all diabetics will need are listed first. Tools that only insulin users will need are listed separately. Some are necessary, and some are optional. You can show your physician the list and he or she can decide which items are appropriate for your needs.Following the tables of supplies is a brief description of each, what it's for, where you can purchase it, whether you'll need a prescription, and Where in this book you'll find a complete description of its use.If you can't locate some of these supplies in your area, all prescription items and most nonprescription items can be ordered via telephone and credit card, check, or money order from Trotta's Pharmacy at (877) 987-6882.Your Diabetic Tool Kit 65SUPPLIES FOR ALL DIABETICS For measuring and recording blood sugar Is On 6 w with a scheduled visit to the doctor approaching, will improve their eating habits so that their blood sugar records improve. I have seen several teenagers whose falsified blood sugar data were discovered by this test. I therefore suggest that HgbA lc be measured at regular visits every two to three months. This test costs about $60.Ideally, the other blood and urine tests should be performed before attempting to normalize blood sugar and annually thereafter. If an abnormal value is found, your physician may wish to repeat that test and related tests more often. The exception is the fasting C-peptide test, as there is little value in repeating it except to see if the pancreatic function is deteriorating or improving. I certainly like to repeat the thrombotic risk and lipid profiles about two months after blood sugars have been normalized. The improvement that I frequently see tends to encourage patients to continue their efforts at blood sugar normalization. The R-R interval test should be performed every eighteen months. J consider it the second most important test I perform on my patients after theHgbAC. A final note: Dietary vitamin C is important to good health. In doses above 500 mg/day, however, vitamin C supplements can destroy the enzymes on blood sugar test strips and can also raise blood sugars. Finally, in levels higher than about 400 mg/day, vitamin C becomes an oxidant rather than an antioxidant and can cause neuropathies. If you are already taking supplemental vitamin C, I urge you to discontinue it or lower your dose to no more than 400 mg daily. Only use the time-release form. Your DiabeticTool Kit SUPPLIES YOU WILL NEED AND WHERE TO GET THEM In order to monitor and control your blood sugar levels, you're going to need certain tools. This chapter lists and describes them; you'll learn more about them in later chapters. Also included are supplies for foot care and for treating dehydrating illnesses. For most items, approximate costs are listed. Some expenses will be onetime outlays, such as for your blood glucose meter outfit. Others will continue on an ongoing basis. The tools that all diabetics will need are listed first. Tools that only insulin users will need are listed separately. Some are necessary, and some are optional. You can show your physician the list and he or she can decide which items are appropriate for your needs. Following the tables of supplies is a brief description of each, what it's for, where you can purchase it, whether you'll need a prescription, and Where in this book you'll find a complete description of its use. If you can't locate some of these supplies in your area, all prescription items and most nonprescription items can be ordered via telephone and credit card, check, or money order from Trotta's Pharmacy at (877) 987-6882.Your Diabetic Tool Kit65SUPPLIES FOR ALL DIABETICSFor measuring and recording blood sugar credit card. They work quite simply: with one drop of blood from a finger stick, the instrument gives you a reading of your blood sugar. (See Chapter 4,\"How and When to Measure Blood Sugar.\")-For small children and for people who develop calluses on their fingertips from frequent blood sugar testing, try Vaculance (Bayer), which can secure a drop of blood from arms, legs, buttocks, or abdomen. I use it myself for about one-third of my measurements.Blood sugar meters are available at most pharmacies and chain drug stores. Some are more accurate and reliable than others. Because of the rapid advances in technology, it would be counterproductive to recommend a particular meter in this book. If you want our current recommendation, please call our Diabetes Center at (914) 698-7525, Monday through Thursday, 9:30 a.m. to 3:30 p.m. Eastern (U.S.) time.Disposable 30-gauge lancets. These are used with or without your finger-stick device to puncture your skin for glucose testing. I reuse mine until they become dull. The small supply packed with the various meter outfits should easily last a year.* For people with severe gastroparesis (see Chapter 22).Blood sugar test strips. When you stick your finger, you'll put the drop of blood on or into one of these. They work with your meter to give your blood sugar readings.Glucograf II data sheets. See Chapter 5, \"\Recording Blood Sugar Data.\" These are essential to record properly your blood sugars and other important data. They are available from Trotta's Pharmacy and Bayer Corporations. These are the only data sheets that I recommend.-Hydrogen peroxide. Now and then, when you're sticking your fingers or injecting through your shirt, as I do, you may get a little blood on your clothing. Hydrogen peroxide is an effective way to eradicate it. You can get small bottles for home, office, car, or travel. Available at any drugstore and at many groceries. (See Chapter 16, page 250.)For dehydration. Dehydrating illnesses, such as vomiting, diarrhea, or fever, are potentially fatal for diabetics. If you become dehydrated, these products can help you replace lost electrolytes. Look for potassium chloride on the list of ingredients. These should be available at the supermarket or grocery store. Their use is covered in Chapter 21, \"How to Cope with Dehydration, Dehydrating Illness, and Infection.\" They should be used as directed by a physician.\For diarrhea. Diarrhea can cause dehydration. The one product that appears always to Work is Lomotil (diphenoxylate HCl with atropine sulfate). This is a prescription drug. Generic versions are available at lower cost.For vomiting. Vomiting can also cause dehydration, which, as noted above, can be life-threatening for diabetics, Tigan suppositories (trimethobenzamide HCl) are for vomiting and should be used for no more than 1-2 days at a time, unless directed\" lubricant. Don't use mineral oils or petroleum-based products, as your skin will not absorb them. Do not use products containing urea or mostly glycols. Available at Trotta's Pharmacy, drugstores, and health food stores. Olive oil is available at most food markets.Bath thermometer. Many diabetics have impaired sensation in their feet. Without knowing it, you can scald and seriously injure your feet if showers or baths are too hot. Don't take foot care lightly, Poor foot care for diabetics can lead to amputation, especially if you have poor circulation. Available at most pharmacies.Books and publications. There are many books of food values available that can be helpful in trying to figure out your meal plan (see Chapter 11, \"Creating a Customized Meal Plan\"). They are optional, but the table lists a few I think are valuable. They are all available at most bookstores and on the Internet.Artificial sweeteners. As we will discuss in Chapter 10,\"Diet Guidelines,\" the little packets of artificial sweetener you see on restaurant tables in the United States are predominantly glucose. Stay away from powdered sweeteners (except stevia extract), and always scan the lists of ingredients for any word ending in -ose. Also, avoid maltodextrin. In the United States, use only the tablet form or stevia liquid or powder. You can get saccharin or Equal (aspartame) tablets in any drugstore and in many groceries. Stevia is sold at health food stores. If you have a sweet tooth, there is no restriction on how many or how much of these you use. Cyclamates are available in Canada and elsewhere outside the United States. These won't affect your blood sugar.For Insulin-Using DiabeticsInsulins. The types of insulins I recommend are Humalog (lispro insulin); Humulin R or Novolin R (regular human insulin); Humulin L or Novolin L (Lente human insulin); and Humulin U (ultralente human insulin). A new, clear, long-acting insulin, Lantus, is comparable to ultralente. I recommend it as a fully equivalent alternative (see Chapter 17). In the United States, many states require a prescription for the purchase of Humalog or Lantus.You should keep at least two vials of the insulins selected by your doctor on hand at all times. You may need a prescription, and your physician will select the insulin(s) appropriate for you. A thorough discussion of their characteristics, use, storage, and administration appears in Chapters 16-19.Frio. This very clever product, a wallet-style cooler activated by immersion in water, will keep insulin cold when you are traveling in hot climates. For periods shorter than six weeks, insulin need not be kept refrigerated but should not be exposed to high temperatures. Frio is available in the United States from Medicool, Inc., (800) 433-2469 or WWW.medicool.com/diabeteSy and in the U.K. from Totally Cool (+44-1437-741700) or WWW.friouk.com.Insulin syringes. Any 25- or 30-unit short-needle insulin syringe, preferably with A-unit markings, should be satisfactory. They come in boxes of 100, and you should get at least 200 to start. They are available with a prescription at most pharmacies. Their use is covered in Chapter 16,\"Insulin: The Basics of Self-Injection.\" Syringes with longer needles for more rapid correction of elevated blood sugars should also be considered after reading Chapters 16-19.action, exercise, and any other pertinent data that affect blood sugar, is best recorded on the Glucograf III data sheet, illustrated on page 82.How Frequently Are Glucose Profiles Necessary?If your treatment includes insulin injections before each meal, your diabetes is probably severe enough to render it impossible for your body to automatically correct small deviations from a target blood glucose range. To achieve blood sugar normalization, it therefore may be necessary for you to record blood glucose profiles every day for the rest of your life, so that you can fine-tune any out-of-range values. If you are not treated with insulin, or if you have a very mild form of insulin-treated diabetes, it may only be necessary to prepare blood glucose profiles when needed for readjustment of your diet or medication, Typically, this might be for one to two Weeks prior to every routine follow-up visit to your physician, and for a few weeks while your treatment plan is being fine-tuned for the first time. After all, your physician or diabetes educator cannot tell if a new regimen is working properly without seeing your blood glucose profiles. It is wise, however, that you also do a blood glucose profile for 1 day at least every other week so you will be assured that things are continuing as planned.Selecting a Blood Glucose Measuring OutfitThe measuring system usually consists of a pocket-sized electronic meter with a liquid crystal display. The outfit will include a spring-driven finger-sticking device and a supply of lancets. The meter is designed for use with disposable plastic strips, onto or into which a drop of blood is placed. Some brands of strips change color when exposed to glucose, and the accompanying meter measures color change. Other strips contain electrodes that-conduct or generate more or less current depending upon the amount of glucose in the blood.About twenty different blood glucose metering outfits are presently being marketed in the United States. Only one or two of these currently have a degree ot accuracy acceptable for our purposes. Some Systems routinely report blood glucose values that are 40-100 percent in error. This can be very dangerous to the user. How these have secured approval from the Food and Drug Administration FDA I is a matter of conjecture. Usually the problem involves poor quality control or poor design of the plastic strips, or inability to calibrate the meter accurately for different batches of strips,Although your supplier should be in a position to advise you properly on the selection of systems for blood glucose monitoring, this is almost never the case. Even physicians and educators specializing in diabetes rarely conduct the studies necessary to evaluate these products. Reports in medical journals that purport to be evaluating different blood glucose self-measurement systems are frequently financed by one of the manufacturers and often present grossly deceptive conclusions. All this puts you, the consumer, in a difficult position.Designs advance so rapidly that it's impossible to predict what will be available when you read this book. I frequently compare new meters for accuracy versus a major clinical lab. I also check the reproducibility of results. You can call our Diabetes Center at (914) 698-7525 Monday through Thursday between 9:30 a.m. and 3:30 p.m. Eastern time (U.S.A.) to find out what system we currently recommend for our patients.Accuracy is the most important feature to keep in mind when selecting a meter, so do not be seduced by low cost, size, appearance, or special features, such as built-in memory, built-in lancet, or built-in insulin injector. Buy from a dealer who will refund your money if the system is inaccurate. You can get a rough idea of the precision or reproducibility of results of the system by performing four blood glucose measurements in succession at the dealer's store. They should be within 5 percent of one another when blood sugars are in the 70-120 mg/dl range. Ask your physician about the systems he has evaluated. He can secure virtually any system from its manufacturer for study at no cost.A number of my patients have been tempted by advertising for blood sugar meters that contain a built-in device to puncture the skin at sites other than the fingertips (arms, buttocks, abdomen), where the puncture causes absolutely no pain. I have tested several of these products and found their blood sugar readings to be inaccurate. Far superior to these is the Bayer Vaculance for painless punctures of these alternate sites. I use it myself and a separate, very accurate meter. If blood sugar is changing rapidly, these alternate test site results may lag behind fingertip tests by as much as 20 minutes.MEASURING YOUR BLOOD SUGARS: IMPORTANT TECHNIQUES Many instruction booklets give inadequate or erroneous instructions for preparing thefinger or putting the drop of blood onto or into the test strip or electrode. If the instructions that follow conflict with what you ve been told, believe mine.."
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