What is the best kind of glucose monitor?

Since insulin became  available, probably nothing has more revolutionized the  day-to-day  management  of diabetes, especially type 1 diabetes, than the arrival of the capillary glucose monitor. So successful  has this technology been  that  this  is a difficult question  to

answer  specifically  because   there   are   up   to   20

approved glucose monitors for use at any one time, with  new  or  updated  models  appearing  frequently. Also,  different  features  are  important  to  different individuals, depending on  their needs. Probably the best way to answer this question is to discuss some of the  available features. Size is  one  of  the  first  that springs  to  mind.  Monitors  have been  getting  ever smaller since they first appeared more than 30 years ago. It is now possible to get a monitor that is about the same size as a standard lipstick (e.g., One Touch Ultra-Mini®) and is yet  highly functional. Memory size is not as important as it might  at first seem. A memory of about 100 readings is probably sufficient, although almost every monitor now has more. There is limited practical usefulness of going back too far, since  treatment  decisions should be based on recent information, rather than distant data. Sample size is sometimes important  and most available meters now use much smaller blood samples  than was previously the case. Microsample meters such as some Freestyle® and One Touch® models use samples less than 1/50th the size of an actual droplet of blood. Many monitors will permit sampling from sites other than the finger- tip, such as  the forearm (most) and palm, which is useful for those with  sensitive fingers or for people who are heavily involved in manual or delicate work. The  speed of obtaining  the  reading  is  now usually around 5 seconds after the blood sample is  applied, although some models (such as the Prestige IQ®) can take  up  to  50  seconds. This  is  much  shorter  than models in  the  early days, which could take from 1 to  2  minutes.  Most  meters  can  now  be  linked  by cable, Bluetooth,  or  broadband  to  a  computer  and their  contents  are  downloadable,  including  to  the Internet. Some meters have multistrip  cassettes that dispense between 10 and 20 test strips, such as  the Accuchek  Compact  Plus®, for  added  convenience. Other  features include the  ability to display results graphically (e.g.,  One Touch  Ultrasmart®), to func- tion at high altitude (e.g.,  Advocate Duo®), and to speak the results for those with  limited vision (e.g., Prodigy Duo®). The features of 10  available glucose

Table 11   Features of 10 Available Capillary Glucose Monitors

Name                                 Vol        Site        Time           Mem           DL           Other
One Touch Ultra 2 One Touch Ultrasmart One Touch Ultramini Accuchek Compact+ Accuchek Advantage Advance Microdraw Freestyle Flash Advocate Duo Prodigy Duo Prestige IQ	1.0 1.0 1.0 1.5 4.0 1.5 0.3 0.7 0.6 4.0	F, A F, A F, A F, A F F, P F, A F, A F, A F	5 5 5 5 26 15 7 7 6 50	500 3000 50 300 480 250 250 450 450 365	+ + − +IR + + +IN + + +	Graphs 1.2 oz Drum, no code To 10,742 ft Talks, 5 oz WB/plasma

Vol: Sample vol in _L; F=finger; A=arm; P=palm; Time=time to results in seconds; Mem=mem- ory capacity; DL=downloadable; IR=infrared; WB=whole blood.

monitors are shown in Table 11 and an example of a typical data printout can be seen in Figure 6.

Finally, those  with  longstanding  or  complicated diabetes might want  to  consider the  option  of continuous  glucose monitoring, which is discussed in Question 60. However, bear in mind that you will still require a conventional capillary glucose monitor.

Figure 6   Example of a data printout  from contemporary  glucose monitor.

Source: Used with permission from LifeScan, Inc. © 2009