I was inspired once again by my colleagues post two weeks ago when she did her blog on Health Technology http://jeanniebeaudin.wixsite.com/author/post/could-screen-time-be-good-for-you-health-technology-during-covid and I want to elaborate today on the some of the technology used by individuals with diabetes.
I will start with a device I would expect the majority of us use or at least have seen and that is the Blood Glucose Meter (BGM). I remember when the meters came out and I paid $365.00 for mine and the strips were $100.00 for 100 strips. We have witnessed how the price of meters has fallen over the years, unfortunately not the strips. The first meter required a large drop of blood, then the blood had to be washed off with a steady stream of water and then the strip could be inserted in the machine. It took ONE minute for the device to read the results. That ONE minute seemed like forever. The meter required frequent calibration and it was a fair size so it was not easy to transport.
New blood glucose meters (BGM) are added to the market frequently these days. So what does one do or how do you choose your device? Should price be a consideration, the more costly, the better the machine? Do you want your results to link with your smartphone or watch? Ask yourself why you are doing this and be able to understand what to do and how to use this information to manage your care. Your results aren’t meant to be just a number, rather it is meant to guide and help you in making decisions about your diabetes management. If my BG reading is 2.5 mmol/L (45 mg/dl) then I know that I don’t need insulin but some form of fast acting glucose while on the other hand if my BG value is 14.9 mmol/L (268 mg/dl) then I need to receive some insulin. Also important is that by taking time to review the information you can see a pattern develop that helps you to make adjustments before a disaster occurs. Many of the meters allow you to download the statistics and you can see graphs and data but again you need to know what to do with the information.
According to a Canadian Report (1) done in 2013, the total Canadian expenditure on blood glucose test strips was an estimated $370 million in 2006 and exceeded $500 million in 2010. It would be interesting to know how this has influenced diabetes management or affected the rate of hospitalizations. We know diabetes is on the rise so we can expect the cost to Health Care will rise as well. Medical Devices have to be approved by Health Canada/FDA to get to the market. As for drugs, the data provided for review must be thorough and the information and studies provided must prove the device will do what it says it will do, in this case, monitor blood glucose values as accurate as possible.
Some questions we may ask ourselves when thinking about the purchase;
Why do I want a BGM and what do I do once I get it? Am I motivated to participate more in my diabetes management when I have results in front of me?
Only you can answer this question but I know for me knowing what my BG value is either helps me to relax and feel comfortable with how I am doing or it can be disappointing and frustrating when you don’t understand why your sugar is out of range. As with many things in life, trial and error is a big part of diabetes management. Stress, age, activity, food, and fatigue can all influence your values. For myself, I can have a low blood sugar (ie 3.3) and still feel fine and be functioning properly but we know that is not a good value and the risk for a severe hypoglycemia reaction is high. When people tell me they know what their sugar is by how they fell I have a hard time to always believe the story, but maybe they can and I hope that it is true for them, but too many times I have seen that theory fail for myself and for others. If you are have high sugars showing as frequent urination and excessive thirst than yes perhaps you can say your sugar is high but in either situation checking your blood glucose helps you decide what to do and get things under control.
What features should I consider when buying a device? (personal opinion only)
How do you like technology? Do you like gadgets and want to have the most up to date meter? For me, some of the most important qualities are:
I. How big the drop of blood has to be on the strip. Underfilling the strip could provide false information. For myself, after so many years of checking my sugars the tips of my fingers are calloused so getting a drop of blood sometimes takes 3 or 4 tries. For me, blood quantity is important.
II. Timing- how long does it take to get the test result. Is it 5 sec, 30 sec or longer?
III. How big or small is the device? Can it be transported easily?
IV. How easily can the strips to be obtained? Does your pharmacy carry the type you use or does it have to be ordered in all the time?
V. How reliable is the company that manufactures the meter and strips? Have they been in business for a long time? Has there been any recalls on their devices? What support do you receive once you have the machine?
VI. What type of warranty is provided?
VII. How easy can you read the screen? Are the numbers large, too small or just right?
VIII. Does the machine have a voice telling you your meter reading?
IX. Have you checked out any reviews online or asked your diabetes care team if they have any preferences?
X. Are you able to check it’s accuracy against a lab value? (see more about accuracy below)
XI. Maybe you want a device where you don’t have to pick your finger referred to as Flash Glucose Monitoring or Continuous Glucose Monitoring. The devices offering this type of measurement are now readily available from different companies/manufacturers.
XII. Do you want it to have a memory which means it saves a certain number of tests in the meter?
XIII. Do you want or need alternate site testing (e.g., palm, forearm)?
Most devices have several of the above options so take a minute and compare 2 or 3 that you think you would like to use. Your pharmacist and diabetes educator can help you with choices depending on your needs.
Now that you have your meter, be sure to follow the instructions on how to operate the device and do a proper testing technique. Many of the companies offer on-line videos to watch and may offer a 24 hour help line. Improper use can give you false results.
Interstitial versus blood glucose values:
For people who wear continuous sensors, these devices are measuring the sugar in the interstitial fluid which can lag behind that of an actual blood glucose check. When values are changing rapidly a blood glucose check should always be performed. This could happen during exercise or strenuous work or if sugars rise rapidly the values may show a major difference. Please be sure you have an understanding of this concept. There are several youtube videos and I have listed one but you may find one you like better. https://www.youtube.com/watch?v=yOvDOYHIt9o.
Are there steps I can take to ensure meter accuracy?
Even though these devices are tested for accuracy by regulating bodies, there are measures you can take such as:
Read the manual for directions on how to use
Wash and dry hands before doing any test
Use a new sterile lancet before each test
Follow instructions for testing conditions because extreme humidity or altitude can affect results
Keep the meter clean and follow instructions for calibration if this is required
Make sure your test strips have not expired and have been stored as recommended
Dehydration, sickness, being stressed or an increased intake of vitamin C could affect results
Check with the manufacturer for any issues that you can’t solve on your own by reviewing the “troubleshooting” section of the manual or calling their help line
Know what temperatures it can tolerate and still be able to operate. When I use to run in the winter if I wanted to check my BG I had to stop and wait for the meter to warm up before I could do the test.
The frequency of testing your blood sugar will vary depending on factors such as the type of diabetes you have, the medications you are taking and the goal of therapy. Your diabetes care team will individualize each person's schedule.
This brings to a close Part I of my health technology series. Stay tuned for the next blog that will consider other formats of technology that are being used in diabetes management.
Stay safe. Wear a mask.
Feel free to subscribe so you won’t miss an issue. I welcome any feedback or topics you want to have covered in future blogs.
I will include all my references in the next blog. Stay tuned.
Comments