6.1.6 Diagnostic and monitoring devices for diabetes mellitus

6.1.1 Diagnostic and monitoring devices for diabetes mellitus

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.

A range of meters have been evaluated and approved locally for adults with Type 2 diabetes.

These meters are:

> TEE2 +®

> 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 TEE2 +® 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 TEE2+® 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® Glucose Monitoring System / Dexcom®

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 mist 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® sensor

AMBER Dexcom®

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