Talk:Glucose meter

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I have a some problems with the section on technology in the Glucose Meter article. In the first line it claims that "So far all glucose meters have in some way employed the oxidation of glucose to gluconolactone catalyzed by glucose oxidase" - this is essentially not true - the largest selling meters in the USA, the Roche Accuchek, use an alternative to glucose oxidase called glucose dehydrogenase. In shorthand glucose oxidase is often called GOD and glucose dehydrogenase is often called GHD. GHD tends to be about 30 times more sensitive than GOD, weight for weight but is more subject to interfering reactions.

The last paragraph says "Today's glucometers use a coulometric method. Test strips contain a capillary that sucks up a reproducible amount of blood and an enzyme electrode containing glucose oxidase. The enzyme is reoxidized with an excess of ferrocyanide ion. The total charge passing through the electrode is measured and is proportional to the concentration of glucose in the blood." Their are two approaches to this, the coulometric approach as described (but the alternative using GHD should be described as well) and the alternative method of estimation which is the amperometric approach. As far as I understand it, the amperometric approach (as for example used in the LifeScan One Touch Ultra and the Roche Accuchek) allows a fixed test time. The coulometric approach, as used in the Freestyle, gives a variable test time between 5 and 30 seconds. Also its worth noting that other methods than ferrocyanide are now under development for the next generation of episodic meters.

Soarhead77 13:11, 12 December 2006 (UTC)

Please note site http://en.wikipedia.org/wiki/Blood_glucose_meter should these be combined? 4.254.224.155 23:28, 14 August 2006 (UTC)jeffrey

You are correct; they are duplicates. Want to take the info from the other article and include it in this? We can then make the other a redirect. alteripse 00:14, 15 August 2006 (UTC)

I tried to delete the section. It seems from all these comments there is somewhat of a consensus on that already, since 2006. I was reverted when I tried, though. Can someone with more muster do it? Habanero-tan (talk) 20:12, 19 May 2015 (UTC)

Glucose meter and nonketotic hyperosmolar coma

A comment: I had added the information on hyperosmolar coma to the Glucose meter article. Although today's glucose meters do not provide specific values beyond their high — which as you indicate is <=600 — the ability to monitor very high blood sugars is important, allowing a patient to take action before they reach the point of of hyperosmolar coma (e.g. prevent the complication). Compare to the pre-glucometer days ... I've not added the information back, but would appreciate a conversation on the point. —ERcheck @ 11:56, 20 January 2006 (UTC)

I was not convinced that meters were of much value because nearly all of the important decision points for HHNC (specifically as opposed to hyperglycemia as a daily issue in diabetes care) lie upwards of meter limits. This is especially true when you specifically address HHNC as an acute emergency. The real advantages of meters for helping with hypoglycemia were illustrated in the early 1980s when it was no longer necessary to simply treat symptoms and when patients had a quick method in their own control and when doctors had access to real time info (since stat lab turnaround was usually an hour, much longer than the desired time frame for diagnosing and reversing hypoglycemia). HHNC is completely different and all three points are irrelevant. I can't think of a single way in which TesTape or Clnitest measurement of urine sugar wouldn't give the same warning of hyperglycemia for the undiagnosed (e.g., nursing home or iatrogenic cases of HHNC), while for people with known diabetes, a meter provides no info other than "above 600". I realize that no one wants to go back to urine testing and I am not advocating it, just that (unlike hypoglycemia) there is no aspect of HHNC prevention that could not be implemented with urine testing, and no aspect of acute emergency HHNC mgmt that a meter helps with, so the meter gave no specific advancement in the acute emergency treatment of HHNC. If you are really set on including it go ahead, but I think the usefulness of meters in hypoglyemia vs HHNC are so disparate as not to warrant mentioning in same sentence. alteripse 12:15, 20 January 2006 (UTC)

• Thanks for the comments. I am not adamant about adding HHNC back in; onset and recovery are more rapid with hypoglycemia, and as such the immediate impact of the glucometer is easily noted. —ERcheck @ 17:47, 21 January 2006 (UTC)
  • Thanks for being agreeable over a deletion. Please contribute your ER (? I am guessing) knowledge to our medical articles. alteripse 18:06, 21 January 2006 (UTC)

mg/dl vs mmol/l

My understanding is the mg/dl unit of measurement for blood glucose is unique to the United States; Canada (where I am) and much of the rest of the world use mmol/l.

This is incorrect. The units of measure vary from country to country. There is some regional clustering, but countries vary. You can see the full extent here: http://www.abbottdiabetescare.com.au/diabetes-faq-measure-units.php

The assumption that the US is the only nation to support Mg/dL as the standard is often an artifact of the United State's position not to adopt the metric system. —Preceding unsigned comment added by 216.214.251.158 (talk) 21:28, 9 February 2010 (UTC)

If mmol/l is the international standard, should this article use those units instead? In fact, I'm thinking we could do something like:

Thoughout this article, units are expressed in the international standard mmol/l unit of measure, with the American unit of measurement, mg/dl, following in parentheses. So a phrase like "A measurement between 3.5 (63) and 7.0 (126) is considered normal" means "A measurement between 3.6 mmol/l (64 mg/dl) and 7.0 mmol/l (126 mg/dl) is considered normal."

Or I could just be bold and make the changes :) Bradlegar the Hobbit 18:23, 13 July 2006 (UTC)

• I would treat this like we treat the British English vs American English policy since there are very large contingents of readers using both systems. In other words, leave the basic system as written by the first people to use the article, and explain the other system and put mM values in parentheses in a few of the key places where mg/dl values are mentioned (not necessarily every single number, but enough that a reader quickly gets a sense of the other system). There are some medical journals that use one set of units and some that use the other. We need to accommodate both, not start an argument over which system is the "real one". OK? alteripse 03:18, 14 July 2006 (UTC)

Hmmm ... I'll venture to disagree with you, even though you're an honoured veteran Wikipedian, major contributer to the medical sections, and an admin!

The Manual of Style says, "For units of measure, use SI units in science articles, unless there are compelling historical or pragmatic reasons not to do so."

Milligrams and deciliters are both units of SI. If this American medical term (mg/dl) was truely an English or non-metric unit, it might be ounces per gallon. Perhaps what gets the world's knickers in a bunch is the fact that Americans finially use a metric term, but manage to use a different metric term than the rest of the world.Mbbradford 17:57, 8 November 2006 (UTC)

After some searching on the web, I came across this post from 2002 on a message board (relavent bits reproduced below). When it comes to relavance as authority, I realize quoting a poster on a message board is probably worse than quoting Wikipedia ... but here goes:

"In the U.S. values for serum cholesterol, LDL-cholesterol, and other serum lipids are reported as milligrams per deciliter, e.g., 200 mg/dL. The rest of the world uses SI units (Systeme International d'Unites). This system presents hematological and clinical chemistry values in molar concentrations per liter. The SI is the standard international measurement system, and for at least a decade most research and medical journals have required that results be reported in SI units. Patients in the UK and Europe know their personal serum lipid values in SI units. In the U.S. the medical community has continued to use the old, familiar mg/dL values in patient care and practice.

"However, SI units make more biological sense and that is why they have become the international standard. Molar concentration, not weight, is the basis for the SI units. Molar concentration refers to numbers of molecules, for example the number of cholesterol molecules in blood. Biological reactions occur on a molecular basis, and molar concentrations reflect the proportional amounts of various components within the body that are available to participate in reactions. Milligram or gram amounts are based on the weight of a substance present in the body. Large molecules that are heavy may appear to be present in larger amounts than small, light-weight molecules. Yet, in reality there may be very few of the heavy molecules and vast numbers of the lightweight molecules. It is the actual number of molecules of a substance that determines the potential for action in the body."

Bradlegar the Hobbit 18:01, 14 July 2006 (UTC)

It is daily made clear in many ways that the majority of readers are American, and many people have criticized our science articles for being too "scientific". If the choice is between the units familiar to the majority of readers and those that "make more biological sense", I unhesitatingly vote for both. I think this is nitpicking and would urge you to spend more time adding content than quibbling over which system takes precedence in an article like this. However I am not going to edit war over this as long as it remains easy for all readers to see their familar units. alteripse 21:05, 14 July 2006 (UTC)

Your comment about the majority of readers being American is, well, obvious.

Referring back to the Manual of Style, " ... unless there are compelling historical or pragmatic reasons not to do so." You've provided a good reason for not giving precedence to the SI units. I'll proceed on that basis and work on providing content. Bradlegar the Hobbit 22:51, 14 July 2006 (UTC)

I am a systems engineer, so my POV is, well, warped. In any standard of measure, there is an issue of accuracy and precision: more precise terms give the false impression of more accuracy. Digital displays are contributing to this. Ask a person "What time do you have?" If the person has an analog watch, he might say "It is about ten minutes after 6 o'clock." But a person with a digital watch will usually say "It is 6:12." Unfortunately, the digital watch may be fast by 4 minutes. The mmol unit is less precise than the mg/dl. However the glucometers used right now have an accuracy of about 10%. In the US if you take your blood sugar reading, the digital meter says "BG = 158" but it can be anywhere between perhaps 140 to 180. The mmol unit on the other hand, while it does not add accuracy, does a better job of matching the precision appropriately to the accuracy of the actual test.Mbbradford 17:58, 8 November 2006 (UTC)

And that is clearly a systems engineering perspective. I don't mean that in a bad way, but cannot think of any real practical (i.e., clinical) advantage to units which match the degree of precision better as long as people do understand the degree of imprecision. When people get hung up over the imprecision of the meters, I remind them that a meter that accurately told them low, normal, somewhat high, quite high, and off the scale would be just as useful for nearly every significant management decision. That is a bit of an exaggeration, as newer methods of flexible insulin therapy base doses on smaller increments of blood sugar readings. alteripse 03:27, 9 November 2006 (UTC)

I added some information that may be helpful: When a reading is given, if there is a decimal point in the result, the result is in mmol/l, when there is no decimal, the reading in mg/dl. Colin Pye (talk) 06:09, 10 September 2013 (UTC)

A line is not clear

The article structure and contents are good. In my opinion there is one sentence which is not clear.

"Since 2001 a first device (no full replacement for existing methods) is available."

Some references to this device, or at least its name, should be included.

Emanuele

A Typo

A sentence in the first paragraph under 'History' reads: "It relied on a thin layer of glucose oxidase on an oxygen of oxygen consumed by the enzyme." This is obviously wrong (what is an "oxygen of oxygen"?), but I don't know what the correct term should be - a "layer of oxygen" seems a bit strange since oxygen is a gas. Can anybody correct it? Ynotna......Ynotna (talk) 05:39, 11 October 2011 (UTC)

Future

I think the future of the glucose meter should be in the main article for blood glucose monitoring, where many forms of BG monitoring are discussed. It should be removed from this article. mbbradford 09:01, 16 December 2006 (UTC)

Agreed. See my long comment below. Habanero-tan (talk) 20:10, 19 May 2015 (UTC)

Blood meter sources

hi

this is the first time i have commented in a wikipedia article. Being a reletivly new diabetic (about 2 years) i wanted information regarding the different blood meters out in the market. But finding a source for this information is hard and i think wikipedia would be a great source for this information so could someone with the required knowlage of blood meters give a list of modern glucose meters with specifications and perhaps advantages of each meter to help diabeteics to make a choice of witch one suits them. also a list of links of the companys who make the meters would help people sourcing out more information regarding the products.

thanks

62.30.81.85 23:17, 9 January 2007 (UTC)

The names of the meter companies are blue to indicate that they are links to the manufacturers websites. Click on each and it will take you to their information pages. I can also recommend a great summary on www.childrenwithdiabetes.com (surf the clinic section, starting with the diabetes basics). mbbradford 18:55, 27 May 2007 (UTC)

Differences in humans and other animals

Quite a lot of vets are keen on getting owners to monitor diabetic pets at home - for cats in particular this is hugely useful as cats get a significant hyperglycaemia when stressed.

This site ( http://www.alphatrakmeter.co.uk/alphatrak2-species-specific.html ) says that due to differences in the proportion of glucose contained in the plasma vs red blood cells, human glucometers underestimate cat and dog glucose levels.

I assume then that they measure glucose in plasma + red blood cells and multiply by 0.58 to get the plasma levels?

Only reason I ask is that you'd think that it would be easier to test the glucose levels in the plasma only. Can anyone shed any light on this (and also explain if there is any reason one can't just multiply the result you get with a human kit by a set factor to get around the discrepancy, or whether this is just a way of putting a big markup on anything "designed for veterinary use")? — Preceding unsigned comment added by Jongbray (talk • contribs) 06:11, 17 November 2013 (UTC)

Future section needs major overhaul or deletion

Re: (https://en.wikipedia.org/w/index.php?title=Glucose_meter&oldid=661345652&diff=prev)

The CGM info is obsolete.

This article should only be about blood meters. Other technologies are summarized and linked in the parent article, Blood_glucose_monitoring. This article shouldn't try to be redundant with that.

Specifically, the "There are currently three CGMS" part of the section is very obsolete. There are more than 3, and the 3 listed are no longer on the market. The Paradigm RTS is replaced by the 530G with Enlite. The DexCom STS System is several generations obsolete. The currently available CGM from Dexcom is the G4 with Share. Ultimately this is irrelevant details as there's no reason to have this type of info here when CGM is talked about on the parent article.

The rest of the section isn't as bad, but it gives details on a random few, very old technologies. It would need to be filled in with the (dozens?) of other CGM/meter prototypes to be balanced, and again, that belongs in the other two parent articles.

I suggest the section be reduced to a few sentences about the genre's of prototypes out there, followed by links to the parent articles where details are found. Google_Contact_Lens, Blood_glucose_monitoring, Noninvasive_glucose_monitor via a quick search.

Perhaps this whole section should be moved to Blood_glucose_monitoring as well, and a link to the section here titled Future Advances would be best. There doesn't seem to be an up to date narrative anywhere on Wikipedia. Most are a list of technology taken off the market.

I don't plan to write an updated section, sorry, but this is excellent array of current info if anyone else would like to. Clicks through the links here [[1]].

There really needs to be a dedicated CGM article.

Habanero-tan (talk) 20:26, 19 May 2015 (UTC)

= FDA REGULATION LIMIT OF +/- 20% GLUCOSE METER ACCURACY =

Does anyone know why the FDA allows glucose meter accuracy of plus or minus 20 percent? Hence a meter used at home by a patient may be -20% of the "real" glucose level while a meter used in a doctor's office or medical facility may be +20% of the "real" level. This situation has happened to me and it causes significant confusion between patients and medical staff. Why can't glucose meters be designed for 10%, 5% or even 1% accuracy? Obviously, the more accurate the meter and test strips, then the cost of the meter may be priced higher. Is this a cost issue or a design limitation?

([User:Telecom_eng]) — Preceding unsigned comment added by Telecom eng (talk • contribs) 07:45, 6 October 2015 (UTC)

This really isn't the place to ask this type of question. Best to go find a forum for diabetes.

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Unit mmol/mol in the UK unlikely

It seems as if there is some confusion about what exactly is measured in mmol/mol in the UK. According to information from the UK NHS web site ( http://www.nhs.uk/Conditions/Diabetes-type2/Pages/Diagnosis.aspx ) the glycated hemoglobin is measured in mmol/mol, whereas glucose concentration is measured in mmol/l. In addition, using the unit mmol/mol for blood glucose concentration would require specification of the substances whose amount is given in the denominator. Because the reference given in the article is "UK National Health Service" without any further links, I changed the text and the table. 2A02:8070:D18D:5E00:E187:B071:C34F:5F37 (talk) 22:18, 2 June 2017 (UTC)

Picture BGM twopart.JPG of FreeStyle Libre misleading

This picture of the FreeStyle Libre system is misleading. The sensor is not part of the blood glucose monitoring system, but of the so-called "flash glucose monitoring system" (this is similar to continuous glucose monitoring, but lacks real-time data transfer from the sensor to the reader). The FreeStyle Libre system has an integrated port for blood glucose test strips (seen in the picture at the lower edge of the reader), that can be used completely independently from the displayed sensor unit. I therefore suggest removing the picture BGM twopart.JPG. 2A02:8070:D18D:5E00:E187:B071:C34F:5F37 (talk) 22:25, 2 June 2017 (UTC)

The Frestyle Libre systems is indeed a FGM and has NO capabilities for strips. The reader is the only way of obtaining a reading. Abbott just used the same case.