This may sound odd, but there’s never been a better time to have diabetes. One reason: There have never been more tools to help you monitor and manage your condition. The first self-monitoring tests didn’t appear until the 1970s, and they consisted of test strips that indicated blood-glucose levels by changing into a color that you had to compare to a color chart for your result.
Today there’s an array of sophisticated testing devices. Don’t be daunted by having to sort through them. Instead, rest assured that the basic task is not very difficult and the range of choices means you should be able to find equipment that will meet your specific needs.
Looking at Lancets
Technically, the lancet is the sharp instrument that punctures your skin, while the handheld unit that holds the lancet is called a lancing device. Lancets are disposable both for sanitary reasons and because they can get dull. Some experts recommend that they be thrown out after each use to ensure that you always use a sterile one, but many people with diabetes (including some doctors) think this is wasteful — not to mention expensive — and reuse their lancets. (An obvious point that’s nevertheless worth making: You should never use somebody else’s lancet.)
Many glucose meters come with a lancing device or even build them in, but you’re not wedded to what the meter manufacturer provides. Instead, you should find an instrument that’s comfortable for you. (Theoretically, you can use lancets by themselves, but a lancing device is not only easier to manipulate with either hand, it’s less painful. The reason: Lancing devices are spring-loaded so that penetration is very quick.) Because your skin may not be as thick as, say, the callused hands of a construction worker, most devices allow you to make at least one or two adjustments to how deep the lancet penetrates your skin. Many people are partial to a model called the Softclix, which has 10 different settings.
A final word to the wise: Whichever unit you buy, you’ll need to continually resupply your stock of lancets. Lancets are not always interchangeable from one device to the next, and costs can vary, so check out lancet price and availability before you buy the lancing device.
Buying a Blood-Glucose Meter
Meter technology and features change rapidly, and the range of choices can be bewildering. However, variety also means you should easily be able to find a unit that matches your particular needs and preferences.
Most blood-glucose meters work in one of two ways. A few are still based on a color-changing process in which glucose in the blood reacts with enzymes on the test strip. The meter reads the intensity of the color and shows you a number in the unit’s display window — no need to try to match colors by eye. Most meters work by detecting minuscule electrical currents created by the enzyme reactions. The strength of electron flow depends on the amount of glucose present in the blood. Again, the results are displayed on the meter’s digital readout.
To sort through the multitude of meters and find one that’s right for you, check first with your doctor, who may steer you toward a particular unit based on experience, reports from other patients, or compatibility with his own record-keeping systems. Also find out if your health insurer requires that you buy specific meters. If you can, check out the annual resource guide in the December issues of Diabetes Forecast magazine, which is published by the American Diabetes Association and is available at many major chain bookstores or perhaps in your local health center’s library. This guide doesn’t recommend specific meters, but it does provide a comprehensive list of what’s available, along with information about all the units. When evaluating the choices, you should consider a number of factors, including:
Ease of use. Meters come in different sizes and shapes — some as small as credit cards — and you’ll want to choose one that is comfortable for you to use. Some require bigger drops of blood for an accurate result than others do, which may be an issue if you have poor circulation. If you have vision problems, look for a meter that features larger displays.
The information you need. How much you need to know may depend first of all on which type of diabetes you have. If you have type 1 or type 2 and are taking insulin or medication, you’ll probably be taking more readings than if you have type 2 and control your diabetes through diet and exercise. If you’re testing a lot, you may want a meter that has a built-in memory to help you keep track of the dozens of results you’ll accumulate between doctor visits. Some units also have data ports that allow you to download this information into diabetes-management software on a personal computer. On the other hand, if you’re testing only a couple of times a day or even less, these bells and whistles may be superfluous.
Practical details. Points that seem trivial at the outset can become more important to you the more you use your meter. Some units, for example, use standard batteries you can find in any pharmacy or discount store, while others take less common (and often pricier) batteries that may be harder to find. Still others don’t have replaceable batteries, so you have to get a new meter when yours dies. These units usually last for thousands of readings, but how many thousands will vary from one model to the next. Consider cleaning as well: Some meters are easier to maintain than others. Also find out how fast the meter spits out a reading: Most deliver in less than a minute, but the difference between, say, 40 seconds and 5 can seem significant if you’re late for an appointment or on the job.
Cost. Most popular meters run in the $65 to $70 range; prices vary depending on features. Insurers will usually pick up the cost of a meter, and manufacturers routinely offer deep discounts (or even give them away free) to get a unit into your hands and move you ahead to the real expense: buying the test strips.
You’ll find plenty of information about meters on the Internet but little in the way of objective reviews. Instead of guessing, talk with your diabetes educator about which meter might be best for you, given your lifestyle, age, and eyesight, as well as other factors.
Replacing Test Strips
Test strips are an ongoing expense that can easily run to more than $1,000 a year if you test four times a day. (Usually, insurance pays the cost.) But they are the heart of the monitoring process. Most often, the strips are designed to work with your meter and are not usable with other devices.
When choosing your system, check first to make sure the test strips you need are readily available in pharmacies. Also find out whether your health-insurance plan limits payment for the strips, which can vary in price from 50 cents to almost $1 per strip. Choosing a pricier style of strip might put you over budget. Generic test strips are available for some systems, especially those based on color change.
Once you’ve started using your system, be aware that test strips have a limited shelf life; using them past their expiration date can give you inaccurate readings. When you buy replacements, you’ll find them packaged in different ways — for example, individually or in packages of 50. Consider how often you use them. Bulk packages lower the cost per strip, but if you end up throwing some out because they expired before you could use them, it may be more cost-effective to buy the strips singly.
Most self-monitoring systems “throw in” a logbook in which you can record your results, but it’s not a throwaway item. Recording your blood-sugar levels so you can track patterns is one of the main reasons you self-test. If you don’t like the log that comes with your meter, your doctor may have one that meets your needs better by, say, including space to write information about medication, insulin, or other tests. You can get new pages from your doctor or by writing to the meter manufacturer, using the address in your instructions. Or you can simply use a notebook to record your numbers (although logbooks provide ready-made columns that may prove more convenient and legible). Whatever kind of log you use, the crucial thing is to get your numbers down on paper — including the date and time of each reading. Don’t settle for just numbers, though. Remember, you’re looking for patterns and associations. Write down anything unusual about what you eat, how much you exercise, how sick you feel, how much stress you’re under. These are the observations that even the best glucose meter can’t store in its memory.
Bring your logbook with you when you see your doctor. If she has a question based on your numbers — “Was anything unusual going on two weeks ago Friday?” — your logbook might provide valuable clues.