Roche Diagnostics

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Roche Diagnostics sells the meters of Boehringer Mannheim. The batteries in these meters are replaceable at home, and the meters may be used away from the fingers. All the meters come with Spanish language instruction and a

Ketones: Testing at home

The breakdown of fat produces ketones (a type of chemical compound), which can be measured easily by putting a ketone strip into a tube of urine. If your child's blood glucose is above 250 mg/dl, or if you have diabetes and are pregnant and your blood glucose is below 60 mg/dl, it's time to test for ketones. The test is usually done at home.

To perform the test, you place a ketone strip into urine and observe the purple color. Comparing it to a color chart tells you whether your child's ketones are negative, low, medium, or high. A finding of high ketones with high blood glucose means that your child (or you) may be on the way to ketoacidosis (see Chapter 4). A finding of high ketones with low blood glucose means that your child (or you) isn't getting enough carbohydrates. and his body is turning to fat for energy. (This happens during a pregnancy because of the demands of the growing fetus.)

If you find that your child has high ketones, high blood glucose (over 250 mg/dl), and can't keep liquids down, it's definitely time to call the doctor.

If you find high ketones with a low blood glucose, it's time to feed your child more carbohydrates.

phone number for a Spanish-speaking representative. Roche promotes this feature, but all the major manufacturers offer it.

^ Accu-Chek Aviva: This meter works with diabetes management software (DMS). It has a very large memory, storing up to 500 blood glucose values, and can also record other information such as insulin dosages and carbohydrate intake. It requires a tiny sample of blood and can produce on-screen graphs and statistics. It has a code key with each new bottle of test strips.

^ Accu-Chek Advantage: This meter also works with DMS and stores 350 blood glucose values. It uses a test strip that takes 27 seconds to produce results but doesn't require cleaning or wiping. This meter requires a snap-in code key.

^ Accu-Chek Compact Plus: This meter uses a 17-test drum that requires no test strip handling or calibration. It has a lancing device attached to it, which can be removed for separate use. The results are displayed in five seconds, and it has a 350-test memory that's downloadable to a DMS. It allows testing away from the fingers. You can see a 7-, 14-, and 30-day average on the screen.

^ Accu-Chek Active: This meter uses a tiny sample of blood and gives a result in five seconds. It can be used at alternate sites besides the fingers. It has a 200-value memory that's downloadable to a DMS, and it needs a snap-in code key.

^ Accu-Chek Voicemate: This meter is designed for the visually impaired. A new version of this meter is being prepared as of this writing; the main difference is that it reports the blood glucose result audibly. Otherwise, it's similar to the other meters in this list.

Roche's Data Management System is called AccuChek Compass. You need the right hardware and software to download the glucose values, but you can get it from the company.

Checking out meters for continuous glucose monitoring

Continuous glucose meters obtain glucose readings from a needle placed under the skin into the interstitial fluid (the fluid that bathes the tissues). You can see a typical continuous monitoring meter in Figure 7-5. The needle is usually changed every three days. The meter still has to be calibrated with finger-stick blood glucose tests several times a day. The results of a continuous glucose meter can lag behind changes in the blood glucose, especially when the blood glucose falls rapidly. The interstitial glucose may not fall to the same extent for 30 minutes. The GlucoWatch G2 Biographer that I describe later doesn't use a needle under the skin.

Figure 7-5:

A meter that monitors blood glucose continuously.

Figure 7-5:

A meter that monitors blood glucose continuously.

Several companies are making this product, and with improvements, it may replace individual blood glucose monitoring because it provides so much more information. When continuous meters no longer require calibration by finger-stick testing, one insertion of the needle will replace 12 finger-sticks for patients with T1DM.

The main advantage of these meters is the huge amount of data they provide — blood glucose values every five minutes throughout the day compared with four readings in 24 hours for traditional meters. The main disadvantages are that they still need calibration by doing a finger stick blood glucose several times a day, and they tend to lag behind the blood glucose when conditions are changing rapidly, such as after exercise and after eating. Also, the huge amount of information that these devices provide can only be understood with the data management software provided for each one.

Continuous meters are being used for children and in patients in whom the traditional four glucose readings daily don't correlate with the hemoglobin A1c test.

By knowing the direction of the blood glucose over 24 hours (see Figure 7-6 for an example), the doctor can adjust the rapid-acting and long-acting insulins or the insulin pump to provide tight control of the blood glucose without causing hypoglycemia.

Figure 7-6:

A reading taken from a continuous blood glucose meter.

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Figure 7-6:

A reading taken from a continuous blood glucose meter.

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