According to the American Diabetes Association, one-quarter of Americans age 65 and older have diabetes. The disease can seriously impact health if it is poorly controlled—in fact, it is the seventh leading cause of death in the U.S. Diabetics are 1.8 times more likely than non-diabetics to be hospitalized for heart attack, and 1.5 times more likely to be hospitalized for stroke. Diabetes also raises the risk for kidney failure, vision loss, depression, cognitive impairment, and falls in older adults.
As a certified diabetes educator, Mount Sinai nutrition consultant Fran Grossman, RD, MS, CDE, CDN helps guide patients in how to regularly monitor their condition so they can avoid serious complications. “Food, medications, exercise, hormones, and stress can influence blood sugar,” she explains. “Keeping track of your blood sugar levels with a home glucose meter is the best way you and your doctor can ensure good management of your diabetes.”
Meter Basics Needle-free glucose meters are in development, but currently available devices incorporate a spring-loaded lancet (you also can purchase a separate lancing device if you prefer) that punctures the skin with minimal discomfort, to produce a small drop of blood. “You place the blood sample on a test strip, and the meter reads the strip in order to calculate your blood glucose level,” Grossman explains.
Home glucose meters are covered by Medicare Part B as durable medical equipment as long as the meter is prescribed by your doctor, and provided by a Medicare-participating supplier, which may be a local pharmacy or a mail order supplier (check your options via the online supplier directory at www.medicare.gov). “If you purchase a meter and supplies from a supplier that isn’t enrolled in Medicare, you will not be covered,” Grossman cautions. “If you have a Medicare Part C Advantage plan, contact your insurer to find out what is covered and what co-payments might be required.”
The lancets, lancet devices, and testing strips you use with your diabetes meter also are covered by Medicare Part B, but there may be a limit on how often you can get these—for example, lancets and testing strips are limited to 100 of each per three-month period (which should cover once-daily testing), unless you use insulin, in which case you are covered for up to 300 of each per month (for testing three times per day). “If your doctor confirms it is medically necessary for you to get more, Medicare will cover additional supplies,” Grossman adds.
If you don’t yet have Medicare, it’s important to factor in the price of the recommended testing strips before selecting your meter. “If you need to check your glucose levels several times a day, copay costs can mount if the strips for your chosen meter are expensive,” Grossman says. “Look for co-pay offers from manufacturers, since these can help lower the cost.”
Features to Look For Ease of use is important—if a home meter is too difficult to use, it’s likely that you simply won’t use it. Also consider other health conditions that might interfere with meter use. “If your vision is poor, choose a model with a larger display,” Grossman says. “Some meters also relay the results in audio mode for those who are visually impaired.” Think about your manual dexterity too—if you have arthritis in your hands, you may need a larger model with bigger controls that also utilizes larger test strips or a cartridge of test strips instead of strips you need to load individually.” A lancing device that uses a pre-loaded drum of needles also may be easier for you.
Some meters offer added features, including the ability to chart your glucose levels. You can download your readings to a computer or smartphone and create an online logbook, which, in turn, can help your doctor track how well you are controlling your diabetes and make any necessary adjustments to your treatment regimen. The American Diabetes Association has a free online logbook tool (www.247.diabetes.org), and also offers a printable glucose log you can fill in by hand.
Using Your Meter Some glucose meters can take a blood sample from your forearm or thigh—however, since these areas take longer to reflect changes in your blood sugar, you should always test from your fingertip if there is any reason to believe your blood glucose levels are low or may be changing rapidly (for example, after a meal, after taking insulin, during exercise, or if you are unwell). “If you prefer to use your fingertip generally, aim the lancet so that it pricks the side of your finger,” Grossman suggests. “This way you’ll avoid a sore fingertip that might interfere with activities.” Before using your meter, wash the area where you are taking the blood sample, to ensure that it is free from sugar residues that could render the result inaccurate. Dry the area thoroughly too, since water droplets on your skin can dilute the blood sample.
Use the recommended test strips for your meter, since its accuracy may rely on it recognizing a code that is encrypted in the strips, and generic strips may generate inaccurate readings. “Auto-coding meters recognize the code automatically, while others require you to enter the code manually,” Grossman says. “Since forgetting to do this can interfere with the accuracy of the reading, it’s worth paying more for an auto-code glucose meter.” Keep in mind that you may still have to check that the code number on your meter display matches the one on the test strip box.
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