Choosing a Glucose Meter

Choosing a Glucose Meter

At least 25 different meters are commercially available.

They differ in several ways including

Amount of blood needed for each test

Testing speed

Overall size

Ability to store test results in memory

Cost of the meter




Cost of the test strips used
To search FDA's 510(k) database for glucose meters available over-the-counter (without a prescription), use the following link:

FDA 510(k) Database Search (Over-the-Counter Glucose Meters)

Newer meters often have features that make them easier to use than older models. Some meters allow you to get blood from places other than your fingertip (Alternative Site Testing). Some new models have automatic timing, error codes and signals, or barcode readers to help with calibration. Some meters have a large display screen or spoken instructions for people with visual impairments.

Cholesterol

Cholesterol

If you have diabetes, you have a higher risk of heart and blood vessel disease (cardiovascular disease). One way to limit this risk is to measure your cholesterol routinely and control it by changing your lifestyle or taking prescription drugs. A cholesterol test usually shows your total cholesterol, total triglycerides, and high-density lipoproteins (HDLs). The Centers for Disease Prevention and Control (CDC) has set up a National Reference System for Cholesterol Testing and many manufacturers verify their test through certification with this method.

For more information about cholesterol testing, use the following link:

Medlineplus Healthline Health Information, Medical Encyclopedia, Cholesterol Test
http://www.nlm.nih.gov/medlineplus/ency/article/003492.htm

Microalbumin

Microalbumin

One common and extremely serious result of diabetes is kidney failure. Under normal conditions, the kidneys filter toxins from the blood. When the kidney's filtering processes begin to become impaired, protein (microalbumin) begins to spill into the urine. Testing urine for small, yet abnormal amounts of albumin (microabluminuria) is a common way to detect this condition early, before it can damage your kidneys.

Many urine dipsticks are used to test for large amounts of albumin. To measure a small amount of albumin, which may show an early stage of kidney disease, your health care provider may use specific tests for low levels of albumin (microalbumin tests). To do this test, you may have to collect your urine for several 24-hour periods.

The ADA recommends that adults with diabetes be tested for microalbumin every 3- to 6-months. The ADA recommends testing in children with type 1 diabetes at puberty or after having diabetes for 5 years.

Early detection of microalbumin is important because it indicates increased risk for both renal and vascular disease. Fortunately, early detection allows for treatments that may delay the beginning of a more serious disease.

For more information about microalbumin tests, use the following link:

Medlineplus Healthline Health Information, Medical Encyclopedia, Microalbuminuria
http://www.nlm.nih.gov/medlineplus/ency/article/003591.htm

Urine and Blood Ketones

Urine and Blood Ketones

When the body does not have enough insulin, fats are used for fuel instead of glucose. A by-product of burning fats is the production of ketones. Ketones are passed in the urine and can be detected with a urine test.

If you do not have diabetes, you usually have only small amounts of ketones in your blood and urine. If you have diabetes, however, you may have high amounts of ketones and acid, a condition known as ketoacidosis. This condition can cause nausea, vomiting, or abdominal pain and can be life threatening.

You may use urine dipsticks to rapidly and easily measure the ketones in your urine. You dip a dipstick in your urine and follow the instruction on the package to see if you have a high amount of ketones.

If you have type 1 diabetes, are pregnant with preexisting diabetes, or who have diabetes caused by pregnancy (gestational diabetes), you should check your urine for ketones. If you have diabetes and are ill, under stress, or have any symptoms of high ketones, you should also test your urine for ketones.

Results of ketone testing should be interpreted with care. High ketone levels are found when patients are pregnant (in the first morning urine sample), starving, or recovering from a hypoglycemic episode.

There are now tests for measuring ketones in blood that your doctor may use or you can use at home. Some measure a specific ketone (beta-hydroxybuyric acid) that patients with diabetic ketoacidosis may have.

It is still not known which type of ketone test -blood or urine-- offers more aid to people with diabetes.

For more information about ketone tests, use the following links:

Medlineplus Healthline Health Information, Medical Encyclopedia, Ketones-Urine
http://www.nlm.nih.gov/medlineplus/ency/article/003585.htm

Medlineplus Healthline Health Information, Medical Encyclopedia, Serum Ketones
http://www.nlm.nih.gov/medlineplus/ency/article/003498.htm

Urine Glucose

Urine Glucose

Only patients who are unable to use blood glucose meters should use urine glucose tests. Testing urine for glucose, which was once the best way for patients to manage their diabetes, has mostly now been replaced by self-monitoring of blood glucose. There are three major drawbacks of urine glucose testing compared to blood testing. First, urine glucose testing will not tell you about low (below 180 mg/dl) glucose levels, since at lower levels glucose does not enter your urine. Second, urine glucose readings change when the volume of your urine changes. Third, your urine glucose level is more of an average value than your blood glucose level. There are several dipstick tests available on the market.

For more information about measuring glucose in urine, use the following link:

Medlineplus Healthline Health Information, Medical Encyclopedia, Glucose-Urine
http://www.nlm.nih.gov/medlineplus/ency/article/003581.htm

Glycosylated Serum Proteins

Glycosylated Serum Proteins

Serum proteins, like hemoglobin, combine with glucose to form glycosylated products. Testing these glycosylated products can give information about your glucose control over shorter periods of time than testing glycosylated hemoglobin.

One common test is the fructosamine test. It gives information on your glucose status over a one- to two-week period. High values mean your blood glucose was high over the past two weeks. This test is good for watching short-term changes in your glucose status during pregnancy or after major changes in your therapy. There is no general guideline for when to use this test. Talk to your doctor about whether this test is right for you.

If you have any other disease that can change your serum proteins or if you have large amounts of Vitamin C (ascorbic acid) in your diet, these tests may give wrong values.

For more information about the fructosamine test, use the following link:

Technical and Clinical Evaluation of Fructosamine Determination in Serum.
(Scroll Down)
http://www.cdc.gov/diabetes/pubs/economics/biblio_1-2.htm

Other Diabetes Management Tests

Other Diabetes Management Tests

Glycosylated Hemoglobin

There is hemoglobin in all red blood cells. Hemoglobin is the part of the red blood cell that carries oxygen to the tissues and organs in the body. Hemoglobin combines with blood glucose to make glycosylated hemoglobin or hemoglobin A1c.

Red blood cells store glycosylated hemoglobin slowly over their 120-day life span. When you have high levels of glucose in your blood, your red blood cells store large amounts of glycosylated hemoglobin. When you have normal or near normal levels, your red blood cells store normal or near normal amounts of glycosylated hemoglobin. So, when you measure your glycosylated hemoglobin, you can find out your level of blood glucose, averaged over the last few months.

Doctors have used the glycosylated hemoglobin test for patients with diabetes since 1976 (1,2). The test is now widely used in the routine monitoring of patients with diabetes mellitus. Your doctor may use this test to see how well you respond to treatment. If you have low test values you probably have lowered risk for having complications from diabetes mellitus.

It is good to have your glycosylated hemoglobin tested at least two times a year if you meet your treatment goals or up to four times a year if you change therapy or do not meet your treatment goals. There are now many different ways to measure glycosylated hemoglobin. These tests vary in cost and convenience and you can do some at home. The values (glycosylated hemoglobin index) these tests give can vary too. Talk to your doctor about what your glycosylated hemoglobin index should be.

Patients with diseases affecting hemoglobin, such as anemia, may get wrong values with this test. Vitamins C and E, high levels of lipids, and diseases of the liver and kidneys may all cause the test results to be wrong.

References

1. Bunn HF, Haney DN, Kamin S, et al: The biosynthesis of human hemoglobin A1C: slow glycosylation of hemoglobin in vivo. J Clin Invest 57(6):1652-9, 1976.

2. Fabbay KH: Editorial: Glycosylated hemoglobin and diabetic control. N Eng J Med 295(8):443-4, 1976.

For more information about the glycosylated hemoglobin test (HbA1c), use the following links:

Medlineplus Healthline Health Information, Medical Encyclopedia, Glycosylated Hemoglobin
http://www.nlm.nih.gov/medlineplus/ency/article/003640.htm

National Diabetes Education Program--HbA1c Quiz and Answers
http://ndep.nih.gov/materials/pubs/HbA1c/HbA1c-checkIQ.htm

Glycosylated Hemoglobin
http://www.healthy.net/library/books/textbook/section2/glyhem.pdf

Review Criteria for Assessment of Glycohemoglobin (Glycated or Glycosylated) Hemoglobin In Vitro Diagnostic Devices
http://www.fda.gov/cdrh/ode/odecl658.html

The National Glycohemoglobin Standardization Program (NGSP)
http://www.missouri.edu/~diabetes/ngsp.html