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The blood glucose (BG) meter is the "single most important thing" in the life of a person-type 1 and 2-with diabetes, says Jane Seley, RN, CDE, MPH, MSN, GNP, a doctoral candidate at New York University.
A person with diabetes carries her or his BG meter with them wherever they go. Many trust it with their very life.
Robyn Goldstein, 18, of Brooklyn, New York, was diagnosed with type 1 diabetes when she was 11. She says choosing a BG meter was a very difficult decision. So many meters come with so many different features and benefits, and all of the meter companies tout those features and benefits.
"Everything is overwhelming," says Goldstein. "I think that it is a good idea to use the meter recommended by your doctor until you are able to learn more about the choices available and what your preferences are."
What Features Do You Like?
We recently asked readers what factors led them to choose their BG meters. The answers ranged from size, cost and memory, to quick readings, smaller sample sizes and influence from a health-care member or insurance provider.
Here is what some of them had to say.
Smaller Sizes and Faster Test Results
Kevin Kolkhorst of Glen Cove, New York, has had type 1 diabetes for 23 years. He currently uses the Minimed 508 insulin pump. Kolkhorst tests his BGs 10 to 12 times per day using the FastTake, which he prefers because of its portability.
"I can fit [the FastTake] into smaller places than the larger meters," says Kolkhorst. "I commute to New York City and test frequently. The new strips require less blood, and the meter can be used on areas other than the fingertips. I also like the shorter 15-second results the meter gives."
Kolkhorst has three FastTake meters: one that he travels with, one that he keeps in the family minivan, and one that he keeps at work.
Kolkhorst says his doctor was not involved in his decision to choose the FastTake. He said he saw an advertisement for the FastTake in Diabetes Health. After conducting his own research, he discovered he liked the FastTake's:
Kolkhorst also likes the FastTake's ability to download its BG readings to the Lifescan InTouch Software program.
Kolkhorst adds that his insurance company played no part in the decision to choose the FastTake, but he is thankful that his insurance does cover the meter-100 percent. He says since he is an insulin pumper, his insurance company allows him to test as many times per day as he needs to.
Stressing Accuracy Over Speed
John McNally is a type 2 from Goleta, California, who has been testing his blood sugars five to seven times per day for almost three years. He tried about seven different meters before finally settling on the Glucometer DEX from Bayer. McNally says he prefers the accuracy of the DEX, as well as its cartridge of 10 test strips.
Richard Hartmann has been testing four to six times per day since 1978. His first meter was the GlucoChek. Today, he uses the One Touch Profile by LifeScan. Hartman evaluated the One Touch Profile using information from various Internet sources. He checked the cost versus quality of readings. He discovered the accuracy of its readings was good and the cost was low in comparison to the other meters he researched.
Love that Memory Feature
McNally also likes the DEX's memory and averaging features, and stresses its accuracy over the speed at which he can obtain his BG results.
"The Glucometer Dex is remarkably consistent on both real blood samples and on test solutions," he says.
McNally says his health care practitioner did not influence his decision to choose the DEX. Instead, he saw ads for the meter, conducted his own research and made the decision on his own.
Sam Pennington, a type 1 from Semmes, Alabama, uses the Accu-Chek Advantage by Roche Diagnostics for testing six to seven times per day. He also likes the memory feature of the meter, which prevents him from "cheating" in his log book.
"I don't always write in my log book each time, and it's simple to go back into the memory and pull up the readings," says Pennington. "My doctor downloads readings each time I visit, and doesn't let me get away with any cheating in the log book."
Evan Leepson is a type 2 who also prefers the Accu-Chek. The feature he likes best is the meter's ability to store up to 100 tests.
Likes Ability to Download Readings to a Computer
Hartmann says the One Touch Profile's best features are its ability to download readings to a PC for seeing morning, noon and evening BG trends. Also, he likes that the Profile's strip cost is lowest when compared to other meters.
Hates Testing on Finger Tips
Marcie Boroughs of Window Rock, Arizona, uses the Accu-Chek Advantage and loves its memory feature. However, she says, it requires too much blood for testing. Boroughs says she is keeping her eye on the At Last and FreeStyle meters, by Amira Medical and TheraSense, because they require less blood and allow for testing on sites alternate to the fingertips.
BGs and Fructosamine all in One
Kolkhorst says that in addition to his FastTake, he also uses the In Charge meter by LXN Corporation for testing his BGs and fructosamine. Bill Eastman, a type 2 from Austin, Texas, is another person with diabetes who prefers using the In Charge.
"In addition to checking my BGs, it also has a GlucoProtein test, which shows a two- to three-week BG average," says Eastman, who first learned about the In Charge at a Taking Control of Your Diabetes Conference hosted by Steven Edelman, MD. He says he started using it as soon as he heard about it. "The regular BG test only shows what your BG was at a particular point in time."
Checking Ketones as Well
Lynne Sanders says she uses the Precision Xtra by Abbot Laboratories because her insurance company requires her to do so. She does not mind this, however, because the meter measures both BGs and ketones, in addition to stringing data and measuring BG trends.
As with any relationship, a person with diabetes will find things about his or her meter that they may find less appealing.
Unlike Richard Hartmann, John Kinsley of Rock Tavern, New York, says he is unimpressed by the accuracy of his One Touch Profile.
"FDA-acceptable accuracy of plus or minus 20 percent is, frankly, no longer acceptable," says Kinsley, who does not track BG trends but makes on-the-spot decisions based on his readings. "In the early days of self-testing, a tolerance of 20 percent was okay for tracking daily trends in BG readings. Today, however, with added emphasis on tight control, the 20 percent tolerance is not accurate enough to make the needed insulin adjustments and consistently remain in a safe BG range."
Kinsley adds that he also has trouble removing the strips from the One Touch Profile container after it is opened.
"With stiff fingers and some neuropathy, I have difficulty getting a hold of a single strip and usually end up with many falling out," says Kinsley.
Dr. Stephen A. Bernstein, currently stationed in Enterprise, Alabama, is the father of an eight-year-old girl named Victoria who has type 1 diabetes. Bernstein, who is a Major in the Army and a family physician, does a lot of primary care for type 1s in the military. He says the thing that frustrates him most are the "decision makers [who decide which meter] to carry on formulary or not." He says these decisions are made by people who have "no clue."
"In April 1999, I went to a P&T meeting to demonstrate and explain why I wanted the Elite supported for my patients," says Bernstein. "The hospital was still using the Accu-Chek 3... I brought in all of my meters and no one on the P&T committee even knew how to use any of them."
Bernstein says after having everybody at the meeting test, it was easy for them to figure out why he wanted the Elite for the kids and why they should also consider upgrading the meters they use on the hospital floors. Had he not attended the meeting, Bernstein says they would still be clueless of the consequences of their decisions.
That seems pervasive throughout managed care systems-decisions by people who don't know," says Bernstein.
Most readers say they have no problem paying for or getting insurance coverage for their meters. However, Janet Wagner of Ogden, Utah, told Diabetes Health in 1999 that testing strips are "outrageously expensive," especially for those who test several times per day.
Steve Bohrer of Bar Harbor, Maine, says cost has really not been much of factor, as his strips are covered by insurance.
"[Also], I have always been able to "trade in" an old meter each time I get a new one, which usually makes the new meter pretty much free," says Bohrer. "Obviously, the manufacturers want us to be buying their strips, so why not give away the meter? At one point, several years back, ExacTech [by MediSense] was sending a free pen meter with each order of 150 strips, so I built up a reserve supply for future trade-ins."
Bob Goodman of Cupertino, California, has seven meters (three at home, two at the office and one each in two different cars). He regularly uses the FastTake at home, but dislikes the fact that it does not work well in less-than-ideal climate conditions.
"If it is a little cold or hot, the meter will not work properly," says Goodman. "I would like it better if it had a wider operating temperature range."
Kolkhost also says he often has to warm the FastTake up between his hands during the wintertime, and leave it by an air conditioner in the summertime before it is ready to take a sample. He says this has taken up to 20 minutes and can be problem if he is testing for high or low blood sugar.
Cumbersome Strip Containers
One of Bob Goodman's other meters is the Exactech. He says he is pleased with the meter itself, but he finds fault with the packaging of its strips.
"They are difficult to open," he says. "It takes a little practice to learn how to best open them, but I long ago mastered that."
Another reader, who describes herself as a 59-year-old type 1 woman from Jacksonville, Oregon, suggests that one improvement meter companies can make is to develop a cartridge that has 20 strips instead of ten.
"Also, have a lancing device attached [perhaps with velcro] to the meter, as it would cut down on the items to keep track of and carry with you," she says.
Bring Back the 30-day Meter Membrane
Hartmann would really like to see a company develop a 30-day membrane meter like some models, which disappeared in the late 80s.
"The membrane was good for 30 days for as many readings as you needed in a day," says Hartmann. "The meter was called Direct 30/30. It was recalled, since the company had to replace some meters, so the FDA forced them to drop it. I compared the meter readings to the One Touch and they were closer than 10 mg/dl."
McNally wonders why all meters can't be tested by a single set of test solutions.
"Why are the test solutions of the various meters not compatible?" asks McNally. "All glucometers are supposed to measure glucose in the blood. Why, if the test solution is a known concentration of glucose, can't all meters be tested by a single set of test solutions [low, medium and high levels]?"
Right-handed Design a Problem for Some
Evan Leepson of Rockville, Maryland, uses the Accu-Chek Advantage and is frustrated at what he calls its strip design for right-handed people.
The Clean Sensor
Hartmann says the clean sensor seems to cause problems in getting readings at the worst moment.
"Often you can follow the prescribed instructions and retry, but get clean sensor again. Repeat the cleaning and it finally gives a chance to test."
Comparing and Contrasting Meters
Many people with diabetes like to test their BGs on two separate meters and compare for accuracy. Some have discovered that readings are actually higher on one than the other.
Kolkhorst tested the FastTake and the Profile meters when he received his new meter. He discovered the FastTake was higher.
"But I think the Profile is calibrated to whole blood, as the FastTake is calibrated to plasma glucose values," says Kolkhorst.
Recently, Kolkhorst tried a new meter for his six-year-old daughter who has type 1 diabetes. He says the new meter "gave us many wacky readings," including one reading that had a difference of 150 mg/dl. Kolkhorst decided to switch her back to her old Elite meter.
"Although my daughter liked the meter, we can't take a chance with accuracy, especially on a six-year-old child," says Kolkhorst.
Joe Levy, a type 1 from Clifton Park, New York, uses two different meters: the One Touch Profile at home for morning and evening testing, and the Accu-Chek Advantage at work for noontime testing. He also uses a Precision QID for traveling because, he says, it is "compact and lighter" than his other meters.
Levy has checked the One Touch Profile against the Precision QID.
"They match up well in the range of 50 to 250 mg/dl," says Levy. "They show some spread above 250 [the biggest being] 45 points [266 vs. 311]."
Freedom of Choice
Kevin Kolkhorst says he is pleased that all the meter companies are coming out with smaller samples, quicker results and additional areas to test, but doesn't know where they could go from here except even shorter read times and even smaller drops of blood. One thing he appreciates is the efforts to humanize BG testing.
"My daughter's Glucometer Elite has come out with several color plates [something like the cell phone covers] that fit over the meter," says Kolkhorst. "She likes this very much. If they came out years ago in different colors, more features, and bells and whistles, a lot more people would want to test. Take the clinical lab look out of the procedure, and give creature comforts that are pleasing to the eye and features and accessories to individualize it, and pretty soon non-diabetics will want them out of envy."
When it comes to BG meters, what some people consider the ideal meter, others may find strewn with shortcomings. However, as Steve Bohrer so aptly puts it, "It is great that there are so many options on the market."