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Four generations of blood glucose meter, c. 1993-2005. Sample sizes vary from 30 to 0.3 μl. Test times vary from 5 seconds to 2 minutes (modern meters are typically below 15 seconds).
Four generations of blood glucose meter, c. 1993-2005. Sample sizes vary from 30 to 0. 3 μl. Test times vary from 5 seconds to 2 minutes (modern meters are typically below 15 seconds).

A glucose meter (or glucometer) is a medical device for determining the approximate concentration of glucose in the blood. A medical device is an object which is useful for diagnostic or therapeutic purposes Glucose (Glc a Monosaccharide (or simple Sugar) also known as grape sugar, is an important Carbohydrate in Biology. Blood is a specialized Bodily fluid that delivers necessary substances to the body's cells such as nutrients and oxygen—and transports Waste products It is a key element of home blood glucose monitoring (HBGM) by people with diabetes mellitus or with proneness to hypoglycemia. Blood glucose monitoring is a way of testing the concentration of Glucose in the blood ( Glycemia) Diabetes mellitus (ˌdaɪəˈbiːtiːz or /ˌdaɪəˈbiːtəs/ /məˈlaɪtəs/ or /ˈmɛlətəs/ often referred to simply as diabetes ( Ancient Greek: grc Hypoglycemia or hypoglycaemia is the medical term for a pathologic state produced by a lower than normal level of Glucose ( sugar) in the blood A small drop of blood obtained by pricking the skin with a lancet is placed on a disposable test strip, which the meter reads and uses to calculate the blood glucose level. The meter then displays the level in mg/dl or mmol/l.

Since approximately 1980, a primary goal of the management of type 1 diabetes has been the achievement of closer-to-normal levels of glucose in the blood for as much of the time as possible, guided by HBGM several times a day. Diabetes mellitus type 1 (Type 1 diabetes Type I diabetes T1D T1DM IDDM juvenile diabetes is a form of Diabetes mellitus. The benefits include a reduction in the occurrence rate and severity of long-term complications from hyperglycemia as well as a reduction in the short-term, potentially life-threatening complications of hypoglycemia. Diabetes mellitus (ˌdaɪəˈbiːtiːz or /ˌdaɪəˈbiːtəs/ /məˈlaɪtəs/ or /ˈmɛlətəs/ often referred to simply as diabetes ( Ancient Greek: grc Hyperglycemia, hyperglycaemia, or high blood sugar is a condition in which an excessive amount of Glucose circulates in the Blood plasma Diabetic hypoglycemia describes a low blood glucose level occurring in a person with Diabetes mellitus.


Contents

Characteristics

A glucose meter being used in Brasília, Brazil.Photo by Wilson Dias
A glucose meter being used in Brasília, Brazil. Brasília (bɾaˈziliɐ is the Capital of Brazil. The city and its District are located in the Central-West region of the country along a Plateau |utc_offset = -2 to -4 |time_zone_DST = BRST |utc_offset_DST = -2 to -5 |cctld
Photo by Wilson Dias

There are several key characteristics of glucose meters that may differ from model to model:

  • Coding: Since test strips may vary from batch to batch, some models require the user to enter in a code that may be found on the vial of test strips, or a chip that comes with the test strip. By entering the coding or chip into the glucose meter, the meter will be calibrated to that batch of test strips. However, if this process is carried out incorrectly, the meter reading can be up to 4mmol/L inaccurate. The implications of an incorrectly coded meter can be serious for patients actively managing their diabetes. For miscoded meters, the probability of making an insulin dose error of 2 units is 50%. The probability of making an insulin dose error of 3 units is 24%, compared to 0. 49% when using a no coding meter. This may place patients at increased risk of hypoglycaemia.
    Bayer's No Coding Technology involves a range of meters and test strips with automatic coding. [1]
  • Alternative site testing: Smaller drop volumes have enabled "alternate site testing" — pricking the forearms or other less sensitive areas instead of the fingertips. Although less uncomfortable, readings obtained from forearm blood lag behind fingertip blood in reflecting rapidly changing glucose levels in the rest of the body.
  • Glucose vs. Plasma glucose: Glucose levels in plasma (one of the components of blood) are generally 10%–15% higher than glucose measurements in whole blood (and even more after eating). This is important because home blood glucose meters measure the glucose in whole blood while most lab tests measure the glucose in plasma. Currently, there are many meters on the market that give results as "plasma equivalent," even though they are measuring whole blood glucose. The plasma equivalent is calculated from the whole blood glucose reading using an equation built into the glucose meter. This allows patients to easily compare their glucose measurements in a lab test and at home. It is important for you and your healthcare provider to know whether your meter gives its results as "whole blood equivalent" or "plasma equivalent. "
  • Data transfer: Many meters now have more sophisticated data handling capabilities. Many can be downloaded by a cable or infrared to a computer that has diabetes management software to display the test results. Diabetes Management Software refers to software tools than run on Personal computers and Personal digital assistants to help persons with Type 1 diabetes Some meters allow entry of additional data throughout the day, such as insulin dose, amounts of carbohydrates eaten, or exercise. Insulin is a Hormone with intensive effects on both metabolism and several other body systems (eg vascular compliance Carbohydrates (from ' Hydrates of Carbon ' or saccharides ( Greek σάκχαρον meaning " Sugar " are the most A number of meters have been combined with other devices, such as insulin injection devices, PDAs, and even Game Boys. The is a handheld video game console developed and manufactured by Nintendo. [1] A radio link to an insulin pump allows automatic transfer of glucose readings to a calculator that assists the wearer in deciding on an appropriate insulin dose. An insulin pump is a medical device used for the administration of Insulin in the treatment of Diabetes mellitus, also known as continuous subcutaneous One model also measures beta-hydroxybutyrate in the blood to detect ketoacidosis (ketosis). beta -Hydroxybutyric acid ( beta -hydroxybutyrate or 3-hydroxybutyric acid is a Ketone body. Ketosis (kiːˈtoʊsɪs is a state in Metabolism occurring when the Liver excessively converts fat into fatty acids and Ketone

Cost

The cost of home blood glucose monitoring is substantial due to the cost of the test strips. In 2006, the consumer cost of each glucose strip ranged from about $0. 35 to $1. 00. Manufacturers often provide meters at no cost to induce use of the profitable test strips. Type 1 diabetics may test as often as 10 to 12 times a day due to the dynamics of insulin adjustment, whereas type 2 typically test less frequently, especially when insulin is not part of treatment.

Some batches of counterfeit test strips for some meters have been identified, and these have been shown to produce inaccurate results[2]. A counterfeit is an imitation that is made usually with the intent to deceptively represent its content or origins They should not be used and should be reported to the supposed manufacturer.

Accuracy

Accuracy of glucose meters is a common topic of clinical concern. Nearly all of the meters have similar accuracy (±10-15%) when used optimally. However, a variety of factors can affect the accuracy of a test. Factors affecting accuracy of various meters have included calibration of meter, ambient temperature, pressure use to wipe off strip (if applicable), size and quality of blood sample, high levels of certain drugs (such as ascorbic acid = vitamin C) in blood, hematocrit, dirt on meter, humidity, and aging of test strips. Models vary in their susceptibility to these factors, and in their ability to prevent or warn of inaccurate results with error messages. The Clarke error grid has been a common way of analyzing and displaying accuracy of readings related to management consequences. The Clarke Error Grid Analysis (EGA was developed in the 1970s to quantify clinical accuracy of patient estimates of their current blood glucose as compared to the blood glucose value obtained More recently an improved version of the Clarke error grid has come into use - this is known as the Consensus Error Grid.

History

The earliest glucose meter was the Ames Reflectance Meter by Anton H. Clemens. It was used in American hospitals in the 70's. It was about 10 inches long. It needed connection to an electrical outlet for the power. A moving needle indicated the blood glucose after about a minute.

Home glucose monitoring was demonstrated to improve glycemic control of type 1 diabetes in the late 1970s, and the first meters were marketed for home use around 1980. Diabetes is a Chronic disease with no cure As of 2008. It is associated with an impaired Glucose cycle, altering Metabolism. The two models initially dominant in North America in the 1980s were the Glucometer whose trademark is owned by Bayer[3] and the Accu-Chek meter (by Roche). A trademark or trade mark, represented by the symbols ™ and ®, or mark is a distinctive sign or indicator used by an individual For other uses see Bayer (disambiguation or Beyer or Buyer. Bayer AG (German ˈbaɪə () is a German F Hoffmann–La Roche Ltd is a Swiss global health-care company which operates world-wide under two divisions Pharmaceuticals and Diagnostics. Consequently, these brand names have become synonymous with the generic product to many health care professionals. A brand is a collection of Images and ideas representing an economic producer more specifically it refers to the descriptive verbal attributes and concrete symbols such as a A genericized trademark (also known as a generic trademark or proprietary eponym) is a Trademark or Brand name that has become the colloquial

Test strips that changed color and could be read "visually", without a meter, were also widely used in the 1980s. They had the added advantage that they could be cut with scissors longitudinally to save money. As meter accuracy and insurance coverage improved, they lost popularity and are no longer marketed.

At least in North America, hospitals resisted adoption of meter glucose measurements for inpatient diabetes care for over a decade. A hospital is an institution for Health care providing treatment by specialised staff and equipment and often but not always providing for Managers of laboratories argued that the superior accuracy of a laboratory glucose measurement outweighed the advantage of immediate availability and made meter glucose measurements unacceptable for inpatient diabetes management. A medical laboratory or clinical laboratory is a Laboratory where tests are done on clinical specimens in order to get information about the Health Patients with diabetes and their endocrinologists eventually persuaded acceptance. Endocrinology (from Greek grc ἔνδον endon, "within" grc κρῑνω krīnō, "to separate" and grc -λογία

Home glucose testing was adopted for type 2 diabetes more slowly than for type 1, and a large proportion of people with type 2 diabetes have never been instructed in home glucose testing. Diabetes mellitus type 2 or Type 2 Diabetes (formerly called non - Insulin -dependent Diabetes mellitus (NIDDM or adult-onset diabetes is a metabolic

Future

Development of noninvasive devices may enable continuous monitoring. Research is being done on noninvasive methods for measuring blood glucose, such as using electric currents and ultrasound.

There is one noninvasive glucose meter that has been approved by the FDA: The GlucoWatch G2 Biographer is designed to be worn on the wrist, and it uses electric fields to draw out body fluid for testing. The device does not replace conventional blood glucose monitoring. One limitation is that the GlucoWatch system is not able to cope with perspiration at the measurement site. The sweat must be allowed to dry before measurement can resume. Due to these limitations and others, the product is no longer on the market.

The market introduction of noninvasive blood glucose measurement by spectroscopic measurement methods, in the field of near-infrared (NIR), by extracorporal measuring devices, failed so far because at the present time, the devices measure tissue sugar, in body tissues, and not the blood sugar in blood fluid. To determine blood glucose, the measuring beam of infrared light, for example, has to penetrate the tissue for measurement of blood glucose. [4]

It is speculated that within the next decade, meters may be replaced with continuous glucose sensors for many people with diabetes. Blood glucose monitoring is a way of testing the concentration of Glucose in the blood ( Glycemia) This will likely decrease complications found in people with diabetes by limiting problems associated with hyperglycemia and hypoglycemia.

There are currently 2 CGMS (continuous glucose monitoring system) available. The first is Medtronic's Minimed Paradigm RTS with a sub-cutaneous probe attached to a small transmitter (roughly the size of a quarter) that sends interstitial glucose levels to a small pager sized receiver every 5 minutes. As well, the DexCom STS System is available (2Q 2006). It is a hypodermic probe with a small transmitter. A hypodermic needle is a hollow needle commonly used with a Syringe to inject substances into the body The receiver is about the size of a cell phone and can operate up to five feet from the transmitter. Aside from a two hour calibration period, monitoring is logged at five-minute intervals for up to 72 hours. High and low glucose alarms are user-settable.

There is currently an effort to develop an integrated treatment system with a glucose meter, insulin pump and wristop controller, as well as an effort to integrate the glucose meter and a cell phone. An insulin pump is a medical device used for the administration of Insulin in the treatment of Diabetes mellitus, also known as continuous subcutaneous Wristop is a small wrist-mounted computer which has an in-built processor for data processing These glucose meter/cellular phone combinations are under testing and currently cost $149. 00 USD retail. Testing strips are proprietary and available only through the manufacturer (no insurance availability. ) These "Glugophones" are currently offered in three forms: as a dongle for the iPhone, an addon pack for LG model UX5000, VX5200, and LX350 cell phones, as well as an addon pack for the Motorola Razr cell phone. The iPhone is an internet-connected Multimedia Smartphone designed and marketed by Apple Inc Motorola Inc ( is an American, multinational Fortune 100, Telecommunications company based in Schaumburg Illinois. This limits providers to AT&T for the iPhone and Verizon for the others. Before proposing a merge request please see Talk and see if the merger you propose has recently been made and "Verizon" redirects here this article is about the corporation see also Verizon Wireless, Verizon Online DSL and Verizon FiOS. Similar systems have been tested for a longer time in Finland.

Technology

Many glucose meters employ the oxidation of glucose to gluconolactone catalyzed by glucose oxidase. Glucono delta-lactone ( GDL) is a naturally -occurring Food additive used as a Sequestrant, an Acidifier or a curing, The glucose oxidase enzyme (GOx ( binds to beta-D-glucose (an Isomer of the six-carbon sugar Glucose) and aids in breaking the sugar down into its Metabolites Others use a similar reaction catalysed instead by another enzyme, Glucose Dehydrogenase (GHD). Enzymes are Biomolecules that catalyze ( ie increase the rates of Chemical reactions Almost all enzymes are Proteins This has the advantage of sensitivity over glucose oxidase, but is more susceptible to interfering reactions with other substances.

The first-generation devices relied on the same colorimetric reaction that is still used nowadays in glucose test strips for urine. Colorimetry or Colourimetry can refer to the quantitative study of Color perception Besides glucose oxidase, the test kit contains a benzidine derivative, which is oxidized to a blue polymer by the hydrogen peroxide formed in the oxidation reaction. Benzidine is the trivial name for 44'-diamino Biphenyl, a Carcinogenic Aromatic Amine which has been used as part of a test for Cyanide Hydrogen peroxide (H2O2 is a very pale blue liquid which appears colorless in a dilute solution slightly more Viscous than water The disadvantage of this method was that the test strip had to be developed after a precise interval (the blood had to be washed away), and the meter needed to be calibrated frequently.

Most glucometers today use an electrochemical method. Test strips contain a capillary that sucks up a reproducible amount of blood and an enzyme electrode containing glucose oxidase. The enzyme is reoxidized with an excess of ferrocyanide ion. Ferrocyanide is the name of the Anion Fe ( C[[Nitrogen N]]64− The total charge passing through the electrode is measured and is proportional to the concentration of glucose in the blood. The coulometric method is a technique used to define a reaction where the amount of charge measured over a fixed time is measured. Coulometry is the name given to a group of techniques in analytical chemistry that determine the amount of matter transformed during an Electrolysis reaction by measuring The amperometric method is used by some meters that allows the reaction to go to completion and where the total charge transfer is measured. The coulometric method allows for a fixed test time, whereas test times with a meter using the amperometric techique can vary.

Meter use for hypoglycemia

Although the apparent value of immediate measurement of blood glucose might seem to be higher for hypoglycemia than hyperglycemia, meters have been less useful. Hypoglycemia or hypoglycaemia is the medical term for a pathologic state produced by a lower than normal level of Glucose ( sugar) in the blood Hyperglycemia, hyperglycaemia, or high blood sugar is a condition in which an excessive amount of Glucose circulates in the Blood plasma The primary problems are precision and ratio of false positive and negative results. An imprecision of ±15% is less of a problem for high glucose levels than low. There is little difference in the management of a glucose of 200 mg/dl compared with 260 (i. e. , a "true" glucose of 230±15%), but a ±15% error margin at a low glucose concentration brings greater ambiguity with regards to glucose management.

The imprecision is compounded by the relative likelihoods of false positives and negatives in populations with diabetes and those without. People with type 1 diabetes usually have glucose levels above normal, often ranging from 40 to 500 mg/dl (2. 2 to 28 mmol/l), and when a meter reading of 50 or 70 (2. 8 or 3. 9 mmol/l) is accompanied by their usual hypoglycemic symptoms, there is little uncertainty about the reading representing a "true positive" and little harm done if it is a "false positive. "

In contrast, people who do not have diabetes but periodically have hypoglycemic symptoms will have a much higher rate of false positives to true, and a meter is not accurate enough to base a diagnosis of hypoglycemia upon. A meter can occasionally be useful in the monitoring of severe types of hypoglycemia (e. g. , congenital hyperinsulinism), to ensure that the average glucoses when fasting remain above 70 mg/dl (3. Congenital hyperinsulinism is a medical term referring to a variety of Congenital disorders in which Hypoglycemia is caused by excessive Insulin secretion 9 mmol/l).

YouTube Videos of Blood Glucose Meters

External links used as references

References

  1. ^ Healthcare Professionals -- Products and Services. Bayer Healthcare. Retrieved on 2008-01-30. 2008 ( MMVIII) is the current year in accordance with the Gregorian calendar, a Leap year that started on Tuesday of the Common Events 1648 - Eighty Years' War: The Treaty of Münster is signed ending the conflict between the Netherlands and Spain
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