Insulin :: Insulin dose errors can result when blood glucose meters are miscoded

When persons with diabetes use miscoded blood glucose meters to determine how much insulin to take, significant errors in insulin dose can result that may potentially lead to short- and long-term health complications, according to findings of a new study just published in the Journal of Diabetes Science and Technology.

The study findings also showed that meters with No Coding technology (meters that automatically set the correct code anytime a test strip is inserted) gave superior performance over meters used in this study that had been correctly coded manually. This also translated into a lower probability of insulin dose error.

The American Diabetes Association estimates that there are 14.6 million children and adults diagnosed with diabetes in the United States, of which an estimated 4.4 million, or 30%, require insulin to manage their disease. Those who require insulin must closely monitor their blood sugar with a blood glucose meter to plan their meals, exercise regimens and insulin dosage.

In this study, using the low dose insulin algorithm, for certain miscoded blood glucose meters, the probability of insulin error of plus or minus 2 units of insulin could be as high as 50% as compared to 7.1% for correctly, manually coded meters. The probability of insulin dose error of plus or minus 3 units of insulin could be as high as 22.3% for the miscoded meters but only 0.49% for the correctly, manually coded meters.

For the meters that do not require manual coding, the probability of plus or minus 1 unit and plus or minus 2 units of insulin could be as high as 35.4% and 1.4% respectively. There were no calculated insulin dose errors above plus or minus 2 units with the meters that do not require manual coding.

Coding is the process by which a blood glucose meter is matched to each new box of test strips being used. This is done either by inserting a code strip or code chip into the meter, or by entering a code number into the meter. If this step is not performed, the meter may give inaccurate results which may lead to wrong therapy. For example, relying on a miscoded blood glucose meter to determine how much insulin to take can result in a potentially harmful overdose. Insulin overdose may cause dangerously low blood sugar (hypoglycemia) leading to behavioral changes, confusion, loss of consciousness and, if untreated, seizure, coma and even death. Chronic under dosing of insulin may contribute to the long-term health problems associated with high blood sugar including kidney disease, nerve disease, eye problems, and heart disease.

?When dealing with patients with diabetes we?ve observed that many either do not understand what proper coding is, or do not realize its importance. Patients sometimes use expired test strips and/or do not properly code their blood glucose meters to the lot of test strips they are using,? said Dr. Steven Edelman, an author on the study, and Professor of Medicine, division of Endocrinology and Metabolism, University of California, San Diego, and the Veterans Affairs Medical Center and founder of ?Taking control of your diabetes? (

?This is significant because a previous study I conducted found that approximately 16% ? or one out of six ? persons failed to properly manually code their blood glucose meters to the lot of test strips being used (3),? said Dr. Charles H. Raine, III, also an author on the newly published study and Director, Diabetes Control and Endocrinology Center, Orangeburg, South Carolina. ?Understanding the potentially serious consequences of relying on a meter that is not properly coded ? is essential for every person with diabetes, especially those who need to take insulin,? he added.

The study authors concluded that to avoid insulin dosing errors, people should be carefully instructed how to correctly code their meters or be advised to use a blood glucose meter that does not require manual coding.

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