The meter

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The meter


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Old 05-05-2018, 00:18   #1
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Default The meter

I went to a public nurse, she pricked me, used her meter and got me a reading of 7 mmol/L. I then with the same prick put some blood on my meter strip and got a reading of 8.6. She recommended getting a new meter. However, when I then asked the doctor, he did not seem concerned about this sort of error.

I then went to the pharmacist who gave me the meter as the meter is free in Australia. He then gave me a new meter and I tested myself again with the new and old meter. The new meter showed 7.3 and the old meter showed 6.6. The pharmacist then explained to me that these meters are only accurate from about 10% to 20%. So from 7, he would expect a range of readings from 5.4 to 8.4. After some thought, I thanked the pharmacist and decided that I may as well in this case stick with the old one and left.

My question is, is 20% error acceptable? Should I look for another meter?

It does not sound right as I would imagine that 7 is acceptable while 8.4 is a cause for concern.

Thanking you in advance.

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Old 05-05-2018, 01:37   #2
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Bernard, there are a few things which are helpful to understand when testing blood glucose:

- Blood is not homogeneous. It does not have a uniform concentration of glucose, lipids, red blood cells, and other components. So taking multiple blood samples of the size your meter requires may show some differences. You could poke yourself twice even in the same finger, as quickly as you could switch strips, and get different readings.

- Meters can, indeed, be off by some percentage and still considered accurate. I don't know about Australia, but in the U.S. meters can be off up to 15% either way. Most meters work within a much narrower band than that, but 15% is legal. You can Web search for glucose meter percentage error if you want to see how various brands of meters stack up when tested.

- That said, I don't see that margin of error as being quite so critical for you right now, partially because so much can affect the entire process of acquiring and testing the blood sample, and partially because you're not Type 1 -- you don't have to so carefully match insulin to glucose levels.

Finally, your blood glucose level is changing all the time. What you're primarily interested in is trends -- does a certain food always raise your BG? Do you tend to run 20-30 points higher when you take your fasting reading in the morning? If you're not feeling well, is your BG up? Those trends are easier to address in a comprehensive manner than successive pokes which are 10 to 30 points different. If your fasting BG typically is around 105, a reading of 135 some morning should cause you to re-test or think about why it might be that high.

I hope that helps....

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Old 05-05-2018, 03:56   #3
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A 15% to 20% error can show trends when no such trend exists! Is there any that are considered to be better.

Also, I did a search as you suggested and found a site.
diabetesforecast with a page "10 Ways to Master Your Blood Glucose Meter: Diabetes Forecast¬"

I do not dry my hands which is clearly wrong, I do no use the second drop and I squeeze. None of this I like as I need to make a deeper prick.

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Old 05-05-2018, 04:52   #4
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Quote:
Originally Posted by BernardZ View Post
A 15% to 20% error can show trends when no such trend exists! Is there any that are considered to be better.
There are some comparison tests out there, which you'll be able to find with a Web search. Some models of meters tend to finish toward the top. The issue I find with those tests is that they're typically using a sample of just one meter per model, and we can see how well that works sometimes.

Mind you, I'm not dismissing the issue; I just think that there are too many variables involved in measuring blood glucose "at home" to be very concerned about this level of variation over the dozens/scores/hundreds of tests you (should) perform as a diabetic. It is possible to find a meter that generally runs within a narrower band of values, but does that resolve poor technique or human nature or the meal you ate which had far more carbs in it than you ever suspected?

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I do not dry my hands which is clearly wrong, I do no use the second drop and I squeeze. None of this I like as I need to make a deeper prick.
I hear you on not wanting to poke myself any harder than necessary! My mantra is that, if I'm poking myself, I want some actionable information out of the poke! I think another poster mentioned washing your hands in warm water; that helps the blood flow. Another trick is to prick the sides of your fingers rather than the (more sensitive) fingertips.

Some meters even offer "alternate site" testing: you can prick the palm of your hand or your arm or thigh for blood. The results are not quite as useful as finger pokes (for instance, they're slower to show changes in BG levels) but they're an option if finger pokes are too painful or otherwise present a challenge.

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Old 05-05-2018, 05:15   #5
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Bernard, does Austrailia have the FreeStyle Libre real-time “flash glucose monitoring system available or similar? In the US, it is approved for adults with diabetes only. Like the international version, the FreeStyle Libre sensor is considered a replacement for fingersticks. It was made available in Europe years before the US.

See below for more

https://diatribe.org/abbotts-freesty...e-fingersticks

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Old 05-05-2018, 05:27   #6
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Bernard check out the url below for

https://www.diabetescare.abbott/worl...australia.html
ABBOTT DIABETES CARE IN AUSTRALIA
Abbott Diabetes Care
666 Doncaster Road
Doncaster 3108
Victoria, Australia
ABN 95000 180 389

Phone Number: +1-800-801-478

www.myfreestyle.com.au

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Old 05-05-2018, 21:32   #7
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Quote:
Originally Posted by BernardZ View Post
A 15% to 20% error can show trends when no such trend exists! Is there any that are considered to be better.

.......

I do not dry my hands which is clearly wrong, I do no use the second drop and I squeeze. None of this I like as I need to make a deeper prick.
True, if meter readings were helter-skelter and results were above and below lab results of the same values, then your meter's trend would not be very relevant. After comparing my meter with lab results, I check my BG when the doctor's office draws blood, I feel my meter is fairly consistent with the lab results and that its trends are fairly reliable, if my test results are going up daily, I feel my BG is really going up daily. I feel that most meters are fairly linear, most reading higher or lower than than what is real and their readings drift away from what would be a true reading. A few may even cross over, being above or below at one end, nearly dead on at some point, and then being on the other side beyond that. This is just my opinion, and it could be way off base.

The meter itself is not the only thing affecting the accuracy of the reading. The test strips themselves can cause a lot of variance as well as how you prep for testing, as you have learned.

The meters available would probably not be affordable to most of us if built to a much more degree of accuracy, not to mention what the costs of the test strips would be. The best we can do is to try to be as consistent as we can in how we prep to take away the only variable we have control of in the testing procedure. If we find we can't trust our meter, we should get a new one. Just know that there are bad meters even if you get the what you think may be the Cadillac of meters.

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Old 05-06-2018, 05:52   #8
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Thanks, everyone for your comments.

Just for myself, assuming I am about 7. I wrote a quick simulation program which over 4 days (I am supposed to do four reading a day) and assumed a normally distributed error and what the forecast figure would be, over 99% of the time it stated I was less than 9.

So I suppose its acceptable as long with these assumptions if it really is random error and not a systematic error.

We work with what we can.

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Old 05-06-2018, 06:20   #9
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For those recommending the Libre: I hope Bernard has plenty of money because as far as I know, the Libre is not covered by any insurance, and our medicare doesnt cover it either. So an initial cost of $180+, then $180/month is just ridiculous for most of us. I want it, cant afford it.

My favourite meter was my Accucheck Aviva Connect, until it went swimming in Toby's water bowl. I then reverted to my Freestyle Freedom Lite. Both of these tended to give results in the same ballpark. I've given up on Dario because I get weirdly high readings and gave myself a hypo just once when correcting for something that Dario was clearly wrong about. The Freestyle Lite started eating batteries, but until then was reliable. I've since acquired an Accucheck Guide, I like having the Bluetooth transfer to my iPhone app. It seems as accurate as any and so far so good.

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Old 05-06-2018, 13:05   #10
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Quote:
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So I suppose its acceptable as long with these assumptions if it really is random error and not a systematic error.

We work with what we can.
In a sense, it is a systematic error in that us diabetics, the medical care community, and the manufacturers of glucose meters have arrived at the (uneasy) agreement that what we have in meters now is as good as it gets for 1) the money; 2) the usability; 3) the size of the device; and 4) the size of the blood samples used. Of course, that will improve over time. But making big changes right now will have some effect that makes it undesirable today.

My dad was diabetic back in the 50s and all he had to measure blood glucose were pee sticks and doctor's tests (much bigger blood draws than any meters today). His level of glucose control was orders of magnitude lower than what I can manage with my $20 meter. But there were no meters in his day. He worked with what he had.

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