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Is my blood testing monitor up to standard?

 by angela blair rn cde on 28 Feb 2018 |
4 Comment(s)
When testing your blood glucose levels (BGLs) you want to be sure that your monitor is as accurate as possible. 
It’s also important to make sure it suits your needs, and the best way to find the right one is to chat to your diabetes educator or pharmacist. They can also provide you with additional information, further instruction and support.

Once you have a monitor take the time to read through the manual. This will tell you how to change the time and date (for day light saving, travel), troubleshoot problems and the correct testing technique to use (eg how to insert the test strip).

Once you’re comfortable with your monitor choice, it’s important to know your testing times, the target range for your results and what you need to do when your BGLs are outside your range. Talk to your doctor or diabetes educator about your times, target levels and what action to take.

Many monitors have inbuilt recording of results, however, if you have a doctor’s visit it’s always a good idea to write down your results for a couple of weeks prior to the appointment. Add in any comments such as sick day, extra activity or carb amounts at meal times.

People sometimes ask why testing the same finger twice may give different results?
This can be because the first drop of blood is thicker with more concentrated blood cells so the result may be slightly higher than the second drop. Some educators and monitor companies will recommend wiping away the first drop and using the second.

If you have unpredictable results it may be time for a review of you monitor and testing method with your diabetes educator. If a result is much higher or lower that you usual ones, repeat the test with re-cleaned hands. It may be that your blood glucose level is accurate so compare this with any symptoms you may feel. Many situations effect your levels such as medications like steroids, sickness or stress.

Errors in your results can happen especially if you don’t have clean hands or struggle to obtain a drop of blood. Environmental factors such as temperature can still effected the accuracy of the result as well.

You can check the accuracy of your monitor using control solution, which provides a pre-determined result range. If your monitor doesn’t return the same result as the range listed on the control solution bottle, your monitor is likely to be faulty. Manufacturers will replace faulty monitors if they read outside the range and will also provide you with control solution free of charge.

So how do I know what I am buying?
All monitors sold in Australia for people to test their blood glucose level must meet the international standard called ISO 15197:2013 by May 2016.

This works to ensure reasonable accuracy. BGL results from the monitor are compared to laboratory measurements. These comparison tests also cover whether the accuracy of the result in effected by other interferents (a substance that results in an incorrect result) such as drugs like ibuprofen, the volume of red blood cells (haematocrit level), or cholesterol levels. There are twenty-four different interferents tested for. How the monitor is used is also evaluated to ensure user error does not compromise the result.

To achieve the ISO standard, 99% of the results must be within 15% (plus or minus) of the true result. For ISO 2013, for an actual true value of 5.0 mmom/L the result must fall between 6.0 and 4.0 to be accurate.

The previous standard (ISO 2003) was 95% of the results must be within 20% (+/-).
The new standard has meant that more accurate monitors are available in the market.
Figure 1: An example of the standard – the true value is a blood glucose level of 5.0mmol/L
 
New ISO + 15% True Value -15%
  6.0 5.0 mmom/L 4.0
Old ISO + 20% True Value -20%
  7.0 5.0 mmol/L 3.0
 
What does this really mean? 
Your monitor may be 1 to 2mmol/L higher or lower than your actual BGL depending on your monitor type and if it meets ISO 2013. Health professionals understand this. Remember monitors older than 2013 may only meet the 2003 standard and are therefore are not as accurate.

How do I find out if my monitor meets the standard?
The quickest way is to do a “google” search online for ISO 2013 and your monitor name. This should provide a simple statement such as “meets ISO standard 15197:2013”.  It can also often be found on the manufacturer’s information supplied with a monitor or you can contact the manufacturer’s customer support. 
We’ve done the research work though for the monitors that we sell. All monitors listed below are ISO 2013 compliant and available from diabetesshop.com.
 
Other brands of monitors we sell meet the current ISO 2003 accuracy standard and more recently manufactured versions of these monitors may also be ISO 2013 compliant.
 
If you need to update your monitor find out what options you have to ensure it meets your needs as many of the newer monitors come with a range of extra features. You can chat to your diabetes educator who can show you the range of monitors currently available or you can call us to speak to one of our diabetes educators;

 
Call Diabetes NSW & ACT or Diabetes Tasmania on 1300 136 588 or visit diabetesshop.com

About the Author
Angela Blair
 

I am a credentialled diabetes educator through the Australian Diabetes Educators Association and have worked in diabetes care and management since 1979 in a number of clinical and management roles.

My professional qualifications are NSW registered nurse/midwife with a Bachelor of Nursing from the University of Newcastle (1993), and a Masters in Applied Management (Health) through the University of Newcastle.

Comment(s)4

Nerida - Comment
Nerida02 Mar 2018Reply
Hi. Im currently using acuchek mobile metre and the battery co mpartment keeps popping open. Ive always been given replacement metres from my local diabetic educator but moree recently they have been very difficult to engage with (always miss each other's calls etc). I am considering moving to the Dario for my samsung galaxy s8. I have read heaps about it but before i outlay the $80, i would like to know more info about it - pros and cons that arent coming from a biased supplier. Also are you able to advise on ongoing costs for this device - strips, lancets etc (i dont hold a pension or health card)?
Thanks for your time.
Nerida
Matt - Comment
Matt02 Mar 2018Reply
Hi Nerida

Matt from Diabetes Shop here.

If you are registered or eligible to be registered with the NDSS you will pay no more than $17.00 for a pack of 100 test strips (as of March 2018). If you are not Eligible for the NDSS you will pay between $54.95 and 79.95 for a pack of 100 test strips. The Dario uses universal lancets, so depending on which brand you use you will pay between $10.95 and $17.95 for a pack of 100 lancets.

A quick run down of the Dario Pro's and Con's are as follows;

Pros: Small self-contained unit, the Dario Monitor, Lancing Device and storage space for test strips are all held together in a small unit, great for when you are at of the house. Dario app tracks BGL readings and allows you to tag activities and foods eaten. By using your phone the Dario is able to have a larger screen than traditional monitors, which is great for people with low levels of vision.

Cons: You need to use your phone, no phone no monitor. In rare instances, an update to the operating system of your phone can make the Dario unusable for a few days.
Neil - Comment
Neil02 Mar 2018Reply
This would have to be one of the most poorly designed meters on the market in both the actual meter and the case it comes in. Not designed to easily store the blood strips without folding them over and the tough "butterfly" doesn't always work to turn off...really have to tough the centre of the butterfly only. Give me normal buttons and a larger carry case.
Di - Comment
Di20 Mar 2018Reply
ALL IN CAPS SO ABLE TO READ.
I HAVE AN ACCU-CHEK MOBILE. NO STRIPS REQUIRED ( thus one thing less to remember)
ALTHOUGH YOU MUST CARRY REPLACEMENT CASSETTES AT ALL TIMES AND MAKE CERTAIN USE BY DATES ON CASSETTES WELL IN ADVANCE WHEN PURCHASING. SOME CHEMIST STAFF HAVE NO IDEA. THAT USE BY DATES ON THESE EVEN EXIST!
WARNING THOUGH. PUT WHITE OUT ON BATTERY REPLACEMENT COMPARTMENT OPENER AS WELL AS CASSET COMPARTMENT OPENER BECAUSE WHEN IN A PANICK HARD TO LOCATE THESE AFTER NOT HAVING TO ACCESS FOR SOME TIME. I HAVE FOUND THIS TO BE A FANTASTIC READER. MAKE CERTAIN YOU WAIT FOR THE TWO SIGNALS BEFORE PLACING BLOOD SAMPLE ON THOUGH BECAUSE IF IMPATIENT YOU WILL HAVE TO RESET MACHINE AND START ALL OVER AGAIN. ALSO USE ONLY BATTERIES THEY SUPPLY YOU ( for free).
EXCELLENT COMPANY TO DEAL WITH, KIND, CONSIDERATE AND PROFESSIONAL EACH AND EVER TIME.
Di
PS ALL READINGS RECORDED FOR YOUR CONVENIENCE.
I have experience a difference of " 5" from different machines, this is a huge amount. Why is this?
Diabetic educator could not answer this. Who can?
Robert Rayner - Comment
Robert Rayner19 Mar 2018Reply
Re difference between "new" ISO and "old" ISO. Surely the arithmetic is a bit out. +/- 15% of "5" is 4.25 to 4.75 while +/- 20% of "5" is 4 to 6. Somewhat better than the figures of 4 to 6 and 3 to 7 quoted. Still represents a "spread" of 30% to 40%.
Cheers Bob

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