Someone on the alt.support.diabetes newsgroup recently generated more heat than anyone else with her message. "I've never known a diabetic who used one of those things," she quotes her husband as saying about her blood glucose meter. "Diabetics get treatment from their doctors. They don't need this meter nonsense."
You have to know your blood glucose levels.
To her husband, using a blood glucose meter is a sign of health fanaticism, she reports. Actually, as misguided as this man is, this is a good reminder that not everyone knows the benefits of tight control and how to get it.
Two long-term studies completed in the past few years—one of people with type 1 diabetes and the other of those with type 2—proved that tight control dramatically reduces the possibility of complications. To get that tight control you have to know what your blood glucose levels are.
Finger sticks with a blood glucose meter help in telling us how we are doing. But they measure only one point in time. Another test measures glycated hemoglobin or HbA1c. Since hemoglobin has a half-life of two to three months, this test indicates the level of control over that extended time period.
Now there is a third, intermediate option for testing. LXN Corp. (pronounced Lex-in) in San Diego, California, recently introduced the In ChargeTM meter. This new meter measures both blood glucose and something called fructosamine (LXN calls it GlucoProtein®). It is the only meter on the market to offer both tests.
Fructosamine is similar to HbA1c in that both indicate the average of continuous blood glucose changes over a period of time. But the fructosamine test measures a shorter window of two to three weeks, allowing you to more quickly discover if your glycemic control is slipping and lets you and your doctor respond with diet, exercise, or medication as appropriate.
LXN sent me one of the first meters off the production line, and I have been testing every week since September 21. I have found the In Charge meter to be very useful. The In Charge is actually a second generation of fructosamine-testing meters.
The Duet Came First
LXN introduced the first meter that tests fructosamine about a year and a half ago. I reviewed that meter, the Duet, for the February 1999 issue of Diabetes Wellness Letter. Anyone who read that article could see how lukewarm I was about the Duet.
The Duet was a large, expensive, clunky machine that was too sensitive to the tester following the correct technique of collecting a huge drop of blood—25 microliters—through a straw. The In Charge meter is a significant improvement from the Duet, which LXN markets only to health care professionals.
The In Charge meter is in fact the first home meter to measure fructosamine. The system, including an initial supply of both glucose and fructosamine test strips, lists for $79.95, and like most meter manufacturers LXN offers a rebate and trade in. The rebate is $20 and the trade in is $45.
The blood drop for the fructosamine test is much less than that required by the Duet meter, but is still a fairly large drop at 15 microliters. But unlike the Duet meter no straw is required. Also, the blood drop needed to do a standard blood glucose test with the In Charge meter is significantly smaller than that needed for the fructosamine test (six microliters).
Lower than Expected Numbers
In my experience with the In Charge meter to test fructosamine, numbers were lower than I expected (except for the week I had a cold), based on my finger stick results which I was still conducting with my usual meter. I always took my blood glucose tests the first thing in the morning. Those fasting numbers were looking so bad—in the 140s and 150s—that I got a HbA1c test and was sure that my endocrinologist would prescribe oral medication or insulin.
I should have believed the fructosamine results. They averaged about 220, which is the equivalent of an HbA1c of between 5 and 6, according to the conversion chart produced by LXN. The HbA1c test I got in mid-November was 5.4.
That made a believer out of me.
Accuracy does not appear to be a big consideration. Fructosamine test variability is inherently greater than glucose test variability. The key is that trend information is more valuable than is single-test information.
I still have some reservations about the In Charge meter. The biggest problem for me is that it is sometimes difficult to get a large enough blood sample.
Derek Paice, a retired engineer in Palm Harbor, Florida, notes a few other things you have to be careful with. You can't milk your finger like you do with a blood glucose test, because that will cause hemolysis—a modification of red blood cells in which hemoglobin is liberated—which raises the reading. Also, drinking alcohol or taking 1000 mg of vitamin C in the previous five hours will impact test results.
Teri Robert, who lives in Washington, West Virginia, just got her In Charge meter. Her doctor encouraged her to get it. "My initial impression is pretty good," she tells me. "It's compact and easy to use."
Two Control Tests Onerous
What she doesn't like is the recommendation for running two control tests (labeled "normal" and "high") every time you open a new vial. A way around this is to buy GlucoProtein test strips together with glucose strips in LXN's Value Pack, which includes 50 glucose test strips and four GlucoProtein test strips at a suggested list price of $36.95. That compares quite favorably with other manufacturers' glucose-only strip pricing, which averages $35 per 50 glucose strips. That provides the GlucoProtein strips at little or no extra cost.
But if more strips came in each vial, the requirement would be less onerous. And, of course, not everyone does all the recommended control tests.
Another user, Richard Aleksander in Austin, Texas, emphasizes the other test that the In Charge meter performs, a regular blood glucose test. He likes the speed. "I can perform a test while walking around or sitting at a stoplight in traffic," he says. "Low readings are reported in five seconds or less. High BGs take durations approaching 15 seconds."
The In Charge meter can, indeed, test blood glucose faster than any other meter on the market. It requires a six microliter blood sample, while several other new blood glucose meters need only 2 or 3 microliters. But the more I used this little meter with its clear, large display the more I like it for testing both my blood glucose and fructosamine.
The meter's memory is another plus. The In Charge stores the most recent 200 glucose tests results and 50 fructosamine test results with the date and time. You will soon be able to automatically upload these test results to glucose and fructosamine tracking software on the LXN Web site, http://www.inchargenow.com/. I am currently beta testing the software and data cable used to connect the meter to a PC. This is something that no other meter offers.
This article appeared originally on the DiabetesWebSite.com, which is no longer on-line.
In 2002 LifeScan bought LXN and discontinued all of its products including the In Charge and Duet meters. It also recalled all GlucoProtein (fructosamine) test strips because they may produce false highs.
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