12) DIABETES MEDICATIONS
e) Blood Sugar Testers
There are a whole host of blood sugar (glucose) level testers on the market and more coming out every year. There are trade-offs to be made between price, ease of use, computer compatibility, and pain. We prefer the testers that have the lowest price test strips, this way an individual with diabetes is encouraged to test often. There is an amount of unreliability built in to blood sugar meters. They are sensitive instruments and can be put out of adjustment by shock, high temperatures, high humidity, or just age. It is always a good idea to buy two testers and check them against each other every once in awhile to make sure they are still working. We knew one person with type 2 diabetes who thought his blood sugars per his meter were running consistently low and under 100 and was surprised when his A1c came in high at 7.5. When he checked his meter against the meter of a diabetic friend's (changing needles of course), his meter was a huge 40 points off.
Once again, Wikipedia has an article we cannot improve upon:
There are several key characteristics of glucose meters that may differ from model to model:
Size: The average size is now approximately the size of the palm of the hand, though some are smaller or larger. They are battery-powered.
Test strips: A consumable element containing chemicals that react with glucose in the drop of blood is used for each measurement. For some models this element is a plastic test strip with a small spot impregnated with glucose oxidase and other components. Each strip can only be used once and is then discarded. Instead of strips, some models use discs that may be used for several readings.
In the near future the test strips may even become unnecessary, thanks to the development of new kind of measuring methods. Obviously the nowadays manufacturers resist this kind of development in fear of losing markets.
Coding: Since test strips may vary from batch to batch, some models require the user to enter in a code that may be found on the vial of test strips, or a chip that comes with the test strip. By entering the coding or chip into the glucose meter, the meter will be calibrated to that batch of test strips. However, if this process is carried out incorrectly, the meter reading can be up to 4mmol/L inaccurate. The implications of an incorrectly coded meter can be serious for patients actively managing their diabetes. For miscoded meters, the probability of making an insulin dose error of 2 units is 50%. The probability of making an insulin dose error of 3 units is 24%, compared to 0.49% when using a no coding meter. This may place patients at increased risk of hypoglycaemia.
Volume of blood sample: The size of the drop of blood needed by different models varies from 0.3 to 10 µl. (Older models required larger blood samples, usually defined as a "hanging drop" from the fingertip.) Smaller volume requirements reduce the frequency of unproductive pricks.Alternative site testing: Smaller drop volumes have enabled "alternate site testing" — pricking the forearms or other less sensitive areas instead of the fingertips. Although less uncomfortable, readings obtained from forearm blood lag behind fingertip blood in reflecting rapidly changing glucose levels in the rest of the body.
Testing times: The times it takes to read a test strip may range from 3 to 60 seconds for different models.
Display: The glucose value in mg/dl or mmol/l is displayed in a small window. The preferred measurement unit varies by country: mg/dl are preferred in the US, mmol/l in Canada and Europe. To convert mmol/l of glucose to mg/dl, multiply by 18. To convert mg/dl of glucose to mmol/l, divide by 18 or multiply by 0.055. Many machines can toggle between both types of measurements and there have been a couple of published instances in which someone with diabetes has been misled into the wrong action by assuming that a reading in mmol/l was really a very low reading in mg/dl, or the converse. Recent production U.S.-marketed machines are pre-set at the factory for mg/dl and cannot be changed.
Glucose vs. Plasma glucose: Glucose levels in plasma (one of the components of blood) are generally 10%–15% higher than glucose measurements in whole blood (and even more after eating). This is important because home blood glucose meters measure the glucose in whole blood while most lab tests measure the glucose in plasma. Currently, there are many meters on the market that give results as "plasma equivalent," even though they are measuring whole blood glucose. The plasma equivalent is calculated from the whole blood glucose reading using an equation built into the glucose meter. This allows patients to easily compare their glucose measurements in a lab test and at home. It is important for you and your healthcare provider to know whether your meter gives its results as "whole blood equivalent" or "plasma equivalent."
Clock/memory: All meters now include a clock that is set for date and time, and a memory for past test results. The memory is an important aspect of diabetes care, as it enables the person with diabetes to keep a record of management and look for trends and patterns in blood glucose levels over days. Most memory chips can display an average of recent glucose readings.Data transfer: Many meters now have more sophisticated data handling capabilities. Many can be downloaded by a cable or infrared to a computer that has diabetes management software to display the test results. Some meters allow entry of additional data throughout the day, such as insulin dose, amounts of carbohydrates eaten, or exercise. A number of meters have been combined with other devices, such as insulin injection devices, PDAs, and even Game Boys. A radio link to an insulin pump allows automatic transfer of glucose readings to a calculator that assists the wearer in deciding on an appropriate insulin dose. One model also measures beta-hydroxybutyrate in the blood to detect ketoacidosis (ketosis).
Hospital glucose meters: Special glucose meters for multi-patient hospital use are now used. These provide more elaborate quality control records, and the data handling capabilities are designed to transfer glucoses into electronic medical records and the laboratory computer systems for billing purposes.
Cost: The cost of home blood glucose monitoring is substantial due to the cost of the test strips. In 2006, the consumer cost of each glucose strip ranged from about $0.35 to $1.00. Manufacturers often provide meters at no cost to induce use of the profitable test strips. Type 1 diabetics may test as often as 10 to 12 times a day due to the dynamics of insulin adjustment, whereas type 2 typically test less frequently, especially when insulin is not part of treatment.
Some batches of counterfeit test strips for some meters have been identified, and these have been shown to produce inaccurate results. They should not be used and should be reported to the supposed manufacturer.
Accuracy: Accuracy of glucose meters is a common topic of clinical concern. Nearly all of the meters have similar accuracy (±10-15%) when used optimally. However, a variety of factors can affect the accuracy of a test. Factors affecting accuracy of various meters have included calibration of meter, ambient temperature, pressure use to wipe off strip (if applicable), size and quality of blood sample, high levels of certain drugs (such as ascorbic acid = vitamin C) in blood, hematocrit, dirt on meter, humidity, and aging of test strips. Models vary in their susceptibility to these factors, and in their ability to prevent or warn of inaccurate results with error messages.
Next Chapter: 13) TYPE 2 DIABETES SUPPLEMENTS
a) Introduction
b) The Benefits of Fish Oil
c) Issues with Fish Oil
d) Flax Seed Oil
e) Bad Omega 6 oils
f) Nuts and Phytosterols
g) Aspirin Therapy
h) Magnesium
i) Vitamins C, D and E
j) High Water Intake
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