Dear Michael,

Thank you for contacting your American Diabetes Association. I received your e-mail regarding meters.

The cost of a blood glucose meter and diabetes care supplies is often covered by health insurance. But some insurance companies will not reimburse you. Find out what your insurance company covers and get approval before you buy. Some insurance companies and/or health care systems have special arrangements for certain meters or systems. If you have an established health care team, you should discuss choices and cost before you buy. You can usually find a deal on meter trade-ins with rebates and special purchase offers. Check with your doctor and diabetes educator. Keep an eye on ads and compare prices before you buy.

In the past, before the advent of blood glucose meters, urine testing was the only method for gauging blood glucose levels in one's system. But it is, and always has been, a very imprecise method and does not provide a complete picture of diabetes management.

In most cases, for example, glucose is not detectable in the urine unless the blood glucose levels have been above 180 mg/dl, which means that urine tests are virtually useless at detecting hypoglycemia (low blood glucose levels).

For this reason, and others, health care providers recommend that those interested in attaining good blood glucose control use blood glucose meters, not urine test strips or tablets.

Urine, however, contains many other substances and is still very important in diabetes care. For example, if the body burns fat for fuel in the absence of insulin, poisonous ketones are produced, and these substances find their way into the urine. Also, when the kidneys' filtering processes begin to become impaired, microscopic amounts of protein (microalbuminuria) begin to spill into the urine, which is an early sign of kidney disease.

Urine testing kits are available for testing three different substances in the urine: glucose, ketones (some kits can test for both glucose and ketones), and microscopic amounts of protein (microalbuminuria). Urine tests, though no longer recommended for blood glucose control, still play an important role in diabetes care. They can detect the presence of harmful ketones; new tests can even measure indicators of kidney health.

Home urine glucose tests are available in strip form. They may or may not be less expensive than blood glucose test strips. Insurance companies may not pay for urine test strips, however, because blood glucose meters are now held as the standard.

Strips are either foil-wrapped or in vials, and are marked with shelf-life dates. Strips should be stored according to manufacturer's recommendations, because the chemicals on the strip will react to light, temperature, and changes in humidity. Foil-wrapped strips may be a better choice if strips are infrequently used, to preserve the integrity of the strips.

Urine specimens must either be collected in a clean, dry container (one would then dip the test pad into the collected specimen), or by passing the test pad through the urine stream to saturate it. Timing for the result varies.

Results are obtained by noting the presence of a visible color change on the test pad of the strip. A color scale will indicate the result, either in an estimated quantitative value (example: 250 mg/dl, 300 mg/dl), as a percentage (1/10 percent, ¼ percent, etc.), or a descriptive term (for example, trace, small, or large). People who have problems with color perception or poor visual discrimination are not candidates for using color charts and should use other methods.

Improper handling or storage could skew the readings. There are also certain medications and vitamins that potentially could alter the urine color, causing false results. Check with your health care professional about interfering agents if you plan to use home urine testing products.

Ketone bodies (acetone, acetoacetic acid, and beta-hydroxybutyric acid) are by-products of burning fat, rather than glucose, to fuel the body.

Ketones are a waste product. If they build up, they can lead to very serious energy problems in the body, resulting in diabetic ketoacidosis. The body tries to dispose of ketones as quickly as possible when they are present in the system. Urine test strips can detect ketones as the body tries to rid itself of these poisons.

Ketone testing should be performed by people with type 1 diabetes when their blood glucose is high (usually greater than 240 mg/dl), or as directed by their physician. All people with diabetes who are sick, under stress, or who have blood glucose over 300 mg/dl should also test for ketones, as should pregnant women with any type of diabetes (type 1, type 2, or gestational). And, of course, anyone who suspects onset of ketoacidosis should test for ketones immediately. Check with your diabetes health care professional about the ketone-testing guidelines and record-keeping methods he or she recommends.

Please note: Urine ketone strips will detect only some of the ketone bodies produced by the body, not all of them.

Ketone strips are available in foil-wrapped packets or vials. Follow all manufacturer's guidelines and procedures.

Test results are revealed through color changes, which indicate the presence of ketones, either quantitatively (for example, 5 mg/dl, 15 mg/dl, etc.) or by descriptive terms (for example, negative, trace, small, or large). False positives may occur if you are also using certain medications or vitamins, or if the strips have been handled or stored improperly.

New blood ketone testing meters more accurately detect some ketone bodies and may be preferred by some providers, as previously noted, or they may be used in combination with urine strips.

Talk to your doctor regarding what chemical reactions take place in order for the meter to read the results. Blood glucose meters are small computerized machines that "read" your blood glucose. In all types of meters, your blood glucose level shows up as a number on a screen (like that on your pocket calculator). Be sure your doctor or nurse educator shows you the correct way to use your meter. With all the advances in blood glucose meters, use of a meter is better than visual checking.

Step-by-Step Blood Glucose Checking

Wash and dry your hands.

Prepare the glucose meter. Each meter works a little differently. Read the instructions carefully. At first, you should practice with the meter under the supervision of the doctor or diabetes educator.

Choose your spot. Don't test on the same finger all the time. Choose a different finger each time you check. Prick the side of the fingertip, not right on top. The side hurts less and is less likely to bruise.

Prepare the lancet and finger-pricking device. Like meters, each finger-pricking device is different. Read the instructions and follow them carefully.

Place the finger-pricking device against your finger and push the button.

Squeeze out a drop of blood. Some people have more trouble getting the blood out than others. If it's hard to get a drop of blood out, try hanging your hand down and gently shaking or squeezing the finger. If it is often troublesome to get a drop of blood, ask the doctor to recommend a different lancet or finger-pricking device.

Place the blood on the test strip and put the test strip in the meteraccording to manufacturer directions. Wait for the results.

Record the results in the logbook

Here are a few common problems that can cause inaccurate readings:

Hands are not clean & dry (you forgot to wash them, there's powdered sugar on them from that doughnut you just ate, or you used an alcohol wipe and the alcohol is interfering with the meter) I no longer eat powered doughnuts...alas...

Blood drop is too small

Codes on strips and meter do not match

Dirty meter

To receive our free packet of information on diabetes management and wellness, please reply to this e-mail with your mailing address. You may also contact our National Call Center at 1-800-342-2383 or visit us on the web at www.diabetes.org.

Sincerely,

Jane ......

Email Specialist

American Diabetes Association

1-800-342-2383

www.diabetes.org
===========================================================================================