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Choosing a glucose meter is like choosing a home. You have your dream home in your head, but it does not exist in the real world, just like a noninvasive meter. Then, even among the existing homes, what you really want, (for most of us) you cannot afford. Similarly, the meter that has all the features you are looking for may not be covered by your health insurance. Yet, just when you've given up hope, it all comes together and you find the one you want. After some work, your home, and your meter, become sources of protection and comfort. Most importantly, your meter becomes your lifeline.
Your meter travels everywhere with you, extending your health and well-being with each use. You literally trust it with your life-a bond between human and machine rarely equalled.
A father of two young boys with diabetes, Robert, tells of his sons' special attachment to their meters.
"We decorate their meters with stickers and funny pictures of the boys making silly faces," says Robert. Robert says this personal attachment helps them remember to test, and forms in their minds that testing leads to well-being.
This bond is hard to break, a downside when it comes to new technology. Robert says that, a few years ago, the family got the boys new meters, with features that would improve their glucose control, but the change proved nearly traumatic.
"This was a big event to change their meters," Robert recalls. "They really trusted the old ones."
"A meter is the single most important thing in your life," says Jane Seley, RN, CDE, a diabetes educator at Beth Israel Medical Center in New York City.
Here are some of the features that our readers have identified as most important.
"The quicker the better," says Londoner Terry Friel.
Every person with diabetes wants to minimize the time it takes to perform a test, for convenience, and for emergency situations.
"Glucose meters should be convenient to use," says Peter Lodewick, MD, medical director of the Diabetes Care Center in Birmingham, Alabama. Lodewick, who has diabetes, also believes faster meters are best.
Jeffrey Jodoin, a type 1 pump user from Tulsa, Oklahoma, agrees. He says meters "should be very fast."
With most meters now reading in less than 45 seconds, no one wants to return to the two-minute tests. Out on the streets, people test in their cars at stop lights, and also in more public places, so the more quickly you can test, treat and get on with your day, the better.
Not just a convenience, fast testing can also help bring you out of a low more quickly.
"I need a fast reading, because my patience is very thin when I'm hypo-ing," says Annie Kilsby from Penola, South Australia.
Kim Advent's 8-year-old daughter has diabetes, so she places great faith in the memory feature. For her, it's more important than any bells and whistles. The meter is easy to use. "Right now, simplicity is best, as long as it gives an accurate reading, and has memory for me to check her numbers when she gets home from school," says Advent.
For adults, memories can help them assess their past few weeks of diabetes care and make changes. The information can be used for everything from simple, daily log books, to elaborate, computer-generated analyses.
Nancy Matthews's meter memory helps her when she's away from home, in Jonesboro, Arkansas. "I like a meter that lets me review test results with the time and date," she says. "There are times that I test away from home, and it is not always convenient to write down all of this information."
Steve Bieringer takes the memory a few steps further. "The best feature is the ability to track blood glucose averages for different times of the day, in addition to the 14-day and 28-day averages," says Bieringer. "I input the averages into a spread sheet on the 15th and 30th of the month, then do long-term and yearly averages. This way, I can easily see changes (good or bad). It complements my regular glycosolated hemoglobins."
For those who value their meters' downloading capabilities, but use Macintosh computers, choices are limited. One Mac user claims, "They should all be downloadable to both Windows and Mac computers, since not all of us follow the Windows herd."
Robert Cramer, director of marketing at meter manufacturer Chronimed, reports that smaller blood samples is the biggest wish among consumers with whom he corresponds.
"Besides the holy grail of a noninvasive meter," says Cramer, "micro-sampling, or minimally invasive technology, is what people are looking for." To fulfill customers' wishes, sample sizes continue to decrease.
Less blood may not really mean less pain, but it could have a psychological effect. According to Don Domoulin, Roche's director of marketing, "Most people associate the blood drop size with the amount of pain they're enduring. There's really no relationship, according to our scientific efforts, but in people's minds there is, so by taking a drop that's two-thirds smaller, people think they're testing with less pain."
Small, Discreet Meters
"Small and discreet," is what Annie Kilsby wants in a meter.
Meters are getting smaller, to meet the demands of today's active people with diabetes. "Flexibility and transportability" are key features for meters, according to Jeff Christensen, of LifeScan's marketing communications department.
Karen Tank loves her new meter, because "it is small and very lightweight, and is easy to carry in a pocket or small bag," explains Tank, a Morristown, New Jersey, resident.
Christensen says LifeScan also puts emphasis on "broader operating ranges," so people can safely test in different types of weather and higher altitudes.
Frank Church of Oshkosh, Wisconsin, appreciates these changes, saying his transportable meter is "very convenient for travel and the variety of outdoor activities I participate in."
Jeffrey Jodoin lives in a warm climate, but skis in a cold climate, and wishes his meter could perform better in these extreme weather conditions. "I wish the meter worked better in the Tulsa heat and the Colorado cold," he says.
Broader temperature ranges don't just benefit the outdoor adventurer. During recent cool summer nights in Salt Spring Island, British Columbia, Marial Shea has had to warm her meter between her hands for 30 to 60 seconds, in the middle of the night, an uneasy time for many. "It's been a cool summer, and my bedroom is a bit chilly, but, what's it going to be like in the winter?" she worries.
Testing in a crowd calls for different conveniences than testing in the great outdoors. A feature like beeping helps guide people through testing, but for some, it's a nuisance. Shea is glad her meter does not beep, because she can test during lectures and concerts.
No Need to Clean
"I like that the blood doesn't go into the machine," says Judy Carter of Hoquiam, Washington, "so there's no cleaning problems."
Newer strips do not need to go inside the machine, which keeps the blood away from the meter, so there's no need to clean.
One reader thinks back to the days of hanging drops. "I hated the difficulty of getting a large enough drop to fill the circle, and the awkwardness of trying to hit the target."
One of the most recent, and most popular, diabetes innovations is sipping, or capillary, strips. Instead of holding your finger above the meter's sensor and dropping the blood down onto the sensor, capillary strips do the aiming for you.
"I like the sip feature of the strips," says Pat Cook of Port Charlotte, Florida. "I don't have to blot, or get the drop of blood in the right place. It uses a very small drop and [the meter] tells me when it has enough."
Roche's Comfort Curve strips use this technology, which Roche calls a "capillary fill" feature, allowing the meter to test with a much smaller blood sample. Users touch their fingers to the curve in the strip. Within the curve, a v-shaped device takes the blood and draws it into the strip's sensor.
Bayer uses the term "capillary action" for its strips. Linda Parks, RN, CDE, a Bayer diabetes representative, compares the technology to a straw, that sucks up the blood.
While most readers report that they have adequate health insurance, some type 2s cannot get coverage for their testing supplies, because they do not take insulin. Judy Carter believes this is an unfair distinction. "I'm desperately trying to stay off any medications through diet and exercise, but I'm penalized for trying to stay healthier," she says.
If you are type 1 or type 2, and you have no health insurance, or insufficient health insurance, the costs can be staggering, and can even affect your health.
"My doctor has advised me to check at least four times a day," one reader says. "But I usually check only once or twice a day, as the test strips for [my meter] are too costly for me, and my insurance does not cover them."
"Because we don't have health insurance all costs come out of our pocket," says Advent. "So, before I buy a new meter, the old one would have to break." Advent's 8-year-old daughter with diabetes could be forced to use an out-of-date meter.
Even with coverage, diabetes finances can be tricky. Shea's insurance covers her supplies after an $800 deductible. "Those first few months of each year, when my diabetes expenses rise by a couple hundred dollars until I reach the deductible, are always a bit challenging," she says.
The cost of strips, even with insurance coverage, amazes the diabetes community.
"I think the strips are outrageously expensive, especially for those of us who test multiple times per day," proclaims Janet Wager of Ogden, Utah.
Netta Benton of Blacksburg, Virginia, likes her meter because "it's possible to test without removing the meter or lancet from the case, so I can test discreetly in a meeting or other public place."
Testing in public is a hot issue.
"Cases should give you a good working surface, so that you can test in a public rest room without having to put any supplies directly on the sink surface," claims Steve Bohrer, of Bar Harbor, Maine.
Strip wrappings evoke opinions as well.
"I like the strips in bottles rather than individual wraps, as there is less junk to throw away after each use," says Bohrer.
On the other hand, the individually wrapped strips are more convenient for some readers. Before leaving the house, they can take a few strips out of the bottle. A few strips weigh down your purse or briefcase much less than an entire bottle.
Alice Mees of Rochester, New York, likes her new meter that has 10 strips on a cartridge. "I love the fact that I don't have to carry around separate strips." Terry Friel agrees, saying, "You don't have to carry another container around, and you aren't changing strips every time you've got to check."
Help When You Need It
Some people with diabetes place great value in helpful technical support from a meter manufacturer.
Julie D'Arrigo from Staten Island, New York, appreciates good customer service from her company.
"They're always there," says D'Arrigo about her meter company. "Also, when you call, they get your telephone number on their screen. In case there's an emergency, they can call your local 911, if there's a bad hypo in the works."
With all the different meters out there, people find that one meter works best when you are on the go, and another functions well for home use, making two meters a necessity.
Tank uses two different meters, one by her bed and another smaller meter in her purse. "I find I am much more likely to test often if I don't have to go running around looking for a meter, especially during the night," she says.
Priorities for Older and Visually Impaired People
Big numbers on read-outs help everyone, but they are crucial for those with impaired vision, often elderly people. Besides large numbers, other extras are not necessary for many older people.
"Ease of use is all that matters for elderly patients," says Loretta Jacobs, RN, CDE, a Marin County, California, diabetes nurse. "Most of my patients are elderly," reports Jacobs, "and simplicity is the key to success."
Besides being unnecessary, says Jacobs, the more complex systems can confuse her patients.
"It makes people nonadherent if it's just too hard," she says. "My patients don't care much about memory, snack messages or data ports."
Toward a Kinder, Gentler World?
"I wish there were a lancet device that could draw blood and not hurt so bad," says Toni Fuller of Lancaster, Texas, echoing the cries of all with diabetes. Everyone wants the same thing in a lancet: no pain. It is not here yet, but until painless testing arrives, adjustable depths seem to relieve fingers somewhat, especially children's little fingers.
Benton finds her lancet's five different depth settings vital. "I need a higher setting when I stick my index finger because it is more calloused than some other fingers," she says.
Bohrer has tried several different lancet brands, looking for comfort and value. After experimenting, he now sticks with the generic brand. "I've tried samples of the more specialized ones," he says, "but I found there was not enough difference to be worth the price."
Others believe brand names matter, and praise the smallest devices as less painful. People also appreciate ease in changing their lancets.
Tank likes her lancets "because they have caps, or covers, that can be used to remove a lancet from a lancing device before you put the new one in."
Even with adjustable depths, lancets still hurt. Many companies are racing to take the pain away from testing, and three have come out with alternatives to traditional lancing devices. The question now is whether people with diabetes will view these devices as the next best thing to noninvasive, or, just as an insignificant improvement.
Lasette Laser Finger Perforator
Now only available to doctors' offices, the Lasette shoots a laser beam through the finger tip to draw blood. The Personal Lasette is predicted to be available for any consumer to use at home this autumn. Manufacturer Cell Robotics International and distributor Chronimed call it "painless."
Chronimed is currently testing 27 different Personal Lasette prototypes on focus groups of consumers. With their reactions, the company will design the final version to hit the market.
One thing users may not like is the smell of burning flesh that some report after using the Lasette. The laser actually burns away a tiny amount of skin. Paul Dunn of Chronimed's marketing department reports that adjustable power settings control how deeply the device penetrates the skin. With a lower power, the odor can be eliminated, or at least reduced. If not completely eliminated, however, Dunn says it will have to be a "tragic by-product" of less painful testing.
Just as with standard lancing devices, you probably will not want to use the same finger for two consecutive tests, as some healing must occur. How long it takes to heal, according to Dunn, depends on the individual, but it can be up to two days. Even if you've used up all 10 fingers, says Dunn, you can still use different sides of the same finger.
Alternate Site Testing
Diabetes businesses have experimented with devices that do not lance finger tips, but lance the arms or thighs, as these areas have fewer nerve endings, and are thus less painful upon poking. Critics say that using these sites is less discreet, as you have to pull down your pants, or roll up your sleeves.
Others disagree, predicting that people with diabetes will take the opportunity for less painful testing. Some of the traditional meter manufacturers do foresee a dent in their market shares. Cascade Medical's national sales manager, Cindi Shore, thinks alternate site devices will have a big impact. "It will take the industry to a different level," she says.
The AtLast meter has a built-in lancing device. Approved by the U.S. Food and Drug Administration (FDA), it is expected to be available this winter.
Called a system of "preferred site testing," it lances the forearm, upper arm or thigh, areas with fewer nerve endings. The AtLast can use these body sites because it requires a much smaller amount of blood than traditional strips and meters.
Bill Feagin, director of marketing for AtLast's manufacturer, Amira, says the device uses a "press and release" action to draw blood up from the body. The lancing devices comes down through a tunnel-like tube attached to a meter. After the device pierces the skin, the user presses and releases the device several times, an action which draws more blood to the surface. Once the blood is visible, you flip around the AtLast to the other end, which contains a strip. After you touch the strip to the blood drop, a beep will indicate that the system has enough blood to measure, and the glucose level is then displayed.
Laura Lettunich of Watsonville, California, participated in the AtLast clinical trials. A type 1 for 30 years, Lettunich says, "I think the AtLast has potential. I think it will take people time to get used to it. It is a whole new way of doing something, and that in itself will make a lot of people cynical about it."
Alternate site testing can be just as discreet as finger poking, according to Lettunich. "I think being able to test on the thigh would be great," she says. "With a pair of shorts on, testing with an AtLast would be totally discreet. The person would test sitting at a table, with nothing on the table top. Sounds pretty discreet to me."
Feagin says that the retail price will be $63, and charges for strips and lancets will be similar to the costs of current strips and lancets.
The Vaculance is another alternate site lancing device from Bayer, made for use with its Elite XL and Dex glucose meters, or any meter that uses strips which suck up the blood into the meter. A sip, or capillary action, strip, which does not require hanging drops of blood, is necessary, because you cannot get a hanging drop of blood from a body part like the leg. The Vaculance is less painful because blood is drawn from sites that have fewer nerve endings than the finger tips. Bayer recommends using the outer thigh, the base of the thumb and the fleshy part of the palm.
The Vaculance has four different levels of penetration. After the skin is lanced, a vacuum action sucks blood to the surface. The Microlet Vaculance costs $25.
Along with less painful testing, diabetes manufacturers are also banking on consumers' using their computers to improve their control with specialized diabetes management software. The companies also put money into sponsoring Web sites that offer diabetes information, in the hopes that those hitting the site will see their advertisements.
Software that Analyzes Your BGs
Probably the most significant development in the last five years is diabetes management software-programs that take your glucose levels, food intake and insulin or medication doses, then make all kinds of graphs and charts so that you can analyze your self-care, and make adjustments for improvement.
Yet even with software packages adding more conveniences, most people with diabetes aren't buying them. Domoulin believes that "a very small percentage" of people with diabetes are using software, but, he adds, "it's growing pretty dramatically."
It could be the demographics of the disease.
"Keep in mind who the average customer is in this category," explains Domoulin. "The average [diabetes] consumer is between 58 and 65, she's female, and she may have eyesight or dexterity problems because of the disease. I think that's why today we don't have a lot of folks using it now."
"Computer downloading was initially desirable, but now it's just a pain, and boring," says Lloyd Rain. The software novelty has worn off for Rain.
For others, computers and software just add too much to an already steep diabetes budget.
Diabetes Specialty Web Sites
If consumers do not want to spend money on software, they can get some free help on the Web. Pharmaceutical and other diabetes product businesses have invested funds in sponsoring diabetes Web pages. The sites offer diabetes education and even interactive sections, where consumers can ask health advice from nurses and doctors, and companies pay to have their logos and diabetes product information flash on consumers' screens. Along with general advice, sites offer free daily log books, which users can print out and bring to their doctors for advice.
MyDiabetes.com provides a free daily diary for people with diabetes. Besides basic insulin doses and glucose readings, you can also keep track of your emotional well-being, and how glucose levels affect how you feel, with a monthly quality of life assessment.
While diabetes-related Web pages, for the most part, do not offer truly interactive advice, where you can get immediate help from health care professionals, they do provide a less expensive alternative to commercial software.
Bonding With New Technology
With all of this 21st century diabetes technology, how far will the diabetes consumer go?
"Consumers are hard to change," says Domoulin, "and we respect that." While companies race to develop the latest and greatest products, they must still keep the older technology available, because people become so attached to their current routines.
With many choices, consumers can choose what features and software supplements they want to add to their trusted glucose meters, and the pace at which they want to add them.
The challenge for all is to find the best products, despite the constraints of budget and insurance coverage.
"If there were a choice of two meters," says Friel, "I would save up to get the better meter. You can't really put a price on health."