To use the blood glucose meter a user pricks their finger to release a small amount of blood. This blood is then placed on a test strip and is read by the meter. If you have type 1 diabetes, you’ll probably check your blood glucose at least six times a day, though it is not uncommon for people to check much more than this. Bear in mind that the more often a person checks their glucose, the lower their HbA1c is likely to be.
What type of blood glucose meters are there?
There is a huge range of blood glucose meters on the market, with over forty meters currently available in the UK. They usually have some common components such as a lancet to prick the finger, a digital display, and a place to insert the strip.
Some modern meters include features like calculators to help you work out insulin to carbohydrate ratios, a USB connection so that you can read results on a computer, and lights so that they can be used in the dark. There are also ‘strip free’ meters, whereby 50 tests are stored on a rotating cassette.
How do I choose a blood glucose meter?
Be sure to research the different types of blood glucose meter and ask your healthcare professionals about the different features that might benefit you.
Smart meters / bolus calculator meters
If you are on MDI or an insulin pump, there are a number of steps to calculating how much insulin to give in response to your blood glucose measurement.
- Count or estimate the carbohydrate content in the food you are about to eat (if you are testing pre-meal).
- Calculate your meal bolus according to your insulin to carbohydrate ratio at that time of day.
- If your blood glucose measurement is above target, calculate your correction bolus, according to your insulin sensitivity at that time of day and whether or not any insulin is still active from your last bolus.
- Adjust for expected activity if you will be exercising within 2 hours after your bolus.
- Finally – eat and enjoy!
These steps can become second nature and perhaps we don’t even realise we are making so many mental calculations. A smart meter is a custom-built calculator to take away steps 2, 3 and 4. They make a calculation of how much insulin should be taken to bolus for food or correct a high blood glucose. Smart meters can help you avoid under or over dosing, stacking correction doses, and guestimating!
Examples of blood glucose meters
In its 2016 document Standards of care for management of adults with type 1 diabetes, the Association of British Clinical Diabetologists (ABCD) said:
“All patients with (type 1 diabetes) who are carbohydrate counting should be offered a bolus calculator to ease the burden of calculating insulin at mealtimes.”
There are some smartphone apps such as MySugr and RapidCalc which will calculate meal and correction boluses for you, including some open source (unregulated) options.
Access to sufficient test strips / choice of brand
Has your GP changed the quantity or type of blood glucose test strips that you get on prescription – without asking you? If so, you’re not alone.
Across the UK, Clinical Commissioning Groups (CCGs) (in England) and Local Health Boards (in Scotland & Wales) are attempting to reduce the cost of diabetes care by limiting the number of blood glucose test strips available on prescription. Some authorities are requiring people with diabetes to use a particular blood glucose meter so they can buy strips in bulk at lower prices.
Saving money within the NHS should be encouraged, provided that the changes needed are consistent with National Institute for Clinical Excellence (NICE) guidelines and clinical evidence. NICE guidelines NG17 (for adults with type 1 diabetes) and NG18 (for children and young people with diabetes) support the need for blood glucose monitors that are most suitable for the individual patient.
NG17 (for adults with type 1 diabetes) says:
1.6.17 When choosing blood glucose meters:
- Take the needs of the adult with type 1 diabetes into account.
- Ensure that meters meet current ISO standards.
and NG18 says:
1.2.60 Offer children and young people with type 1 diabetes and their family members or carers (as appropriate) a choice of equipment for monitoring capillary blood glucose, so they can optimise their blood glucose in response to adjustment of insulin, diet and exercise.
Yet in some cases, individuals’ needs and preferences have not been taken into account. This tendency to discount patients as stakeholders needs to be addressed in order to maintain and improve the quality of diabetes care in the UK.
Obtaining adequate glucose testing strips
It has often been said that 99% of diabetes care is self-care: many people with type 1 diabetes spend less than 24 hours in the company of diabetes care professionals in an average year. Patients’ ability to self-manage diabetes depends on access to appropriate resources, including both drugs and blood glucose monitoring.
NICE NG17 and NG18 (published in August 2015) sets out advice for commissioners and clinical teams on how many test strips should be used (and therefore prescribed by your GP):
1.6.10 Support adults with type 1 diabetes to test at least 4 times a day, and up to 10 times a day if any of the following apply:
(the list of circumstances that may demand more than four tests a day include illness, pregnancy, sport, and experiencing more hypos.)
1.2.59 Enable additional blood glucose testing (more than 10 times a day) for adults with type 1 diabetes if this is necessary because of the person’s lifestyle (for example, driving for a long period of time, undertaking high‑risk activity or occupation, travel) or if the person has impaired awareness of hypoglycaemia.
1.2.58 Advise children and young people with type 1 diabetes and their family members or carers (as appropriate) to routinely perform at least 5 capillary blood glucose tests per day.
1.2.59 Advise children and young people with type 1 diabetes and their family members or carers (as appropriate) that more frequent testing is often needed (for example with physical activity and during intercurrent illness), and ensure they have enough test strips for this.
If your GP does not give you adequate test strips on the grounds of cost, this simple statement may be all you need to persuade them: ‘If you think test strips are expensive, wait until you see how much it costs when I don’t test.’
If that argument doesn’t work, you could try the following steps in order:
- Discuss the matter with your GP. Even though it might seem obvious, say you have type 1 diabetes and have different needs from someone with type 2 diabetes.
- Ask your GP practice manager why they are not prescribing in line with NICE clinical guidance.
- Print this article, and this letter, and this blog post by Professor Peter Hindmarsh, and discuss them with your GP.
- Ask your diabetes consultant or diabetes specialist nurse to write to the GP to explain your individual clinical needs with regard to blood glucose testing.
- Raise the matter with your CCG/Local Health Board. Your GP will be able to give you the relevant contact information. In many parts of the country, local policies do not distinguish between type 1 and type 2 diabetes.
- Contact your local MP and ask them to help you resolve the situation.
If you would like support in following these steps, please contact us.