Blood Glucose Meters
The blood glucose meter is one tool that many people with diabetes can't do without. Whether you prick your finger many times a day or less often, checking your glucose levels is an important part of managing your diabetes. And so choosing a meter that suits you and helps provide you and your health care team with vital information is a task for which a little preparation can pay big dividends.
Blood glucose meters have changed significantly, and for the better, since they first became available for home use 30 years ago. Those early meters required large drops of blood that were more painful to squeeze out than the tiny samples now typically needed. Today's lancets, outfitted with spring-loaded lancing devices, can puncture the skin quickly and with minimal discomfort. Improved test strips wick up the blood sample easily, results are available within seconds, and meters have fewer testing errors than in the past. Yet meter accuracy has become a hot-button issue, and manufacturers may be forced to meet a higher standard.
Despite the advances in self-monitoring of blood glucose, if you are newly diagnosed with diabetes, learning how to test yourself and how to deal with the results can still be daunting. If you're buying your first meter, you're probably considering all the ways your life will change now that you have diabetes, and now that you're testing. Not all meters are created equal, and there can be many choices to make when selecting a model.
What Will It Cost?
The price tag on the meter itself isn't the key. In fact, a lot of the time your meter will be free or reduced from its retail price, thanks to rebates and other discounts from the manufacturer, or because insurance will pay for it. You may even be able to get a free one from your doctor or educator. What does add up is the long-term cost of test strips: They can run anywhere from 50 cents to $1 per strip. Even if you test only twice a week, that could come to $104 a year in test strips. If you test five times a day, you may be looking at $1,820. If you have health insurance, it usually will cover some of the cost, but how much and how many strips are covered can vary by insurer and by the type of diabetes you have. Always check with your insurance provider before choosing a meter, because insurers often only cover test strips and meters manufactured by one particular company. And remember that when it's time to buy new test strips, you'll have to buy a brand that is compatible with your meter.
Keep in mind, too, that not all meters come with accessories. You may need to separately purchase a carrying case, a lancing device and lancets, control solution, containers for sharps disposal (though many household items, like plastic laundry detergent jugs, will work), a logbook, and computer software to go with your blood glucose meter. And you'll also want to plan on periodically replenishing your supply of lancets and control solution.
Talk About It
Your doctor or diabetes educator may not know all the details of your insurance plan, but he or she will be able to help you select a meter. Discuss which brands are best and which components matter most to you: Do you want your meter to be very small? Do you want all the extras, including graphs of test results? Your pharmacist may be able to help, too: Ask about pharmacy discount cards and about saving by buying test strips in bulk. And then talk with friends who have diabetes—especially someone whose job or lifestyle is like yours. Ask them if you can try out their meters (using your own lancets, of course). You can also compare notes with others online at sites like the American Diabetes Association message boards.
Features That Matter
Coding. For your meter to produce accurate results, it must be set to recognize a batch code encrypted in each test strip. Some meters recognize the code automatically when a test strip is inserted, while others require "coding," meaning that you do some of the work. With most meters that need coding, you push buttons to set the code manually. Coding may also mean inserting a code chip or a code key into your meter every time you open a new package of test strips, verifying that the code number on your test strip package matches the number that pops up on your meter, and leaving the chip in the meter until it's time to open a new box. Some meters use calibrator strips, which you insert just like a test strip with every new box. Since forgetting one of these steps could very likely lead to inaccurate results, it may be worth considering a meter that needs no coding.
One caveat: There is no industry standard of what "auto coding" means. You'll need to check the meter's instructions to know for sure you're getting a meter that only asks you to prick your finger, insert the test strip, and read the result. You can find a user manual on the manufacturer's Web site or call customer service for help.
Some auto-code or no-code meters still call for you to check the code number on your meter display against the one on the test-strip box. This step is an extra precaution that you should take, but some meters don't call for it or don't display the code number on the meter. If you suspect you're getting inaccurate results, first check that the code numbers match. If your meter doesn't display the code number, test it with control solution or call customer service.
Size. Most standard meters are about the size of a deck of cards. A few meters are small enough to fit easily in your pocket. Shapes can vary; meters marketed as "compact" are often longer and thinner than standard-shaped meters. Note that just because a meter is small overall doesn't necessarily mean its display will be small and hard to read. Travelers, teens, and athletes may especially like compact meters, while standard-size meters may work better for people who want more data storage or who just find them easier to handle, hold, and read.
Sample size. Each meter requires a minimum blood sample size on a test strip. It generally ranges from 0.3 to 1.5 microliters (chart, left). Most people prick their fingers using spring-loaded lancing devices that release a lancet at the push of a button. The smaller the needle's gauge and the shallower its penetration under the skin, the less painful it is. (Changing lancets after each test may also help reduce pain and ensure an adequate blood sample.)
Alternate-site testing—taking blood samples from other parts of the body, including the palm, forearm, and thigh—requires a smaller blood sample and can reduce pain; some people are unable to get enough of a sample from alternate sites, however. All the meters in this guide offer instructions for such testing. You should ask your doctor if it is OK for you. (Never use alternate-site testing when your blood glucose is changing rapidly.)
Memory and averages. Most meters hold from 200 to 450 test results, apart from a few (click here for a list of meters that have a large amount of digital storage), as well as 7-, 14-, 30-, and 60-day average blood glucose readings. You may choose to sacrifice data storage for the convenience of having a very compact meter. Some examples: the True2Go, which holds 99 results; the Glucocard 01-mini, ReliOn Micro, and Sidekick, each of which stores 50; or the Rightest GM100, which stores only 10. Many meters let you sync your results to a computer program, which may help you better track your long-term control and keep your doctor informed. You'll want to find out what software is needed, how much it costs, and whether it's compatible with your computer.
Operation in hot and cold temperatures. Most meters are guaranteed to work in the same temperature range, about 50 to 104 degrees. Only one meter operates in less than 40-degree temperatures: the Sidekick, which is rated as working at 36 degrees. And a few operate at temperatures higher than 110 degrees. These meters (click here for a list of meters that work at higher and lower temperatures) may appeal to hikers, campers, hunters, and others who spend a lot of time outdoors. Heating and cooling packs can help keep your meter functioning in winter or summer conditions.
Travel ready. Many people buy a backup meter for travel use only. If shopping for one, pay special attention to size, operating temperatures, battery type, and data storage. A disposable meter like the Sidekick may be an easy option; you can pitch it when you're done with it. If you don't expect to buy many test strips, you may just want to buy the cheapest meter on the shelf, like a Walmart ReliOn Ultima, only $9 (other meters can range from $15 to $70 retail in a pharmacy). But if you travel frequently, do consider the cost of the test strips—and your insurance coverage. If you have to purchase a meter on the fly, you may want to select one that includes all the accessories you'll need in one box—test strips, lancets, a lancing device, control solution, and batteries. No matter what meter you use, always travel with a set of backup batteries.
Whether a meter offers "skins" in trendy colors or can store 500 test results may matter little to someone who can't read the meter's display. For some people, certain features make or break the decision of which meter to buy. If you or your child fits into one of the following categories, your choice will involve special considerations.
Deciding which meter is best for a child will depend on his or her age, experience with diabetes, and comfort level with blood glucose testing. To make testing from small fingers easier and less painful, very young kids should have a meter requiring a small blood sample size. For parents who check blood glucose while a child sleeps at night, a meter with a backlight might help. Older kids may like a durable meter that both withstands bumps on the playground and looks fashionable. Teens often prefer smaller meters that are easy to stash away. For a child on an insulin pump, you may want to consider a meter that communicates wirelessly with a particular model of pump.
A child who is still learning how to test may do better with a meter that doesn't require coding; a simple mistake could cause inaccurate readings and possibly dangerous highs and lows. For young kids, certain types of test-strip packaging, like individually wrapped strips, can be tough to open. Strips with shaded areas for wicking up blood samples with ease also make testing simpler.
People With Visual Impairments
Meter screens vary in readability and size. Small meters aren't necessarily hard to read, so simply looking up a meter's dimensions may not provide the information you need. Be sure to test any meter you're thinking of buying. You may also benefit from a meter with a backlight for testing at night or in dim lighting, or from an audible meter (charts, right). Some meters offer audio in Spanish, too.
People With Limited Dexterity
Those with arthritis, injured or malformed hands, multiple sclerosis, Parkinson's disease, muscular dystrophy, or other conditions may find it physically difficult to test their blood glucose. While most meters are comparable in size and weight, you can choose one that uses larger test strips or that can dispense test strips itself (with the Accu-Chek Compact Plus, for instance, you load the test-strip vial into the meter itself and need not insert a strip for each test). Look for test strips packaged for easy handling; it's best to avoid ones that are individually wrapped or packed tightly into small vials. Lancets that come in plastic cartridges can be directly loaded into the lancing device and disposed of more easily. Click here for a list of meters that have audio and backlight capabilities.
Checking for accuracy
If you test your blood glucose four times in a row with the same meter, using test strips from the same batch, your blood glucose is likely to be slightly different each time. How can that be? Meters aren't always consistent. More important than consistency, though, is meter accuracy, or how close your meter results are on average to lab results.
Meters now are required under an international standard to produce results within a 20 percent margin of error, but the Food and Drug Administration is pressing for a tougher standard. Yet, even though home blood glucose tests can vary from lab tests and often are inconsistent, "almost all current meters are accurate enough to help you make good decisions about your therapy," says David Marrero, PhD, J.O. Ritchey Professor of Medicine in the Division of Endocrinology and Metabolism at Indiana University's School of Medicine. Despite the considerable margin of error, Marrero says, analyses show that meters are generally not so far off that "you would make an incorrect therapy decision" and, say, eat glucose tabs instead of injecting yourself with insulin. (Consumer Reports publishes ratings of blood glucose meters, including their accuracy.)
So What Can You Do?
Your meter's control solution remains the best tool for making sure that your meter and test strips are working properly. Marrero recommends that you run the control solution—a liquid that has a known glucose level—through the meter when you first purchase it, and every time you open a new box of strips. "A good meter will run reliably," explains Marrero, "but the thing that breaks down is not the meter; it's the strips." At the very least, you should test with control solution if your blood glucose results do not seem right. Some companies have stopped including control solution with new meters, so you may need to buy it over the counter for about $15. Insurance may cover the purchase. The solution expires after 30 days.
Doubts about meter accuracy make it all the more important to record your blood glucose readings in a logbook and to get regular A1C tests at the doctor's office. If you've kept close tabs on your diet and exercise, and your A1C is still unexpectedly high, it's much more likely to be a result of your testing times and technique (which your health care provider can help you pinpoint by reviewing your logbook) than of an inaccurate meter.
Blood glucose monitoring can be a vital part of diabetes management, and a key step is finding a meter that's right for you. Then you'll need to use it faithfully at the frequency your doctor recommends, and let the results guide you to adjustments in insulin, diet, and exercise to reach your blood glucose targets.
This guide is a starting point. You should discuss your specific meter needs with your doctor or diabetes educator. If the meter you use is not listed in this guide but works well for you, there's no need to switch. Most manufacturers pull older models off the market to make way for new products but continue to make test strips and offer customer support for them. But if a newer meter has features that would make your blood glucose management easier or more effective, then it may be wise to change. In the end, of course, the most important part of diabetes management is not the meter you select, but how you use it.