Maybe they aren't the holy grail of blood glucose testing. But the new meters that use alternative sites to test your blood are so painless that they are the next best thing.

Alternative sites can lag…

All of these new meters use very little blood. This makes it possible for you to use them on areas of your body where you have few nerve endings. Testing at one of these sites is such a radical difference that I call these second-generation meters.

Using one of these meters makes a big difference in your control if you are like me and hate the ouch of fingersticks. I know that I now test much more frequently and retest whenever I get a dubious reading.

Not to put down fingerstick meters. When they became available in the 1970s they were probably the most important advance in controlling diabetes since the discovery of insulin in 1921-22. I list and link on my� On-line Diabetes Resources Part 14: Blood Glucose Meters the 11 companies that currently manufacture a total of 33 meters for the U.S. market, including those intended primarily for alternative site testing.

The first of these to come to market in December 1999 was Amira Medical with its AtLast meter. Since then, LifeScan introduced new test strips for its One Touch FastTake meter that require only 1.5 microliters of blood, permitting forearm testing. Even newer, LifeScan's One Touch Ultra is a similar monitor, but requires only 1 microliter. TheraSense then introduced its FreeStyle, which takes the least blood of all available meters, 0.3 microliters. The newest alternative site meter, Abbott Laboratories' MediSense Sof-Tact, is motorized and hides the test strip, lancet, and blood drop internally.

The Food and Drug Administration has approved each of these meters for use on the arm. The AtLast and FreeStyle meters can also be used on your thigh.

Consumer Reports magazine reviewed and rated one-third of the currently available meters in its October 2001 issue. The magazine rated these meters in terms of accuracy, consistency, and ease of use. It rated the alternative site meters, except for the MediSense Sof-Tact, which was probably too new to be included. The magazine gave its highest rating to the One Touch Ultra, but several other meters also performed well.

Some recent studies, however, show that tests on alternative sites can lag behind fingerstick results. This could have serious consequences preventing timely detection of hypoglycemia if blood glucose levels were falling quickly. My article, Lag Time in AlternativeLand looks at both sides of this controversy.

Meanwhile, the third generation of blood glucose meters is arriving. My Blood Glucose Meters page describes and links 37 companies known to have non-invasive meters under development. Some of these meters will continuously test blood glucose and help guard against hypoglycemia or low blood sugar by sounding an alarm.

The first has passed FDA review. After daily calibration with a first or second-generation meter, the Cygnus GlucoWatch Biographer uses a low level of electric current to draw out and measure glucose through the skin at frequent intervals throughout the day and night. The watch is already available for limited distribution in the U.K. and received FDA market clearance in the United States in March 2001. However, the cost of the GlucoWatch may be significant, perhaps $400 to $500 for the hardware and $4 to $5 for each AutoSensor, which snaps into the back of the GlucoWatch and provides up to 12 hours of automatic readings.

Two other companies have continuous sensors in development. The SpectRx technology (not yet named) uses a proprietary method that is designed to painlessly create a tiny micropore in the outer, dead layer of skin. Interstitial fluid is collected through this micropore and measured for glucose.

The initial version of Medtronic Diabetes's Continuous Glucose Monitoring System is FDA-approved and uses a tiny sensor implanted just below the skin of your abdomen. After three days you return to your doctor, who removes the sensor and downloads the readings to a computer, where you can both get a complete look at where your glucose levels have been.

The American Diabetes Association originally published this article on its Web site as one of my “About the Internet” columns.

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