What are the contraindications for the use of the blood glucose meter for blood glucose monitoring?

Blood glucose meters measure blood glucose levels electronically. Such measurement utilizes only a small drop of blood from the fingertip placed on a disposable test strip. The digital meter obtains information from the blood on the strip, and within seconds, the glucose level is displayed on the screen. Patient discomfort and inconvenience are minimal, and compliance with testing regimens is therefore high. There is a recurring cost to using blood glucose meters and disposable strips or sensors, but it is outweighed by the costs related to complications of diabetes.

Table of Contents Show

Blood sugar testing equipment
Ketone testing equipment
Problems with testing and monitoring equipment
Blood glucose meters
Continuous glucose monitoring (CGM)
Flash glucose monitoring
Other equipment problems
Managing my diabetes - video

Alternate-site testing uses the same meter and strip but acquires blood from the palm or the forearm. Thus, it causes virtually no pain and allows patients to rest sore fingertips. The disadvantage of alternate-site testing is that decreased blood flow may be encountered and may affect testing accuracy.

Multitest systems are available that utilize a cartridge or a disk with multiple test strips. These systems may be more convenient for patients.

Newer systems utilize a sensor that can be applied to the arm or abdomen and determine glucose levels from interstitial fluids. These do not require any blood. The transmit their data to the app on a patients phone for interpretation.

Many meters allow patients to download results to a computer so that they can be shared with their health care provider; this has the potential to improve diabetes management.

iBGStar (Sanofi) was the first blood glucose meter to connect directly to iPhone and iPod Touch. It uses the iBGStar Diabetes Manager application for recording, tracking, managing, and sharing blood glucose data. Recent research has shown good interassay and high intra-assay precision using the device. [6]

A continuous blood glucose monitor (CGM) assesses blood glucose levels on a near-continuous basis. A typical system consists of a glucose sensor placed subcutaneously, a nonimplanted transmitter, and a receiver worn like a pager, which records blood glucose levels at frequent intervals and monitors trends.

CGM systems monitor interstitial fluid glucose levels. They must be calibrated with traditional fingerstick tests. Before treatment of reported hypoglycemia or hyperglycemia with insulin, confirmation with a fingerstick test is recommended because of the 5- to 15-minute lag in data reporting.

Continuous monitoring provides documentation of blood glucose response to insulin dosing, eating, exercise, and additional influences. Overnight monitoring may identify problems with insulin dosing and allow adjustments of basal levels. Many units are equipped with alarms to warn patients of hyperglycemia or hypoglycemia and provide time for treatment. Studies have demonstrated that patients using CGMs experience fewer hyperglycemic episodes and may decrease their glycated hemoglobin (HbA1C) levels. [7, 8, 9]

One recent concern, however, is proper calibration and availability of control solutions at pharmacies and appropriate use by patients during calibration. Lack of adherence to proscribed methodologies of use may lead to erroneous data and thus possible mistreatment of diabetes by patients. [10] Future development and technological advancements aim to allow for improved sensors and calibration software, creating better systems designed to automate delivery of insulin partially (eg, low glucose suspend) or entirely (eg, “fully closed-loop” artificial pancreas). [3, 5, 11]

If you have diabetes, blood glucose monitoring can help you keep your glucose levels within a target range by balancing food, exercise and insulin, reducing your chances of diabetes complications. A range of testing and monitoring equipment is available to help people manage their diabetes. Your doctor or diabetes nurse or educator can advise you on the most appropriate equipment for you and your situation.

The Royal Australian College of General Practitioners recommends that if you have type 2 diabetes and take oral medication only, you should talk to your doctor or specialist about the need to test your blood sugar levels at home, as most people in this situation do not need to do this type of monitoring. For further information, visit the Choosing Wisely Australia website.

Blood sugar testing equipment

Testing your blood glucose (blood sugar) level is the only accurate way of knowing whether it is too high or low. You cannot accurately judge your blood sugar level just by how you feel.

You can check your blood sugar level using the following equipment:

Blood glucose meter — a finger-prick device is used to draw a drop of blood from your finger, which you put on a special stick. You then use the meter to see how much glucose is in the blood.
Flash glucose monitoring — this system uses sensor technology to test glucose levels without needing to prick a finger. A sensor worn on the back of the arm connects to a reader or mobile phone application, which stores your glucose levels day and night.
Continuous glucose monitoring device (CGM) — a sensor is placed under the skin, which measures your glucose levels 24 hours a day. CGM is useful for people who have ongoing problems controlling their blood sugar level. The cost, including consumables (sensors), is around $5,000 per year.

The Australian Government provides access to subsidised continuous and flash glucose monitoring products through the National Diabetes Services Scheme (NDSS).

Products that are subsidised by the NDSS, such as needles, syringes, blood glucose monitoring strips, urine monitoring strips and insulin pump consumables, are available from NDSS Access Points, usually your local community pharmacy.

Ketone testing equipment

Not all people with diabetes need to test for ketones. Mostly it is for patients using insulin. Your doctor or diabetes nurse or educator will advise if you need to or not.

If you need to test for ketones, you can use:

Testing strips or sticks — these are dipped into your urine and change colour to show the amount of ketones in your body.
Blood test meters — these test for ketones in your blood, and work in a similar way to blood glucose testing.

Problems with testing and monitoring equipment

If you have a problem using your diabetes equipment, or if it breaks or becomes faulty, refer to the manufacturer’s user manual or contact its customer care department. Your doctor, diabetes nurse or educator or pharmacist will also be able to advise you.

Blood glucose meters

Blood glucose meters can stop working properly if:

the meter gets old, too hot, damp or dirty
the batteries need replacing or recharging
the testing strips are out of date
the calibration code is incorrect
you are using the wrong strip for the meter
there isn't enough blood on the strip or the strip has been put into the meter the wrong way
there was something sweet on your hands before you did the test

To avoid problems with your blood glucose meter:

Read the manufacturer’s instructions on caring for and using the device correctly.
Before testing, wash your hands with soap then rinse and dry them, as dirt can cause an inaccurate reading.
Don’t use wet wipes to clean your hands since they may contain chemicals such as glycerine, which can cause an inaccurate reading.
Always check you have the right strip for the meter and that is has been put into the meter the right way.
Each time you visit your doctor or diabetes nurse or educator, use your device while there and see if the readings it gives you match the readings taken by the doctor.

Continuous glucose monitoring (CGM)

When using CGM, the sensor must be removed and a new one placed in a different part of the body once a week.

Regularly check your blood sugar level using a finger prick blood test to ensure your CGM is measuring properly (i.e. make sure the readings match).

Flash glucose monitoring

It is important to ensure your skin is clean and dry before applying the flash glucose monitor or it may not work correctly. Tips using flash glucose monitoring correctly can be found here.