Following a previous disaster where I found myself without a tester due to a flat battery I now make a habit of having one at work, one a home and another that I carry around with me so that I never find myself in a situation where I have to ask someone if they can spare me a loan of theirs to do a test (something that I’ve had to ask of at least two people on at least one occasion each). As luck would have it though, it seems like when life wants to take you for a ride it will and even if you have three testers, Murphy’s law will apply and they will all give up the ghost on the same morning.

This, is exactly what happened to me yesterday when all three meters that I have died! Not being able to test was a little stressful just cos I’m so used to it but I figured that I’d just get some more batteries that evening and think of it as a holiday. Having just looked at the 3V battery in these machines and seeing if any of them worked in another machine meant that I had them in my hand a little longer than the usual 30 seconds it might take to do and test and I started to think about them a little deeper. I mean, we would be absolutely screwed without these little machines. We’re used to talking and thinking about insulin and pumps and CHO content and exercise and playing the juggling game but what stuck me this morning is that despite having used a tester on several occasions a day for almost 20 years I don’t actually know the first thing about how they even work and very little (i.e. absolutely nothing) about the technology behind them or who invented it. So I ended up doing some research and discovered that the history of testers is actually quite an interesting one.

According to an article on Wikipedia about testers, the technology was originally invented in 1962 in the United States by a guy called Clarke at the Cincinnati Children’s Hospital. Then there was another one that followed in the 1970’s which had to be plugged into mains! That’s like the equivalent of boiling needles…

After they were introduced, they were initially shunned by hospitals and only gained gradual acceptance within the medical community in North America after persuasion by endocrinologists and their patients (i.e. diabetics). The article on the development and history of blood glucose monitors is on the Wikipedia site if you want to read about all of this in detail but suffice to say that things have gotten a lot better since the process was invented in 1962.

Fast forward 37 years though and PHARMAC has introduced a system in NZ whereby there are only two meters available and that seems to be a bit of a shame to me. Are we missing out on better meters as a result? I don’t know anything about the blood tester market and what there is overseas cos I’ve not done any research and maybe it’s only because I don’t get to see the new meters anymore that I feel like meter tech isn’t advancing as fast as insulins and pumps for example but I do know that accuracy is something I have been thinking about a lot. Tonight for example I did a test and I was 14.8 so I did another and I was 11.8. My hands had been washed and everything was on an equal footing as far as I can tell so my assumption is that the tester is flawed. That makes it seem like a shame to work so hard at getting your basals right, ISF calculated (insulin sensitivity factor) and the effort that goes into the carb counting on a fancy new set of scales I just spend money on trying to keep your BGs within such a small range. Are we being foiled by our meters being inaccurate? Should be accept two testers as the only option? How often to PHARMAC review their decision on which two to market?

I read an article about a week or so ago in the New York times about how the FDA (or Federal Drug Administration which is the US equivalent of PHARMAC) is looking at reviewing its acceptance of meters in their country adhering to “international standards that allow the devices to be wrong by as much as 20 percent”. I’m not sure why they have moved in that direction and wouldn’t be surprised if it was driven by economics given the nature of the american healthcare system but the American Association of Clinical Endocrinologists  has also formally petitioned the FDA to “act on the issue” who have reasoned that “because of the highly variable quality of the meters and the glucose testing strips in widespread use, the safety of our patients who depend upon those meters is threatened”.

I don’t want to make this post any longer (and I want to go to bed) but what is the consensus out there? Was anyone involved in the process of choosing the meters that PHARMAC went with as the only two we could have? Have you ever had serious doubts about the tester you use? I would be very interested to hear.

- Aaron