Islets of Hope treatment options for persons with diabetes

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Article disclaimer

Source:  edited for content, from Wikipedia.com

Original article, edited for content, with substanitally added information, came from Wikipedia.com and the NIH


    The Glucowatch offers non-invasive (no needle) glucose testing.  It is not a replacement for traditional glucose monitoring, but serves as a complementary approach to glucose monitoring.  For more information about the GlucoWatch visit GlucoWatch.


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Links to Related Information

Blood Glucose Monitoring Tips

Insulin Injection Devices

Symptoms, Causes, Treatment and Prevention of Hypoglycemia

Symptoms, Causes, Treatment and Prevention of Hyperglycemia

FDA Glucose Meter Warnings

Links for More Information and Meter Comparison


type 2 diabetes complete food management  Sherri Rd Shaffer
Type 2 Complete Food Management:
 "A timely an comprehensive roadmap to improving blood glucose control and reducing diabetes complications through simple modifications of diet and lifestyle."
—Susan Carter, M.S., R.D., C.D.E., Stanford University Hospital


defeating diabetes  Brenda Davis, Tom Barnard

Defeating Diabetes:  This books has detailed dietary and nutrition information to empower readers. Because diet and lifestyle factors are the primary causes of Type 2 diabetes, most Type 2's can control their diabetes completely. This is good news because the health problems that can occur as a result of untreated diabetes include blindness, early heart disease, and amputation of body parts. With over half of those with Type 2 not knowing they have it, following the suggestions in the book makes sense whether you have diabetes or not.  Pre-diabetes (the precursor to diabetes) and insulin resistance ar explained and the authors point out that although being overweight puts one at high risk for diabetes, one can be thin and have insulin problems due to "metabolic obesity," which is explained further in the book.

 

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Diabetes treatment - devices

Blood glucose meters


Mini Site Index
About Glucose Monitoring and Glucose Meters
How They Work and Meter Features
Cost of Meters and Tips on How to Get Free Meters
Why Should I Test My Blood Glucose?
Meter Accuracy
History of Glucose Meters
Non-Invasive Blood Glucose Monitoring Devices

About glucose monitoring and glucose meters

Blood glucose monitoring is a way of testing how much glucose is in the blood (glycemia). A drop of blood, usually taken from the fingertip, is placed on the end of a specially coated strip, called a testing strip. The strip has a chemical on it that makes it change color according to how much glucose is in the blood. One can tell if the level of glucose is low, high, or normal in one of two ways. The first is by comparing the color on the end of the strip to a color chart that is printed on the side of the test strip container. The second is by inserting the strip into a small machine, called a blood glucose meter, which "reads" the strip and shows the level of blood glucose in a digital window display. Patients can adjust doses of hypoglycemic treatment by guidance of blood glucose monitoring and achieve better glycemic control.

A blood glucose meter is a small, portable, battery-powered, medical device for personal or professional blood glucose monitoring. The device is used by diabetics and other persons who need to be able to determine and track blood glucose levels to maintain their health.  A glucose meter determines the approximate amount of glucose in a drop of blood obtained by pricking the skin with a lancet.

   


                     
Meters offer a wide range of features.  Be sure to talk with your doctor about which meter is best for your needs.

How blood glucose meters works, and their features

The glucose value in mg/dl (U.S..) or mmol/L (much of the rest of the world) is displayed in a small window. Current "count times" range from 5 to 60 seconds for different models.  The size of the drop of blood needed by different models currently 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.  Smaller drop volumes have enabled "alternate site testing"-- pricking the forearm or other less sensitive areas instead of the fingertips. Although less uncomfortable, readings obtained from forearm blood are lag behind fingertip blood in reflecting rapidly changing glucose levels in the rest of the body.

A specially treated test strip containing reactive chemicals is placed inside a blood glucose meter. A drop of blood is then taken from the fingertip or an alternate site (thigh, calf, forearm, upper arm can be used on certain meters)by using a lancing device, which shoots a sterile lancet into the skin with the press of a button. The blood sample is placed on the opposite end or top of the test strip, depending on the model of blood glucose meter. The blood reacts with the chemicals in the test strip causing a small electronic pulse to be sent into the meter which then calculates the level of glucose in the blood sample and shows the result in a digital display.

Different makes of meters offer a variety of functions and data management capabilities to match individual testing needs. Newer models of meters feature one-step sampling and readout. The chemically-treated strip is placed in the device and a drop of blood is placed on the test strip which acts like a straw drawing the blood sample into the strip. and the meter then gives a reading.

Newer meters offer on screen averages for weeks past, can hold hundreds of previous test results with time and date, and may even have graphing capability. The new generation of meters may also have upload features so that a person or doctor can upload meter readings directly from the meter and into a computer for analysis and review. Some meters allow entry of additional data throughout the day, such as insulin dose, amounts of carbohydrates eaten, or exercise.  Not all meters have this feature so be sure to talk with your doctor about what features are available and suit your needs best.

Some meters offer alternate site testing, which allows a consumer to test on sites other than the fingertips, which can become sore and callused over time.  However, alternate site testing is not as accurate as finger pricks.  If your reading is low from an alternate test site (i.e., forearm), or you feel like you may be low, you still have to repeat the test on a fingertip.  (I personally find finger sticks not only more accurate, but also less painful when done properly.  See "Tips on Testing Your Glucose" for more information.)

Meters that working in tandem with other devices

A number of meters have been combined with other devices, such as insulin injection devices and PDAs. 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 ketosis.

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 glucose into electronic medical records and the laboratory computer systems for billing purposes.

   


Cost of meters and tips on how to get free blood glucose meters

No prescription required for purchase

You do not have to have a prescription to purchase glucose meters or testing strips.  They are sold over-the-counter at pharmacies, Wal-Mart, Target, and in many grocery stores.  You can also purchase them over the Internet, and we would love it if you would consider purchasing glucose meters through our site (via Drugstore.com)  If you do, sales commission proceeds from your purchase go directly to IPump.org to help others in financial need with the purchase of their own diabetes care supplies.

Getting quality meters inexpensively or for free

Meters can be expensive but are usually covered under most medical insurance plans when they are prescribed by a doctor.  Most doctors and hospitals will give persons with diabetes a free glucose meter when they are diagnosed.  You can also ask to talk to a social worker at most hospitals who can provide you with a glucose meter for free.  You really should have more than one glucose meter in case of failure.  If you work, or go to school, keep a meter there as well as one at home.  You should also have a glucose meter with you everywhere you go.  If you are on insulin never, ever, go anywhere without a glucose meter!

All meter companies want your business.  While the cost of a meter at full retail price can run between $40-$120 on average, manufactures make their money from the sale of test strips.  If they can get you hooked on their meter you will reward them with the purchase of test strips.  For this reason, most meters from major manufactures go on sale from time to time.  Many companies even offer free meters by giving trade-in or rebate allowances.

It is my personal feeling that, if at all possible, you should stay away from cheaper models made and sold under store-brand names.  With a glucose meter you get what you pay for and it is imperative that you have a good one.  Recently, several manufactures were admonished by the FDA for faulty meters or meters that were inaccurate.  To learn more about meters warnings please visit Islets of News.

Before purchasing additional meters check websites and store flyers.  It is not at all uncommon to see a particular meter at full price in one place and for free on another (free, with rebate or old meter trade-in).  For example,  Abbott Care, makers of the Freestyle Flash (read FDA warnings first) offer free glucose meters when you join their Friends for Life Program and use a meter for a minimum of three years.  For more information visit Abbott's website.

IPump.org and some other diabetes organizations distribute free test meters and other diabetes medical supplies to qualifying persons in need.  Visit their website for more information:  IPump.org.  You can also find information about insurance coverage laws (most states require insurance companies to cover the cost of testing supplies) as well as various aid programs.  See Islets of Hope's "Health Care" section for details.

Test strips are expensive

The cost of daily testing is one of the most expensive aspects of diabetes care. In 2005, the consumer cost of each glucose strip ranges from about 40 cents to 80 cents, so that testing 4 times a day (many persons need to test a lot more often than 4 times per day) costs about $2.00-$3.00 per day. 

Lancing devices and lancets

Lancing devices are hand-help devices that prick your finger to draw a droplet of blood.  Most have various settings that allow you to adjust the level of needle penetration.  Not all lancets are equal -- some do hurt more than others -- but they all draw blood.  Lancing devices that often come with glucose meters do not have to be used.  Any device that draws blood will work with any meter as long as the blood sample is large enough for the meter.  Since different meters require different blood droplet size, be sure your lancing device matches the needs of your meter.

Lancets are not all that expensive, averaging $10-$15.00 per box of 100.  The lancet must be compatible with the lancing device you are using.  Lancets do not have to be changed with ever glucose test performed.  See "Blood Glucose Testing Tips" for more information.

Lancing devices and lancets are one are that you can purchase whatever cheapest and not worry about affecting the quality of your glucose reading.

   


Why should I test my blood glucose?

The glucose meter is a key element of home blood glucose monitoring (HBGM, also called "self glucose monitoring") by people with diabetes mellitus and other disorders that require blood glucose monitoring. Since approximately 1980, a primary goal of the management of type 1 diabetes has been the achievement of closer-to-normal levels of glucose in the blood for as much of the time as possible, guided by HBGM several times a day. This has greatly increased the trouble and time spent in the daily care of this disease but has also reduced rates of long-term complications and improved the management of short-term complications such as hypoglycemia.  It is estimated that approximately 85% of all diabetics do not adequately keep their blood glucose levels at, or near, their target ranges.  This may be one reason for the high rate of associated diabetes complications. The best way to manage your blood glucose levels is simple: test regularly, and often.  You cannot correct highs and lows if you don't know about them.

Glucose monitoring is also an important tool for helping your doctor determine your best care plan approach.  Readings can help determine what your basal (background) insulin should be, as well as your insulin-to-carb ration, correction factor, and how your blood glucose levels are faring during the nighttime.

Meter use for hypoglycemia

Although the apparent value of immediate measurement of blood glucose might seem to be higher for hypoglycemia than hyperglycemia, meters have been less useful. The primary problems are precision and ratio of false positive and negative results. An imprecision of ±15% is less of a problem for high glucose levels than low. There is little difference in the management of a glucose of 200 mg/dl compared with 260 (i.e., a "true" glucose of 230±15%), but the difference between 70 mg/dl and 55 (i.e., 67±15%) represents a more unsatisfactory uncertainty. The imprecision is compounded by the relative likelihood of false positives and negatives in populations of people with diabetes and those without diabetes. People with type 1 diabetes usually have glucose levels above normal, often ranging from 40 to 500 mg/dl, and when a meter reading of 50 or 70 is accompanied by their usual hypoglycemic symptoms, there is little uncertainty about the reading representing a "true positive" and little harm done if it is a "false positive."

In contrast, people who do not have diabetes but periodically have hypoglycemic symptoms, will have a much higher rate of false positives to true, and a meter is not accurate enough to base a diagnosis of hypoglycemia upon. Hypoglycemia (unrelated to diabetes) needs to be diagnosed by a medical professional.

A meter can occasionally be useful in the monitoring of severe types of hypoglycemia (e.g., congenital hyperinsulinemism), to ensure that the average glucose when fasting remain above 70 mg/dl.  

   


Blood glucose meter 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, size of blood sample, high levels of certain drugs in blood, hematocrit, dirt on meter, 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. The Clarke error grid is a common way of analyzing and displaying accuracy of readings related to management consequences.

Islets of Hope Health Tip:  High altitude, pressurized airplane cabins, heat, and humidity can sometimes affect meters and test strips. This can cause false readings.  If you are not feeling good, retest your blood glucose levels.  Also, at least while on the plane, do not use "alternate" testing sites like your forearm.  This is especially important for children as alternate sight testing is not as accurate and does not always reflect rapid changes in blood glucose levels.  Read more about alternative site testing and meter accuracy.

Learn more about how to test accurately in our "Blood Glucose Testing Tips" section.  

   


History of glucose meters

The earliest widely used meter was the Ames Reflectance Meter, which was used in American hospitals in the 1970s. It was about 10 inches long and required connection to an electrical outlet for power. A moving needle indicated the blood glucose reading after 60 seconds.

Home glucose monitoring was demonstrated to improve glycemic control of type 1 diabetes in the late 1970s, and the first meters were marketed for home use around 1980. The 2 models initially dominant in North America in the 1980s were the Glucometer and the Accuchek meter, and to many nurses and other medical professionals these brand names became synonymous with the generic product (the Kleenex/Xerox phenomenon) and are still current in hospitals.

Test strips that changed color and could be read "visually", without a meter, were also widely used in the 1980s. They had the added advantage that they could be cut with scissors longitudinally to save money. As meter accuracy and insurance coverage improved, they lost popularity and are no longer marketed.

At least in North America, hospitals resisted adoption of meter glucose measurements for inpatient diabetes care for over a decade. Managers of laboratories argued that the superior accuracy of a laboratory glucose measurement outweighed the advantage of immediate availability and made meter glucose measurements unacceptable for inpatient diabetes management. Patients with diabetes and their endocrinologists eventually persuaded acceptance.

Home glucose testing was adopted for type 2 diabetes more slowly than for type 1, and a large proportion of people with type 2 diabetes have never been instructed in home glucose testing.

It is speculated that within the next decade, meters may be replaced with continuous glucose sensors for many people with diabetes.  

   


Noninvasive blood glucose monitors

The U.S. Food and Drug Administration (FDA) has approved a noninvasive blood glucose monitoring device for adults, children, and adolescents with diabetes. Noninvasive monitoring means checking blood glucose levels without puncturing the skin for a blood sample. The GlucoWatch G2 Biographer, manufactured by Cygnus Inc., was approved to detect glucose level trends and track patterns in people with diabetes. It must be used along with conventional blood glucose monitoring of blood samples. The device, which looks like a wristwatch, pulls body fluid from the skin using small electric currents. It can provide six measurements per hour for 13 hours.

Over the years, scientists have been trying to find noninvasive ways for people with diabetes to measure their blood glucose. Most methods of monitoring blood glucose require a blood sample, usually obtained by using an automatic lancing device on a finger. Some meters use a blood sample from a less sensitive area, such as the upper arm, forearm, or thigh. Other devices use a beam of light instead of a lancet to pierce the skin.

For More Information

Researchers are developing other methods of noninvasive monitoring. Potential ways to determine blood glucose levels include

  • shining a beam of light onto the skin or through body tissues
  • measuring the energy waves (infrared radiation) emitted by the body
  • applying radio waves to the fingertips
  • using ultrasound
  • checking the thickness (also called the viscosity) of fluids in tissue underneath the skin
To learn more about such monitors and new products after approval, call the FDA at 1–888–INFO–FDA (1–888–463–6332) or check the FDA website on diabetes at www.fda.gov/diabetes and click on the section titled "Glucose Meters & Diabetes Management."

For more information on the latest developments in diabetes technology see our "New Technology in Diabetes Research" and "Diabetes Headline News, Technology" sections.


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Page Updated 09/02/2006