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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
    To see the agreed list of approved meters and associated  functions click here 
    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.
    The range of recommended meters have been approved locally for adults with Type 2 diabetes.
    These meters are: 
         >       CareSens S Fit BT
         >       Contour® Plus Blue Meter
          >       Contour® Next Link [For use with insulin PUMPS]
          >       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.
    Contour® Plus and CareSens S ® 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
    GREEN      CareSens® S test strips
    GREEN      Contour®  Plus test strips (as well as the criteria above this product is used to facilitate insulin dose titration) by 
                       DSNs/DNs and renal patients with low haematocrit levels)
    Additional options:
    GREEN      Contour® Next  (For use with insulin PUMPS)
    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 2® Glucose Monitoring System / Dexcom one®
    NHS England have provided the national criteria for accessing Flash Glucose Monitors, providing unified access to these devices 
    across the country. The existing local criteria for use of Flash Glucose Monitoring in children who require third parties to 
    carry out monitoring and where conventional blood testing is not possible remains in place.
    Patient eligibility must be determined by a specialist clinician or the clinician who has specific responsibility for the patient's
    care. When a patient satisfies the eligibility criteria, ongoing supplies of sensors can be prescribed by GPs in Primary Care. 
    The initiating clinician must have received appropriate training on the initiation and use of flash glucose monitoring products 
    and will supply the patient with a scanning device and sensors to cover the initial 2 weeks of use of flash glucose monitoring.
    The amended policy can be viewed here
    Please note that only the criteria for Flash Glucose Monitors have been amended: the eligibility criteria for Continuous Glucose 
    Monitoring remains unchanged. This can be accessed here
    Specialists are responsible for initiation, training and reviews at 3 and 6 months.
    AMBER        FreeStyle Libre 2® sensor
    AMBER        Dexcom one®

    RED              Freestyle Libre 3, Dexcom G6 & G7, Medtrum TouchCare, Medtronic Guardian 

     Ketone Testing
      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® Areo Ketone Sensor [for use with the Glucomen® Areo2K]
      GREEN          KetoSens test strips [for use with the CareSens Dual Meter]
     Click here to access local guidance - 'Ketone testing and sick day guidance'
     Click here to access 'Medicine Sick Day Rules: Advice for Clinicians Health Care Professionals'
   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
     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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