john elliott

[john elliott]

can anyone help me to choose ?
I have a 4yr old ultra 2 it seems to be ok.
I was given a jazz by my doctor [with free strips] for free

when testing with both meters at the same time the jazz consistently reads 2 full points more than the ultra 2
I called the company [ultra] and they sent me a brand new machine
I also went back to the doctor and got a new jazz

NOW I have 2 ultra 2 machines WHICH AGREE WITH EACH OTHER

AND 2 JAZZ machines WHICH ALSO AGREE WITH EACH OTHER

BUT the jazz machines BOTH consistently give results 2 points higher than the ultra 2 machines
When testing I use a new lancet for each meter and a new puncture for each meter and perform all 4 tests within 30 seconds of each other
I don,t mean to seem silly but which machine should I trust??

 

[Copepod]

Welcome to the forum, John Elliot.

Meters have to be within 10% of each other, so it's your decision which one you trust. What treatment are you using to manage your diabetes? If on insulin, then always best to assume the lowest reading is accurate, to make it less likely you will go hypoglycaemic when driving, exercising etc. If you're not taking insulin or any medication that can cause hypoglycaemia, then it's npot so important - please note there's a different between causing hypoglycaemia and becoming hypoglycaemic while taking medication, which can happen to anyone, even if they're not taking medication for diabetes, usually after long periods of not eating, or after extended extreme exercise.

Do you mean that readings from Jazz meters are typically 2.x mmol/l higher or 0.2mmol/l higher than readings from Ultra meters? If the former, then selecting which to choose is more of an issue than if the latter.

 

[Vicsetter]

Welcome to the forum, John Elliot.

Meters have to be within 10% of each other, so it's your decision which one you trust.

Don't know where you got that from, but you are wrong! meters are supposed to be accurate to within +/- 20%, and more accurate at readings close to 4.0 (see this interesting article: http://forecast.diabetes.org/meters-jan2013).
There are similar findings to you on the diabetes.co.Uk review of the Jazz (here: http://www.diabetes.co.uk/blood-glucose-meters/wavesense-jazz.html)
They have been advertising an upcoming bluetooth enabled meter since about 2007 and it's not appeared. I'm surprised they sent you a new meter without asking you to do a control solution test (have you done one? on both meters).
I wouldn't do 4 tests in different sites though. Can you not get enough blood for 2 tests (one for each meter) from the same site?

In my experience (and statistically) the higher the reading the bigger the discrepancy may be, so if your Ultra2 reads 10 then it's quite possible that the Jazz may read 12 (20%).
If you are on drugs that might send you hypo then I would stick to the meter with the lower reading, the Ultra. I would also stick with a meter manufacturer that provided the better support (like new batteries, replacement meter, record books) etc.

 

[Vicsetter]

Just found this: http://www.abbottdiabetescare.co.uk...clinical_papers/accuracycomparison_fslite.pdf

which with a limited test gives the freestyle top marks but the Ultra2 is good enough. Can't find the accuracy of the Jazz, although they are supposed to publish the accuracy in the user guide.

 

[Copepod]

Sorry, was a typo - I typed 10% in haste, should be 20%.

 

[yorksman]

Differences between meters are quite usual. I can get a 0.5 mmol/l difference between fingers. My Accuchek Mobile user guide says not to be worried about the occasional reading of 11.0 my DN says not to be worried about the occasional reading of 15 mmol/L.

For type 2s, we are either looking for a trend, which we hope goes down over time or, if we are testing food types, we are looking for a sudden high increase, which warns us not to eat that again. The actual readings are less important. One of the big problems with finger prick tests of capilliary blood is that the sample quality is variable as it contains other fluids in unknown proportions. Sometimes, you get a bunch of platelets, which you can see here. The two big purple bunches contrast with the two smaller purple dots in the upper left quadrant. Finger prick tests ony ever give you a general idea.

 

[everydayupsanddowns]

Vicsetter, just to mention that diabetes.co.uk is a privately owned commercial enterprise/community, part if the SFN Networkof websites and nothing to do with Diabetes UK the charity.

 

[Vicsetter]

Differences between meters are quite usual. I can get a 0.5 mmol/l difference between fingers. My Accuchek Mobile user guide says not to be worried about the occasional reading of 11.0 my DN says not to be worried about the occasional reading of 15 mmol/L.

For type 2s, we are either looking for a trend, which we hope goes down over time or, if we are testing food types, we are looking for a sudden high increase, which warns us not to eat that again. The actual readings are less important. One of the big problems with finger prick tests of capilliary blood is that the sample quality is variable as it contains other fluids in unknown proportions. Sometimes, you get a bunch of platelets, which you can see here. The two big purple bunches contrast with the two smaller purple dots in the upper left quadrant. Finger prick tests ony ever give you a general idea.

Sorry, I disagree. I have targets which I try and stick to. My meters give me very consistent results and I rarely see anything over 10, and 15 would really alarm me, it's usually caused by contamination on the finger.

I think your DN is not talking about meter inaccuracy. I looked at the Accuchek mobile manual and couldn't see any reference to occasional high readings.
As a T2 you will probably have targets such as fasting 4-7 and 2 hrs after food 5-10. Given a meter with 20% over-reading (permitted) then the highest reading you could get is 12, certainly not 15. and the fasting reading just over 8.

diabetes.co.uk corrected, just a typing error, I know the difference.

 

[yorksman]

I think your DN is not talking about meter inaccuracy. I looked at the Accuchek mobile manual and couldn't see any reference to occasional high readings.

To clarify, the 20% range around the true value only has to apply to 95% of the readings, one in twenty will be out of range, usually because of poor capilliary blood sample.

As a T2 you will probably have targets such as fasting 4-7 and 2 hrs after food 5-10. Given a meter with 20% over-reading (permitted) then the highest reading you could get is 12, certainly not 15. and the fasting reading just over 8.

Well the meter goes upto 33 and the meter does not concern itself with what its user eats. It places no limit on that. The target range is a user defined objective.

 

[Vicsetter]

To clarify, the 20% range around the true value only has to apply to 95% of the readings, one in twenty will be out of range, usually because of poor capilliary blood sample.





Well the meter goes upto 33 and the meter does not concern itself with what its user eats. It places no limit on that. The target range is a user defined objective.

Unless you are totally not in control of your condition and not on any meds than the meter will no doubt give you higher readings. You are not in control if you get a reading of 15 even accepting that your meter is reading 20% high (this is outside the NICE guidelines for T2). The original thread was about comparing 2 meters, please try not to read things into my comments that are not there and your comments are far from helpful, I have never thought that my meter was a sentient being with feelings😱

The actual readings are important as you would find out if you are on insulin and get tested by the police, the readings for driving specify the readings you can or cannot drive with.

 

[yorksman]

please try not to read things into my comments that are not there and your comments are far from helpful, I have never thought that my meter was a sentient being with feelings😱

Then please provide some clarity. As it stands your statement above "Given a meter with 20% over-reading (permitted) then the highest reading you could get is 12, certainly not 15. and the fasting reading just over 8." is wrong. Not only is the meter able to provide this reading the DN stated that occasional readings of 15 were not a cause for concern and only repeated readings of 15 or above were. It's not a necessarily a question of meter accuracy and not a question of the true blood glucose level. The two parameters which cause the greatest uncertainty are the number of outlier readings, a permissable 5% and the other, the quality of blood sample.

The manufacturing specification for home meters is that they are within 20% of the true value 95% of the time. It is permissable for one in 20 readings to have a degree of error greater than 20% and for that reason, there is no reason to go back to the DN because of one outlier reading. In addition, blood obtained via skin puncture is a mixture of undetermined proportions of blood from arterioles, venules, capillaries, plus interstitial and intracellular fluids. As you might imagine, these factors too contribute to inaccuracies.

The actual readings are important as you would find out if you are on insulin and get tested by the police,

Well my wife is a biomedical scientist who works in blood sciences and who specialises in haematology and the night shifts are often punctuated with police requiring analysis of samples for various purposes. Even a breath analyser result requires confirmation with a venous, not capillary, blood sample analysed using the correctly calibrated equipment in the laboratory. Control fluids don't cut it. For safe convictions in serious cases, involving deaths for example, arterial blood, rather than venous blood is required, an exceptionally painful procedure I am led to believe.

You must never allow any test by the police alone to be presented as evidence. Not only is their equipment of low quality and often badly maintained, they have good reason to skew the result.

I looked at the Accuchek mobile manual and couldn't see any reference to occasional high readings.

Try the Quick Start User Guide.

 

[Vicsetter]

It is still not very helpful for John's original question posed about which meter is it? and all very technical and statistical. Most of us get pretty good results with our meters. But some, like John are being forced into using cheap meters which from the testing I have done are less accurate than the mainstream ones we currently use.

Eventually found a Wavesense Jazz paper on their meter accuracy:
http://www.wavesense.co.uk/uploads/pdf/Whitepaper, Performance, Jazz, mmoll.pdf
Which claims a better than ISO standard accuracy!

I have eventually found a clinical test comparing various meters (unfortunately not the Jazz) here: http://www.clin-lab-publications.com/files/eaop/2013_07+08/120710-Hasslacher.pdf
it's a pdf file so you will need a PDF reader. (100mg/DL is 5.6 in mmol/l)
I use a Onetouch Ultra for day to day stuff and a Mylife Pura for driving as I find it reads consistently lower than the onetouch. Both meters have confirmed hypos with below 4 readings. If at any time you get a reading out of what you expect then wash and dry your hands and retest, that usually confirms the donut residue or that you have an erroneous reading.

 

[yorksman]

It is still not very helpful for John's original question posed about which meter is it?

I do not think my answer could be clearer. The question was, "which machine should I trust??" and my answer was that it does not matter as differences are to be expected and the causes are often not even machine dependent.

You took issue with that and criticised my reply but made no attempt to answer the question youself. Accusing me of being unhelpful here is simply projectional and argumentative.

Home meters are not precision instruments and there is no point in any manufacturer making them so because BG levels vary every few minutes and vary from finger to finger. In addition the blood sample quality is variable and outliers are to be expected.

Labs run controls several times per day and recalibrate every time there is an outlier result. Home meters do not even have a calibration facility despite the fact that one in 20 readings are likely to be outliers.

People getting unnecessarily stressed over a two point difference is one of the reasons why some practices are cautious about handing out these instruments. That is why when they do, they are told not to get worried about the occasional high reading and only contact them if it is a series of high readings. These things are handed out for monitoring trends. That is the point you took issue with.

Eventually found a Wavesense Jazz paper on their meter accuracy:
http://www.wavesense.co.uk/uploads/pdf/Whitepaper, Performance, Jazz, mmoll.pdf
Which claims a better than ISO standard accuracy!

By necessity it has to claim to exceed DIN EN ISO 15197:2003 as that standard is a minimum standard.

 

[m1dnc]

I'm a little wary of adding to this thread as it seems to be getting a bit contentious, but here goes.

Last summer I reviewed the papers presented at a conference in 2010 organised by the US FDA to consider the use and accuracy of consumer BG meters. I quote from the post I subsequently made and apologise as it's a little long winded:

"Firstly, the background to the meeting. The current international standard for meters is ISO 15197. Amongst other things, this states that the minimum system accuracy for meters/strips requires them to be accurate to + or - 0.83 for readings <4.2, and to + or - 20% for readings > or = to 4.2. Both these definitions are to 95% confidence limits. The system in this context is the combination of meter and strips meant for it.

This is the minimum standard, but in reality most modern meter systems (as of 2010) met these requirements without difficulty and most were accurate to + or - 15%, and some were even better than that.

As far as precision is concerned (i.e. repeatability and reproducibilty), most meter systems were better than 5% when properly operated.

The accuracy/precision of the meter system should be seen in the context of all the errors that can arise in patient treatment. In particular, other sources of error include, with their probable range of inaccuracy:

Carb counting: 15-20%
Carb/insulin ratio: 10-25%
Administration variability (i.e. the accuracy of syringe/pen/pump to delivery the desired dose): up to 20%
Insulin absorption variabilty once administered: depends on insulin but e.g. for Humalog, 20%

From these, the total error for the whole treatment process can be estimated at about 27% of which only about 1-3% can be put down to the meter system errors.

The biggest source of error in home testing is inadequate hand washing. Four out of five patients do not wash their hands properly before testing.

Outliers (i.e. completely random and inexplicable results) are potentially a problem, especially for making critical decisions for treating/not treating hypos, since the patient has no idea whether the result is an outlier. Around 0.1% (i.e. 1 in a 1000, or once or twice a year if you're testing 4/5 times a day) of results are estimated to be outliers.

The current 20% accuracy standard means that up to 10% of hypos could be missed. If the standard was tightened to 15% (which most current meter systems meet anyway), that would go down to 5%. At 10%, it would drop to 1%, and at 5% hypos would always be detected. The best meters (at 2010) achieve 5% accuracy about 70% of the time.

Meter systems could probably be engineered to get better accuracy but, as in all things, it's a balance of priorities with other factors like convenience (blood drop size, measurement time, size etc) and cost.

Most patients rarely test their meters with the control solutions supplied by manufacturers. This is something that patients should not neglect.

Always use in-date strips. The strips can be affected by heat and humidity. Never leave the strip container open, nor in a car in sunny weather.

There was a lot of stuff about meter system accuracy when they are used in critical care situations in hospitals (e.g. concern about relying on consumer meters for testing unconscious patients), and some interesting discussion about using consumer meters to calibrate cgm systems.

My own view after reading all this stuff, is that I have little option but to accept the reading that my meter gives at face value and make my treatment choices accordingly, but always with the thought at the back of my mind that the reading could be out - re-test if I think there's something funny going on, and dig out that bottle of control solution. I'm also going to be more careful to make sure I wash my hands every time I test!"

 

[DeusXM]

When testing I use a new lancet for each meter and a new puncture for each meter and perform all 4 tests within 30 seconds of each other
I don,t mean to seem silly but which machine should I trust??

That depends on a variety of factors.

The first to consider is 'which one more closely tallies with how you feel?' Generally you'll feel a bit rubbish with high readings (over 9) and low readings (under 4). So you may wish to pick a meter based on which seems to most closely tally your immediate situation.

Or, you could take another approach. Alternate between the meters for a bit and get an A1c done. Find out what average mmol/l reading that A1c converts to and compare it to the average readings from your meters. Closest one wins.

Or, if you want to be a little more hardcore, go for the meter that reads higher. That would then act as a motivation to really keep a lid on your BG control as if it's constantly reading slightly higher, then you'll put more work in to get normal blood sugars.

Or....go whichever one you find the easiest to use. The central thrust behind these points about meter inaccuracy is that they're all pretty variable. I can get a substantially different reading between my left and right hands sometimes or even the same finger done twice - particularly if my control has gone to pot and I'm up in the teens. So I'd suggest that convenience should actually be the driving factor more than anything else.

 

[john elliott]

Wow I Am Very Grateful To All Who Are Trying To Help Me
I Am A Type 2 Controlling My Diabeties By Metformin And Glibenclamide[?] [cant Spell Ho Ho]
I Get A Consistent Difference Between The 2 Brands Of Meter Of 2 Full Units Not .2 Most Days My Readings [ultra 2] Are Between 7 And 10 After A Fast Of At Least 12 Hours Usually Around 8 Does This Help To Help Me Choose?
I Naturally Use The Ultra More As It Seems To Tally Closer To My 3 Monthly Test For Average Results That The Doctor Gives Me Which Was 8 Thankyou All For Your Help John

 

[Vicsetter]

Wow I Am Very Grateful To All Who Are Trying To Help Me
I Am A Type 2 Controlling My Diabeties By Metformin And Glibenclamide[?] [cant Spell Ho Ho]
I Get A Consistent Difference Between The 2 Brands Of Meter Of 2 Full Units Not .2 Most Days My Readings [ultra 2] Are Between 7 And 10 After A Fast Of At Least 12 Hours Usually Around 8 Does This Help To Help Me Choose?
I Naturally Use The Ultra More As It Seems To Tally Closer To My 3 Monthly Test For Average Results That The Doctor Gives Me Which Was 8 Thankyou All For Your Help John

John, are you aware that Glibenclamide is a Sulfonylurea and carries the possibility of hypos. You need to make sure that you have read and understand the DVLA rules for this (assuming you drive). It shouldn't be a problem unless you have a hypo that requires professional assistance. Please read the DVLA rules. You need to test before driving and every 2 hrs whilst driving.

If you have a choice then I would stick with the Ultra, especially in the light of the Glibenclamide as you need to know if you are going low. Although both makes of meter are probably quite similar below 5mmol/l as the accuracy improves (and the results of error are smaller). The Ultra has better support from the manufacturer (control solution and log books) than the Jazz.

 

[john elliott]

Hi I Have Never Ever Been Below 7 Even When I Lived In The Us [with Their Wacky Diet] For 10 Yrs Ho Ho I Was Between 125 And 195 On Their Scale [mg/dl] And Iam Between 7 And 10 In Uk Consistently After An Overnight Fast. I Will Consult My Doctor On Monday To Make Sure What To Do Thanks Again John