Let’s talk about test strips, shall we?

Blood glucose.  It’s front and center when it comes to diabetes.  It is how we get diagnosed and it is what we are trying to manage.  An important tool we use to manage our blood glucose is our meter and its strips.  But what happens if our meters aren’t giving reliable information?  Let’s explore that this month as we discuss a topic from the June 26th chat Fill in the Blank.  Weigh in on the following statement:

Test strip accuracy is important to me because______.

Short answer: Because we are too technologically advanced these days to make any other excuse.

First, a trip down memory lane.

I was diagnosed in October of 1982, shortly after my first birthday. (I got called an overachiever yesterday… gotta start early!) The technology that was handed to my scared parents was the equivalent of a typewriter in a room full of Macbook Airs. Heavy, clunky, and involved a lot of guessing.

The first round of test strips didn’t belong to a meter at all.

These are Chemstrips (thank you Google Image Search.) They measured ketone amounts in urine. Ketones in urine are usually a tell-tale sign of a high blood sugar. If I had ketones, surely it must mean that my blood sugars were way too high and we must give me more insulin. Have I mentioned that I spent a lot of my early childhood in the hospital?

Along with these colorful test strips where the early blood glucose strips of the 80s.

These test strips required enough blood to satisfy a vampire’s sweet tooth and only really gave you a range of what your blood sugar could be. They also required time – 2 minutes of waiting for a semi normal blood sugar reading and 3 minutes if you thought your BGs were high. You might as well try to download a 5 MB song on dial-up. It wasn’t exactly accurate either. As I mentioned, it gave you a range based on whatever color the blood left behind on those enzymes. Sandy beige and teal? You were 120 mg/dl. Pea Soup Green and Dark Teal? Hmmm… you are probably in the 200s. Black and blue? You are probably dead. Just sayin’.

Later in the 80s, I had this dinosaur.

I’m fairly certain I had another machine before the Reflolux 2, but this is the one I remember. Again – I was probably 6 or 7 when I started using this on my own. (Editor’s note: this may in fact be the Accu-Chek II, but Google has been unhelpful.) This machine would take the test strips from above and read them into a more accurate number. Or – more accurate than the ranges provided on the side of the bottle. The machine, if I remember correctly, had some sort of elaborate coding ritual which involved taking it apart and it weighed about 2 pounds. It was also about the size of my dad’s hand. Huge. The strips still required the 2 minute wait time, but after that, you stuck it into Johnny 5 and waited another minute or so before it spat out an analog number. Thus, you knew what your blood sugar was. Nevermind that it varied greatly from your doctor’s machine results. (Which it often did.)

Along with the bad hair and fashion of the 80s, the Reflolux went out of style, making way for new, smaller, less cumbersome meters. These meters had smaller test strips that didn’t require a tourniquet every time you wanted to test. Some even came in fancy colors and could easily fit into a purse. But, again, with this newer technology comes less than perfect results. We’d like to think that the numbers our meters are spitting out are accurate, but our A1Cs didn’t always agree, leaving us frustrated.

Now that we’re in the 2000s, we have a wide array of technology available to us. Insulin pumps that make administration easier and more precise than long acting insulins; CGM technology to alert us of spikes and valleys in our sugars and provide us with trends and patterns; meters that take 5 seconds or less to provide results; and really fast acting insulin. All items that should, in theory make our lives easier and our control more streamlined.

So what’s the problem?

We live in a society of instant gratification. If we want a song, we download it. If we want to map a roadtrip, we look on our GoogleMap app and it guides us. Want food? A drive through is around the corner. We like things fast, quick, cheap, easy and painless with the least amount of effort. We thrive on short cuts and if it’s “good enough,” it’s acceptable.

Apparently, the FDA agrees.

Per Strip Safely, a grassroots movement to urge lawmakers to push for meter strip accuracy:

“At a recent public meeting the FDA acknowledged¹ that there are some 510(k) cleared blood glucose (BG) meters and strips that do not meet the accuracy standards for which they were approved. There is currently no clear course of action to insure people with diabetes are using blood glucose strips that meet regulatory requirements.² “

And…

“The have-nots will be stuck with meters that met 20% standards several years ago but probably couldn’t meet 40% standards in post market analyses today.”⁹“

Guys, this isn’t something that you should “get what you pay for.” The fact that my meter could be pushing out results that are 20%-40% off from whatever number pops up on screen is a bit unnerving.

I pay (well, my insurance pays) good money for those boxes of name brand test strips. I ran an experiment this morning.

Two different, name brand meters. Two very different post-meal results. I’d be inclined to issue a correction bolus for the 205, but what if I were closer to the 189? With the extra insulin in my system, I’d flatline by 10 am. Can you imagine what generic test strips and meter results would be popping out? Sure, they are within 20% of each other, but when it comes to insulin dosing, that margin of error can mean the difference between grabbing my GlucoLift or spilling keytones.

We have so many pieces of technology available to us and so many advances in our care than I had when I first started out. Why does the FDA still think a colorful range of blood glucose results is acceptable? Let’s leave that nonsense in the 80s where it belongs.

This post is my July entry in the DSMA Blog Carnival.  If you’d like to participate too, you can get all of the information at http://diabetessocmed.com/2013/july-dsma-blog-carnival-3/

ETA:

I was curious and ran a test when I got home using every meter I owned.

Not horrible, however, surprised that the two meters that are essentially the same model came up with wildly different results in comparison. I also issued a correction bolus for the 175 mg/dl. Let’s see if I crash, stabilize, or rise after dinner.