Part 2: The Blood Glucose Monitor
Editor’s Note: This is the second installment in Scott Ehrlich’s multi-part series, What’s a Diabetic to Do? Join us as he shares a first-hand account of his experiences as he moves along his treatment journey after having been diagnosed late this summer. Click here to read his first article on this subject.
A few months ago, I went for a blood test and found out my A1C was over 10%. This, combined with an unexplained weight loss of about 30 pounds, lead doctors to the obvious conclusion that I had joined the ranks of about 30 million Americans who had diabetes. At this point, the two major questions were which type of diabetes, and how can I treat it? Because it came on suddenly and quite severely, my doctors suspected type 1. I, knowing my diet and physical activity regime over the last 30 years, suspected type 2. I decided to detail my experience as a newly diagnosed diabetic and the challenges I have faced, having spent so much of my time on the marketing side, to now be on the patient side.
In this article, I detail my experiences with the blood glucose monitors. My future articles will deal with the medications available and the overall consumer experience of being a newly diagnosed diabetic.
After going to my GP with my initial blood results, I went to an endocrinologist for a follow-up. I was sent home with an Accu-Chek Aviva Plus meter. However, my insurance prefers OneTouch meters, so I acquired one of those, a OneTouch Verio. I also received an offer for a free Abbott FreeStyle meter, which I took advantage of as well. Lastly, I took a trip to Europe and was able to acquire an Abbott FreeStyle Libre wearable monitor, which isn’t yet available in the United States. My impressions of all of these monitors are detailed below.
The Accu-Chek Aviva Plus monitor was my first experience using a blood glucose monitor. It looked similar to a stopwatch and had some pretty good functions on it that allow you to mark when you did your test, get averages, and transfer to a computer. It takes 0.6 µL of blood for a successful test that go into a strip from the front. You know you have enough blood when the strip sucks it up. All in all, upon first glance, it didn’t seem that difficult.
My actual experience with the monitor itself was far less pleasant. It took me quite awhile to figure out how to use it properly. The biggest issue I had was that it would often flash that too much time had passed from when I inserted the strip to putting blood on it, and that I had to try again. This meant I had to prick myself again AND waste another testing strip (which weren’t cheap), even when I knew I had done the test promptly. It was only after a few weeks that I learned that this message really meant that there wasn’t enough blood on the strip.
While 0.6 µL didn’t seem like that much blood, compared to some older and cheaper monitors that took 1 µL, it was often more than I got from a single finger prick, meaning I had to do lots of squeezing or additional pricking to get enough blood for a sample. And once you put blood on a strip, if there wasn’t enough, you couldn’t add more blood, so that strip was lost. I wasted probably 1 out of every 2 strips at first and even after a few weeks, I was still wasting 1 out of every 4 or so. That’s a lot of money on wasted strips.
Another thing I disliked was how it transmitted your data. It came with a wireless way to connect and transfer data to your cell phone, for storage and further analysis, which I thought was great. It was only when I tried it that I learned the wireless wasn’t compatible with my Droid phone so all of that functionality was out the window and I could only import some raw numbers via USB.
Between the strips’ issue and cost, the large amount of blood needed for testing relative to other current meters, the lack of alternate site testing, and the mediocre interface, this was my least favorite meter I used. I still have it for emergencies, in case something happens to one of my others, and it’s certainly functional, but I didn’t find anything on it that was comparatively excellent and it definitely had many shortcomings.
The next meter I tried was a OneTouch. My insurance said they preferred OneTouch so I was allowed to get one of a variety of meters for no cost. I opted for a OneTouch Verio IQ. This meter was advertised as only needing 0.4 µL of blood and had some alternate site testing. It also had an analysis program that you could do through computer. And, since my insurance worked closely with the makers of OneTouch, I thought the strips would be very affordable.
On some accounts, this meter was all that it advertised. Taking it out of the box, it was by far the slickest looking meter, looking like a modern iPod, with a full color interface. It had the best graphics and definitely looked like a modern monitor should look. It also took less blood to work, which was nice. The blood, however, was inserted into the side of the strips (which were much smaller than the Accu-Chek strips); I found that to be easier after a few tries. It was a promising meter but it did have a few shortcomings.
Firstly, it wouldn’t turn on when I took it out of the box. I realized it has a rechargeable battery, unlike the rest, and needs to be charged before use. That’s not a big issue, but can be a problem if you need to test right away or frequently and don’t remember to charge it regularly. Another issue is that the alternate site testing was somewhat limited. Think your palm or sides of fingers but not other places on the body, if that matters to you. Finally, it only came with ten strips and, despite being the preferred (and, in fact, only covered meter) by my insurance, they still wanted nearly a dollar a strip, considerably more than I was paying for the Accu-Chek. Because of this, I opted not to continue use past the ten included strips. For the limited time I used it, it seemed like a quality monitor and if someone really needed a lot of analytics on their blood tests and tested frequently, it could be very useful, even if it still left some things to be desired.
The final monitor I tried was the Abbott FreeStyle InsuLinx. I received this through a coupon I found on the Abbott FreeStyle website. While the coupon has proven incredibly difficult to use (more on this in a future article), I found the trouble to be worth it with this monitor. I was excited about it because it only required 0.3 µL of blood and allowed testing in many sites. When I first used it, I was hoping it would make my testing, which I had done quite frequently at that time, much easier. It’s nice to see I was proven correct.
Firstly, it required only half the blood as the Accu-Chek monitor and about 75% as much as the already low amount needed by the OneTouch. Secondly, you can test nearly anywhere you like. So if you are getting sore or have an aversion to testing on your fingers, you can use forearms, upper arms, wherever. And finally, my favorite part, if you don’t get enough blood on the strip when you test, you have 60 seconds to add more. This gives you plenty of time for one or two additional pricks if need be, meaning you almost never have to waste a strip. The strips themselves are also tiny and allow you to put blood in from either side, giving a lot of flexibility that way as well. From a simple testing standpoint, this is by far the best monitor of the three in every way.
This is important because the in-monitor features, at least the ones I’ve found, are minimal. You can only do a small bit of labeling, analytics are pretty much none existent, and I have not found out how to do any sorts of averages on the monitor itself. The interface is also nothing special, with the ability to choose a background image the most advanced thing I have found.
Still, analytics aren’t that important to me as I just need to stay in a fairly wide range of sugars and don’t have to treat often with insulin or other meds throughout the day. So for me, simple functionality with little blood and little wasted strips is paramount. And to that end, this monitor is by far the best of the ones I have used.
Despite that, I still felt there had to be something more. Pricking your finger, testing a few times a day, getting a few snapshots of blood sugar readings. All of these things seemed very archaic with today’s technology. So, in researching for something better, I found two continuous blood glucose monitors. These were wearable devices that would give you your blood sugar on a fairly constant basis without finger pricking or strips. The first, which is currently available in the United States, is made by Dexcom. This is a device you can wear on your arm for seven days and get consistent blood sugar readouts. Unfortunately, the cost of $700 or so for the initial device and its lack of coverage by insurance made testing it a bit out of my reach.
Another device I had seen was the Abbott FreeStyle Libre. This device, at a cost of $80 for a wearable patch and another $80 for the scanning device, along with a wear time of 14 days, was much more in my wheelhouse. When I found out that you can use an app on your cell phone instead of purchasing the reader, bringing down the cost of trying it even further, I was even more intrigued. There was one hitch, however; this device has yet to be submitted to the FDA for approval and is therefore not available in the US. In fact, you can’t even access the website or apps from a US computer.
This was quite discouraging. As luck would have it (or as lucky as someone can be when having diabetes), I was headed to Germany for an extensive vacation around this time, where it was for sale, so I made some arrangements to procure a single pod for trial. I was curious to see how my newly diagnosed body would hold up to the diet of beer and pretzels I planned on feeding it, as well as how my blood sugar reacted outside of my normal testing hours or while I was sleeping.
After getting my device and downloading the app, I watched YouTube videos on how to set it up. Seeing the size of the needle I would need to put into my skin to “install” it, however, made me quite queasy (although seeing six-year-olds putting it in themselves without even flinching both put me at ease and made me realize how big of a baby I was). Still, after a copious dose of liquid and pretzel courage, I had my wife put it into the fatty part of my left arm. To do this, you put the pod (about the size of a quarter) in an applicator-type object, push down almost like a stapler, and take it off. Shockingly, not only did it not hurt, I didn’t even feel it go in. And yet there it was, on my arm. I initialized it with the app and took the first reading on my phone. I then checked it against my blood glucose monitor. They were nearly identical.
I was enthralled with this device, how it could be there, attached to my arm and I could just wave a phone over it to get my blood sugar, cursing that this wasn’t available in the US. I checked my blood sugar over and over, amazed at this new technology. Oddly, though, my sugar readings dropped, first to slightly low, then very low, then to the point where I would be in a hypoglycemic coma, then to the point I would be dead. I confirmed on my blood sugar monitor that I was not, in fact, dead at that point, nor were my readings even low, and thus I began to see a flaw in my new toy. Further research told me it could take 1-3 days to calibrate the device. With only 14 days of use and it being basically useless for the first few, I became less enthralled. Furthermore, my wife noticed a fairly massive (albeit painless) bruise forming from the insertion site, taking up most of my upper arm. Perhaps technology wasn’t as great as I thought it would be.
After toying with removing the device, I waited out the few days and it did, in fact, calibrate. The results would deviate from my blood sugar monitor, sometimes by five points, sometimes as much as 20. I read that because this was measuring your sugar through fluid in your skin rather than blood, the readings wouldn’t be as current as finger testing and weren’t to be used if your sugar was rapidly changing, such as after eating or if you needed it for insulin doses. This was a fairly severe limitation of the product. I am not sure if this calibration time or inaccuracy was a result of the device itself or the third party app I used to read it, but it is definitely an issue.
Still, this device was amazing. I could swipe my phone over my arm for a few seconds and get an instant reading. I could test as much as I want, wherever I wanted, in seconds. I could have, at a glance, all my results for days, including during when I was sleeping. I could see my highs and lows, when I was rising and falling, what really caused my sugar to spike and drop. It was very instructive and I could see this sort of device is the future.
After 12 days (and another few beers), I took it off. It peeled off fairly simply and painlessly, and the bruise itself started to go away. I don’t feel the need to get another device because of the trouble involved in procuring one and the lack of support once I had it, as well as the fact that it is also a bit cost prohibitive now since it is a cash payment. I do, however, think that when Abbott submits this to the FDA in 2017 or 2018, assuming it’s approved, I would definitely consider using it again, maybe even as a replacement for my other device. Right now, at $80 every 14 days, I am not sure the value is there. But cut that to $10-$20 with insurance and improve the issues with calibration, this could cause testing compliance to skyrocket. Improve the life to 30 days and this device would really take off. As much as I find my other Abbott FreeStyle InsuLinx to be useful, it’s obvious that a wearable CGM, integrated with apps and analytics on common cell phones, is the future of testing.