CHARACTERISTICS There are several key characteristics of glucose meters which may differ from model to model: Size

: The average size is now approximately the size of the palm of the hand, though some are smaller or larger. They are battery-powered. Test strips: A consumable element containing chemicals that react with glucose in the drop of blood is used for each measurement. For some models this element is a plastic test strip with a small spot impregnated with glucose oxidase and other components. Each strip is used once and then discarded. Instead of strips, some models use discs that may be used for several readings. Volume of blood sample: The size of the drop of blood needed by different models varies from 0.3 to 1 μl. (Older models required larger blood samples, usually defined as a "hanging drop" from the fingertip.) Smaller volume requirements reduce the frequency of unproductive pricks. Alternative site testing: Smaller drop volumes have enabled "alternate site testing" — pricking the forearms or other less sensitive areas instead of the fingertips. Although less uncomfortable, readings obtained from forearm blood lag behind fingertip blood in reflecting rapidly changing glucose levels in the rest of the body. Testing times: The times it takes to read a test strip may range from 3 to 60 seconds for different models. Display: The glucose value in mg/dl or mmol/l is displayed in a small window. The preferred measurement unit varies by country: mg/dl are preferred in the U.S., France, Japan, Israel, and India. mmol/l are used in Canada, Australia, China and the UK. Germany is the only country where medical professionals routinely operate in both units of measure. (To convert mmol/l to mg/dl, multiply by 18. To convert mg/dl to mmol/l, divide by 18.) Many machines can toggle between both types of measurements; there have been a couple of published instances in which someone with diabetes has been misled into the wrong action by assuming that a reading in mmol/l was really a very low reading in mg/dl, or the converse. Glucose vs. plasma glucose: Glucose levels in plasma (one of the components of blood) are generally 10%–15% higher than glucose measurements in whole blood (and even more after eating). This is important because home blood glucose meters measure the glucose in whole blood while most lab tests measure the glucose in plasma. Currently, there are many meters on the market that give results as "plasma equivalent," even though they are measuring whole blood glucose. The plasma equivalent is calculated from the whole blood glucose reading using an equation built into the glucose meter. This allows patients to easily compare their glucose measurements in a lab test and at home. It is important for patients and

Data transfer: Many meters now have more sophisticated data handling capabilities. Most memory chips can display an average of recent glucose readings.[5][6] Test strips that changed color and could be read visually. or exercise. The two models initially dominant in North America in the 1980s were the Glucometer whose trademark is owned by Bayer and the Accu-chek meter (by Roche). were also widely used in the 1980s. and even Game Boys. etc. Clock/memory: All meters now include a clock that is set for date and time and a memory for past test results. BM stands for Boehringer Mannheim. The memory is an important aspect of diabetes care.[4] Another early glucose meter was the Ames Reflectance Meter by Anton H. such as insulin injection devices. as it enables the person with diabetes to keep a record of management and look for trends and patterns in blood glucose levels over days. Clemens. As meter accuracy and insurance coverage . without a meter. Many can be downloaded by a cable or infrared to a computer that has diabetes management software to display the test results. and the first meters were marketed for home use around 1980. In Britain. Home glucose monitoring was demonstrated to improve glycemic control of type 1 diabetes in the late 1970s. such as insulin dose. Consequently. Some meters allow entry of additional data throughout the day. A moving needle indicated the blood glucose after about a minute. The sensor worked by measuring the amount of oxygen consumed by the enzyme. these brand names have become synonymous with the generic product to many health care professionals. now called Roche. Leland Clark and Ann Lyons at the Cincinnati Children's Hospital developed the first glucose enzyme electrode. PDAs. a health care professional or a patient may refer to "taking a BM": "Mrs X's BM is 5". who produced test strips called 'BM-test'. amounts of carbohydrates eaten. It needed connection to an electrical outlet for power. A number of meters have been combined with other devices. They had the added advantage that they could be cut longitudinally to save money.their health care providers to know whether the meter gives its results as "whole blood equivalent" or "plasma equivalent. It relied on a thin layer of glucose oxidase on an oxygen electrode. It was about 10 inches long. It was used in American hospitals in the 1970s. HISTORY and DEVELOPMENT In 1962.[2] A radio link to an insulin pump allows automatic transfer of glucose readings to a calculator that assists the wearer in deciding on an appropriate insulin dose." One model measures betahydroxybutyrate in the blood to detect ketoacidosis (ketosis).

insulin pump. The user can set the high and low glucose alarms. Sweat must be allowed to dry before measurement can resume. As well. the product is no longer on the market. VX5200. Development of noninvasive devices may enable continuous monitoring.improved. as well as an add-on pack for the Motorola Razr cell phone. It is a hypodermic probe with a small transmitter. the devices measure tissue sugar in body tissues and not the blood sugar in blood fluid. Testing strips are proprietary and available only through the manufacturer (no insurance availability). in the field of near-infrared (NIR). There is a UK Pharmaceutical company (Ambe Medical Group) who have the executive rights for distribution within the United Kingdom. The device does not replace conventional blood glucose monitoring. The market introduction of noninvasive blood glucose measurement by spectroscopic measurement methods. Research is being done on noninvasive methods for measuring blood glucose. they lost popularity. and LX350 cell phones. The receiver is about the size of a cell phone and can operate up to five feet from the transmitter. monitoring is logged at five-minute intervals for up to 72 hours. the measuring beam of infrared light. a generic version of the BM is marketed under the brand name Glucoflex-R.S. These glucose meter/cellular phone combinations are under testing and currently cost $149 USD retail. failed so far because at this time. and wristop controller. One limitation is that the GlucoWatch is not able to cope with perspiration at the measurement site. Aside from a two-hour calibration period. has to penetrate the tissue for measurement of blood glucose. for example. the DexCom STS System is available (2Q 2006). The third CGMS available is the FreeStyle Navigator from Abbott Laboratories. such as using infrared or near-infrared light. However. This limits providers to AT&T and Verizon. FDA: The GlucoWatch G2 Biographer is designed to be worn on the wrist and uses electric fields to draw out body fluid for testing. To determine blood glucose. by extracorporal measuring devices. electric currents. as well as an effort to integrate the glucose meter and a cell phone. There is currently an effort to develop an integrated treatment system with a glucose meter. Due to this limitations and others. The first is Medtronic's Minimed Paradigm RTS with a sub-cutaneous probe attached to a small transmitter (roughly the size of a quarter) that sends interstitial glucose levels to a small pager sized receiver every five minutes. Another visual strip is also marketed under the brand name Betachek. Similar systems have been tested for a longer time . There are currently three CGMS (continuous glucose monitoring system) available. an add-on pack for LG model UX5000. and ultrasound. These "Glugophones" are currently offered in three forms: as a dongle for the iPhone. One noninvasive glucose meter has been approved by the U.

The coulometric method is a technique where the total amount of charge generated by the glucose oxidation reaction is measured over a period of time. Besides glucose oxidase. Recent advances in cellular data communications technology have enabled the development of glucose meters that directly integrate cellular data transmission capability. from Telcare. was exhibited at the 2010 CTIA International Wireless Expo. The glucose in the blood reacts with an enzyme electrode containing glucose oxidase (or dehydrogenase). . They will start marketing the device early 2011. Inc. then by using sophisticated mathematical algorithm. glucose dehydrogenase (GDH). Others use a similar reaction catalysed instead by another enzyme. The enzyme is reoxidized with an excess of a mediator reagant. The same principle is used in test strips that have been commercialised for the detection of diabetic ketoacidosis (DKA). the test kit contains a benzidine derivative. CNOGA's technology is based on real-time tissue photography. Tissue image color is processed in real-time providing the temporary color distribution using dynamic range of at least 36 color-depth representing over 6. which is oxidized to a blue polymer by the hydrogen peroxide formed in the oxidation reaction.which generates an electrical current. This device is currently undergoing clinical testing in the US and Internationally. The first such device.[9] where it won an E-Tech award. has developed a noninvasive Glucometer. This has the advantage of sensitivity over glucose oxidase but is more susceptible to interfering reactions with other substances. The first-generation devices relied on the same colorimetric reaction that is still used nowadays in glucose test strips for urine. a ferrocene derivative or osmium bipyridyl complex. such as a ferricyanide ion. Test strips contain a capillary that sucks up a reproducible amount of blood.. The total charge passing through the electrode is proportional to the amount of glucose in the blood that has reacted with the enzyme. The mediator in turn is reoxidised by reaction at the electrode.in Finland. Many glucose meters employ the oxidation of glucose to gluconolactone catalyzed by glucose oxidase (sometimes known as GOx). and the meter needed to be calibrated frequently. enabling the user to both transmit glucose data to the medical caregiver and receive direct guidance from the caregiver on the screen of the glucose meter. The disadvantage of this method was that the test strip had to be developed after a precise interval (the blood had to be washed away). These test strips use a betahydroxybutyrate-dehydrogenase enzyme instead of a glucose oxidising enzyme and have been used to detect and help treat some of the complications that can result from prolonged hyperglycaemia.8^10 color combination. An Israeli company by the name of Cnoga Medical Ltd. Most glucometers today use an electrochemical method.

it is oxidized by the enzyme glucose oxidase. This type of device requires at least four finger sticks per day for calibration. This sensor can be implanted in the subcutaneous tissue using a specialized tool designed to minimize tissue damage. At the electrode surface.Blood alcohol sensors using the same approach. Once the glucose passes through the membrane. have been tried and patented but have not yet been successfully commercially developed. The tip of the sensor is made of a membrane selectively permeable to glucose. Reduced glucose oxidase can then be oxidized by reacting with molecular oxygen. it is more effective as a continuous glucose sensor that its transcutaneous counterpart. hydrogen peroxide is oxidized into water. The sensor is connected by wire to a pagersized unit which records data that can later be downloaded onto a computer. such as the Medtronic-MiniMed CGMS (above). forming hydrogen peroxide as a by-product. but with a lag time of approximately four minutes. The most promising method for continuous monitoring of glucose levels are implantable enzymatic sensors. generating a current which can be measured and correlated to the glucose concentration outside the membrane (see above right). . but with alcohol dehydrogenase enzymes.

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