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Miscoded meters may result in insulin dosing errors
Proper education and automatically coded meters are recommended to help reduce errors in insulin dosing.
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Miscoded blood glucose meters can be problematic for people with diabetes and may result in significant insulin dosing errors.
Blood glucose monitoring is essential for diabetes management, and the accuracy of blood glucose levels is crucial when patients are adjusting their insulin dose based on these levels, according to Charles H. Raine III, MD, with the Diabetes Control Center in Orangeburg, S.C.
Raine and colleagues conducted a study of automatically coded, manually coded and intentionally miscoded blood glucose meters. The results of their study were published in the Journal of Diabetes Science and Technology.
Data from miscoded meters cannot be used, and “people who are checking their blood glucose with miscoded meters are literally poking their finger for nothing,” Raine told Endocrine Today.
Assessing miscoded meters
Several years ago, a number of patients came into Raine’s office with blood glucose values on their meters that did not seem to make sense when compared with other parameters such as HbA1c, he said. He found that one in six patients had a miscoded meter.
Raine and his colleagues sought to expand upon this observation and to assess what could potentially happen as a result of patients not properly coding their meters.
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They enrolled 116 patients at three clinical centers. All patients had blood glucose values that ranged from 52 mg/dL to 498 mg/dL. After fasting, patients were given a two-hour meal tolerance test. The researchers tested each patient’s fingerstick blood at zero, 60 and 120 minutes using five different popular blood glucose meters.
The researchers used Monte Carlo simulations to generate ideal and simulated meter glucose values and the probability of insulin dose errors.
Errors in insulin dosing
Automatically coded meters had superior results compared with manually coded meters. “The probability of insulin misdosing with either manually, correctly coded or autocoded meters was significantly lower than that with miscoded meters,” the researchers wrote.
The probability of a two-unit insulin dosing error range using a miscoded blood glucose meter was as high as 50%, compared with 7.1% for correctly and manually coded meters. The probability of three-unit insulin dosing error range was as high as 22.3% for miscoded meters and 0.49% for correctly and manually coded meters.
An error of two to three units of insulin is significant and can cause considerable short-term difficulty with low blood glucose, especially in children and insulin-sensitive patients, Raine said.
With automatically coded meters, the probability of a one-unit insulin error was as high as 35.4% and of a two-unit error, 1.4%. The researchers observed no insulin dose errors above two units with automatically coded meters.
Using meters the right way
“All patients who receive a blood glucose meter should have instructions on proper use,” Raine said. He explained that many companies send meters to patients through the mail or through the pharmacy with no more than an instruction booklet. Patients often use expired test strips or incorrect measuring techniques. It is essential for patients to understand the potentially serious consequences of miscoded meters.
At his practice, Raine said he prefers automatically coded meters that set the correct code when a test strip is inserted, “just to take that extra step away from the patient who has so much to do related to managing their diabetes.” – by Katie Kalvaitis
Dr. Raine is a paid consultant for Bayer Diabetes Care.
For more information:
- Raine CH, Schrock LE, Edelman SV, et al. Significant insulin dose errors may occur if blood glucose results are obtained from miscoded meters. J Diabetes Sci Technol. 2007;2:205-210.