Got questions about navigating life with diabetes? Ask D'Mine! Our weekly advice column, that is — hosted by veteran type 1, diabetes author and educator Wil Dubois.

This week, Wil gets a very creative question about sharing blood sugar checks in public, and possibly making a game of it. Now, play on to see what Wil has to say about that...

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

{Editor's Note: This question was rather long, but too important in its many issues to edit or ignore any element.}

Winston, type 1 from Maine, writes: I met a fellow type 1 pumper a few years ago and during a party, she broke out her meter and said, "Let's play the blood sugar game." This was something she and her friends did regularly, and under her rules, the highest number won. Not to say that anyone was trying to be high, but I think it was her way of winning every time vs. a bunch of non-diabetics. Clean needles each test, and all precautions taken obviously.

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I was surprised by the willingness of 90% of the people to have their finger pricked, and how much everyone seemed to enjoy seeing instant results on the meter... kind of like an instant health check without a doctor's appointment.

Anyway, it's something I've tried at a few of our own parties over the years, and people seemed again to enjoy it... even kids. I've done it probably 5-6 times over the last few years, and I've found some really interesting or scary results. Some "non-diabetics" I've tested have had some quite high sugars. A couple of kids have been in the 180's, and a few adults ranging from the 140's into the 200's.

It's always shocking when then those numbers pop up on the meter, and the testees obviously get concerned and start asking questions. I tell them to get checked out by their doctor, and they all have (one is now on metformin) but my real questions are:

  1. Based on the published numbers of Americans at risk for pre-diabetes, or full-blown diabetes, why isn't a blood sugar test part of a standard physical?
  2. Do other people do this?? Test Friends and family? And if so, how do you handle high numbers?
  3. Am I doing good or doing harm? My wife is a pediatric nurse, and I'm a very informed and socially conscious person. The last thing I would want to do is cause people stress in their lives unnecessarily.
 

Wil@Ask D'Mine answers: First off, your friend's Blood Sugar Game is poorly named. It should be called the Hepatitis-B Game. Or the Hep-C Game. Or maybe even the HIV Game. It's really just the bio-warfare equivalent of good old-fashioned Russian roulette.

A clean needle does not make a clean lancing device. Blood-borne pathogens get on/in the lancing device itself and can transfer from one player to another, even after a needle change, especially with the quick one-after-another use you've described.

Bottom line: A clean needle in a lancing device isn't a condom. If you play the game the way you described, none of the players are safe, and I guarantee you that at any party worth attending there will be at least one person with some blood-borne disease you'd really rather not have. That's a simple fact based on blood-borne pathogen prevalence rates, not a subjective opinion about the party crowd.

Hell, I don't even recommend sharing blood with people you share spit with, much less with strangers.

This is a big deal, one the FDA's pretty vocal about and has a whole sharps awareness campaign focused on.

But aside from that whole public health issue, I rather like the sound of the game. So let's it play safely. If youBlood Games column photo (or any other readers) want to play the Blood Sugar Game, you're going to need to bring a bag of party favors with you. You need totally disposable one-prick lancing devices. And enough of them for every player.

Disposables are designed for clinic and hospital use, and are also deployed at public heath screenings. They are engineered in such a way that they cannot be reused. You twist the cap off, hold the inch-long device against the partygoer's fingertip, and depress the plastic trigger. The lancing needle is spring-loaded, and snaps out and back in just like your own lancing device. But unlike the hornet-like personal lancing device that came with your meter—which can sting again and again—the disposable is more like a honey bee that commits hara-kiri when it stings. These lancets are designed to self-destruct after one use.

No second use, no transfer of blood. No transfer of blood, no transfer of nasty things that live in blood.

Now some folks will argue that the meter itself can be contaminated and shouldn't be used person-to-person, but I find that a bit of a stretch, given the length of the test strip and the fact that blood does not go into the meter, nor does the meter touch the blood sample under normal operating techniques.

Disposable lancing devices are cheap. They run about a quarter a pop, maybe less if you shop around, and they don't require a prescription. I've actually carried a handful in my Go-Bag for years. Why? Well, because like you said, people are actually surprisingly interested in blood sugar and will sometimes ask to be tested when they witness me testing myself. I'm always willing to do that, in a safe way, but it never occurred to me to turn it into a game.

Still, as gamified, I think your friend has moved public health screening to a new level in a positive way. Consider the typical health fair message: We'll test you for high blood pressure, elevated cholesterol, and diabetes. For free!

Any takers?

For general public awareness, making it a game could be a good thing if it motives people to learn more and to think more about their health. And of course the peer-pressure element of a gamified health screening shouldn't be discounted. Is that taking advantage? Who the hell cares? I'm results-orientated. According to the Centers for Disease Control, there are eight million undiagnosed people with diabetes in this country. Diabetes kills and maims enough amongst people who know they have it and are under treatment. It's much more dangerous to those who don't know they have it.

So what numbers should you see? Well, it used to be a "given" that sugar normals were always under 100 mg/dL all the time, and but that's only true half the time. Fasting blood sugar in sugar-normals should be under 100, but it's common for non-diabetic people to clock up to 140 after eating. That's where the classic American College of Clinical Endocrinologists glycemic goal of under 140 mg/dL came from. They assume that, as normal people go that high, it's safe for D-folks to go that high; and with a medicine cabinet full of options, they see no reason for D-folks not to have sugar every bit as good as normal folks. (I don't agree with this, but that's a story for another day.) Still, from this we can take away that it would not be unusual to see numbers up to 140 at a party, and there would be no reason to be alarmed by numbers that high.

Kiddos, on the other hand, normally run higher than adults. The under five crowd can spike to 200 after meals and not be diabetic. Up to twelve years of age, 150s-180s are considered normal after-meal numbers. Once you're a teenager, the numbers should be in the adult range.

As to what sort of numbers might indicate pre-diabetes: Before we used A1C readings for diagnosis of diabetes and pre-diabetes, we used to say that any fasting reading between 100-125, and any random reading between 126-199 was diagnostic for pre-diabetes. One hundred twenty six and above fasting, and 200 and above random, were diagnostic for full-blown diabetes in adults. Of course, it required two tests on two days for an actual diagnosis.

Based on those traditional values, most of the "high" adults you saw at your Blood Sugar Parties were most likely pre-diabetic, with the exception of the person who was in the 200s -- assuming they all had nice, clean hands so nothing was skewing the results.

This certainly isn't the first time we've heard about diabetes being gamified; others have ventured into this before, too. Just look at what Lilly Diabetes did over in the UK with its Shreddin' Diabetes game, and then this clever little game board created by a fellow diabetes blogger a couple years ago. There's even this educational game geared toward dogs with diabetes...

 

See, it can be done!

Now, to run through your three other questions:

  1. A blood sugar test is part of a standard physical; it's hidden in the lab test called a comprehensive metabolic panel, which includes the fasting glucose level. That said, I'm often surprised—when reviewing historical records on patients—to see how many physicians ignore slowly elevating blood sugars year after year.
  2. Most D-folks do test family members. A wise precaution, given what we know about the genetics of diabetes. Friends? I don't know, but a large percent, I'm sure. Testing strangers and making a game out of it? I don't think too many people do that. Your question was the first I heard of it happening. As to how to deal with an unexpected winner, all I can suggest is that you know what's normal and what isn't, and to remember you're not a doctor. I then think the best way to handle it is to say, "Wow, this kind of number might suggest you have pre-diabetes (or diabetes), I think you really need to check in with your doctor as soon as possible to make sure everything is OK." It then wouldn't hurt to assure the person that controlled diabetes is harmless, while it is ignored diabetes that kills. Cite yourself as an example that D-folks still party with the best of them in spite of having the big D.
  3. I think, so long as you use the disposable lancing devices, you're doing more good than harm. Ignorance kills, especially ignorance of a chronic progressive illness that has set up shop in your body. If the diabetes is there, it's there. Taking the fingerstick didn't cause it (diabetes isn't a blood-borne pathogen), and knowing is always better than not knowing when it comes to diabetes.

Might you stress someone out? Sure you will.

But you might just save their life in the process.

 

 

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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