Fortunately, advances in blood glucose monitoring devices have been plentiful, so keeping tabs on blood sugar levels is simpler and faster than ever, even for children.
About 1.5 million people in the United States suffer from Type I diabetes, and they must inject insulin to survive and to keep blood glucose levels under control. Out-of-control glucose levels raise the risk of long-term complications, such as blindness, kidney problems and the need to amputate limbs.
The traditional blood glucose monitoring devices all operate on the same premise: you prick your finger (or sometimes the forearm) with a special needle called a lancet to get a drop of blood, then you place the blood on the test strip, which is then read by the monitor.
In the past few years, there have been two important advances in blood glucose monitoring devices, says Dr. Gerald Bernstein, a New York City endocrinologist and past president of the American Diabetes Association. "One is the ability to use a small amount of blood so that a micro drop is very often enough. And the second is a very fast read." On some monitors, he says, the number comes up in five seconds.
A reading that is faster by just a few seconds might not seem like much, he says, but consider that some adults and children with diabetes test their blood sugar levels several times a day and the saved seconds add up, he says.
"Seven or eight years ago, it was a big drop of blood and 45 to 60 seconds [to get a reading]" Bernstein says. "The whole ceremony begins to add up."
Another issue with blood glucose monitoring, Bernstein says, is "how much the fingertips can take, especially for those with Type I, who might be sticking themselves six to 10 times a day."
Some monitors take blood from the forearm, such as the LifeScan OneTouch UltraSystem. The monitor is promoted by blues legend B.B. King, who must save his fingertips for picking his guitar. The system gives results in five seconds.
Another development is the GlucoWatch, a wristwatch-like glucose monitoring device that was approved for adult use in 2001 and for children and adolescents last summer. The watch extracts fluid through the skin and then measures the glucose in the fluid, according to the U.S. Food and Drug Administration.
Once the device has been warmed up and calibrated via a finger stick blood test, it can provide up to six painless measurements every hour for 13 hours.
"Those who get the best advantage from the GlucoWatch are those who get frequent low blood sugars," Bernstein says. "It gives you the opportunity to recognize a falling blood sugar."
What's next in glucose monitoring?
"The next biggest advance is continuous glucose monitoring," says Dr. Francine Kaufman, president of the American Diabetes Association and a pediatric endocrinologist at Childrens Hospital, Los Angeles. If there was some way to know all the time what your blood sugar level was, and be alerted to an "impending aberration of the glucose level," that would be a significant advance, she says.
Right now, she says, intermittent testing, "even if you are compulsive," does not give you the whole picture, particularly at night, when blood sugar drops.
Currently, doctors can have patients wear a monitoring system that works continuously for three days. "Then we download [the data] and detect patterns," Kaufman says.
Called the Medtronic MiniMed Continuous Glucose Monitoring System, the device collects electrical signals from the glucose sensor every five minutes, converts the signals to glucose values and stores them, providing up to 864 readings in three days.
In the works, says Deanne McLaughlin of Medtronic MiniMed, is a consumer version of the CGMS device. "It will allow patients to set a high or low threshold" for blood glucose with an alarm sounding when the thresholds are crossed, she says.
Whichever monitor or monitoring system is deemed best by a diabetic patient's health-care provider and the patient, close surveillance of blood sugar is here to stay, Kaufman says. "Our own data and our own reports have always shown that those who do glucose monitoring and take action as a result of the measurement do better."
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