Place the head of the lancet against the tender tip of a finger. Press the button so the needle can plunge forward into the flesh of the fingertip. I have never witnessed the beginner who did not flinch. However, if one has been successful in penetrating the skin, a drop of blood springs from the tip of the finger. If a drop fails to immediately appear, then the site must be “milked.” That is, squeeze the flesh until the blood drop grows big enough. Then place the drop of blood on a test strip and push the “countdown” button. At the end of thirty seconds, the diabetic’s near-present blood sugar can be read.
Many diabetics do actually live in fear of their glucometer paraphernalia and the sudden pain of the tiny jab, then the sight and the messiness of blood. Even worse, though, are the numbers that are liable to flash up accusingly—211, 250, 310 (Hi, Hi, Hi) or 36, 42, 54 (Lo, Lo, Lo). A diabetic can function on fairly high blood sugar levels; however, a normal blood sugar is usually considered to be 70-120. So as the individual numbers appear, the diabetic can feel guilty again, guilty again, guilty again—feelings planted by the public and medical establishment that these numbers would never appear if the diabetic is truly good.
The medical community generally holds that the numbers should read as if one does not have trouble achieving balance. Hence, doctors and such perhaps do become much like enemies—they want the diabetic numbers perfect, perfect, perfect. As a woman, perhaps as a human being, I’d rather be perfect, perfect, perfect anyway. So when my numbers aren’t perfect, confused feelings start to rise within me. Is the medical profession trying to control me?
A friend who works as a forensic scientist was recently inspecting my fingertips to determine my type of fingerprint. Did my prints run horizontally or in a whorl? This inspection was idle, dinnertime chatter, yet I grew embarrassed as it seemed I had no fingerprints! None that would show without ink anyway. Why, I’d make a wonderful thief! Laughing with the others, I didn’t bother to explain right then that puncturing my fingertip as many times a day as I did had seemed to make the adult surfaces smooth, almost shiny. See—does not the medical profession just love to “stick pins” into the diabetic. Stick, stick, stick!
At any rate, I do appreciate blood sugar testing that is far, far better than it used to be. That is, blood sugar can be checked more often and insulin levels, using a faster-acting insulin, can now also more easily be adjusted to suit the results. Also, the diabetic is now actually allowed to perform that blood sugar test and mete out that needed insulin or sugar. There is now even a glucometer that may be used on the arm instead of the tip of the finger, a process supposedly less painful. However, portable glucometers have not always been available, and are still not always available to the poor of the land or around the world. Not to mention, those test strips cost money too!
In the past, there were not even A1Cs (tests for blood sugar average over previous recent months, the better currently judged to be under 7.0); rather a diabetic’s regime was actually judged due to say, one blood test a month in a medical setting! Even worse, in the not-so-distant past, diabetics used to have to test their own urine to get some sort of daily sugar reading. As a child, I was given a small, plastic urine testing kit. It contained a test tube, a dropper, and a bottle of what was known as Clinitest tablets. I think it was five drops of urine and ten of water needed for the test. I’m not sure, but after this concoction was gotten into the test tube, I was told to add one of the toxic blue tablets. The mixture would then fizz up into the test tube and “boil down” into a color. Navy blue stood for negative, no sugar in your own urine. Dark green and various browns meant the yellow urine held varying low amounts of sugar. Bright orange—well, that horrifying shade signaled 4+, 4+, 4+, too much, way too much sugar in the urine. Again, guilty, guilty, guilty, must be your fault, your fault, your fault.
More to the point, what girl on the brink of adolescence wouldn’t rebel at the urine process? I considered the whole process not only embarrassing but disgusting—the very idea of considering one’s own urine with interest! More importantly, the tests were certainly not enhancing to a young woman’s growing sense of herself as attractive to the opposite sex.
In fact, years and years passed before it was known that in actuality, the urine tests showed nothing about what a diabetic’s blood sugar might be at the moment. After I’d had chemistry and biology in high school, I began to question the results—urine came long after food intake, didn’t it? However, I had long since simply quit doing the tests often anyway. As I grew older, I did them at the doctor’s office when required, or perhaps occasionally before or after a large holiday dinner. Otherwise, I simply did not test. I certainly had a sense of how I felt, but no one in those days knew my exact blood sugar for days on end. Still, I don’t think I did that badly in the early days as I used most means open to me, even the Clinitest strips and/or ketone strips (strips picking up on whether protein is in the urine) if I was worried. I also simply did not, as a general rule, eat much sugar. I felt even back then that less food was better for me overall. I always took my shot and generally abstained from “gorging.”
The blood tests of the day were even more of an ordeal for a child. Doctors insisted I have a blood test at least once a month, and I dreaded them as I have dreaded little since. The tests were what we think of today as a simple and ordinary blood test, but they didn’t seem simple to me. First and foremost, though, as the more normal the number the better, even a young diabetic “of right mind” knows not to eat too much on the evening before a fasting blood sugar, and this thought brought up further suspicion of the medical profession. Do they know what they’re doing? Do they know much about diabetes at all? At any rate, the blood tests back then also necessitated a visit to the lab at the local hospital, meaning my poor mother had to drag me out of bed very early in the morning on the designated Friday for my blood sugar test.
In my memory, the drive to the hospital always takes place in winter. My mother and I ride through streets lined with bare trees under skies of gray cold. We pull into the parking lot behind the emergency room. (Because we’re known to all as the local diabetic child and her mother, we enter through the back door near the lab, foregoing the paperwork and embarrassment of coming through the front doors.) The hospital corridor is narrow and dingy, filled with bright, garish light, and I feel as if I can hear the clock on the wall though its ticks are not audible. My mother and I sit and wait, and wait, and what I do hear is the clatter of needles and test tubes inside the lab, as well as the most hated sound–one I can pick out to this day—the snap of rubber tubing. My terror mounting, I pray inaudibly that my favorite techie is working that particular day. (Later on in my teens, I would insist that my mother actually call ahead to make sure this particular phlebotomist was scheduled.)
The problem was, is, and will continue to be that I have no good veins. As is usual, a piece of tubing was tied around the upper arm, I’d be told to make a clenched fist, and then the thick and threatening needle was inserted into the inner arm over the elbow. Then in my case, quite often, nothing happened. I’d watch the technician’s hand in terror as it pulled the syringe and needle out some and then pushed the apparatus back in again at a different angle. I did have one vein that sometimes worked in my right arm, and my favorite techie seemed to have the most luck in “hitting it.” Sometimes, I’d be asked to lie down on one of the long examining tables, so a technician could strap the same arm with a blood pressure cuff and pump, pump, pump—just as tight as it would go. More than once, I almost fainted.
If “old faithful” just didn’t seem to be pumping on a blood sugar day—the ordeal that followed could only be called a fishing expedition through the flesh of a child with a very long needle. My left arm was always tried next. A vein that could sometimes be found there and “slapped up,” but, the inside of my arm always bruised. It turned dark purple. The purple would spread up and down, and the upsetting color took days to disappear. Even when I was still in grade school I’d want to die of embarrassment as I trailed into class late sporting a Band-Aid doing little to cover the bruising. See, if I’d been a boy, I could perhaps have learned to just brag!
At any rate, if no blood was found in either arm, the phlebotomist would begin to tap at the veins on the back of my hands. The needle used then really hurt when inserted into the hand (not like the thin needles and tubing of today). Through the whole ordeal, I’d look off to the side of the room, or look out the lab window into the hall. I didn’t want them to see me grimace or cry. Though not always kind, I knew it would be hard if not impossible for Mom to find time to bring me back on another day. Somehow I’d also gotten the idea that I had to stay calm for the blood to flow. Stay calm and sit still. I’m sure the technicians whispered with me: bleed, bleed.
When I went to college, I skipped blood tests as often as I could. Once after a blood test at a university health center though, I bumped into a good friend as I exited the elevator. His words were: “Cinda, you’re bleeding.” These were famous last words. I turned to spot a trail of blood left all the way behind me and then I slumped to the ground, my fall broken only by the young man’s gallant arm. You see, once a vein is found, I’m quite a bleeder. At any rate, years later, a test called the A1C is taken roughly four times a year to tell the diabetic how he or she is doing. Not to mention, it can be also be taken with a finger prick. Still, I do have regular blood tests, but as they do not happen as regularly, my vein now stands up better. Also, I’ve been told as an adult, never as child, to drink a bottle of water before a regular blood test. This, indeed, seems to help blood flow. Did no one know this before?
I do not want to be misunderstood. I do appreciate especially these days that I can somewhat know what my present blood sugar is. Though I can feel low blood sugars coming on, high blood sugars are and always have been another story. If the levels are really high, perhaps sleepiness sets in; however, all too often, I and other diabetics report feeling “just fine” as the blood sugar soars.
When I was a child, I remember being told about another diabetic child who supposedly died due to high blood sugar and diabetic coma. The story was that a smart-alecky boy had dared her to eat five candy bars in a row on the way into the movies. She did, and lo and behold—this girl not far from my own age became a casualty. Her story was often cited to me to keep me away from sugar—not that I needed that much encouragement. I had, after all, gone into a coma before diagnosis, and my poor mother had run home to destroy a newly baked chocolate cake. My poor sisters!
At the very most, a taste of any dessert, if that, was enough for me. I hated everybody staring at me as I generally though they knew I couldn’t have sugar, and no, I didn’t want anyone to think I was the cause of my diabetes. Perhaps even more importantly, I didn’t want anyone to think I was weak. I could withstand temptation, thank you very much. I was strong. Stronger than strong.
These days, those using an insulin pump are often given the option of also using a glucose sensor or continuous glucose monitor (CGM). This is yet another electronic device that can be inserted much like the pump into a site on one’s stomach with a needle, in order to monitor the blood sugar, supposedly much in sync, with the use of the pump. In this way, the sensor should give a reading that will enable a more accurate meal or non-mealtime dosage to be given. Of course, the disappointment comes with this promise of a “real-time” blood sugar. Really, one still has to stick one’s one finger four or five or more times a day to verify the real blood sugar.
In addition, though perhaps a good try, the first sensors tended to be highly inaccurate, and again, one is always warned to manually take a blood sugar before insulin dosage of any type. The new sensors do work somewhat better. However, if one looks on the internet, one can find any number of people who are questioning the role of drug and pharmaceutical companies. Yes, there seem to be those who actually suspect a conspiracy to make money off of illness. I don’t necessarily want to join those ranks. I am just disappointed that to date that nothing artificial seems to work well enough. Even pancreas implants have been known to fail. Does medicine, then, need to be exploring different avenues of health and healing?
Anyway, back in the day, I’d been told my whole young life that God never gave any individual more than he or she could bear. Well, I grew to feel that I couldn’t bear the blood tests, so I’d pray for the blood to flow, perhaps my silent prayers resembling what I’d been taught Jesus prayed in Gethsemane—Lord, let this cup pass from me. I’m wondering why you thought I could bear being a diabetic for a lifetime. I am your child. God, spare me. Of course, the “why me” question comes up again. Yet I don’t believe I ever cried during those painfully bruising blood tests, and I did learn something. Seemingly, no one could help me–there is nothing more isolating than pain. Nothing.
My point, though, is I don’t want anyone to have to make the journey I have made during over fifty years now with diabetes. No one. Maybe God, or whomever or whatever can’t spare you, but I would if I could. Of course, I have about the same power I had as a child. All I can say is: Let’s live on. Something might happen. Keep working, insisting, changing, hoping or praying. I want to at least encourage not just diabetics, but anyone with a chronic illness, to do your best to live on. Don’t die outside or inside. Live and prosper!