Product Information and Historical Development of Glucometer - Assignment Example

?Glucometer Product Information A glucometer is a small portable instrument used to determine blood glucose levels. Along with glucometer are test strips made of paper pieces. Paper pieces are coated with chemicals such as glucose oxidase, dehydroginase, or hexokinase. These chemicals combine with the glucose in the blood and change blood color. The glucometer displays blood glucose level as a number (Manthappa, 2008, p. 67). In order to provide advance care to a diabetic patient, paramedics initially take the blood glucose level of the patient. Hand’s area for blood glucose testing is cleaned by applying alcohol and then letting it dry. Fingertip will be prick by a lancet – a needle like device. After pricking the fingertip, hand is held down and a drop of blood is squeezed from the pricked area. The drop of blood is applied in the test strip and be inserted in the glucometer. Then, the glucometer displays the blood glucose level (Manthappa, 2008, p. 68). Treatment Blood glucose monitors such as glucometers are an important tool for people with diabetes. Glucometers assess diabetic people’s physiological status and assess the needs for adjusting medication dose or meal frequencies. Glucometers are very helpful most especially during the hypoglycemic attack. If hypoglycemia is not treated, it will result in autonomic, cognitive and affective disruption, acute brain damage, coma, or worst, death (Steptoe, 2010, p. 825). Hypoglycemia is defined as the fall in blood glucose levels and is the most common and dreaded complication of diabetes. Hypoglycemia occurs when timing of meals or exercise does not match with the timing of insulin injections. Critical hypoglycemic attack often happens at night and signs such as presence of nightmares, excessive perspiration, and waking up in the morning with a headache are manifested. Some patients may go from feeling normal to unconsciousness within a few minutes (Molitch, 1990, p. 182-194). Thus, taking blood glucose level before taking medications or insulin is very important in preventing hypoglycemia. Glucometer testing utilizes capillary blood samples. It is easy to use, is quick, and does not require blood to be wasted. In fact, it only uses a drop of blood. Having a glucometer prevents the health care provider from leaving the patient unattended by using a blood gas analyzer for glucose measurements. However, blood glucose level measurement’s through a glucometer has been found to be the least accurate method of measuring glucose levels when compared to laboratory results (Bench, 2011, p. 120). Kanji et al. (2005) found that capillary sampling over-estimated blood glucose significantly, and in cases of hypoglycemia, results using this method agreed with laboratory results only 26.3% of the time. To ensure accuracy of the measurements, health providers preferred the arterial sample for glucometer testing over the capillary blood sample and are thus recommended in blood glucose monitoring. Arterial blood sampling via arterial catheter is used to measure blood gases and electrolytes. It is sometimes called blood gas analyzer. The used of arterial blood sample in a glucometer is considered to be the most accurate and the most reliable method of measurement when compared to laboratory testing. However, frequent arterial sampling may lead to air embolus, infection, and anemia in critically-ill patients (Bench, 2011, p. 120). Thus, samples must be taken using a non-touch technique with some support for closed blood sampling circuits to allow blood return to the patient and prevent incidence of anemia. Because of the long duration of waiting for the laboratory results of blood glucose level and the physician’s requirements, glucometers became extremely popular. Glucometer reading is not as accurate as laboratory blood glucose measurement. There are some limitations with regards to the use of glucometer. First, the accuracy of glucometer test results depends partly on the quality of the meter, test strips, and training. The strip must always be compatible with the meter. Also, humidity and heat easily damage the test strips and affect the blood glucose reading. The battery of the meter must be check always for it may display wrong values (Manthappa, 2008, p. 70). As stated earlier, blood glucose readings are important in medication dose adjustment and meal intake so if glucometer displays wrong values, there is an increased risk for patient to suffer either hypoglycemia or hyperglycemia. Aside from the quality of the test instruments, patient teaching also plays a role in accuracy of blood glucose measurements. Health providers must ensure that patient understands instructions on how to get blood glucose measurements. Health providers must include the right timing, testing technique, route, and complications of blood glucose testing. Thus, the limitation a glucometer has depends upon the test instrument, patient, and health provider. Historical Development Very few are known and published about glucometers. In 1962, Leland Clark and Ann Lyons at the Cincinnati Children's Hospital developed the first glucose enzyme electrode relying on a thin layer of glucose oxidase and oxygen electrode. The sensor worked by measuring the amount of oxygen consumed by the enzyme. In 1965, Ames Company developed and introduced a product called Dextrostix®. These are sets of paper strips where drop of blood was placed. Strips changed into blue after a minute and then, it will be compared to a standard chart to determine blood glucose level. However, a scientist named Anton H. Clemens found difficulty in using Dextrostix®. In 1970, Clemens started to develop a reflectance meter that could read reflected light. Clemens introduced the first blood glucose meter on September 14, 1971 and named it Ames Reflectance Meter (A.R.M.). Clemens was claimed as the inventor. Clemens’ invented ARM as a reader for Dextrostix®. ARM cost $495. It is very expensive and available only for physician’s use so the Japanese invented the Eyetone in 1972. Unlike ARM, Eyetone was smaller, light in weight, easier to operate, and most importantly, it was less expensive. The Japanese brought Eyetone to the U.S. and showed it to Ames Company. Ames introduced the Japanese invention but they did not develop the Eyetone. ARM also needs prescription from a doctor. The first diabetic patient to have the ARM is Dick Bernstein. The wife of Dick Bernstein, whom is a psychologist, prescribed him ARM. In mid-1970s, Dr. Lois Jovanovic believed that pregnant diabetic mothers should have blood glucose monitoring for care management. Also, there was a doctor in Pittsburgh, Pennsylvania, named Ted Danowski of University of Pittsburgh. He was the first to publish a paper in a scientific journal on patient self-testing in 1977-1978 and taught a group of 7 or 8 patients how to use the ARM. In the meantime, the German company, Boehringer Mannheim developed a competing blood glucose strip and it was called Chemstrip bG. Boehringer Mannheim paid for and supported an international symposium on blood glucose management called "Diabetes in the 80s." in Rockefeller University, New York and it was chaired by Charles Peterson, Lois Jovanovic's husband. International array of speakers talked about the future of diabetes in the next 10 years and patient self-monitoring. Boehringer took 6 years to develop a meter to read the Chemstrip bG and that was the first Accu-Chek. Then, MediSense introduced the first biosensor glucometer that operates on a whole different principle and read all reflected lights. It also utilized electro-chemical technology. Test strips that could be read visually without a meter were also widely used in the 1980s. They had the added advantage of saving money. As meter accuracy and insurance coverage improved, these test strips lost popularity. However, a generic version of the Boehringer is marketed under the brand name Glucoflex-R. The UK Pharmaceutical company (Ambe Medical Group) has the executive rights for distribution of Glucoflex-R within the United Kingdom. In North America, hospitals resisted adoption of meter glucose measurements for inpatient diabetes care for over a decade. Managers of laboratories argued the accuracy of a laboratory glucose measurement over the advantage of immediate availability. Patients with diabetes and their endocrinologists eventually accepted the used of glucometer but policymakers still resist the idea of laboratories’ managers. Home glucose testing for type 2 diabetes was adopted more slowly than for type 1. Added to that, a large proportion of people with type 2 diabetes have never been instructed in home glucose testing mainly because of reluctance over the cost of the test strips and lancets. Future Developments Researchers are conducting continuous studies about ways on how to make glucometer non-invasive, more accurate, and better for continuous monitoring. Researchers included the use of infrared or near-infrared light, electric currents, and ultrasound to determine blood glucose levels. Glucometers nowadays have sensors, wireless transmitters, receivers, and monitors. GlucoWatch G2 Biographer made by Animes Corporation is a typical example. GlucoWatch G2 Biographer is a glucose monitoring device that is worn on the forearm. Glucose readings are taken non-invasively through the skin. G2 Biographer can provide readings every 10 minutes for up to 13 hours at a time and is intended to track glucose patterns and trends. It has alarms that alert the patient of abnormalities in blood glucose levels. DexCom STS Continuous Blood Glucose Monitor (DexCom) and Guardian RT Glucose Monitoring System (Medronic Diabetes) are two other examples of high-technology blood glucose monitoring equipments introduced in 2006 (Lee, 2009, p. 280). References List Bench S. and Brown K. (2011) The patient with altered blood glucose. Critical Care Nursing United Kingdom: Blackwell Publishing Ltd., pp. 117-129. Kanji, S. et al. (2005) Reliability of point care testing for glucose measurement in critically-ill adults. Critical Care Medicine 33(12), pp. 2778-2785. Lee, M. (2009) Endocrine Disorders. Basic Skills in Interpreting Laboratory Data 4th ed. Maryland: American Society of Health-Systems Pharmacists, Inc., pp. 271-309. Manthappa, M. (2008) Monitoring Your Blood Sugars. How to Manage Your Diabetes and Lead a Normal Life New Delhi: Peacock Books, pp. 65-72. Mendosa D. History of Blood Glucose Meters: Transcripts of the Interviews. Accessed on April 30, 2011 in http://www.mendosa.com/history.htm Steptoe, A. (2010) The Electric Brain and Behavioral Medicine. Handbook of Behavioral Medicine New York: Springer Science Business Media, pp. 821-841. Read More