Blood Glucose Meter Selection
Now we have reached the important bit, the one you have been wondering if I will ever get to - Which meter to buy!
If you were hoping I would say "Get the Transylvanian Special, it has more of a sweet tooth than Dracula, it is the crme de la cr me of blood glucose monitors. Forget all other makes and buy this one today!" - SORRY - you are out of luck.
Like so much of diabetic care it is all about individuality. You must decide what meter is the right one for you.
Of course this is easy for me to say. I live in the UK and thus was supplied with a meter, free, almost simultaneously with the diagnosis of diabetes. The NHS has it's good points! It took the decision making out of my hands at a time when I had enough other stuff to deal with.
I have been happy with this meter, it suits my needs at the moment. Should those needs change I will have to read my own research and decide whether to stay with it or get another brand - time will tell.
Enough about me, what about you? Relax, I am not just going to leave you fumbling around in the dark here. I intend to give you as much advice as I can so as to enable you to make an informed choice. So here goes.
If you have read other pages in this site you will have realised by now that I love doing things in point form, and this will be no different. However before I start my usual lists there is something that is more important than anything on them.
REMEMBER THIS DEVICE MUST BE USED, DAY IN AND DAY OUT, FOR YEARS.
Do not make a snap decision!
(Because of the problems of the folks on low speed connections I have decided to do this section as a single item instead of making them jump to other pages all the time. This has resulted in a rather long page! You can read it in two ways:-
1) From top to bottom in the usual way. This is recommended for the first time you read it. Just scroll down over the links and read in the normal way
2) You can use the links here to jump to the section you need. These are all on this page and will not cause another page to load.(Further down there are some outside links (http://www type stuff) those will load other sites.))
Selection Criteria.
Appearance
Accuracy
Ease of use
Size and portability
Sample size
Test time
Strips
Altitude to be used at
Coding
Test sites
Backlight
Measurement range
Audio meters
Technology
Batteries
Ketone testing
Lancets
Cost
Availability
Disposable meters
Round up of issues
Appearance
Now I know some of you may be thinking "What a strange thing to put at the top of the list. What about accuracy, features etc?"
But look at it this way. You would not buy a vase that you disliked the appearance of, even if it performed it's job of holding flowers very efficiently.
If you did you would probably end up putting it in the cupboard and ignoring it.
Well I know someone who did just that with her meter. Oh it was a good one, had all the bells and whistles, but she said it's appearance somehow irritated her and she just could not use it. So it went into a drawer and she went back to an old one that was much simpler but was an old friend.
A lot of us are very visual people and we need to pay attention to that.
This situation is made worse by our modern way of purchasing via mail order or over the internet. We do not get to see and feel the real thing and pictures can be deceptive.
Children in particular can be persuaded to use their meter if it appeals to them in some way. A friend changed to a Freestyle Flash because her son thought its front looked like an 'alien face' and he enjoyed sticking the strip in its mouth. Hey, if it works why argue!
Accuracy
This is determined by how closely the results of the meter match those of a standard laboratory result.
You would expect all meters sold to be accurate wouldn't you? Unfortunately this is not always so. And price is not a factor here, some cheaper models are better than some of their more expensive cousins.
There is nothing illegal about the inaccuracies. The industry, as of the moment, is allowed up to a 20% error.
Accuracy can vary, not just between models but also between individual meters of the same make, so this is a difficult problem to tackle when buying a meter.
The best I can suggest is that you check out the various diabetic forums and see what folk have to say in regard to their own meters.
Once you have done that, (and are more confused than you were before), look at the other factors relevant in buying a meter and go with the one that suits you - the accuracy situation is a bit like playing Russian Roulette!
To check the accuracy of your meter take it along when you go to your diabetic health advisor to have blood drawn after fasting. Check your BG with the meter directly after they have taken blood from your vein (within 5 minutes or less) and note the reading.
When the tests come back from the lab compare the two readings, take the difference between the two readings and divide it by the lab reading. Then multiply by 100 to get a percentage. This will tell you how accurate, or not, your meter is.
In any case consistency is just as important as accuracy, though accuracy would be nice. The idea behind blood glucose monitoring is to enable you to spot trends - when do you go up or down and act on the information received so as to even things out as much as possible.
There are various outside factors that can influence the accuracy of your test, it is not always the meters fault.
If your hematocrit (the amount of red blood cells in the blood) values are out you will get incorrect readings. The higher the values the lower your BG and visa versa. This can occur in diseases like anaemia or Sickle Cell Anaemia.
Uric acid, ascorbic acid and glutathione or GHS (an anti-oxidant) can all cause incorrect readings. Usually the package insert that comes with a meter will let you know what substances will affect it.
It is possible to read some of these inserts online via the manufacturers home page. Otherwise check when you go to buy your meter and discuss it with your pharmacist, he should be able to help you decide if any apply to you.
The only meter I know of that says it is totally unaffected by these outside influences is the little known Swedish meter, the HemoCue Glucose 201.
Ease of use
Remember that 'every day' statement. You want a meter that you can use easily, not just when you have all the time in the world to sit down and make a production out of taking your BG reading.
It must be easy to use when you are in a hurry - you have to get this damn reading done before dinner, which is busy burning on the stove while your mother-in-law is watching the clock and sipping her third pre-dinner cocktail!).
When you are stressed - the kids are already waiting in the car, school, which starts in 5 minutes time, is 10 minutes drive away and you really need this post-prandial reading.
When you are in an awkward situation (balanced on the loo of the ladies cloakroom in the 5 star resturant to which your boss has taken you and half a dozen important clients!). Get the picture?
Size and portability
The actual physical size of a meter can be important if you tend to carry yours around. It is much more useful to have one that fits in a pocket or a small handbag than one that needs a backpack!
Remember that when you do carry your meter around with you that it will not just be the meter, it will include the lancet device and possibly the test strips.
So does it come with a conveniently sized carry case in which all these devices fit or are you going to have to resort to slinging them all in an old plastic grocery bag and hoping for the best.
Note - sometimes it is more convenient to have 2 meters, one for work and one for home. As usual price comes into play here.
Most meters these days are relatively small, but small may not always be best.
While a very small one will be great for a child, with their small hands and 20/20 vision it may be a dead loss for someone with manual dexterity problems or impaired eyesight.
The actual physical size may not be an indicator of display size though, so if you have vision problems you need to check that the numbers that come up on the screen are of a decent size and easy for you to see.
The size of the one you chose must be tailored to your own particular needs.
Sample size
Unless you are into masochism and enjoy stabbing yourself in the finger innumerable times a day, the amount of blood needed by the meter to give an accurate reading is very important.
The less the amount the smaller the hole needed and the less pain is endured.
How much blood is needed varies from around 0.3 L (microlitres) at the low end up to 10L at the top end.
Personally I want a meter that requires 1 microlitre or less but hey, whatever works for you.
Here's a list of some of the meters and the volume of blood they require:-
BD Logic/Latitude - 0.3L
Freestyle Flash/Tracker - 0.3L
Accu-chek Aviva - 0.6L
Ascensia Contour - 0.6L
Accu-chek Active - 1L
LifeScan One Touch Ultra/Ultra Smart/ InDuo - 1L
Sidekick - 1L
TrueTrack Smart System - 1L
TrackEASE Smart System - 1L
Accu-chek Compact - 1.5L
Precision XTRA - 1.5L
Ascensia Elite/XL - 2L
Ascensia DEX2/Breeze - 3L
ReliOn NewTek - 3L
Precision QID - 3.5L
Accu-chek Advantage - 4L
Accu-chek Complete - 4L
HemoCue Glucose 201 - 5L
LifeScan One Touch Basic - 5L
LifeScan Sure Step - 10L
Test Time
This refers to how long the meter take to give you a readout after you have put in the strip. It does NOT take into account the length of time you take trying to get up enough courage to press the button on your lancet device!
In the days of the Ames Reflectance Meter patients had to wait at least a minute for a readout, now we glitch at anything over a few seconds.
Needless to say meters vary considerably in the length of time they take and people vary in their ability to put up with the wait.
If you are one of those hyperactive types champing at the bit to be up and doing don't chose a meter that will make you tap your foot with impatience while you wait for a readout. Frustration raises BG's too you know!
Even if you think you are the placid type who does not mind waiting those extra seconds can seem like hours, especially if you are afraid of confirmation that the chocolate you sneaked has sent your glucose levels soaring!
There is a serious side to time. If you are the type of diabetic who may experience hypoglycemia then the time it takes to carry out a blood glucose test could be the difference between going into a coma or not.
Below is the test times of some of the popular brands of meters:-
Precision XTRA - 5 seconds
Accu-chek Active - 5 seconds
Accu-chek Aviva - 5 seconds
BD Logic/Latitude - 5 seconds
LifeScan One Touch Ultra/Ultra Smart/ InDuo - 5 seconds
Freestyle Flash - 7 seconds
Accu-chek Compact - 8 seconds
Sidekick - 10 seconds
TrueTrack Smart System - 10 seconds
TrackEASE Smart System - 10 seconds
Freestyle Tracker - 15 seconds
Ascensia Contour - 15 seconds
HemoCue Glucose 201 - 15 to 240 seconds (depending on blood glucose level)
ReliOn NewTek - 15 seconds
Precision QID - 20 seconds
Accu-chek Advantage - 26 seconds
Accu-chek Complete - 26 seconds
Ascensia Elite/XL - 30 seconds
Ascensia DEX2/Breeze - 30 seconds
LifeScan Sure Step - 30 seconds
LifeScan One Touch Basic - 45 seconds
Strips
These are what you really need to look at when buying a meter. That is because this is where the manufacturers make the real money, not on the meters themselves.
In fact you will frequently find they will give the meter away free.
Sounds good but it is not pure altruism on their part, they have hooked you into buying their strips, and these are what are termed expendables, the things you will buy month after month.
Needless to say strips are usually specific to one brand of meter. If they made them standard the price would have to come down wouldn't it?
Here are a list of prices taken from the November 2005 issue of Diabetes Forecast. It deals with the prices in American Dollars. I am afraid I do not have data for other countries and in other currencies.
Where I live in the UK this is not much of a factor as we get a quantity of our strips free on the NHS. Though this is often enough, when I have wanted to do some intense testing I have resorted to buying my own and they came to around 60 for 100 strips.
The US prices for that make is around $81. If my conversion rates are right that means I am paying about 12 more for my strips than I would if I bought them in the States. Oh well, who am I to complain when I get so many free.
The promised list, per 100 strips:-
Accu-chek Active - $51.70
Ascensia Elite/XL - $71.49
Ascensia DEX2/Breeze - $74.95
BD Logic/Latitude - $75.42
Ascensia Contour - $77.49
Accu-chek Aviva - $77.90
Freestyle & Flash - $78.39
Precision XTRA - $79.39
LifeScan One Touch Ultra/Ultra Smart - $80.85
LifeScan One Touch Basic - $81.99
LifeScan Sure Step - $81.99
Accu-chek Comfort Curve - $82.49
Accu-chek Compact - $82.49
HemoCue Glucose 201 - $100 (uses microcuvettes)
Individual strips can come either foil wrapped or as a collection of 25 0r 50 in a vial.
The foil wrapped ones are more difficult to break into. Now there's an understatement for you. Either I am the classic 98 pound weakling (and I assure you the 98 lb. bit is a laugh!) or the ones I tried were made by a sadist on a bad day.
Repeated tugging failed to gain me entry and I resorted to a pair of scissors. This can be a problem if you are somewhere where no sharp object is available.
However they have the benefit of being resistant to humidity and so will last longer - useful if you are an occasional tester. They also take up less room when carrying them around.
So one goes for those in the vial does one - or does one? They have there own small problems. And small is exactly the right term. I have no problem with them, I simply put my hand in the container, take out a strip and insert it in the tester.
My friend Peter on the other hand (and yes, he knows that I am going to mention him so won't sue me) can afford us plenty of amusement as he tries to do the same. You see he is not exactly an average man. He kind of fills a doorway when he enters through it and has hands to suit.
His fingers do not, in any way, fit into the neck of the containers. It must have been watching something like this that sparked Jonathan Swift to write the story of Gulliver in Lilliput.
Peter has now got round the problem by emptying all the strips out onto a piece of clean paper, separating one out and turning the paper into a funnel to replace the rest in the vial. Needless to say a few spills do occur.
For folk like Peter one of the following may be of more use.
In an attempt to make BG monitors even more user friendly some manufacturers have put their strips into packaging that allows you to load a number of strips at a time.
For instance the Ascensia Breeze from Bayer uses what they call an Autodisc. It is a round disc holding 10 strips. It reminds me of those discs of dressmakers pins you can buy, or the packaging of some birth control tablets.
The Accu-chek Compact has a drum which holds 17 strips and has it's code written on the outside of the drum where it is automatically read by the meter, so eliminating the need to calibrate.
These devices have made testing easier for those with physical disabilities that make getting the small strips into the meters very difficult, for instance someone with Parkinson's disease or with neurological damage to the hands.
The Accu-chek Compact plus even has a lancet device built in so you do not have to carry a separate one - ideal for those carting it around with them.
Strips also operate over different temperature ranges. You might think that this is not important, but what if you are an Inuit diabetic who lives in the frozen north, or an Australian in the baking heat of the outback?
Then there is the chance that you might travel to somewhere with extreme temperatures and your normal test strips might not work.
Even just working outside in very hot or cold weather can affect your readings if the strips do not have a wide enough range. If you fit into any of these categories you need to know what strips (and therefore what meter) would work best for you.
Here are the temperature ranges of some popular strips:-
Ascensia Elite/Elite XL & Ascensia DEX 50-104F 10-40C
Accu-Chek Advantage & Accu-Chek Simplicity 57-104F 14-40C
One Touch Ultra & UltraSmart & InDuo 43-111F 6-44C
One Touch Basic 59-95F 15-35C
LifeScan SureStep 50-95F 10-35C
Flash & FreeStyle 50-95F 10-35C
Precision XTRA 64-86F 18-30C
Looking at this it is pretty obvious what our Inuit or Auzzie friend would be better off with isn't it.
Next one needs to consider strip availability. With the wide range of meters on the market one cannot, in reality, expect pharmacies to keep strips for all of them. It would be wise to find out which ones your local pharmacy carries as normal stock.
If you are hung up on a meter whose strips they do not carry perhaps you can ask them if they would start carrying them or if they could order them for you and how long will this take and what the cost will be?
It is possible to get strips over the internet but remember to factor in the delay period - and pray there is no postal strike!
Some sites sell generic strips. These will not work with all meters and need to be carefully checked for accuracy.
Also beware of buying cheap strips from online auctions. They can be cheap because they are out of date and will give you false readings - always check first.
Altitude
If you are part of the jet set or fly frequently as part of your job you may have concerns about what meter will work best for you if you need to take your BG's in flight.
In fact it can be disregarded as a decision factor. No meter will test accurately at over 10,400 feet.
In flight testing is very often inaccurate even below that level so it would be better to test before you take off so you have some idea where you are re the status of your blood sugars.
Then beware of airline food, it is a frequent source of complaints from people, even though they thought they had eaten carefully.
Rather take stuff you know will work for you on board with you. Beware of taking stuff through customs at places that do not allow it - fruit is a problem item here!
Coding
I have mentioned this briefly in connection with other factors but will now explain more clearly.
A thousand and one minute changes can occur within the manufacturing process of a strip. This will cause variations in the sensitivity of each batch.
A sample of each batch of strips is taken and tested against a standard solution. The reading thus produced allows the manufacturers to calculate what the code number for that batch should be so that when this code number is entered into your meter it will recalibrate your meter correctly for the sensitivity of that batch of strips.
Each time you open a new batch of strips you will need to recalibrate your meter. This is not difficult to do, usually involving placing one of the new strips in the meter and holding down a single button until the displayed code in the window matches the one on the vial.
The book accompanying the meter will explain all you need to know. A miscoded meter can give readings that are out by as much as 43 per cent. You do not need the angst this will cause so remember to calibrate!
The Accu-Chek Comfort Curve takes a Code Key that comes within each vial of strips and is inserted into the meter, which then calibrates for that batch of strips (no buttons to push here). If the code that comes up in the window does not match that on the vial you need to return the vial and get a new one.
If this all seems to be too much trouble then you need to look at those meters that do this calibration automatically. Examples are the Ascensia Breeze, the Ascensia Contour and the Accu-Chek Compact.
Test sites
All meters will test blood from your fingertips but there are some that allow testing from other sites, like the palm of the hands, the forearm, the upper arm, the base of the thumb or the thigh. These are places that have less nerve endings than your fingers do.
Some people find that their fingertips are just too sensitive and like the idea of alternative sites.
There are others to whom painful fingertips are an actual career problem, like many musicians, notably guitarists & harp players and anyone whose day revolves around the constant use of a keyboard.
If you think you might like this option then you need to look out for a meter that allows it.
Examples are :-
LifeScan One Touch Ultra - forearm
Accu-Chek Active - palm, forearm, upper arm, thigh, or calf.
Freestyle flash - palm, forearm, upper arm, thigh, or calf.
Home Diagnostic's Sidekick - forearm
BD Logic - palm and forearm.
Paradigm Link - palm and forearm.
MediSense Soft-Tact - Fleshy part of upper arm, base of thumb & forearm.
If you are looking at using an alternative site for testing remember that the readings from these sites are not as accurate as from the fingertips.
The reason the fingertips have remained the place of choice for so long is because changes in your blood glucose levels show up faster there than in other parts of the body.
If you are ill or worried about hypoglycaemia, have just exercised, are stressed or have just eaten a meal or taken insulin it is best to test from the fingertip even if you usually test from elsewhere.
Backlight
This means that your display window lights up and allows you to see if the room is dark.
If you are the parent of a diabetic child this can be a real boon as you can do night-time testing with the chance of not waking the child with bright lights.
For those who are thinking "Fat chance, the kid will wake when you stick the needle in it's finger" let me tell you that there are some children out there who actually sleep through the whole process - amazing isn't it?
If you are addicted to movies and find you need to test while the picture is showing - we diabetics test in all sorts of weird places - then a meter with backlighting is the one for you.
At the moment there are very few meters that offer this but here are the ones I have been able to find:-
One Touch UltraSmart
Freestyle Flash
Precision Xtra
Optium Xceed
Measurement Range
This indicates the lowest and highest blood glucose level at which the meter will give a reading. Most meters read in a range between 0.6mmol/L and 33.3mmol/L (10mg/dL and 600mg/dL).
This is more than most of us need. If you are lower than that it is just possible you, or rather the folk around you, will notice and carry your comatose body off to hospital.
There are people who have exceeded the upper range but they are also usually at the doctor's or hospital when this is discovered!
There are a couple of meters that read lower values. These are the One Touch Basic which reads from 0 - 33.3mmol/L (0 - 600mg/dL) and the HemoCue Glucose 201 which reads from 0 - 24.6mmol/L (0 - 444mg/dL).
Most of the Freestyle meters only read as high as 27.8mmol/L (500mg/dL), as does the Precision Xtra and the ReliOn Ultra.
Audio meters
For those diabetics who suffer from blindness or impaired vision there a couple of meters available that talk you through your testing.
The Accu-Chek Voicemate
This is the best meter for visually impaired diabetics around today. It is basically the Accu-Chek Advantage with an incorporated synthetic voice attachment.
Instructions on it's use come on an audio cassette for the blind and also in large print for those who are visually impaired. You have a choice of only two languages, English and Spanish.
Coding is done via a Code Key which comes in each vial of strips and is easily inserted in the back of the voicebox.
It does not require cleaning. It includes 'repeat' feature, volume control and an earphone.
An additional advantage is that, as well as talking the user through the process of the blood glucose test, it also has the ability to read the bar-coded labels of Eli Lilly brand insulin vials (humulin and humalog) out loud. These slot into a hole in the front of the meter and this will let you know what type of insulin you have in there.
It is really simple to use. The Comfort curve strips are sturdy and you can handle them without causing problems.
They have a curved cut out section on one side which aids you in getting them into the meter the right way round - the curved section goes to the right.
The curve is also where you place your lanced finger so that the blood will be drawn up automatically. An advantage with this meter is that if you do not get the right amount of blood the first time round it allows you to add to it for up to 15 seconds after the first contact with the strip.
Results take 40 seconds.
Digi-Voice Deluxe and Mini-DV
These are not meters themselves but speech modules that plug into the data plug point on the LifeScan Basic or SureStep meters.
They are Not made by LifeScan but by independent companies.
The Digi-Voice Deluxe has rechargeable batteries and the voice and meter controls are separate. This is a tad awkward as the user has to remember to turn both the voice and the meter on and off.
The Mini-DV offers a choice of a 9-volt battery or AC/DC adapter and is an improvement in that it has automatic shut-off.
Instructions for use come on a cassette. It is very simple to set up.
It comes with an earphone.
Unfortunately the codes need to be entered by a sighted person.
The speech can be difficult for some patients to understand as it is quite fast.
LHS-7
This is another voice attachment for the LifeScan Basic only, made by a different company.
It can be attached to the base of the meter with Velcro which makes it quite convenient if you are going to carry it around. It works off either AAA batteries or an AC/DC adapter. The voice and meter turn off together.
Disadvantages are the fact that the speech is rapid and so can be difficult to understand and you are limited to two volume settings.
Instructions are only available in print, and in normal, not large print at that.
Technology
As technology has advanced and we have become more and more attached to our computers (you are using one here are you not? I rest my case! ) so the 'bells and whistles' that we can get on our meters have advanced.
These are not for everybody. I am, despite how it may seem, what my husband refers to as a 'technophobe'.
I like my equipment plain and simple. I do not want it to think for me. I have a brain and two good hands, I can turn switches, push buttons and write down results.
Manufacturers of all sorts of machines tell me fuzzy logic is the 'in thing'.
Is it just me or does that name not conjure up visions of one really confused piece of equipment? I thought the whole point of logic was to be clear and concise, not 'fuzzy'! Oh well, I did say I was a technophobe.....sigh.
If you are one of those people to whom technology is an exciting adventure, who must have the very latest mobile phone, who owns the latest in computerised washing machines that picks your clothes off the floor, sorts them, washes them, softens them, dries them, irons them, fold them and replaces them in the correct drawers (after locating that elusive lost sock) then you will love some of the latest meters.
Note - if I could find a washing machine that did all that maybe I would become a convert to technology too!!!
Most meters now offer loads of memory which is great for those who do not like keeping written records in log books. They store the results of each test and can calculate an average blood glucose level for a particular period of time.
They vary in the number of past test results they keep so if you want to follow trends over months and years then you are either going to have to write the results down before they scroll out of memory or use yet another of the abilities many meters now have - the ability to interface with your computer via a data cable and download all the data from your meter onto your PC.
A software program (usually downloadable free from the web) then allows you to analyse this data, frequently in the form of graphs and charts.
This is useful in that it enables you to recognise patterns in your BG readings and allow you to adjust your lifestyle or meds (with the advise of a doctor) to suit.
Features on meters are changing so fast that whatever one you buy will soon be short some of the features of the latest ones out.
Many people like to change their meter yearly for that very reason. I have seen advice to change your meter at least every other year because they become inaccurate as they age.
However some folk have a meter that they have had since the year dot and hang onto it avidly (I know someone who has even named their meter and says she cannot part with it because it has become like a part of the family!).
These folk claim their meters are still reading perfectly so, as usual, opinions differ - do what works for you.
Batteries
A dead meter or even one that tells you 'battery low' is not much use.
And of course it is going to do this on a Public holiday when all the shops are shut, possibly for the next two days, you have promised the kids a 10 mile hike and your sugar levels have been fluctuating madly.
Naturally you have spare batteries tucked away in the drawer against such an emergency - faint hope! The problem is that the meters can do so many tests on one set of batteries - sometimes as many as 1000 - that we become complacent and forget about them.
And unless you are very lucky you cannot just rob some out of your torch.
When looking at purchasing a meter check what sort of battery it uses and whether you can get them easily from your normal stores. I battled to find information about batteries, even on the manufacturers home pages.
The results listed below were the ones I did manage to come up with:-
LifeScan One Touch Basic - Two AAA alkaline batteries
LifeScan One Touch SureStep - Two AAA alkaline batteries
LifeScan One Touch Ultra - One 3-volt lithium battery (#2032 or equivalent)
LifeScan One Touch UltraSmart - Two AAA alkaline batteries
Ascensia BREEZE - One 3-volt Lithium
Ascensia CONTOUR - Two 3-volt Lithium
BD Logic - One 3-volt Lithium (#2450)
Tru Track Smart - One 3-volt lithium battery (#2032)
Sidekick - Built into meter and never needs to be changed.
Precision Xtra - Two AAA
Accu-Chek Aviva - One 3-volt lithium battery (#2032)
Accu-Chek Advantage - Three 3-volt lithium battery (#2032)
Accu-Chek Compact - Two AAA
FreeStyle - Two AAAA
FreeStyle Flash - One 3-volt lithium battery (#2032)
Glucometer Dex 2 - Two lithium (#CR 2016)
Testing for Ketones
Sometimes your doctor will want you to test your ketone levels. This is very rare, usually only if you constantly suffer from hyperglycaemia.
If you are on a low carb, high protein diet to lose weight i.e. Atkins, you may want to test for ketones yourself.
There are urine ketone test strips that do this adequately, but the Precision Xtra meter has the ability to test for both glucose and ketones and may be one to consider if ketone testing is part of your regime.
Lancets
Most meters come with a lancet as part of the package though there are a few that don't.
Check before you buy that yours has a lancet or you will need to order one separately. Sometimes people get a different lancet anyway because there are lancets and then there are lancets. Some definitely cause more pain than others.
In the far distant past, when I was studying haematology, we were required to prick our own fingers so as to produce blood for slides etc.
There was no fancy equipment then (or if there was we were not told about it). We were presented with a foil wrapped piece of flat metal that had been sharpened to a point at one end.
You held it in one hand and jabbed the end into a finger of the other hand. The principal was simple, the act much more difficult! No matter how hard you tried, the 'to be jabbed' hand instinctively pulled away.
You ended up resting it on a table or getting a pal to do it for you - an enemy would probably been better, they might have actually enjoyed it!
Fortunately lancet devices have come a long way. You can get short, needle like devices that you hold in your hand much as we used to do, but mostly the lancets fit into some kind of spring-loaded device, about the size of a fountain pen.
You just put the end against the place you want to prick and press a button and.... wham, the needle is in and out in milliseconds. Most come with a dial that allows you to chose how deep the needle will penetrate.
There are devices that will take a number of kinds of lancets, both name brand and generic, but some, like the Accuchek ones, take a different shaped lancet (flattened in this case) and you have to use that particular brand in their device.
I have read some rave notices in a forum about the Accu-chek Multiclix. The 6 lancets come in a drum and as you use them you throw the end one away. When you have used all 6 you just replace the drum with a new one. This is probably a benefit to those who discard their lancets often.
Though lancets are considered 'one time usage' devices most folk use theirs until it is blunt and then change it. This is fine as long as you are the only person using your machine. I definitely am, nothing I have said as yet has persuaded hubby to prick his finger, not even in the interests of finding out what a 'normal' person's BG is.
He is of the genre that faints at the very sight of a syringe so I doubt if I will ever be able to truly share this experience with him - what a shame! Maybe the following device will bring us closer together....
A company called Cell Robotics International, Inc has produced a needle free device. Known as the Lasette Plus it uses a laser to make a small hole in the skin from which you get your drop of blood, which is then tested on your normal meter.
It is reported to be painless, causing just a mild tingling sensation. Apparently there are 16 different settings so you should find one that works for you.
There have been a couple of reports that I have read where people say they could not get sufficient blood at any setting while other folk rave about it. There have also been the odd comments about the smell of burning flesh! - I guess its the old story of your mileage may vary.
It has been cleared by the FDA for use by anyone 5 years or older. Although you do not need to replace lancets you do need to replace a roll of protective film after about 120 uses. The films purpose is to protect the laser optics from skin debris which is created when the laser is used.
In the US a prescription is needed to buy this device while in the UK the NHS will not cover it and you have to pay for it out of your own pocket.
And there is the hitch. It is very expensive wherever you are. Prices I have seen quoted are £495 for the Lasette and £22.11 for the film in the UK and from $495 to $1000 for the Lasette and around $15 for the film in the US. If the price has not put you off and you want to know more check out the website http://www.cellrobotics.com/
There are a couple of meters made that have built in lancing devises.
The Accu-chek Compact is one I have mentioned before.
The other is the Checkmate Plus. I have never actually seen one of these but here is what I have read about it.
The meter looks a bit like a pen. You open a 'door' in the side and cock it - this takes a considerable amount of pressure I believe. Then you place your finger over a finger bowl and trigger the device.
The blood is applied to the test strip and the results arrive in around 15-70 seconds.
This could be quite useful if you travel around a lot and do not want to carry an assortment of equipment with you.
The "Sof-Tact" meter, made by MediSense, has a built in lancet device as well. It works a little differently to other meters in that it uses light suction to hold the skin of your upper arm, forearm or base of thumb firm while the built in lancet pierces the skin and draws a drop of blood, which is then automatically applied to a test strip. The results appear in 20 seconds. No fingertip lancing is needed.
Cost
For many of us this is going to be the deciding factor. However much we may feel we have found the perfect meter if we are going to be unable to afford the strips to use in it then it is going to be a fancy white elephant.
As I have said before, it is the strips that count. The meter may well be given to you at a reduced cost or even free by a company to lock you into using their strips.
Offers of a free meter plus around 100 strips come up all the time and you may well be able to try a number of meters without actually buying them.
This may sound unethical and you may wonder at my advocating it but I am a diabetic too and I know how some of you get ripped off. Remember the places offering these deals are not exactly knights in shining armour either, they have their own ulterior motives.
If you are a diabetic in the UK you will hopefully have received a free meter though I am told not all clinics issue these. I was lucky and received a very nice One Touch Ultra upon diagnosis.
If you did not get one then you will have to buy one and they are not available on prescription. However you can claim VAT exemption, which will save you a bit.
The test strips thereafter will be on script and once you have registered for a medical exemption certificate due to your diabetes all your future prescriptions will be free, so that takes care of that expense.
In the USA you need to find out what meters your insurance will pay for. They may only cover a couple of varieties of meters and their strips and you do not want to sail out and buy your perfect meter only to have your claim turned down.
Availability
I have listed values for a number of different meters here but not all are available in every country and to make matters more complicated the same meter may be sold under a different name in a different country.
You will just have to check your local shops or ask your diabetes advisors what meters are available. Of course world-wide online buying has opened up a wider choice but it would be better to get a meter that had local support
Disposable meters
The Sidekick Testing System. This disposable system is quite small and contains a meter and a vial of 50 test strips. There is no coding required. it uses 1L (1 microliter) of blood and provides results in less than 10 seconds.
ReliOn NewTek. This is the first disposable meter. It contains 100 test strips pre-loaded and pre-calibrated, so there you don't have to handle the strips.
The meter requires a 3L (3 microliter) drop of blood and displays test results in 15 seconds.
Hypoguard markets it exclusively through Wal-Mart and Sam's Club under the ReliOn brand where it currently sells for $54.76. Here is the link Wal-Mart and Sam's Club.
Round Up
There you have it folks, as much info as I can come up with to get you started. If you feel it is too much info and you do not know where to begin I would suggest you go through the list and discard those features that are obviously not applicable to you.
For instance if you are not physically or visually impaired you do not need a meter that caters to someone who is. If you live in a pleasant and reasonably stable climate and are not into extreme adventures then temperature range is not a biggy. If you don't fly a lot you can forget that one - see what I mean, you have eliminated around 5 factors from the list.
Write down the factors that are important to you, shuffle them until you have them in order of importance, from most to least and try and match them to a meter, getting as many as the top ones in as possible.
There are a number of tables on the web which compare meters. I will give some of the URL's below.
Diabetes.org. - pdf you can save on your pc.
Children With Diabetes.com. - grades meters best for use by children with diabetes