Helping Patients Choose the Right Blood Glucose Meter

Nurse Practitioner, May 2004 by Mensing, Carole

Patients with diabetes who take an active role in their own health care can help the others on the team-nurses, nurse practitioners, 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 to the right 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 Table: "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 under investigation; 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.