Happy Saturday! Welcome to Ask D'Mine, hosted by our weekly advice column hosted by veteran type 1, diabetes author and community educator Wil Dubois. This week, Wil is taking a second look at the recently covered issue of smoking and diabetes, and he's also got a question about how often we REALLY need to change our lancets...

Enjoy!

{Got your own questions? Email us at AskDMine@diabetesmine.com}

 

Roger, type 2 from North Carolina, writes: Read with interest your recent column on smoking and it got me to wondering what you thought about the electronic cigarettes. Healthy? Unhealthy? A good choice for us "D-folk?"

Wil@Ask D'Mine answers: No one knows for sure if e-Cigs are healthier than conventional burning tobacco, but on the surface of it, they should be. An e-Cig is basically a nicotine delivery device. It heats liquid nicotine and vaporizes it so you can inhale it. Gone is all the other crap a traditional "analog" cigarette creates as it burns.

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The good quality e-Cigs, and there are a gazillion brands to choose from now, even create water vapor to mimic smoke, giving you the visual feedback that you're really smoking. Some even have ends that glow like the ember of a real smoke when you inhale, and many come with carrying cases that mimic the good ol' box of smokes in your shirt pocket. [Disclaimer: I have not personally tried one of these yet. I'm afraid I might like them too much, and I already have enough bad habits.]

The husband of one of the nurses I work with switched from real cigs to e-Cigs recently, and she was telling me about the wonderful range of flavor cartridges he can choose from: peach schnapps, cherry, coffee, vanilla, mango, rosemary, even eggnog. Uh.... (picture me in the back of the class waving my hand to ask a question). Don't they have a flavor that tastes like tobacco? The nurse looked at me as if I was a crazy man. "Well, what would be the fun in that?" she asked. Then she went on to tell me that another thing she likes about the e-Cigs is that they don't bother her when her husband smokes in bed. Now, I gotta say that this nurse is pretty hot, so that was the end of the conversation as my mind got distracted thinking about her in bed and her husband wasting time smoking...

E-Cig KitBut for you smokers who love to smoke for the taste of tobacco, don't worry! My personal internet research has revealed that not only can you get tobacco-flavored e-Cigs, but they can be optimized to mimic your favorite conventional cigarette flavors such as Benson & Hedges, Dunhill, Kent, Kool, Marlboro, Newport, Pall Mall, Parliament, Salem, Virginia Slims, and Winstons. Wait a sec... No Camels?? Well, surely someone makes one.

e-Cigs are heavily, and quite brilliantly marketed. Men who look like the kind of men all we men wish we looked like have e-Cigs dangling from the corner of their mouths in colorful print ads that fill full pages in magazines. Especially the magazines that also have pictures of naked girls. Well, so I've heard, anyway.

One good thing about e-Cigs, beyond no soot in your lungs, is that you can also "smoke" an e-Cig in public, while there's pretty much nowhere left on the planet where you can light up a tobacco cigarette without being Tazered by the cops. And, of course, the risk from second and third-hand smoke is virtually nil. Plus, they do look cool, don't they? The only problem I can see is that they don't get shorter as you smoke them.  How do you know when to stop?

Now we know that a normal cigarette can kill you five ways from Sunday, but no one really knows yet what role the nicotine itself plays in the toxic cloud created by a burning analog cigarette. So we don't really know how much safer a nicotine vaporizer is over a conventional cigarette. Additionally, many of these e-Cigs are made in China, where they can't even manage to make dog food safely. So lots of folks are wringing their hands about what kinds of poisons and heavy metals might be finding their way into the e-Cig.

I think it comes down to choosing between the devil you know and the devil you don't know. But in this case, given the size and strength of the devil we know, I would cast my lot with the e-Cig. I think that logically, even if not exactly healthy, it just has to be one hell of a lot safer than old fashioned cigarettes—for either D-folks or sugar normals.

So here's my bottom line: Having a highly addictive personality, I'm avoiding e-Cigs like the plague. But if one of my loved ones smoked conventional cigarettes (actually, they've all quit) I would want them to change to e-cigs. If they hadn't started yet, I'd rather they stuck with chewing sugar-free gum. But if one of them was bound and determined to start smoking, and asked me what I thought, I'd recommend the e-Cig.

  

Franklin, type 1 from Arkansas, writes: OK, Wil, give me the real scoop here. Do we really need to change our lancets out EVERY SINGLE DAY like everyone "officially" says we should? Or what? Can I be good to just change them out once a week, or every month, or when the clocks change, or the lancets get blunt...?

Wil@Ask D'Mine answers: Actually, "officially" you're supposed to change your lancet every single USE, not every single day. The theory behind the change-every-time is that this reduces the risk of getting some sort of infection from the "dirty" lancet.

But is this risk real? Well... yes... and no.

First: Can you get an infection of some kind from a lancing needle?  Hell yeah. A used lancet is wonderful transmitter of many a nasty microscopic critter. In fact, OSHA considers a used lancet to be a "contaminated sharp," making it one of the most dangerous things in modern medicine.

Not long ago the CDC and the FDA discovered a boatload of hepatitis B cases that were traced to nursing home staff members reusing lancets on multiple patients while testing blood sugar. How big a boatload? Well, the numbers ran so high the powers that be decided that all dFolks should get hep-B vaccinations. (We wrote about that a while back.) And as Mike repChanging Lancetsorted last week, things are heating up even more with the FDA re-considering how lancing needles are classified. Meanwhile, the CDC has created a guideline for safe testing that basically says don't reuse the little fuckers.

But hold on a second. We need to make an important distinction here. The Feds are freaking out about taking something icky from one person's blood, and transferring it to another person's blood. That's a real threat with any lancing needle. You should never swap blood with anyone else. Not even people you swap spit with.

But the feds haven't gone so far as to say don't reuse the little fuckers on yourself.

Really, so long as you are just re-poking yourself, what's the harm? If you already have AIDs or Hep-C you aren't gonna make yourself sicker by re-poking yourself time and time again. And while we know it's pretty easy to pick up a germ from someone else's blood and move it to yours, what's the risk of picking something up from the environment? Unless you work in a hospital, I think it's pretty remote. There just really isn't any evidence that anyone has ever picked up a kitchen countertop infection by reusing their own lancets on themselves.

And to top that off, depending on the model, I'm not convinced that a new lancet is 100% sterile in the first place; so I don't think pathologically changing the lancet every time you use one would reduce your risk of pathogens, even if there were an environmental risk. Plus, do you know what's on your hands in the first place? I'd be willing to bet there are more microscopic critters on your hands right now than there are on your needle, and don't think for one minute that an alcohol pad will wipe them out.

So where did this "official" recommendation come from? Is it even "official" at all? No, it's not. Like many things in diabetes control protocol, the roots of practice nearly disappear into the fog of diabetes pre-history. Back in the early days of BGL testing, the humble lancing device had yet to be created. You really pricked your finger. We all talk about finger-pricks nowadays, but we have no idea... back in the day you needed to lacerate the fingertip big time. Deeply, to get a big-assed blood drop. These old needles went deep, deep, deep into the tissue. Anything icky on the needle went deep, deep, deep into the issue as well.

But today's little finger pokers just scratch the surface. There's really no evidence that anyone has ever gotten an environmental infection from a lancing needle. That said, tradition rules the day. Medicare won't give you enough strips, but they'll swamp you with lancets. One for every test. We're moving to a new clinic building, so I had to pack up my office this week. I have a 50-gallon drum of donated, unused "Medicare-overflow" lancets from my seniors. I think we could keep the entire Southwest in lancets for seven decades. (But, of course, I still can't get them enough strips to test in pairs.)

So if there's no infection risk in multiple self-poking, how often should you change your needle? I tell my patients to change it when it hurts. You know, not when it hurts a LOT, but when one day when they lance and think... huh... I felt that more than usual. That's when it's time to change. Some people can only get a few pokes. Some folks a week. Others, a month. I know one girl who (jokes?) that she changes hers every year with her smoke detector batteries.

Now with some of the newer, slimmer lancets, they can get bent up pretty quickly. So they do need to be changed more often... but every time?

I wouldn't.

I don't.

 

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.

 
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