Gary Scheiner recalls all too clearly his first blood sugar monitor back in 1985: “It required a hanging drop of blood — 20 microliters, which then had to be wrangled onto a square,” he says. “That’s forty times the amount of blood required by today’s monitors!”
Scheiner, who developed diabetes at the age of 18, has witnessed the many changes leading up to today’s new and improved meters. As the author of Think Like a Pancreas and clinical director of Integrated Diabetes Services, he is an expert on diabetes pattern management. In an exclusive interview with Insulin Nation, Scheiner argues that proper diabetes care begins with choosing an appropriate meter and making the most of it.
How have meters changed over time?
Scheiner: Meters have vastly improved over the past few decades. They’ve become more user-friendly and more clinically-friendly. They’ve shrunk to about the size of a cell phone. They also work faster–you can get a reading within five seconds. That’s vital when you need to chug some glucose fast to counteract a dangerously low blood sugar level!
Today’s readers are also more accurate; they’re only a few percentage points away from laboratory-quality readings — and the accuracy keeps improving. Some monitors can measure other values, such as ketones in the blood. Others enable you to draw blood not only from the finger but also from the upper arm, forearm, thigh, calf, or hand. But perhaps the biggest improvement is how painless it is to get a blood draw, and how little blood is needed – we’re talking .5 microliters. When these monitors are properly used, they barely scratch the skin.
What should people consider when choosing a meter?
Scheiner: Different meters work best for different people. Unfortunately, the number one factor in people’s choice is whether their insurance plan will cover it. But if you have the luxury of choosing, differences between the models can help you decide.
Simpler devices may work better for technically challenged people. More complex devices come with lots of memory – enough to keep records of 500 previous tests — plus software that will sync with your computer. This enables you to back up your data in case you lose your monitor. Downloading your data may also make it easier to share your readings with your physician and track your blood sugars over many months. People with vision problems can especially benefit from today’s full-color, brightly lit screens, and large readouts, all of which make it easier for them to see their results. Other monitors don’t need to be seen at all — they can talk to you!
Finally, people with dexterity issues may have an easier time with larger buttons and larger test strips. But even for people with excellent dexterity, ideal conditions may not always prevail when checking your blood sugar – for instance, when you awaken at 2 am with low blood sugar, bleary eyes, and shaky hands, inserting test strips into a small slot may prove challenging. So ease of use is an important consideration for everyone.
How much do these meters cost?
Scheiner: The meters themselves are fairly inexpensive and sometimes even free. However, the test strips may factor into your choice, as some cost upwards of a dollar each, potentially adding up to more than $100 per month. But remember that it’s the strips, not the monitors, that do most of the work. They must be manufactured under highly controlled, sterile conditions. In addition, test strip sales help fund vital research and development.
What does the research say about the connection between frequent testing and health outcomes for people with diabetes?
Scheiner: Even the most technologically advanced meters, laden with bells-and-whistles galore, are only valuable to the degree that the information they gather is acted upon. Having a good meter and actually doing something with the data are two different things. Research shows that those who perform frequent, regular checks–and then act upon that information–show much better control of their blood sugar levels than those who don’t. However, such data may be skewed in that people who check their glucose levels infrequently may also be lax in other areas, such as diet and exercise, or in keeping written records.
What’s the physician’s role in pattern management?
Scheiner: Poor blood sugar control may not be the patient’s fault. Giving someone a meter is like giving them a fish; teaching them to properly utilize it is like teaching them to fish. Many people are never taught pattern management skills. That should be the role of a good health care provider. But even at major medical institutions, diabetes care may come up short.
That said, it’s not the physician who manages a patient’s diabetes – it’s the patient. And the idea of self-managing and self-treating, rather than relying upon a doctor, is somewhat of a novel idea in the healthcare world. I believe that diabetes educators can make a big difference. Ideally, physicians should refer patients to a qualified diabetes educator, but even if they don’t, people can find one themselves using such websites as www.diabeteseducator.org.
What’s on the horizon?
Scheiner: Continuous glucose monitoring (CGM) systems, which use a tiny tinsel-like sensor inserted under the skin to check glucose levels in tissue fluid, may be the wave of the future. A transmitter sends glucose level readings via radio waves from the sensor to a pager-like wireless handheld device. CGM systems can transmit glucose level measurements as often as once per minute to this device, providing virtually real-time measurements, with glucose levels displayed at 5-minute intervals. Users can set up the handheld receiver to buzz if glucose levels are in the danger zone. Special software is available to download CGM data to a computer for tracking and analysis of patterns and trends, and the systems can display on-screen trend graphs. CGM devices produced by DexCom and Medtronic are FDA-approved and are available by prescription. While CGM systems are more expensive than conventional glucose monitoring, they may enable better glucose control. They can keep people out of danger. It’s a great technology that works well and can potentially save a fortune in emergency room bills.
Until CGM becomes more financially feasible, how can people make the best use of their existing blood sugar meters for pattern management purposes?
Scheiner: Your meter will not analyze the data for you; it takes a trained eye. But with time, that trained eye can be yours. Target goals set by the American Diabetes Association are 70–130 mg/dl of blood glucose before a meal, and less than 180 mg/dl two hours after beginning a meal. Although some people have an aversion to keeping written records, I’m in favor of it. You can simply write your readings down on paper. Alternatively, you can scroll through your meter’s memory, or download the data to your computer. Then, depending on your monitor, computer software can be used to display the records in graph form.
Count how many readings are above, below, or within your target range, and calculate how often you are within that range throughout the day. Then look for solutions for the times you aren’t. If, say, 80% of your readings are within range, you may be doing just fine. However, if 70% of your readings are out of range, you may need to do some problem-solving.
You may be tempted to stop checking blood glucose levels entirely because the numbers seem meaningless, or worse, upsetting. Learning what the numbers mean and evaluating their patterns can help you cope. And diabetes educators such as ours can help you see how your readings correlate with your diet, stress levels, medications, or exercise patterns. It’s a bit like being a detective!
What are some mysterious readings that you’ve helped to decipher?
Scheiner: One client of ours had high blood sugar readings on weekend mornings, but not on weekdays. A bit of sleuthing revealed that this individual often dined out on weekend evenings; these high-fat restaurant dinners showed up in the following morning’s readings. Problem-solving in this case didn’t mean she needed to eliminate this pleasant weekend ritual. She simply needed to make better choices about the restaurants she frequented and the dinners she chose. Increasingly, people like her are taking matters into their own hands – as they should. That’s pattern management at its best.
Tell us about your company in particular.
Scheiner: For the past two decades, Integrated Diabetes Services has provided remote telephone and email assistance to diabetics worldwide. We can help patients find the optimal blood sugar monitor for their particular situation – and then make optimal use of that monitor. We are familiar with the self-management products available, but we do not make or sell any of them. One prerequisite for working here is that everyone on staff has diabetes. They can truly relate to our clients.
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