Shoot Up or Put Up

There are certain things in life that only those of us who are pancreatically challenged will ever have the pleasure of doing. Having a heated debate about whether or not you lick your finger after doing a blood test is one of those things. Said debate over at Diabetes Mine got me thinking.

I lick. I’ve always licked. It has never occurred to me to do anything with the left over blood on the end of my finger other than to lick it (or occasionally spread it round my sheets)

I’ve been licking for almost 27 years now and so far no horrific consequences have befallen me despite the gallons of blood I must have swallowed. Here’s where it gets disappointing. My thinking went along the lines of – 27 years with diabetes, guestimate an average of 5 blood tests a day, a lick each time, I’m virtually a vampire I’ve ingested so much of my own blood.

If we assume a blood test takes on average 1 microlitre of blood for the machine and another 3 microlitres left on the finger for licking purposes, that gives us a starting point.

I’ve had diabetes for almost 27 years or 9,862 days to the nearest year (including leap years – thank you pedantic husband).

Work on an average of 5 blood tests a day, every day and that gives you 49,310 blood tests since my pancreas packed in (which in itself I think is a pretty impressive number).

If I lick 3 microlitres per blood test that means I’ve ingested 147,930 microlitres of blood over the years.

Sadly, it takes a million microlitres to make a litre which means after 27 years of committed licking I’ve only managed to ingest 148ml of my own blood. That’s about the size of one of those small cans of diet coke you get on a plane.

What is it with diabetes and size? I thought I took insulin by the gallon but then discovered it takes less than a teaspoonful per day to keep me alive.

Now I’ve discovered that all those hard years of testing and licking would barely sustain a mosquito on a diet.

If I was a vampire I’d have starved to death by now.

Note: The numbers in this article are a stab in the dark. I’m really not that interested whether they’re 100% accurate or not. I’ve already had a tedious discussion with the husband about rounding up and down, decimal places and how much blood I lick versus what goes onto the test strip. I’m starting to wish I’d never started this. Please just be amazed by the scale rather than finicky about the maths

So old you have to pee on them

Recently I suffered an unwelcome visit from a mild throat infection. I mention this not to get sympathy (because I know I’ll get Sweet FA from you lot) but because it really messed up my blood glucose levels.

Despite being hobbled by MDI, I tend to keep my blood glucose in the single figures (go me!) but with the introduction to my throat of a whole bunch of bacteria or virii (or whatever the plural of virus is) I just couldn’t maintain this happy medium. So I spent a good part of last week testing and injecting, testing and injecting. It got so bad that over a morning I had to shove in 14 units to cover off a small bowl of cereal and glass of orange juice. The Diabetic Gods were not smiling on me that day.

Anyway, with all this testing of my highly-sugary blood my faithful meter kept reminding to “CHECK KETONES”. Usually whenever my meter orders me to “CHECK KETONES” I ignore it. Firstly, I don’t take orders from no one, see; and secondly I’ve never really understood the point in checking for ketones.

If, say, my BG is particularly high I know this because my meter tells me so (and I feel crap, of course). I then duly correct the high by shoving in an appropriate amount of humalog. My BG then comes back down to normal and I get back to humdrum day-to-day stuff – like organising coups in backward African states and international jewel theft, that sort of thing.

If, however, my BG was high and I checked my ketones and I discovered I was indeed producing a low level of ketonic-goodness I would, uhm, do exactly what I was going to do anyway and shove in some humalog and wait for normality to return. Given I’m just doing the same thing, why bother testing for ketones? As an aside, it’s obvious though that if things go really out of goose and my BG is high for days on end, then perhaps ketones, DKA and all that stuff are much more important and work testing for.

Anyway, getting to the subject of this article, after being prompted by my meter 300-or-so times to “CHECK KETONES” I thought, just this once, I would treat myself and check them. It was clearly a quiet evening.

So I dug out my faithful Abbott Optium Xceed, found some ketone strips in the very back of diabetic supplies drawer and prepared to test. Imagine my crushing disappointment when the meter reported an error, prompting me to check the “use by” date on the strips. June 2007. Oops!

Given I was diagnosed at the end of 2005, this packet must have been at most two years old at their expiry date (I suspect they were younger than that as they were the new type of ketone strip that Abbott now do). I understand that strips and what-not will, in time, degrade and it’s probably best not to use them after that time; but a shelf life of only two years or so for something that must be pretty stable? Surely that’s a little suspect? (Please note, I haven’t actually done the slightest bit of research on this fact; it might be the case that test strips are more volatile and unstable than a dodgy nuclear warhead and that Big Pharma has struggled valiantly for years to tame test strip chemicals to last as incredibly long as two years. But I suspect not).

Anyway, in conclusion, this all meant I couldn’t test my ketones the other night. I could blame Big Pharma for evilly building obsolescence into its products; but, really, I blame myself for not checking the use by dates on my spare strips for the last two years. D’oh!

Meters, meters everywhere

It’s fast approaching the end of 2009 and every form of media is crammed with lazy, poorly composed “end of the year” reviews. And, of course, your soaraway Shoot Up is no exception.

But forget those boring articles, TV clip shows or back-slapping awards ceremonies you see on the television. Who cares about comedy awards, or Baftas or even the Oscars, when you have Shoot Up’s soaraway Blood Glucose Meter of the Year award? Yes, I’ve poured myself into my dinner suit to write this article live from the glitzy surroundings of our kitchen table! Woo!

2009 has been a controversial year for blood glucose meters (actually, it hasn’t; I’m just trying – without much success – to add a tiny degree of dramatic tension to the proceedings…) with a whole range of new meters coming on the market, some of which I’ve bothered to test.

Anyway, the first that must have a mention (if only a dishonourable one) is of course Menarini’s GlucoMen LX, which was almost universally despised by anyone who’s had the misfortune to use one. Nasty, tacky and cheap, the GlucoMen LX inspired nothing but revolted disdain in this reviewer. Hopefully Menarini will try harder next time and I hope they forgive me for getting my horrible review to be the second result in Google’s search results for their product.

Moving swiftly on, the Accu-Chek Aviva Nano is certainly worthy of mention for its sexy, sleek looks and useful functions. However, it was badly let down by Accu-Chek’s crappy looking test strip that just makes the whole lot look ugly. Don’t get me wrong – it’s a perfectly good test strip – but it needs a serious redesign to sex it up.

But, in my view, this year’s winner is the pretty wonderful Abbott Freestyle Lite. It looks pretty sexy, has some of the best test strips on the market and two great features. The first is the ability to add more blood to a sample if you don’t squeeze out enough first time around, which saves wasting a strip. And also stops the utter, utter misery having to repeat a test after you’ve spent 5 minutes trying to get blood out of freezing cold fingers. The second worthy feature is a little LED that lights up the test strip when you’re testing in the dark. A simple addition – but one that’s bloody marvellous.

So there we have it – congratulations to Abbott and their joyful Freestyle Lite. Here’s to 2010 – cheers!

You can see all our blood glucose meter reviews here.

I recently did an interview for a diabetes magazine (yes, another magazine – we’re getting really big now in diabetes celebrity circles; such as they are). And I was asked what single development would make life easier for me as a member of the pancreatically-challenged hoard.

I did think about a new pancreas grown from stem cells, but I just don’t think science is advanced enough to come up with a proper cure for diabetes in my lifetime (or what I expect my lifetime to be – obviously even I don’t know how long I’m going to live). When you think about it, science has had 90-odd years since Banting & Best successfully stopped killing dogs and discovered insulin to come up with a complete cure. Although there have been leaps and bounds forward since then, science hasn’t even yet managed to come up with a long acting insulin that actually delivers consistently and smoothly for a full 24 hours (yes, we’re talking about you lantus). So I’m afraid that I think cures are still a long way off.

So I side-stepped the question by answering that incremental improvements to existing systems actually make life a lot easier for people with wonky pancreases. Take for example blood glucose meters. I’m a huge fan of Abbott’s FreeStyle Lite as it uses a tiny sample, is stupidly quick to process your result and is just generally well designed and thought out.

When you compare this to the medieval instruments of torture that were used not that long ago for measuring BG you can see that the world has moved on enormously and checking your BG is now ludicrously easy and relatively pain free. Given that a Good Diabetic will check their BG 4, 5 or 6 (or more) times a day such seemingly small changes to meters make a huge difference to the quality of our lives.

Similarly, faster acting insulins would be hugely beneficial. Humalog is pretty good stuff, but I still have to stick it in about 20 minutes before breakfast to avoid a massive post-port and pheasant peak (there’s nothing like a good, well-matured roast pheasant and a flagon of port for a good start to the day. The sort of breakfast empires were built upon, God be my witness!).

Anyway, so that’s what I’m hoping for the future – not a cure – but lots of little incremental improvements. Each one might not be wildly noticeable by itself, but cumulatively they’ll make a huge difference to our everyday, mundane, shuffling lives.

Not a Maserati GranTurismo. Oh no.

I recently got my hands on Accu-Chek’s newish Compact Plus GT and took it out for a test drive. The “test drive” thing is relatively apt as, for some reason, Accu-Chek have added the suffix “GT” to the meter’s name. I always understood that GT referred to cars and stood for Grand Tourer (or Gran Turismo if you want to go for the Italian – like the Maserati GranTurismo – which is still high on my Christmas wish list). Unfortunately, if the Compact Plus GT were a car it would be big clunky ugly minibus and not the sprightly Maserati above.

The Compact Plus GT is designed to be an all-in-one meter – with finger pricker, test strips and said meter all rolled into one. The meter element isn’t particularly exciting in itself; it has all the features you’ve come to know and love on any modern meter – a 500 test memory, a pretty straightforward user interface and a bright display for night-time use.

Of slightly greater interest is the relatively innovative test strip drum. Rather than sticking in a strip every time you want to test, you put a drum of 17 tiny strips into the machine in one go. A handy dial round the back of the meter tells you how many strips you have left in the meter and the drum incorporates a bar code which automatically calibrates each new set of strips. A switch on the front of the meter then spits out a test strip whenever one is needed. The strips themselves are tiny, very slurpy but require a positively vampiric sample size of 1.5 µL. The attached finger pricker uses an air-pump instead of the usual spring to fire the lancet into your finger. But, as I’ve mentioned before, I’ve not noticed any difference between this and a normal finger pricker. Buy, hey, ten out of ten for effort in trying to reduce wear and tear on our ravaged, pepper pot fingers.

All in all, the Compact Plus is made up of some good components – the meter’s okay (but nothing world-shattering), the finger pricker is acceptable and the strip system is very good. However, combined, they form a pretty ugly, clunky bit of kit; which doesn’t take up any less space than my usual meter and assorted kit and just doesn’t really offer anything greater than I have already.

Some people might like the all-in-one nature of the Compact Plus which makes it very easy to grab and shove in a bag as you leave the house; but sadly I just don’t think the sum of the parts makes it a better system than anything else out there. Pity really.

So, in summary:

Sample size – 1/5
1.5 µL – vampiric

Test time – 2/5
Five seconds – not wildly quick, but not disastrous

Test strip calibration – 5/5
No calibration by user required

Test strip slurpiness – 4/5
Pretty damned slurpy!

Memory – 4/5
500 readings – which isn’t too bad

Sexiness – 1/5
I would say it’s an ugly duckling; but “duckling” implies small and cute.

Beeping – 5/5
Can be turned off. Thankfully.

4am test – 3/5
Bright, easy to read display makes it a bearable meter at 4am. But no light on the test strip – boo!

TOTAL – 25/40

Check out our other blood glucose meter reviews or have a look at the manufacturer’s web site.

I was having a look at the Accu-Chek Compact Plus recently as part of a forthcoming review (hurrah! I hear all you blood-glucose-meter-review fans cry!) and my attention was drawn to the finger pricker, lancet delivery device or whatever you want to call it.

Normally when I review a meter I don’t usually bother with the finger prickers, as they’re all pretty much of a muchness. If you’re interested (which I assume you’re not) I use a pricker that came with the Wavesense Jazz as it’s teeny-tiny and stupidly simple to use. Anyway, the inescapable fact of it is that to get a blood sample to test your blood glucose, you have to shove a sharp bit of metal in your finger, causing it to bleed out a bit of your precious gooey life force onto a test strip. There’s simply no avoiding the whole metal-in-finger thing.

However the finger pricker which came with the Compact Plus claimed to be considerably less painful than other finger prickers. Being quite simple, I was blinded by Accu-Chek’s science but essentially it seems it uses an air-driven pump to shove the lancet into your finger rather than the conventional spring. Apparently this means the lancet wiggles around less as it carves its way through your flesh and is thus less painful.

Intrigued, I gave it go.

“Ow!” I said as the lancet thrust its way into my bloodied little finger.

Yup, you’ve guessed it – I noticed absolutely no discernible difference between the Accu-Chek, it hurts just as much as a normal device. Oh well.

I know that finger pricking doesn’t really hurt all that much (unless, of course, you’re a complete wimp) but after doing it a zillion times a day, day-in day-out, it does get somewhat tiresome. So any improvement on the whole pain thing is good in my book – so ten out of ten for Accu Chek for effort; one out of ten for effectiveness.

We diabetic types can be a grumpy bunch. I can whinge for hours about how inefficient my GP’s repeat prescription service is and how my repeat prescription rarely includes what I actually ask for, but plenty of stuff I didn’t (why would I need hayfever tablets in December?).

Changing an infusion set sometimes feels like an overwhelming hassle, and I’m never happier than when I’ve started a new box of test strips so I know I don’t have to fight with the packaging again for another week or so.

In case you hadn’t guessed, I find the minutiae of diabetes a little tedious to say the least.

Imagine my horror when my beloved (ok, not quite beloved, more “basic model that fulfils all my requirements”) Optium Xceed glucose meter decided it needed a new battery. Oh the hassle. I need to find the box that I’ve filed away safely but can’t remember where, then no doubt fill out forms in triplicate and send off my birth and marriage certificate along with glucose readings dating back to 1996 just to get a new battery from those darn meter makers.

How wrong could I be? In a last ditch attempt to avoid having to find the meter box or call a helpline and answer 101 irrelevant questions about my diabetes just to get a new battery, I went to Abbott’s website. At this point I discovered I am nothing but a weaselled old cynic. They have a free online ordering system for replacement batteries. It’s quick and easy to use and collected an acceptably small amount of data for marketing purposes. And my new battery arrived the next day.

How simple is that? What a refreshing change from the usual quagmire of diabetes admin. Thanks Abbott. Online replacement battery ordering is a small thing, but it makes life so much easier.

Right, I’m off to go and get irritated about having to make an appointment for my eye check

Not shagging other meters

Lifescan’s OneTouch Ultra2 is my current meter of choice and I don’t really know why.

Like a long-term relationship between partners who don’t love each any more, yet can’t be bothered to go to the effort of breaking up, I’m almost completely ambivalent about it. My Ultra2 isn’t really too bad, certainly isn’t abusive and hasn’t been sleeping around with other meters, so I just trundle along with it every day. There’s just no need to get another meter.

On paper at least the Ultra2 is perfectly fine, at 5ul the sample size is okay, but not exactly market-leading. The test time of five seconds is bearable but, again, nothing spectacular. It has a back-light, the colour of which – through lots of association – I instantly associate with night-time hypos (very odd that – a colour being associated with a physiological action; I guess it’s like ersatz synesthesia . Possibly.)

Anyhoo, it’s quite nice to look at, is relatively small and is pretty simple to use. The infernal beeping can be turned off and it does pass the 4am hypo test pretty well. It’s got a pretty big memory for your readings and can be hooked up to the obligatory PC software for further analysis, which is nice, but something even I (as a dedicated computer geek) can never, ever be bothered to do.

So there we have it – the Ultra2 is a perfectly fine meter, it’ll never set the world alight but it does what it’s supposed to.

However, having written this review, I’ve realised it’s a relationship I no longer want to be in, so as soon as I’ve updated my prescription I’m leaving the Ultra2 forever and running off with the sexy, young thing that is the Abott Freestyle Lite – wish me luck!

Sample size – 3/5
0.5μL – fine, I guess.

Test time – 2/5
5 seconds – meh.

Test strip calibration – 0/5
Nope, no automatic calibration

Test strip slurpiness – 5/5
Equal with the best on the market

Memory – 4/5
500 readings – not too shabby

Sexiness – 3/5
A little plain-Jane but bearable

Beeping – 5/5
Can be turned off

4am test – 3/5
No worse than any other meter without a test strip light

Total – 30/40

Check out the manufacturer’s web site or read about our reviews.

Horrible, nasty, plastic, vile, repulsive, tacky

Much like a Russian bride I once tried to buy via the Intermaweb, on paper the Menarini GlucoMen LX looks great. But also much like Irena (the aforementioned Russian bride) the reality is just not like the description.

Shortly after Irena arrived in the United Kingdom I noticed that unlike her cheerful smiling pictures I saw on the seedy web site on which I found her, she wasn’t in fact very smiley in person at all. Rather sullen in fact. With a penchant for hitting the vodka. Before breakfast.

Although I tried my best, sadly I had to end things with Irena after I took her to meet my parents. She spent the whole of Sunday lunch swearing, trying to kick the dog (referring to our elderly King Charles Spaniel as “that bloddy Siberian devil”) and – finally – puking a foul-smelling vodka and chicken mix into mum’s pot-porri. Last time I heard Irena had returned to Moscow, where she eventually married a local Mafia boss and was happily settling into the life of a gangster’s moll. Good luck to her!

And it was much the same with the GlucoMen LX (no, really). On paper it does look good. A small sample size, test strips which didn’t need to be calibrated and a fairly good 400 test memory. However, it just looks and feels utterly horrible. Encased in semi-see-through plastic (much like Irena when she was feeling “cекси”, as she put it) the GlucoMen looks tacky and just feels like it will fall apart the minute you breathe on it a little too heavily.

Such poor looks would be forgiveable if the meter had a range of mind-bogglingly useful features. But, perhaps needless to say, it doesn’t. It has the usual range of average results analysis and so on but while the layout and navigation is pretty straightforward it just doesn’t feel particularly intuitive or particularly nice to use.

When there are a multitude of sexier meters out there (in fact, every other glucose meter, ever) there is absolutely no reason to saddle yourself with this vile piece of design. However, if forced upon you by a particularly cruel diabetic clinic or evil insurance company it’ll just about do.

So, top tip for the day – never expect things to be as good as described on the web. Especially if you’re checking out Russian brides.

Sample size – 4/5
0.3μL per sample – pretty good

Test time – 3/5
4 seconds – quick, but not the quickest

Test strip calibration – 5/5
No need to calibrate. Yay!

Test strip slurpiness – 3/5
Averagely fine.

Memory – 3/5
400 records – not bad, not bad.

Sexiness – -5/5
Scores minus points for its utter hideousness

Beeping – 5/5
Can be turned off.

4am test – 2/5
Not great, but not entirely a disaster either.

Grand total – 20/40

Check out our other blood glucose meter reviews or go to the manufacturer’s site

The Freestyle Lite - with a really rubbish reading

While this tragic world of ours is filled every day with calamity, conflict and catastrophe there are perhaps a few rays of sunshine that poke through the heavy gloom, which give us something to live for and stop us from bashing our owns heads in with a handy paperweight.

My personal happiness list includes waking up next to my wife (ahhh!); roast chicken and the guitar solo from Iron Maiden’s Hallowed by thy Name. With these three things in place I’m sorted and life is good.

But now, having used Abbott’s Freestyle Lite blood glucose meter for the best part of a week, there is now another bright ray of sunlight in the gloomy slough of despond that is diabetes – as it is, in fact, a bloody good meter.

First impressions of the Freestyle are great – it’s absolutely tiny, sleek and looks pretty cool. If only it’d had been in black rather than utilitarian blue it would have scored full marks on the sexiness scale, but we can live with it.

The sample size is a tiny 0.3μL but this is slightly let down by the longish testing time of five seconds – if it had been 3 seconds I would have been ecstatic (well, perhaps not ecstatic exactly – it is only a meter after all and everything’s relative).

Speaking of the test strips, they’re a bit odd. Rather than sucking up your bloody gore through the bottom of the strip as with pretty much every other meter out there, you aim your finger at the side of the strip instead. Once you’ve worked this out (of course, I never read the manual and so it took me a while) the strips are just as good as any other with pretty good “slurpiness”.

The only slight downside with the Freestyle’s strips are that you don’t actually get to see your blood being sucked in – it’s all hidden away under a black section of strip. I find seeing your life-blood being drawn in is useful feedback to ensure you’re actually doing things correctly.

However the strips do have a great, great feature which more than compensates for this minor gripe. As you know, with most strips and meters, if you don’t put enough blood on the strip the meter will churn away as usual and then display an error message asking you to repeat the test. Nothing is more infuriating – after you’ve struggled to get a tiny drop of blood out of stone-cold fingers – than the meter moodily rejecting your sacrificial blood offering. But with the Freestyle Lite, if the meter detects you haven’t put enough blood on it lets you know and gives you another 60 seconds to squeeze another drop out. This is intensely good – it saves a tonne of frustration and stops you wasting test strips, which I guess is a boon if you actually have to pay for them (God bless the NHS!)

The Freestyle Lite has all the usual meter accoutrements – averages over 7, 14 and 30 days; it can be plugged into a PC to produce fancy graphs and the irritating beep can thankfully be turned off.

But I’ve left the best for last – this is the first meter I’ve tested that actually passes the 4am hypo test because – wait for it – it has an internal LED that lights up the test strip! Halle-bloody-luiah! This simple addition allows you actually see where your blood is on your finger, instead of having to randomly stab the test strip around in the pitch dark. Once you’ve successfully sucked up enough blood the meter automatically turns off the strip light and turns on the meter backlight. Bloomin’ marvellous! Why this isn’t a feature on lots of other meters I don’t know, it’s just so handy.

So all in all Abbott’s Freestyle Lite is a very good, sexy, well thought out meter – so much so that once I’ve got my prescription sorted out it’s becoming my regular every-day meter; so this particular ray of sunshine is sticking around!

Sample size - 5/5
0.3μL

Test time – 3/5
5 seconds

Test strip calibration – 5/5
No coding required.

Test strip slurpiness – 4/5
Very good, but not seeing blood being sucked in is disconcerting

Memory - 3/5
400 results – enough to be going on with

Sexiness – 4/5
Petite and cool looking – though if it was black it would be cooler!

Beeping 5/5
Beeping can be turned off

4am test – 5/5
With a lit up strip and automatic backlight it’s the acme of meters when faced with a 4am hypo.

Grand total: 34/40

Read about our reviews, or check out the manufacturer’s web site.