This article is more than 5 years old. Information may no longer be current.
That ‘dumb’ glucose meter may be smarter than you think
Click Here to Manage Email Alerts
A 71-year-old woman with type 2 diabetes complicated by hypertension, hyperlipidemia, retinopathy and peripheral arterial disease came in for a follow-up visit. The patient denied symptoms of hypo- or hyperglycemia. She did not bring her glucose meter, an Accu-Chek Aviva, because it had stopped working a few days prior. The patient asked for a new meter as a replacement, stating that she had many test strips and asked for the same make and model. Ophthalmology and podiatry exams were current.
Ronald Tamler
Medications included:
- Ezetimibe (Zetia, Merck) 10 mg daily oral;
- Amlodipine 10 mg oral tab;
- Valsartan-hydrochlorothiazide (Diovan HCT, Novartis) 320 mg to 325 mg daily oral;
- Carvedilol (Coreg, GlaxoSmithKline) 25 mg 1.5 tablets oral twice-daily;
- Sitagliptin (Januvia, Merck) 100 mg daily;
- Clopidogrel (Plavix; Sanofi, Bristol-Myers Squibb) 75 mg oral daily,
- Metformin ER 1,000 mg oral twice-daily;
- Insulin glargine (Lantus SoloStar, Sanofi-Aventis) 100 U/mL (3 mL) subQ pen at 18 U subcutaneously at bedtime; and
- Aspirin 81 mg oral daily.
In physical exam, the patient was hypertensive, with a blood pressure of initially 160 mm Hg/80 mm Hg, then 140 mm Hg/74 mm Hg, with a heart rate of 58. Exam was otherwise unremarkable. HbA1c was 7.3%.
After addressing her hypertension, the patient was given a replacement glucose meter of the same make and model. A few days later, the patient called and was upset that the new glucose meter worked for a few days, and then stopped working again.
Error message displayed on the patient’s glucose meter.
Source: R. Tamler, MD, PhD, MBA, reprinted with permission.
What is the next best step?
A. Have the patient describe what the meter says or bring in the glucose meter.
B. Prescribe another glucose meter of the same make and model.
C. Prescribe a glucose meter of a different make and model and stop prescribing Accu-Chek meters because they do not work.
D. Explain to the patient that she should not test her blood sugar because her HbA1c is pretty good and her test strips are costing Medicare too much money.
Case Discussion
The patient brought in her glucose meter (answer A, see photo). A quick online search showed that the error message displayed meant that her test strips had expired. This was confirmed with a quick check of the date on the test strip container. She had been using the (current) sample test strips with her new meter and gone back to using the older strips after a few days.
Outdated test strips have been shown to produce false results, sometimes leading to deleterious management decisions. In this case, a code chip that came with the test strips prevented the use beyond the recommended date. The patient had hoarded unused test strips over time and now had outdated test strips that would no longer work. This also meant that she was testing less often than prescribed. There is discussion whether patients treated with oral agents may require only intermittent blood glucose testing, or even none at all, but insulin-treated patients should test their blood glucose levels (D), and the best timing and frequency of these tests should be addressed individually with the patient.
For more information:
- Ronald Tamler, MD, PhD, MBA, is clinical director of the Mount Sinai Diabetes Center in New York. He is also an Endocrine Today Editorial Board member.
Disclosure:
- Tamler reports that he has received research support from Abbott.