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6.1.6 Diagnostic and monitoring devices for diabetes mellitus

6.1.6 Diagnostic and monitoring devices for diabetes mellitus

6.1.1 Diagnostic and monitoring devices for     diabetes mellitus

 Blood Glucose Monitoring
  A patient information leaflet on self-testing can be found here
  See 'Guidance for Self-monitoring of Blood Glucose' ELHE
  Blood glucose monitoring using a meter gives a direct measure of the glucose concentration at the time of the test and can detect 
  hypoglycaemia as well as hyperglycaemia. Patients should be properly trained in the use of blood glucose monitoring systems 
  and be empowered to take appropriate action on the results obtained. Inadequate understanding of the normal fluctuations in 
  blood glucose can lead to confusion and inappropriate action.
  A range of meters have been evaluated and approved locally for adults with Type 2 diabetes. 
  These meters are: 
    >        TEE2 +®
    >        Contour® Plus  [Note this is the meter used by DSN's/DN's  for patients on insulin undergoing dose titration]
    >        Contour® Next Link [For use with insulin PUMPS]
    >        Contour® Next [For Type 1 & 2 insulin patients who are recommended by a specialist to use the CONTOUR®DIABETES app]
    >        CareSens® N Voice
  For Type 2 diabetics that are diet controlled or on metformin alone then routine testing of blood glucose is NOT indicated. 
  CLICK here to download the Guide to Blood Glucose Monitoring Patient Information Leaflet.
  TEE2 +® ,Contour® Plus are the formulary test strips of choice in the following patient groups:
         >       Type  1 or 2 diabetics on insulin alone
         >       Type 1 or 2 diabetics on insulin + oral therapy
         >       Those under the care of a secondary care/intermediate care specialist e.g. renal patients with low haematocrit levels     
                   [NB for gestational diabetes see section below*]
  GREEN      TEE2+® test strips 
  GREEN     Contour®  Plus test strips (as well as the criteria above this product is used to facilitate insulin dose titration)
  Additional options
  GREEN      Contour® Next 
                     [for Type 1 & 2 Insulin patients who are recommend by a specialist to use the CONTOUR®DIABETES app]
  GREEN     CareSens® N [for those with visual impairment] 
  *Gestational Diabetes only
   AMBER      WaveSense® JAZZ blood glucose testing strips 
  Paediatric  Treatment
  Accu-Check® Expert [uses AccuCheck® Aviva test strips AMBER]               
  Accu-Check® Expert has been approved for use by paediatric patients only as it allows  greater flexibility with respect to the
  incremental dosing that is often required for these patients. The choice of meter should be governed by individual need and
  suitability following a discussion with a clinician. For all paediatric patients the meter and initial supply of consumables will be    
  made by the specialist service.
  In all instances of blood glucose monitoring a testing regimen should be agreed with the patient and must include the frequency
  of testing. This should be recorded in the patient's written management plan.
  AMBER       Accu-Check® Aviva
  Other approved 'specialist only' meter options for Type 1 Diabetic/paediatric patients [NOT to be initiated in Primary Care]
  Accu-Check® mobile  [uses AccuCheck® mobile test cassette AMBER]
  FreeStyle® Optium     [uses FreeStyle® Optimum test strips AMBER]
  FreeStyle® Insulinx    [uses  FreeStyle® Lite tests strips AMBER]
  FreeStyle® neo           [uses FreeStyle® Optimum test strips AMBER]
  Continuous Glucose Monitoring
  FreeStyle Libre® Glucose Monitoring System  
  The Policy for the Provision of Continuous Glucose Monitoring and Flash Glucose Monitoring has been updated based on National
  Guidance to CCGs issued by NHS England on unifying the patient access criteria for Flash Glucose Monitoring.
  FreeStyle Libre is now Amber traffic light for individuals meet the criteria set out in the policy
  [Policy criteria for Freestyle Libre®] 
  Specialists are responsible for initiation, training and reviews at 3 and 6 months.
  GPs can continue to prescribe FreeStyle Libre to individuals that fit the policy criteria after an initial supply via the specialist.
  AMBER        FreeStyle Libre® sensor
  Ketone Testing
  Ketone testing is occasionally required for some patients for example pregnant women, patients with recent/frequent DKA, those
  under 17 years of age.  All Type 1 diabetic patients should be offered the option to test for Ketones as part of Dose Adjustment For
  Normal Eating Type 1 education programme. (DAFNE).
  Patients required to self-test for ketones should be identified by the diabetes specialist service and they are responsible for  
  making the initial supply of consumables and providing a meter. The service should provide the patient with structured,  
  meaningful education on the use of the device including what action to take depending on the readings obtained.  It may be    
  necessary for primary care to repeat prescribe such strips.
  The use must be carefully monitored and it is not expected that this will exceed more than one pack per year, with the exception    
  of insulin pump patients.
  GREEN          Glucomen® Areo2K
  The FreeStyle Optium β Ketone test strip is another option and is compatible with either a FreeStyle Optium Neo or FreeStyle    
  Optium meter. 
  Please note that these machines are reserved for Ketone testing only. If patients are also required to self-monitor their blood glucose   then the choice of meter will be the Glucomen® areo2K                              
  GREEN           FreeStyle Optium β  Ketone
  Insulin Pen Needles  
   GREEN      Universal fit insulin pen needles   
                   >       Insupen
                   >       GlucoRx carepoint
                   >       GlucoRx finepoint
                   >       Omnican Fine*
                   >       BD viva™ pen needles
   *Note - Omnican needles do not have an inner cap. This is simply to promote single use of the needles and prevent patients re-
     capping the needle to use again.  The Omnican needle can be safely disposed of by screwing the plastic case back on to the    
     needle and screwing it off the insulin pen.
  EU directive 2010 – to prevent sharps injury 
  This directive required organisations to put  measures in place to improve safety in advance of the legislation which came into
  force 11 May 2013. Such measures include assessing the risk or occurrence of sharps injuries to health care workers, reviewing
  procedures and changing to safety engineered devices where practicable to do so.
  Existing insulin pen needles remain exposed after insulin administration. Insulin syringes also have exposed needles after use. To
  prevent sharps injury the following devices should be prescribed if the patient is having their insulin administered by a 
  community nurse or other healthcare professional:
  Safety Pen Needles 
  GREEN          GlucoRx  Safety Pen Needles - 1st line option 
  GREEN         BD AutoShield™ Duo Safety Engineered / 5mm / 30G /  
                       (Pip Code 360-5615 / FTR1083)

All material in this section is aimed at health care professionals, but is information currently held in the public domain, members of the
 public seeking advice on medicine-related matters are advised to speak with their GP, pharmacist, nurse or contact NHS111 Service
  Email: info.elmmb@nhs.net
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