Blogger Bad Habits

I know I have some bad habits in writing about diabetes, as a reader reminds me of them. I make occasionally mistakes in medical terminology, but I have to be concerned when group like this one fails to follow editorial policy or at least enforce a good policy. With the errors appearing lately, the editor may be on vacation.

I am referring to this blog from January 27, 2015. I know the author should have used blood glucose meter for most of the blog in place of glucose monitor and uses the term monitor correctly when talking about continuous glucose monitor. A monitor does not use test strips.

The only thing I can figure out from this -Quote - “It will be easier on your pocketbook if the monitor you chose is popular. You will find the test strips everywhere with no trouble, often at lower cost because they are widely available.” - Unquote is that the author has unlimited funds and can purchase any test strips desired.

Most of type 2 diabetes and type 1 need to stay with the meter and test strips that are what the insurance provider will reasonably reimburse or pay. Each insurance company is different in their formulary and therefore what is popular may not be the brand that the insurance company will allow.

Quote - “Blood glucose monitor test strips are sealed in packs and vials. Keep the ones you are not using in their original packages.” - Unquote. The author may desire the containers to be sealed, but I have not found any that are sealed and I have never needed to break a seal to use them. I have had to open the box, then open the container lid, and carefully remove the first test strip.

Quote - “Make sure your hands are freshly washed before handling test strips, and be careful not to get the strips wet with water or alcohol. After using an alcohol wipe, let your finger dry before pricking it to get the drop of blood.” - Unquote. Yes, it advised by most test strip manufacturers to wash your hands and dry thoroughly and this is in the instructions that come with each box containing the container of test strips. Alcohol pads or wipes should only be used when water and soap in unavailable. Never rely on alcohol pads when you have been handling or cutting fruit or certain foods and you will receive very elevated readings. Only washing with soap and warm water will remove the sugar of fruit from your hands.

Using alcohol pads on your fingers during late fall to early spring is asking for cracked fingers and very painful testing. Alcohol dries out the skin and this is a serious problem.

This is the type of information we don't need. I have had several emails asking me what the information meant as they had not heard of glucose monitors requiring test strips. It is blood glucose meters that require test strips.

Continuous glucose monitors (CGMs) are very expensive and very few people with type 2 diabetes can have them approved for use, but a few do. Mostly they are used by people with type 1 diabetes.

Choosing and Using a Blood Glucose Meter

How would you choose a blood glucose meter? Most of us have very little choice that have insurance. If you don't have insurance, then it will depend on what you can afford. I am glad that some organizations are publishing information about choosing a blood glucose meters, but very disappointed in the lack of solid information. This information from the Mayo Clinic lacks information.

“If you have diabetes, you'll likely need a blood glucose meter to measure and display the amount of sugar (glucose) in your blood. Exercise, food, medications, stress, and other factors affect your blood glucose level. Using a blood glucose meter can help you better manage your diabetes by tracking any fluctuations in your blood glucose level.”

The above quote makes me wonder why people with diabetes get discouraged and don't test. When the Mayo Clinic staff can say, “you'll likely need” this is about the same at saying you may not need to test. They should say, “you will need.”

“Many types of blood glucose meters are available, from basic models to more-advanced meters with multiple features and options. The cost of blood glucose meters and test strips varies, as can insurance coverage. Study your options before deciding which model to buy.”

I've said this before, but it is worth repeating, knowing what your insurance will cover, may help you avoid problems. The test strips are the real cost and many forget this. If your insurance will not cover the meters with all the bells and whistles, you could be ahead of the game. Some of the considerations are:

1. If you are having eyesight problems, a meter with vocal reading of the number may be for you. If you want secrecy and not having everyone near you hearing the reading, then vocal reading of the blood glucose number is not for you.
2. If you have hearing problems, then a good screen with few distractions and proper size numbers and properly backlit may serve you well.
3. The more complicated the meter is, the less likely you will use it.
4. The more costly the test strips are, the less likely you will test.

This is one time when a doctor may be of help if he/she has the time. If the doctor doesn't take the time, a pharmacist may be the answer. Most will, but sometimes you will need to wait a few minutes for them to complete the task they are doing. 

This by the Mayo Clinic writer makes me wonder if they really know anything about testing and using the equipment. “When selecting a blood glucose meter, it can help to know the basics of how they work. To use most blood glucose meters, you first insert a test strip into the device. Then you prick a clean fingertip with a special needle (lancet) to get a drop of blood. You carefully touch the test strip to the blood and wait for a blood glucose reading to appear on the screen.”

The lancing device holds the lancet. Then the lancing device is cocked and the end with the lancet is pressed against the side of the finger near the tip and the release is pressed. This is how the lancet brings blood to the surface for the meter with the test strip to be slid up to and into the edge of the blood. The blood is wicked into the test strip and then about five seconds later, a reading appears on the meter screen.

For other information about choosing a meter, read this article by the Mayo Clinic.

What Is A Patient to Do – Provide BG Data?

This has been a sore point with me and several of the “diabetes coaches” I have come across in the last few years. Of the five, four were of the opinion that you should never take your blood glucose meter to a doctor appointment. They felt that this was your information and the doctor did not need it. The fifth said take it or not, it was your data and it was up to you whether you shared it or not.


Now I understand why I could not do business with these “diabetes coaches.” I have always been one that believed the more eyes on the data, the better I would be, because what I missed, the doctor might catch and prevent problems down the road. Plus, I have found it easier to convince the doctor that I was doing things correctly and not to be so uptight about my A1c's. This is because they worry too much about hypoglycemia. I am glad they have the concern, but as long as I don't have severe episodes, I don't get concerned about readings above 55 mg/dl. Below 55 mg/dl, even I have concern. They worry about anything below 80 mg/dl and with the new guidelines for 70 mg/dl they had better not complain about mine above 70 mg/dl.


This study, presented at The Endocrine Society Annual Meeting and Expo; June 15-18, 2013 in San Francisco does point out that those that bring their meters to their appointments, have a lower A1c than those that don't. The difference is significant at 1.2% less for those that brought their meters to appointment for Medicaid and Medicare patients.


Therefore, I will continue doing what I do and bring my meter, which is downloaded and the data used during my appointment. And I will continue to stay away from “diabetes coaches” that advise not taking my meter.

What To Consider in a Blood Glucose Meter

Are you confused by all the hype about blood glucose meters? You should be and there is a lot of hype. Every writer approaches this from a different perspective and promotes what they feel is best. There are some general guidelines that it is often wise to follow. I want it understood that I am not promoting any meter over another, but I do urge you to consider the points I lay out and do not be afraid to talk to pharmacists and others that may assist you and provide guidance.

#1. What will your medical insurance cover. This is often what will determine the type of meter that you will chose because the cost of test strips can be prohibitive and you may need to consider this first.

#2. If you do not have insurance, then economic considerations may be the most important. There are economical meters and test strips available that are reliable and that do not have all the bells and whistles that many people think they need and never use.

#3. If you are one of the fortunate people with few economic barriers and chose to go outside your insurance, then you have a wide range of considerations in making a choice.

Once you have determined which of the above applies to you, now the choices become even more difficult. They may be very limited in selection or you may have a wide range to choose from. This will depend on your insurance company and there are some real issues under Medicare which have yet to be resolved. Unless the courts act soon, many on Medicare may be caught with no supplies.

TV ads are very deceptive and often misleading, yet many people become suckered in and spend the money. Then when they receive the meter and test strips, they realize that they have been had, but there is seldom a way to return them. These companies will be very evasive in an attempt to make you keep what you ordered.

Many of the TV ads advocate for alternate site testing and this is okay if you seldom have a hypoglycemic episode and are fairly consistent in your readings from your fingertips. You need to know that the reading you receive from an alternate testing site is an indication from 15 to 25 minutes ago depending on the area used for alternate testing. Also, there are very few alternate test sites that are totally pain free. I urge anyone on insulin not to consider alternate site testing because if you are having a low, you need the now readings of your fingertips.

Many people were enticed into the talking meters and then wondered what to do when they were out in public. I have heard them in restaurants and other places and people just could not muffle the sound. So if you are a person desiring secrecy, forget these, as secrecy is next to impossible.

If you have a computer, you may wish to consider a meter that will upload to your computer. Normally the cost is for software and a cable from a USB port to the meter.

These two blogs seem to think you have all the choice and can purchase any meter which may not be the case.

There is a growing concern about the test strip accuracy and I strongly urge people to read two blogs of many (this one by Ann Bartlett and this one on Diabetesmine) about the declining accuracy and that apparently no one is doing anything about it. I can only feel fortunate that I have one of the top two meters listed in several reports – meaning that the tests strips are considered the most accurate.

Blood Glucose Meters versus Test Strips

Why is everyone blaming their blood glucose meters for being inaccurate? Even the Food and Drug Administration says the meters are not safe and accurate for the purpose many people are using them for. Read the FDA explanation here. If the FDA is this concerned, why have they not issued a warning or a recall? If meters are accurate or inaccurate, why do we need the test strips? Probably because most people think it is the meter doing all the testing, and they forget about the test strip that we insert into the slot in the meter for the meter to interpret the reading and convert it to a reading we can understand.

We need these insignificant little rascals because without them our meters would not be able to give us a reading of our blood glucose. Many doctors and endocrinologists hand the meters out for free as they have received them at no cost because the strip manufacturer knows that to use them, the test strips will be needed and in general, the tests strips are expensive.

Before you go ballistic on me, many of the manufacturers do have good assistance programs. You do have to apply for most of the assistance, but it is available to those in need. Do check with the manufacturer if you are in need of assistance and follow their directions.

I have written before about not wasting test strips. I have added additional information since then and I think it is time to cover this in more detail. First, make sure that you store and use your strips properly. The containers they come in are the proper containers to keep them in. Second, do not transfer the strips between containers as this can damage some of them.

If you are like me and have large fingers, the first few strips are often hard to remove from the container. The method I use is not approved, but it works for me. I keep a small plastic tweezers handy, that I have taken a short section of an appropriate width rubber band that I glued to the tweezer between the two sides (on each side) and one small piece on the outside (of one side) to gently pull the strip out far enough to get a grasp on it. I do this for getting out the first few. No, I did not say metal tweezers, as using them is a good way to damage the delicate strips. Check with your pharmacist for a plastic one, they are available, but may need to be ordered.

The original containers are made of special materials that help preserve the test strips and keep them dry. Keep the test strips in the original container and do not transfer them between containers. It is important to use the strip as soon as possible after removing it from the container. Close the container after removing the strip to use. Keep the container out of direct sunlight especially when taking strips out and do not expose the strip to direct sunlight.

Please do not put a few test strips in a baggie, in a purse, or wallet to carry them. The test strips are delicate and can be damaged beyond use. If you are out in nature, keep the test strips in the container, put the container in a small zip-lock bag, and then put this in a cooler or a Frio pack in the summer or an insulated bag during the winter. Keeping moisture away from the container of test strips is important.

Keep the container of test strips in a dry place. The bathroom or the kitchen is often the worse place to store your test strips. I will repeat what the directions are for my Accu-Chek Aviva test strips. I strongly urge you to read the instructions that come with your test strips.

Always store the test strips between 36° Fahrenheit and 90° F (2° Celsius to 32° C). Do not expose the test strips to heat, moisture, or humidity. Temperatures outside the required ranges, as well as moisture and humidity, can damage the test strips and lead to inaccurate results. Use the test strip removed from the container within three minutes or the results may be wrong, and you will need to repeat the test. You may use the test strip at temperature ranges between 43° F and 111° F (6° C and 44° C). You may also use the test strip between 10% to 90% relative humidity. Use the test strips only until the “Use by” date on the strip container. If the “Use by” date is missing or cannot be read, do not use the test strips. Do not reuse a test strip and properly discard a test strip once it has been used.

Always insert the test strip into the slot in the meter and make sure that the code number on the test strip container shows in the window. If the code does not show, remove the test strip and carefully reinsert to get the code. If it does not happen to show the code, discard the test strip and get a second test strip and repeat. Look at the meter to see if the drop of blood and the strip in the meter window is flashing. If it is, then use the lancet to prick your finger and carefully milk the finger to bring sufficient blood to the surface. Carefully insert the meter with the test strip area to wick up the blood into the drop of blood. Once the blood has wicked into the test strip, you may set the meter on a flat surface; wipe the excess blood off with a tissue or washable cloth. Then record the reading from the meter to a logbook and the time.

The above instructions have been summarized from the instruction sheet accompanying my test strips. There are other instructions that are spelled out on the instruction sheet and it is wise to know them if you are new to blood glucose testing. It also never hurts to review the instructions as they do change as technology is improved upon or like me I will be moving to a new updated test strip in the near future.

One instruction that has changed on my sheet, but I cannot say when it changed, is the instruction for preparing your hands or fingertips for testing. It used to instruct you to clean your hands with alcohol pads. Now the instructions state to first wash and dry your hands. I would correct this based on experience to, “Please wash your hands with warm water and soap, rinse carefully, and dry thoroughly before handling test strips. Never use wet or damp hands or fingers to handle the strip container or for removing a strip from the container. This should be the routine before using the lancet and wicking blood into the test strip.”

I have had two very good emails in response to my last blog informing me that when people are talking about meters, they are talking about both the test strip and meter in combination and that they function together as a unit. This is true, but I will point out that many people that are new to diabetes do not always make this connection and in fact two of the three emails I mentioned in my last blog were asking about why the test strips were not mentioned, and if it was the meters that were actually to blame. That was the purpose of this paragraph (the next paragraph down) in my last blog.

“As for meter accuracy distortion, this is understandable when they are jammed into bags, purses, pockets, and other places where they were not intended to be stored or carried. I have seen test strips wedged in the meter slots and jerked out. With this happening and no care of where the meter is stored, it is small wonder dirt, lint, and test strip particles could affect the accuracy of the blood glucose meter. This is delicate equipment and if you want accuracy within FDA guidelines, treat it accordingly. Some people even store meters and test strips in car glove boxes or on the dash in full sun and heat, so how can they expect accuracy?”

Proper storage of the meter is important for it to function correctly and properly read the test strips. To my readers, please know that there are many variables and that as things currently exist, we have reliable meters and some that are not so reliable. It is the test strips that determine meter accuracy and until our test strips can be calibrated to a more accurate degree of precision, we cannot expect our meters to be any more accurate. Please remember that when we talk about meters, most people refer only to the meter and in fact may mean the meter and test strip as a functioning unit.

Another reader brought up something I admit I had not considered. He stated, “I'm very aware of the problems involved in trying to set an accuracy specification. Very often a measurement device which actually has a tight performance spec when used properly in a stable-temperature environment ends up being given a very loose spec, because the maker is worried about what happens under less favorable conditions.”

I would like to express my thanks to those that sent emails, even some of the unpleasant ones. I was very appreciative of the emails packed with information, some of which I used above, as they added to the information. I am still sorting through the information and may add some to another blog.

For a very incomplete listing and information about blood glucose meters as a meter and test strip unit, some of you may be interested is this PDF file from Diabetes Health web site. Also read this by David Mendosa published on July16, 2012 and follow the link provided for a different perspective on selecting blood glucose meters.

Why Can’t BG Meters Tell Me My BG levels?

This blog upsets me in so many ways. First, blood glucose meters are just that; designed from the beginning to read the blood glucose levels from the test strips containing a sample of your blood. Sugar is sugar and not blood glucose. Sugar is a carbohydrate and is converted in the body to glucose.

Why do writers of articles and blogs make the assumption that blood sugar is blood glucose? I would guess because they do not understand the chemistry that takes place and think they are doing their readers a service. This also means that they do not understand diabetes equipment; correct, they do not understand or even know about their diabetes equipment. Even this type 1 writer does not know diabetes equipment, just how to con readers and attempt to sensationalize something. It is this type of misinformation that creates problems for the rest of us with diabetes. And to this, I say BS does not mean blood sugar, but bullshit.

Readers see one person misusing terms and think when they confront others with diabetes that they are knowledgeable. This really makes it difficult for us to educate people about blood glucose and diabetes equipment.  In the last week, I have had three panic emails about this post.  I have had to explain to people new to diabetes what is really at issue and how to read misinformation like this.

The writer's complaint about the lack of blood glucose accuracy is the only valid point she makes. Even our Food and Drug Administration can't figure out how to solve this. While the FDA does acknowledge that many of us are using our blood glucose meters for tight blood glucose management, the FDA admits this is not the intended purpose. If the blood glucose meters are not safe and effective as they should be, why did the FDA allow them on the market? It is the test strips that need to be more accurate.

Now I know my meter can give me erroneous readings because of expired test strips or contaminated test strips, but when checking it against the laboratory results of a blood draw, my meter reading has always been within 5 mg/dl (0.3 mmol/L) of the blood glucose results, and a few times the same reading. As a result, I have confidence in my meter and test strips – although the FDA says I should not. People that use different meters consistently should expect large variances in their readings. We do not know if the meters used were stored properly or not. We also do not know how the test strips were stored.

The author of the blog laments about the accuracy and further states “we’re on the launch pad for an artificial pancreas — where accuracy will be even more critical — why don’t I have a meter that gives me an accurate reading of my blood glucose.” I say then that they need to have the continuous glucose monitor (CGM) mounted on the fingertips for greater accuracy instead of other places on the body where the readings are always 15 to 20 minutes later than the fingertip readings.

Maybe the FDA needs to withhold approval of the artificial apparatus until the problem can be solved for placing nanosensors in the fingertips and nanofilaments or nanowires under the skin to the CGM. Or maybe a reader of nano or microsensors will be developed to solve this problem. This writer should not have to realize that she is 15 to 20 minutes behind time when needing a reasonably accurate blood glucose reading.

As for meter accuracy distortion, this is understandable when they are jammed into bags, purses, pockets, and other places where they were not intended to be stored or carried. I have seen test strips wedged in the meter slots and jerked out. With this happening and no care of where the meter is stored, it is small wonder dirt, lint, and test strip particles could affect the accuracy of the blood glucose meter. This is delicate equipment and if you want accuracy within FDA guidelines, treats it accordingly. Some people even store meters and test strips in car glove boxes or on the dash in full sun and heat, so how can they expect accuracy?

I can believe medications taken can possibly affect blood glucose readings, but I have no information as to which medications or dosage required. The article referenced mentions maltose given while people are in the hospital. Surprise, maltose and dextrose are commonly used in the hospitals. We should expect elevated blood glucose readings from dextrose and administer insulin accordingly. Maltose does give a falsely elevated blood glucose reading on most test strips. This is why people need to be aware of what the hospital administers. Hospitals are nefarious for not informing patients about medications they deliver and ask patients to take or inject into patients.

I know how improper hand care and washing can affect blood glucose readings, been there, done that. Still people insist on accuracy even though they will not wash their hands or fingers after handling food. Many ignore the fact that they should wash with warm water and soap and dry properly and then declare their meter is inaccurate.

To my readers, please know that there are many variables and that as things currently exist, we have reliable meters and some that are not so reliable. It is the test strips that determine meter accuracy and until our test strips can be calibrated to a more accurate degree of precision, we cannot expect our meters to be any more accurate.

Even I occasionally will have a lapse in memory and say meter when I should say test strips. The meter can only relay what it reads from the test strips. This is the purpose of the battery in the meter to create electronic communication to interpret what the test strip is reporting and translate this information to a reading on the meter. If the meter has dirt or lint in the slot that the test strips are inserted in, then it may be difficult for the meter to accurately read the test strips. The meter just interprets the results of the test strips in a language we can read on the meter. The test solution use to determine test strip accuracy does not change the meter. It can only let you know that the test strips are good or bad. This can happen to a container of test strips.

The meter is calibrated at the time of manufacture and can be altered by improper storage and dropping the meter. The test strip box has an expiration date so that reasonable reliability is maintained. Storing the container in moist conditions or direct sunlight can alter the reliability of the test strips in the container. It is possible for the meter to malfunction or go bad like it is possible for test strips to become unreliable. Proper storage and handling of both is important. Dirty (or contaminated) fingers handling the test strips improperly can affect the readings as can food on the area of blood wicked into the test strip.  For more information on storage and use of test strips, read my blog here.

For information, I use the Accu-Chek Aviva meter and currently the Accu-Chek Aviva test strips. I have been notified that the next order of test strips will change to the Accu-Chek Aviva Plus test strips. They will work in the current meter. The notice states, this is to improve the accuracy and sensitivity of my blood glucose test results. The information I was able to locate about the Aviva Plus test strips says, “New generation of test strips offers advanced chemistry and safety for self-monitoring of blood glucose.” The next paragraph states, “The new maltose-independent test strip is designed to prevent the interference of maltose on blood sugar readings which can occur in rare cases when drugs containing or metabolizing to maltose are parenterally administered.” This takes away the concern about maltose above.

Choosing The Right Blood Glucose Meter

For a person that is newly diagnosed with diabetes, selecting a blood glucose meter is not high on their list of things to do. Most often the certified diabetes educator or a dietitian, or in some cases the doctor or his/her nurse will present you with a limited selection and briefly discuss each and ask which you want. In my case it was a hospital CDE that had done her homework and knew which blood glucose meters were covered by my medical insurance. What many writers on this topic forget, in their push to discuss blood glucose meters, is what brands will the readers medical insurance cover.

So unless you are independently wealthy enough to purchase any brand, check with your medical insurance company to know what brands are included in their coverage. Do not forget to ask if the strips are covered for each brand. There have been some mix ups in the past where they covered a meter, but not the test strips. The test strips are the major cost and needs to be considered. For those on Medicare, most all brands and their test strips are available and covered.

Two of the better discussions are done by Joslin Diabetes and the Mayo Clinic. So take time to read their discussion of choosing you blood glucose meter. This site by the FDA while not the best, has some very good pointers.

One important word of caution. We all have probably seen the advertising on TV for the meters that cause no pain. They are right in that statement only. It is not the meters, but the lancets that can cause pain and if used properly, even they cause none to minimal pain. Many of these meters are advertised for use on your arm. If you want or need more accurate and time sensitive blood glucose readings, you will not use these meters. This is especially important if experiencing a low – hypoglycemia – or are doing a post meal reading – postprandial reading. Their accuracy is suspect and at least 20 to 30 minutes after the fact.

So if you are on insulin or oral medications capable of causing hypoglycemia, avoid any meter recommended for arm testing. You need the almost instant readings that you obtain from your finger tips. If you are dropping rapidly, a reading 20 minutes after the fact may be too late to prevent severe hypoglycemia.

New meters are coming on the market fairly regularly, so if you do have time to research them and your insurance does cover them, do yourself favor and check them out. Many have new features that can be helpful and some have too many bells and whistles you will never use. I do like some that now have a feature of giving you a voice announcement of your blood glucose reading, but if you are out in public a lot when you need to test, this feature may not be something you want if you like your privacy.

If you are unemployed or underemployed and cost is a factor, definitely shop around for the cost of the meter and the test strips. Inquire of the manufacturers if they have programs for assistance (many do) and search the web for support groups that offer assistance with testing supplies. There is a wide range of this type of support and the biggest task is finding a good fit. There are groups or individuals taking advantage of you by getting the money and sending outdated strips, so be careful and ask for references. Some diabetes sites can also offer guidance in finding reputable assistance.

If you have served honorably in the US military and are eligible for Medicare, make sure that you apply for Veterans Assistance from the Veterans Administration. This requires copies of your DD214. What you may have for co-pay is based on your income (means test = income less qualifying medical expenses). Testing supplies are normally no charge, but medications are subject to co-pay.