Stop! Are You Wasting Test Strips?

This blog is about the ways we as diabetes patients take care of our test strips. We need to avoid wasting them as each test strip we waste costs us money. They are expensive so we do not need to waste them carelessly.

Yet, people waste test strips. Common errors include not storing test strips properly, handling them with wet fingers, and not waiting until the meter says the strip is ready to be used. I have seen people jam the test strips into the meter carelessly and bending test strips. These errors happen too frequently and that is wasting money. Yes, errors will happen, but a few precautions will save test strips and save your hard-earned money.

First, make sure that you store your test strips properly. The containers they come in are the proper container to keep them in. 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. I keep a plastic tweezers handy for getting out the first few. No, I did not say metal tweezers, as that would be 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 or in your purse to carry them. The test strips are delicate and can be damaged beyond use.

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. Please wash your hands with warm soapy water (as hot as you can tolerate) and dry carefully 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.

It is important to perform tests with the meter and strips as close to room temperature as possible to get accurate results. Do not freeze your strips or store them in extreme cold, as this will probably produce errors or false readings. This applies to extreme heat or direct sunlight. I have seen people store them on the car dash in direct sun and then they wonder why they get weird test results.

Now that I have explained proper storage, I will return to proper use of the test strips. When you are ready to test, always have your meter out and ready to insert the test strip carefully. Make sure the lancing device is ready to use. Push the test strip straight into the slot provided. Then use your lancing device to prick your finger and get an adequate amount of blood available. By this time, your meter should be ready to have the test strip receive the required amount of blood. Hold the meter with the test strip inserted properly and slide the strip at an approximate 10 to 20-degree angle that will allow the strip to wick sufficient blood to get an accurate reading and move it into the blood. Do not hold the meter and test strip at a 90-degree angle to the blood spot as you may shut off the wicking of your blood before it has enough for a reading. This will get you an error message.

Good luck and may your readings be good and not receiving error messages. The test strips are important and you need to make efficient use to prevent waste.

Problems Removing First Test Strips from a Vial

I am seeing people complain about their finger size and removing the first test strips from a vial. I believe most have this problem to a small or large degree depending on the size of your fingers. Some people are capable of using their small finger, but most of us probably are not able to use them.

What I did was to obtain a plastic tweezers that I have adapted for removing the test strips until I can comfortably remove them with my finger. No, I did not say a metal tweezers! If you wish to ruin several test strips (a dozen or so), go ahead and get a metal, but I won't recommend wasting money like this. Most pharmacies have or can order them and this is what I did.

Then I take a quarter inch wide rubber band and using glue, I attach to the inside and wrap it to the outside so that one leg of the tweezers has a rubber on three sides. Trim to remove excess on the ends of the rubber band. Then attach a short piece to the other leg on the inside only.

When the glue has dried, it is ready for use. I then use the leg with the rubber band on three side and use the outside to align with a test strip and use just enough pressure to raise one test strip above the rest and rotate the three sides to retain a grip on a test strip and bring the other leg against the other side of the test strip to fully remove the test strip. Occasionally in the process, two test strips will adhere together and you will need to start over on a different test strip. I also hold the vial of test strips at about 45 or 50 degrees to make it easier to raise a single test strip.

Often it is easier just to use the tweezers and insert it into the meter. Then set the tweezers aside, use the lancing device, and lance the finger for testing and after having enough blood, slide the meter with the test strip into the blood so that it can wick the blood into the test strip.

Note: It did take some practice to efficiently remove a single test strip and insert it into the meter, but practice was worth getting the test strip remove from the vial and into the meter.

This is neither FDA approved nor a recommendation by the test strip manufacturer, but it works for me and saves test strips being damaged and saves my fingers.

Doctors Don't Always Explain Everything

This article in the Mayo Clinic website is good, but there is an opportunity lost. Doctor Maria Collazo-Clavell answers a question posed with a good answer, but stops too soon. The question is, “Sometimes my blood glucose monitor seems to give incorrect readings. What can I do to make sure the measurement is accurate?”

The doctor says, “When you start a new container of test strips, occasionally perform these quality control tests as you use them and when your results seem unusual.

To perform a quality control test, do one or both of the following:

• Test using a control solution. Follow your normal blood-testing procedure, but use a liquid control solution instead of blood. These solutions usually come with your monitor and are available at most drugstores and pharmacies. Follow package directions.
• Match your reading with lab results. Take the blood glucose monitor along when you visit your doctor or have an appointment for lab work. Check your blood glucose with your meter at the same time that blood is drawn for lab tests. Then compare your meter's reading with the lab results. Your meter's result is considered accurate if it falls within 15 percent of the lab test result.”

These are both great points and something many patients forget to do. The first one should be performed more often than many people want to do. It is a fact that most people never use the control solution. If the pharmacy does not have the control solution, they will order it for you. I have found one bad container of test strips in the 10 years of testing and that was about three months ago. I almost expected to find another bad container in this cold snap we had, but so far, all have been right on. The test strips are shipped in the mail and set in the mailbox too long.

I always check my test strips with the lab, and I have always been within five percent or less of the lab results. Several times, I have received the same result.

Now for the points I think the doctor should have talked about and did not:

#1. Is the person actually talking about a monitor or a meter? If the person is talking about a continuous glucose monitor (CGM), then the answer given by the doctor is completely off base. She does answer the question for a blood glucose meter and test strips; therefore, I will continue for the meter as well.

#2. Were the test strips stored properly? This should have been a point in the answer. Too often, the test strip container is stored in the bathroom or kitchen where excessive humidity can overload the container, which is manufactured to keep the test strips dry within limits. Also keeping the container in an area that is above the proper temperature or below will give erroneous readings.

#3. Were your hands properly washed and dried?

I could make this an extremely long blog, but I have covered this and much more in my blog here. I urge you to read it if you haven't and follow the links to other blogs. This is a topic that is very important and we can easily forget to be proper users of this delicate equipment.

Is There a Best Way, Part 5

This is almost a repeat of a blog I did back on November 9, 2011, but I hope that I have a few new thoughts of benefit to my readers. For those with type 2 diabetes and on oral medications, affording the extra test strips may be a hindrance, but if you are able to afford them you will be better off if you are having problems managing your diabetes. Therefore, most of this is aimed for people newly diagnosed or recently diagnosed with type 2 diabetes whether you are on oral medications or on insulin.


Eating to your meter shortly after diagnosis is very important. We have all read this, but have you really tested this? Eating to your meter can be very beneficial in helping you manage your blood glucose. For those with type 2 diabetes and on oral medications, this is a philosophy you almost must adopt to manage diabetes effectively. Counting carbohydrates is even more important so that you learn how to manage the food intake to get the greatest efficiency from your diabetes medications.


Even being on insulin this is important to make your diabetes management more effective and hopefully reduce the amount of insulin you will need to inject. The medications you are taking will only manage so many carbohydrates effectively and then you start to lose control. This then becomes more important to know what your blood glucose meter is telling you about the quantity of food you consumed. Using your meter also can indicate which foods you need to severely limit and which you can consume or may need to eliminate altogether from your menu.


Most of you will probably need to have a good discussion with your doctor about the number of test strips your medical insurance will over. Most doctors are able to write a letter that will get coverage for extra test strips for up to six months before the insurance will stop covering them, but not Medicare. The important discussion with your doctor is the reason and length of time you want the extra test strips. Extra test strips may not be available if your doctor will not write a letter to your insurance company. Occasionally, you as the patient will need to make a call to your insurance to negotiate for extra test strips. It would be in your best interest of diabetes health to make the plea to your insurance company.


On limited test strips, eating to your meter may be very discouraging because you do not have a lot of information to guide you. That is one reason, I suggest that if you can afford it for a few months, buy extra test trips. The extra testing supplies will give you confidence in your carb counting and portion of food intake. It will also make it easier to determine what foods are best left off the menu.


There are various plans discussed for those on limited test strips so you will need to work with what works best for you. A food log after diagnosis is also an aid that many people just do not understand the need to keep. I can attest to how many times this has told me why my postprandial blood glucose levels were higher than they should have been and what I did not do. The important part is not lying to yourself, but keeping accurate logs. I record my log at the end of each meal and record the carbohydrate count before starting the meal.


Knowledge is power, and therefore knowing what each test is telling you, watch for trends in fasting blood glucose levels and use your meter to learn more from pre-meal testing to tell you about your prior meal. If you can afford extra test strips for a month or two, learn that you do not want your pre-prandial and postprandial readings to increase more than 40 mg/dl if possible. You should also develop an exercise regimen with your doctor's approval to help get your blood glucose numbers to become the best for you.


If you do have trouble with managing your blood glucose levels, give insulin a consideration and study about it before the need arises.


Read a couple of other articles about eating to you meter here and here. Before reading the second article, please locate this conversion chart and page down to glucose. For many of the readings you will need to divide by the conversion factor.

Diabetes Diets and Your Meter

In reviewing some of my blogs, I have found several that have gained readership beyond what I anticipated. This says there is a need for people to understand what they need to know at the early stages and to review some topics after they have gained additional knowledge. It is important to say that I am not an expert, but hopefully my readers are finding some information that they have been able to apply with the help of their meters and that they are adapting some information to their own management of diabetes.

Also, this statement may prove helpful to some as they read other diabetes blogs or websites – “what works for me, may not work for you.” Other people use this - “your mileage may vary” to help them understand that the results worked, but not as well as they hoped. Those of us that blog about diabetes understand that, and know that some ideas are helpful, some ideas make sense, but don't get the great results for them, and a few ideas just don't help. I have found this happens to me and I have a few – now many pages of helpful sites (the URLs and a brief summary) that I use to review from time to time. I apply what I find works for me and keep the information for future reference. Sometimes when one thing quits working, I return to my list and see if something else is now working.

I may overuse this, but testing is important and goes a long way to helping you discover what you body will allow and still get the test results you want. The meters are not expensive (often your doctor will hand them out free), but it is the test strips that are expensive. Insurance will only cover a limited number. I have found it worthwhile to talk with the medical insurance people about allowing extra testing shortly after diagnosis. Some will allow extra for a couple of months and then go back to their allowance, but most will require a letter from your doctor. Forget Medicare, they will only allow one or two test strips unless you are on insulin and then you are allowed four test strips per day. This is unreasonable at best and criminal what they will do to people needing to learn how different foods affect blood glucose readings. For those unable to obtain or afford extra test strips, okay, check with the manufacturer for financial assistance. Most do have this and if you follow their instructions, you may qualify.

In writing about diabetes diets, I made some statements about the collusion between four government agencies and four diabetes organizations. Now another blogger on the nutrition side is speaking out about two government agencies and taking their “experts” to task for our obesity epidemic. She also has an excellent discussion about her organization and their part in promoting the obesity epidemic. This is also why they do not want us testing to see how different foods affect our diabetes management. This last sentence is what drove my thoughts in writing about getting our test strips back from Medicare. It even caused me to listen to one of the candidates for congressional representative from my district and ask some rather direct questions about why USDA was working so hard to give out bad nutritional advice – to which I was totally ignored and then several others asked similar questions which were also ignored. Since the candidate is the wife of our current Secretary of Agriculture, it did my spirits good to see her defeated.

There are many good reasons to ignore some of the quasi professionals in the Academy of Nutrition and Dietetics and the American Association of Diabetes Educators when they do not attempt to help many of us with type 2 diabetes which I blogged about here. Even my cousin that is a certified diabetes educator has now disowned me for some of my positions. Another cousin that has been helping me with nutrition when I am a volunteer peer mentor says she likes working with me and was very surprised at the reception she has received and has continued to have with some of one doctor’s patients. Once she stated she would not be pushing high carbohydrates and low fat, but wanted to work with them at the level they were at, whether low carb or what ever type of regimen they were wanting to discuss, she has been well received. She has now consulted with another group of patients with the same doctor that are interested in nutrition.

My second peer mentoring session with a husband and wife practice in Kansas for October was good. The primary discussion was on different meters and the proper blood glucose levels or guidelines they should follow. I wish I would have had the second question from Diabetes Mine and the second comment to the discussion, but we did cover most of the points. Many were not enthused about the ADA guidelines and wondered about the points in Jenny Ruhl's website here and here. I stated that they were excellent targets for many people. I asked if anyone was hypoglycemically unaware or recently had a low that they were not aware of until they tested. No one had such an experience that they were aware of and I warned them about this and knowing the signs of sweating, nervousness, being lightheaded, and the other symptoms. That did bring one admission from a patient saying now that he knew what to look for; he may have had one in the last month. He admitted that when he tested the reading was 73 mg/dl and an hour later the reading was 88 mg/dl.

I asked him how long it had been since eating and he said about 7 hours because he had not felt good and skipped the noon meal. I asked what medication he was taking and he stated it was one of the sulfonylureas and yes he had taken it at noon. I advised him to talk to the doctor before leaving that afternoon and ask about skipping the medication when he felt like not eating. When the doctor came to get the next patient he did ask and she stated he should not have taken the medication unless he was above 150 mg/dl. He said he had not tested and she advised him to always test if he knew he would not be eating. She stated this would guide him on taking the medication. She asked if there were other questions on medication and not eating – there were so she said they would cover this later before the session ended. I then explained what can happen if someone was high and took their medication without eating and got the hypoglycemia symptoms, but their test showed they were in the upper 80s or in the 90s. I said the symptoms of hypoglycemia can happen when they have a rapid drop in blood glucose levels. One person spoke up and said like a false positive. I agreed, but warned them that testing was important just the same.

Next I asked if any of them had pizza from time to time. Of the 12 patients in the room eight admitted to having a piece or two with the family. So I then asked how many were on a regimen of higher that 40 percent fat for a meal. Six answered yes, and I talked about not testing at one or two hours post meal, but at three or four hours and said this was known as the “pizza effect” because of the fat content that would slow the absorption of carbohydrates. I said I realized many of them could not use that many test strips, but for those that could, they should test at half hour intervals starting at 2 and one-half hours after eating and test until the 4 and one-half hour mark. One woman said she had read this someplace and had tested at the 2 hour, 3 hour, and 4 hour points and her high had been somewhere between the 3 and 4 hour points, so she knew I was right. I stated that it would vary from person to person, but that even a few people might have the high after four hours. One person asked if this would apply to her being on insulin. I said yes, and asked which insulin. She said Novolog and I said definitely, and advised her that she could be like me and only have a 3 and one-half hour effective period. She stated that as far as she could determine she was getting a 4 to 4 and one-half hour effective period. I suggested that she think about not injecting her insulin until after she had eaten, but to test before meals as always and count her carbs she would be eating to determine the dose, but not to inject until the end of the meal. She said she would ask the doctor.

I then had a few other questions before the end. I wished everyone happy holidays and both doctors asked me to remain online until all questions had been answered. The first question was the woman on insulin and the doctor said let her think on it, and she faced the video cam and asked if I had suggested this and why. I responded that this had been raised when discussing the “pizza effect” and the doctor said now she understood the question and that she agreed with my suggestion and it would maximize the effectiveness of the insulin. Then she stated that this would also be a good idea for those on sulfonylureas. Then she asked if anyone thought they had slow emptying stomachs although she did not think anyone did. No responses, so she continued that injecting after eating could also help these people in case anyone had friends with this problem.

The rest of the questions were answered and the husband asked how people felt this was working. Of the 14 people present, only one said it was not helpful and that was because he was still not on medications. The other person that was not on medications said it still was a help for him because he knew what needed to be done if he had pizza with the grandchildren. He said he would have to exercise longer, but how to test was still valuable to him. The husband asked how many would attend in January and 13 of the 14 said yes. Then a person asked a question about something I had written in my blog about the reason insurance companies limited test strips. The wife asked, “the one saying about the collusion between four government agencies and the four diabetes professional groups and them not wanting us to learn what high carb and low fat diets did to our health.” The person said yes, and the doctor said she agreed and her husband said he agreed as well. He went on to say that how were we going to maintain our health on the limited number of strips.

He then announced something that surprised even me. They had written all of the test strip manufacturers and all of the insurance companies they knew were being used by people there and were waiting to receive replies from two of the manufacturers. He said the responses to date would require copies of the front page of each person's federal form 1040 for the prior two years and they would need two copies of each, one set for the test strip manufacturer and one set for the insurance company. Once they had all the copies, they would send them all in and then they would be provided with a list and what would be allowed for each person. At that time, an email would be sent to each person with the details and a return form to say if they wanted to participate or not, and what their cost would be and the amount the insurance company would allow.  He concluded by saying that it may not benefit everyone, but unless they participated, they would not know.

Medicare – Give Us Back Our Test Strips

Where this will go, I don't know, but those of us with type 2 diabetes need to be able to test our blood glucose and not feel restricted by when and how often we are able to test. Yes, people do need the education about testing. They also need to be taught how this will help them be better able to manage diabetes. While I do not want to vent, I have had conversations with several doctors that agree with me and wonder how we are best able to turn this around and get more people to test on a regular basis. Yes, Medicare, give us back our test strips!

Read carefully as I don't plan on pulling back in some areas and I honestly feel that there is some truth as I am getting emails that agree and some medical professionals that agree in part. Some do very carefully state some ideas, as they are not sure they can rely on me not to use their names and quote them. So continue reading about self-monitoring of blood glucose and related educational ideas.

First, I must point out that much of the research for self-monitoring of blood glucose (SMBG) is suspect. Not only are the participants carefully selected, but also most studies seem to exclude people with type 2 that have an interest in or knowledge of SMBG. Many of the studies are observational in nature or rely in participant-completed surveys, which are not reliable for scientific accuracy. In the USA, many of the studies are funded by the National Institutes of Health (NIH) or the Centers for Medicare and Medicaid Services (CMS). Then on the unscientific information, Medicare takes more test strips away from us.

I have made this accusation before and I will again. This is based on my research and in no way is it scientific. There is a conspiracy happening in the USA between government agencies and medical organizations to keep many people with type 2 diabetes unaware of the damage being caused by our grain industry and low fat mantra, which is promoted by the US Department of Agriculture (USDA). In turn, the NIH and CMS have cooperated by funding non-scientific studies giving Medicare the incentive to reduce our testing supplies.

Then the America Diabetes Association (ADA), the American Association of Clinical Endocrinologists (AACE) promote the USDA line of thinking – whole grains, low fat, and people with diabetes that do not know better listen to them. Then the American Association of Diabetes Educators (AADE) and the Academy of Nutrition and Dietetics (AND) which follow the ADA and AACE do little do encourage people to think for themselves. They are pushing mantras and mandates and expect people with type 2 diabetes to accept the dogma blindly.

The AADE does nothing to promote and teach diabetes self-management education (DSME). They give mandates and mantras that patients are learning is bad for their diabetes health. Most CDEs will not teach patients about self-monitoring of blood glucose (SMBG) for fear that patients will discover the truth about whole grains and low fat. The monopolistic workers for the AND mandate that we consume a minimum number of carbohydrates per day and go ballistic when we do not and literally call us noncompliant and often refuse to work further with us. This refusal is the one good thing for us as patients.

Now some will say that the AADE does promote DSME, which in a small way they do, in some sources and pamphlets, but very little of the information ever reaches the patients. A few conscientious CDEs do teach DSME and even fewer teach SMBG until they are confronted by older CDEs and encouraged to stop. So please Medicare give us our test strips back and find us doctors willing to teach us the truth. We know there are doctors that are breaking ranks with the ADA and AACE because of the lack of diabetes education being taught.

I am also aware of doctors attempting to use peer mentors to dispense some diabetes education when CDEs are not available or have taken positions in conflict with the doctors. This may become more common as the increasing numbers of patients diagnosed with diabetes come into existence and the numbers of CDEs entering the field continues at a snails pace. With this gap widening almost daily, is it not surprising that doctors are exploring other avenues to assist in diabetes education. Even more doctors are investigating shared medical appointments to expand education by presenting it to groups of patients when there is not time to do it individually.

The controversy about the registered dietitians will need to play out in the court system before we will know whether their numbers will decline. Nutritionists that are joining other organizations to continue being able to dispense nutrition information may be able to step in and fill the widening gap. This should be great for those of us with diabetes as my experience with these nutritionists has been positive. They are interested in balancing nutrition and not issuing mantras and mandates for us to follow. They will suggest ideas that some of us may disagree with, but will work with us to help us balance our nutrition whether we follow a low carbohydrate, medium fat diet, a paleolithic diet, or even other diet plans. They are not locked into telling us we must eat a required number of carbohydrates.

Patients around the globe need education about diabetes and how to apply this to their daily lives. In the USA, we need Medicare to give us back our testing supplies in sufficient quantity that newly diagnosed patients can determine how the different foods and food combinations affect our blood glucose levels. Then allow enough test strips for people to use on a daily basis and to do random checks when adding new to them foods.

Okay, why do I use Medicare as the scapegoat? Because the medical insurance industry generally follows the lead of Medicare in lock-step. If NIH and CMS are going to do studies, let’s have them do studies for three to five years and give continuous education during the studies. Have the education reinforce the principals set out at the beginning and ask the participants what they need in more information to help them. And, have the studies be scientific studies with the proper scientific methods applied and not the observational and survey format from the past. Do not exclude study participants that are interested or have knowledge of SMBG, Teach the study participants SMBG or DSME. Medicare, give us back our test strips!

I might also suggest that if doctors are going to be paid incentives, they must provide education on a continuous basis to be eligible. This should be audited for verification.

If insufficient CDEs are available, make use of peer mentors and even retired doctors if this is needed. The only way to put a halt to the increase in the diabetes epidemic is to educate the current patients and make sure they have the testing supplies to make it happen. Educated patients will not be afraid to spread the education.

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.

Stop Wasting Your Test Strips

This is not related to self-monitoring of blood glucose (SMBG). This is about the ways we as diabetes patients take care of our test strips and to avoid wasting them in other ways. Each test strip we waste costs us money. They are expensive so we do not need to waste them carelessly.

Yet people do just that. They do not store them properly, jam them into the meter carelessly, and do not wait until the meter says the strip is ready. These errors occur all too frequently and that is wasting money. Errors will happen, but a few precautions can save strips and save your hard-earned money.

First, make sure that you store your strips properly. The containers they come in are the proper container to keep them in. 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. I keep a small plastic tweezers handy for getting out the first few. No, I did not say metal tweezers, 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 or in your purse to carry them. The test strips are delicate and can be damaged beyond use.

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. Please wash your hands with warm soapy water and dry carefully 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.

It is important to perform tests with the meter and strips as close to room temperature as possible to get accurate results. Do not freeze your strips or store them in extreme cold, as this will probably produce errors or false readings. This applies to extreme heat or direct sunlight. I have seen people store them on the car dash in direct sun and then they wonder why they get weird test results.

Now that I have explained proper storage, I will return to proper use of the test strips. When you are ready to test, always have your meter out and ready to insert the test strip carefully. Push it straight into the slot provided. Then use your lancing device to prick your finger and get an adequate amount of blood available. By this time, your meter should be ready to have the test strip receive the required amount of blood. Hold the meter with the test strip inserted properly and slide the strip at an approximate 10-degree angle that will allow the strip to wick sufficient blood to get an accurate reading and move it into the blood. Do not hold the meter and test strip at a 90-degree angle to the blood spot as you may shut off the wicking of your blood before it has enough for a reading. This will get you an error message.

Good luck and may your readings be good and not receiving error messages. The test strips are important and you need to make efficient use to prevent waste.