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Helping your patient choose the right blood glucose meter

Mensing, Carolé RN, CDE, MA

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In Brief

Learn how to match your patient’s needs to the available monitoring equipment.

Patients with diabetes who take an active role in their health care can help the others on the team—nurses, physicians, diabetes educators, nutritionists, or specialists—do an even better job.

Because self-monitoring of blood glucose is crucial to keeping diabetes controlled and decreasing the risk of complications (such as heart disease), matching the patient and a blood glucose meter is important. Recognize the patient’s needs, describe the available choices, and help him decide which meter to use. When it comes to gadgets, one size definitely doesn’t fit all.

Meters, meters everywhere

Thanks to recent technologic advances, the market seems to have something for everyone, from a voice-activated glucose meter for those who are vision-impaired to a software program that analyzes trends in glucose control by the week, the month, or time of day.

Start by knowing the patient’s medical history, current medical condition, dexterity, monitoring needs, capabilities, and insurance plan (see Important Questions to Ask Your Patient).

Because your patient must monitor his blood glucose levels throughout the day, finding a meter he’s comfortable with and can use confidently is far more useful in encouraging testing than finding the most sophisticated gadget on the market.

Factors to consider in a meter include speed, size, ease of use, price, and the ability to test alternative sites such as the forearm or palm. Some meters offer language choices, 12- and 24-hour timing, graphic display, and information documentation.

Remember that convenience and available samples, which often dictate selection, don’t always provide the best choice. The best meter is one that meets the patient’s testing needs and lifestyle preferences.

Discomfort is the primary complaint about blood glucose testing, and may be the reason some patients are reluctant to monitor their blood glucose levels as often as they should. As a result, researchers are constantly testing new meters that are less painful and easier to use. The most popular advances in technology are those that promise noninvasive testing or testing at sites other than the fingertips.

Because it’s still necessary to obtain a drop of blood to test blood glucose levels, all meters require a lancing device or a method to pierce the skin. However, some meters can now take accurate readings with samples not much larger than the period at the end of this sentence. The smaller the sample size needed, the less deep and less painful it is to obtain.

Alternative site devices

As anyone with diabetes knows, fingertips are sensitive. That’s why many companies now market meters that let people draw blood from less sensitive areas, such as the thigh, forearm, palm, or abdomen. Some meters let patients rotate sites, so overused testing areas can rest.

One product not only draws samples from the forearm or upper arm instead of the fingertip, it performs lancing, blood collection, and glucose testing with a single press of the button, providing readings within 20 seconds.

One caution: If blood test results aren’t consistent with symptoms or blood glucose levels are low or changing quickly, fingerstick results provide optimum accuracy.

The ability to perform multiple readings without having to change the test sensor cartridge or perform regular cleaning is another popular feature of some meters. Newer products even eliminate handling individual test strips, offering multiple strips contained in the meter.

Adaptive equipment

Patients who are vision-impaired or have poor manual dexterity may have a difficult time keeping track of their blood glucose levels. Meters are now available with larger, easier-to-read numbers, and a voice-activated meter gives verbal directions for drawing blood, then reads the result out loud.

For those with physical impairments, another meter rests on the patient’s arm and performs the lancing and testing automatically. Following the initial setup by a health care professional, the patient can then do the testing independently.

Noninvasive technology

Noninvasive testing methods are constantly being studied; however, none are on the market. A handheld, infrared meter that measures a wide range of blood glucose concentrations shows promise but hasn’t been approved. Other examples include optical fiber probes; ultrasound; and other wireless, sensing devices.

Continuous, mobile monitoring

For patients whose glucose levels fluctuate severely, a device that’s worn like a wristwatch automatically measures glucose levels every 10 minutes and sounds an alarm if levels unexpectedly change. Sensors periodically monitor glucose and deliver summarized, or averaged, results, compared with the real-time results of conventional blood glucose testing.

The device uses a low-level electrical current to extract glucose from interstitial fluid (not blood), painlessly and continuously throughout the day.

Consider the expense, availability, learning curve, physical comfort, and practicality for the person considering this type of device, which may not be covered by insurance. The device may be most useful as a supplemental device for some patients, such as pregnant women, young children, or people with frequent hypoglycemic events. The continuous monitor doesn’t replace conventional blood glucose testing.

Seeing the big picture

Many meters on the market today contain memory features that store and recall test results. For technologically savvy patients, several manufacturers offer software packages that let these patients go a step further and actually analyze the data—often at little or no cost. Patients can directly download the accompanying software programs, at no cost other than the price of the cable connecting the blood glucose meter to a computer monitor. To find out if a manufacturer provides free software, access the company’s Web site or call the toll-free number on the product packaging.

Obviously, not all persons with diabetes are ready for this technology. For those comfortable working on a computer and navigating new software, however, the payoff in improved self-care is well worthwhile.

One new product displays blood glucose levels in a variety of graphic formats, comparing weekday versus weekend trends or even breaking data down by time of day. Are levels highest (or lowest) in the morning? After lunch? When it comes to glucose control, many people can greatly benefit by a visual display of how well they’re doing.

Other products allow persons with diabetes to access such data as insulin doses, meal content, and carbohydrate values. Some even allow people to plug into lifestyle information, special events (such as birthday parties), or exercise schedules that might affect blood glucose levels.

These products allow patients to become health care detectives, ferreting out clues that can help improve their daily health care routines. Patients using these tools should be encouraged to take this information with them when consulting with health care professionals; as with all information related to patient care, it’s most valuable when shared in a collaborative manner with the health care team.

A1C at home

The hemoglobin A1C test for overall glycemic control is now available as an over-the-counter product for home use. The test measures a person’s average blood glucose levels during a 2- to 3-month period.

Typically, the A1C is performed in a physician’s office where a health care professional can advise the patient on what follow-up care is needed, depending on test results. Patients choosing to use a home A1C test should be encouraged to discuss the results with members of their health care team.

Additional resources

Helping patients with diabetes make informed glucose meter selections empowers them for future decision making, enhances their independence, and encourages participation in this vital tool for good diabetes self-management.

For more in-depth information on blood glucose meters, diabetes, and the importance of glucose control, contact a diabetes educator from a recognized program in your area and visit the American Diabetes Association at http://www.diabetes.org.

For a more complete listing of glucose monitoring devices and manufacturer contact information, consult the American Diabetes Association’s Diabetes Forecast Resource Guide 2003 or visit http://www.diabetesmonitor.com.

Selected References

Böhme, P., et al.: “Evolution of Analytical Performance in Portable Glucose Meters in the Last Decade.” Diabetes Care, 26( 4):1170–1175. April 2003.
    Fineberg, S., et al.: “Use of an Automated Device for Alternative Site Blood Glucose Monitoring.” Diabetes Care, 24( 7):1217–1220. July 2001.

      Important questions to ask your patient

      To help your patient select a blood glucose meter, ask:

      • Have you used a blood glucose meter before? Have you helped someone test?
      • How frequently have you been asked to test your blood glucose levels?
      • Has your health care team recommended a meter or given you a prescription for one?
      • Has your insurance provided you with a meter or recommended a specific meter?
      • Are you interested in a certain meter?
      • Will you be mostly testing at home or is portability of the meter important?
      • Will someone help you with blood glucose testing?
      • Do you have any problems with vision?
      • Do you have any problems with manual dexterity?
      • Would you like the option of testing fingers, forearms, or other sites?
      • Are you able to keep a written record of your blood glucose levels?
      • Are you interested in downloading your blood glucose results to a computer program or handheld data manager?
      • Would you like to know your daily or monthly test averages?
      • Is cost a concern for you? Does your insurance cover the cost of the meter, strips, and lancets?
      • Is the meter easy to obtain or available in your community?
      • Do you use a mail-order service for your medicines and prescriptions?

      Adapted from:Practical Diabetology, G. Spollett, March 2003.

      Selected Web site

      Noninvasive Blood Glucose Monitors

      http://www.niddk.nih.gov/health/diabetes/summary/noninmet/noninmet.htm

      © 2003 Lippincott Williams & Wilkins, Inc.