Q. I have diabetes Type 2. I need to check my sugar levels a number of times a day to ascertain how much insulin to inject. To inject insulin without checking the sugar level is dangerous because injecting too much insulin can result in potentially fatal insulin shock.
In order to check my sugar level, I need to insert a test strip into the testing machine. When I do so, the machine beeps twice and is then ready for a blood application upon the strip. I then use a mechanical pen. I push the top of the pen to tighten the spring and then press a mechanical button that releases the spring, causing the needle to jab into my finger. I then push a drop of blood out, using a finger of my other hand, and I touch the drop to the strip. The machine informs me on the LCD screen of what my sugar level is. I then remove the strip to be discarded and the screen goes blank.
On Shabbos, Yom Kippur and Yom Tov I apply certain changes to the procedure. I insert the strip into the machine in an abnormal manner. Instead of depressing the mechanical button with my finger, I use my teeth. Instead of pressing the drop of blood from my finger with a finger of my other hand, I press my finger to a hard surface, such as the table or shelf, to get the drop of blood out. After the sugar level is determined, I remove the strip from the machine with my teeth.
A Torah scholar of note in my neighbourhood told me that I must get a special automatic sugar level checker that will be stuck in my body all the time, because although the Ramo allows for a Shinui in a Torah Shabbos prohibition, the Acharonim, such as the Taz, differ. Therefore, my use of a Shinui, such as for puncturing my finger and squeezing out blood, is forbidden, since I am a Choleh She'Ein Bo Sakono.
1) Is this scholar correct, that we pasken not like the Ramo regarding a Shinui for a Choleh She'Ein Bo Sakono?
2) If he is correct, am I obligated to get this special automatic sugar level checker despite the high cost (it is only subsidized for Type 1 diabetes sufferers).
3) Perhaps I am classified as a Choleh She'Yeish Bo Sakono, since not checking my sugar level and injecting an amount of insulin based on a guess, could potentially turn into a Pikuach Nefesh situation.
A. Horav Shlomo Miller's Shlit'a opinion is that you should try to make a proper shinui even for a chole sheyesh bo sakono if possible, as the Remo advises (328: 12). The Rov maintains that pressing one's finger on a hard surface such as a table to collect a blood drop, may not qualify as a proper shinui.
Regarding whether the type of diabetes that you have qualifies as a chole sheyesh bo sakono, will have to be answered by a physician familiar with the respective halochos as cases often differ.
In regard to acquiring a Continuous Glucose Monitor, the Rov's opinion is that if it also benefits the health perspective of the patient, and it is maintained on during the entire Shabbos, one should make an effort to acquire it. In respect to carrying the CGM where there is no eiruv, see question 1999 on an Epi-Pen, and 1732 on ankle monitors.
Rabbi A. Bartfeld as revised by Horav Shlomo Miller Shlit'a
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