Diabetes educator Cindy Young used case studies to illustrate the many little things that can have a big effect on your blood glucose-or just on the readings you get with your meter.

First up: Does it matter whether you wash your hands before you check your blood glucose? 

Young figured some people check their blood glucose levels in their kitchen after preparing meals. So she did an "unscientific study" in her own kitchen: She checked her blood glucose after handling various foods. Young does not have diabetes, so she expected her meter readings to be stable and in the normal range. 

When Young washed her hands with soap and water and then tested, the meter read 80 mg/dl. When she had lotion on her hands, the meter read 87 mg/dl. After she handled the following foods, the meter readings were all over the map: 

• Milk: 92 mg/dl
• Raspberries: 92 mg/dl
• Peanut butter: 94 mg/dl
• Red peppers: 117 mg/dl
• Sweet wine: 122 mg/dl
• Grapes: 447 mg/dl
• Grapes, followed by wiping (but not washing) hands: 132 mg/dl

Young had a client who checked his glucose before lunch every day, but the readings he got at work were typically higher than the readings he got on the weekends. He and Young finally figured it out: At work, the client used a no-rinse hand gel, but on weekends, he used soap and water. 

False high readings can lead to big problems. If you adjust your premeal dose of insulin based on a false high reading, your blood glucose level will probably drop too low after the meal. 

Bottom line? Wash your hands or use alcohol wipes (and let the alcohol dry) before checking your blood glucose. 

Real Highs

Illness, infection, stress, and pain can raise blood glucose levels for real, not just on the meter display. 

A client of Young's had a disease that caused chronic pain. Young asked her client to keep a log of her pain severity on a scale of 1 to 10, along with her blood glucose levels. From those figures, they worked out a plan: The woman would use the temporary basal feature on her pump to increase her basal rate by percentages based on her rated pain and blood glucose response.  

Young warns that steroids can jack blood glucose up to the 300s to 400s. With an infection, even a minor tooth infection, you may see blood glucose levels in the 300s. A fight with your spouse or a conflict with your boss may also raise blood glucose levels.

If you are ill or need to take medication that raises blood glucose, you may require more insulin. If you have type 2 diabetes and don't use insulin, you may need to use insulin temporarily.

For stress-related highs, Young advises having a plan in place. Many people use exercise to reduce both stress and blood glucose. Others meditate or play a favorite game.  Identify whatever calms you ahead of time and put it in place when you're stressed.  

Marie McCarren is a medical writer who has specialized in diabetes for 15 years. Her books include ADA Guide to Insulin & Type 2 Diabetes and A Field Guide to Type 2 Diabetes.