TALKING BLOOD GLUCOSE MONITORS

by Ed Bryant

As editor of VOICE OF THE DIABETIC, I am often asked about the relative strengths and weaknesses of the various voice-enunciation equipped home blood glucose monitors available today. There is no "best" talking glucose meter; no one monitoring system is ideal for everyone. Features, prices, convenience, and clarity of instructions vary, and new equipment periodically appears.

Although many companies make blood glucose monitors, and some of these display their results in large print, only three currently available meters allow voice enunciation, in which the device's voice synthesizer "speaks" the meter's instructions and test results.

The meters most often adapted to voice enunciation are the LifeScan One Touch series: the Profile, and the now-discontinued One Touch II. Both meters use the same procedures, the same test strips, and feature the same detachable test strip holder. Both meters are equally accurate, but the Profile, with its vastly expanded memory, allows its user to store up to 250 test records with date and time, to record insulin types and dosages with time and date, to insert "event markers" to help track the impact of specific activities on blood glucose levels, to compute test averages for the past 14 or 30 days, and many other features. To achieve these "bells and whistles," it is electronically more complex than its predecessor, so much so that VOICE SYNTHESIZERS DESIGNED FOR THE ONE TOUCH II WILL NOT OPERATE WITH THE PROFILE.

The "voice boxes," speech synthesizer modules that plug into the meter's data port (no internal modifications are necessary) and provide its voice, are not made by LifeScan, but by several competing firms, described below. These manufacturers have been producing voice units for the One Touch II, and now offer updated versions, for use with the Profile.

If you already have a LifeScan One Touch II or Profile, no modifications will be necessary, to use one of the speech synthesizers. Just plug and play! If you do not yet own a LifeScan monitor, shop around, as some pharmacies and major discount stores sell glucose monitors substantially below list price.

Talking Glucose Monitors and Voice Boxes

1.) The Voice-Touch speech synthesizers, for the LifeScan One Touch II or LifeScan Profile: MYNA CORPORATION (formerly TFI), 239 Western Avenue, Essex, MA 01929; telephone: (978) 768-9000.

Myna makes a pair of light, compact, convenient, and reliable glucose meter speech modules. The two models are not interchangeable. The Voice-Touch modules attach firmly to the meter, adding little bulk, and forming a single reliable unit. There are no separate switches to remember; the modules operate off the controls of the LifeScan monitor. The user may choose male or female voice enunciation. A Spanish-speaking Voice-Touch is now available; other languages are promised.

The Myna Corporation offers the Voice-Touch speech synthesizers for $189 (for One Touch II), $220 (for Profile), the LifeScan meters alone for $135 (One Touch II or Profile). An optional AC adapter is offered, as is a carrying case, $15 each. Myna's instructional cassettes clearly explain the speech modules, but do not describe operation of the LifeScan glucose monitors.

The LifeScan One Touch meters and Voice-Touch speech synthesizers are also offered by the National Federation of the Blind (NFB), Materials Center, 1800 Johnson Street, Baltimore, MD 21230; telephone: (410) 659-9314. NOTE: The Materials Center is open 12:30pm to 5pm, weekdays, Eastern Time. The NFB offers the combination (meter plus voice module) for $309 (the lowest price for a talking glucose monitor in the U.S.), the voice module alone for $189, or the glucose meter alone for $120. An optional AC adapter costs $11.

2.) The Digi-Voice modules: SCIENCE PRODUCTS, Box 888, Southeastern, PA 19399; telephone: 1-800-888-7400.

Science Products makes several versions of their robust and reliable Digi-Voice speech module: The Digi-Voice Deluxe, and the smaller Mini Digi-Voice. VOICE BOXES DESIGNED FOR THE ONE TOUCH II WILL NOT OPERATE WITH THE PROFILE, AND VICE VERSA! The Digi-Voice modules connect to the meter by a 22-inch patch cord, providing audio output for its readings. Controls are simple; on the Deluxe a volume control knob and a toggle switch run the voice synthesizer, separate from the monitor's controls. The Mini's single button both turns on the voice box and adjusts the volume control, again, separate from the meter's controls. Readings are announced in a clear, somewhat military, male voice. Thorough cassette instructions explain both voice box and Profile meter [Science Products' instructional cassettes do not cover operation of the One Touch II glucose monitor]. Science Products sells the Digi-Voice Deluxe module alone for $275 ($395 with glucose meter), and the Mini Digi-Voice modules alone for $199 (9-volt battery) or $219 (with AC adapter), or for $319 and $339 respectively, with glucose meter.

3.) The Touch-N-Talk voice synthesizer units: LIGHTHOUSE CONSUMER PRODUCTS, 36-02 Northern Boulevard, Long Island City, NY 11101-1614; telephone: 1-800-829-0500.

The Touch-N-Talk II voice synthesizer operates with the LifeScan One Touch II meter, and the Touch-N-Talk P voice box works with the LifeScan Profile. AGAIN, THE TWO UNITS ARE NOT INTERCHANGEABLE; VOICE BOXES DESIGNED FOR THE ONE TOUCH II WILL NOT WORK WITH THE PROFILE! Meter and voice synthesizer join by a 12-inch patch cord. A brief instructional cassette is included. The unit uses one 9-volt alkaline battery, not included. An AC adapter is available at an additional cost of $11.95.

Perhaps in the interest of engineering simplicity, the Touch-N-Talk units have simple on-off switches and traditional volume controls. These voice boxes lack any provision for automatic shutoff, and if you forget to turn them off, you can run down your battery. The Lighthouse sells the Touch-N-Talk voice synthesizers for $219.95. They sell the LifeScan meters for $149.95, or the combination for $369.90.

4.) The LHS7 Module, a voice box for the LifeScan Profile: LS&S GROUP, P.O. Box 673, Northbrook, IL 60065; telephone: 1-800-468-4789.

The small and light LHS7 attaches to the bottom of the Profile glucose meter by means of a Velcro patch, and operates through the meter's controls. Two-position volume control (loud and soft); AC adapter included in purchase price. English-language voice only; no audiocassette instructions are provided. Cost $199.

5.) The Diascan Partner talking glucose monitor: HOME DIAGNOSTICS, Inc., 2300 NW 55th Court, Suite 110, Ft. Lauderdale, FL 33309; telephone: 1-800-342-7226.

The Diascan Partner is unique in that its voice synthesizer is internal, part of the meter itself. There is no separate speech module to attach or cords to plug in. This slim, "user friendly" unit allows somewhat more leeway in application of blood to test strip—with care, blood may be "painted" onto the strip; all other speech assisted units require a hanging drop of blood. Powered by two AA batteries, weight is approximately eight ounces.

Some individuals with limited dexterity may find the Partner difficult to operate, as its test strips are designed to receive the blood outside the machine, on a flat surface like a table, so there is no strip guide to aid correct finger placement. Others may appreciate this feature, as it allows movement of strip to sample site, where others require movement of sample site to meter.

An over-the-shoulder tote bag with adjustable straps is included. An easy-to-understand audiocassette with clear operating instructions is also supplied. Suggested retail price is $399.

6.) BOEHRINGER MANNHEIM CORPORATION, 9115 Hague Road, Indianapolis, IN 46250-0100; telephone: 1-800-428-5074.

Boehringer is developing a new talking meter (in cooperation with Eli Lilly and Company), apparently based on their Accu-Chek Advantage glucose monitor. Diabetes Action Network members who have been involved in the testing process tell me the meter is much smaller than Boehringer's old "Freedom System," and contains a "bar code reader" to describe insulin type. I am told this meter will be released to the public some time this year. Boehringer has a fine reputation for accuracy, and this new product is eagerly awaited.

Medicare

Medicare recognizes home blood glucose monitors as "Durable Medical Equipment," and coverage is provided, for insulin-using diabetics, under Medicare Part B. As of July 1, 1998, this coverage is extended to diabetics who do not use insulin as well. Glucose meters without audio output have one specification on the "Fee Schedule" (EO607), and glucose meters with voice synthesis, or add-on voice boxes for home blood glucose monitors, have another (EO609). Be sure to follow all guidelines for reimbursement.

An Invitation to Manufacturers

Currently available "talk boxes" (speech synthesizers) make use of the same "data port" installed in the meter to allow interfacing with and downloading to a computer. For many monitors, the hardware is already in place, and adding speech compatibility should be a simple process. The National Federation of the Blind urges manufacturers to go the rest of the distance, and make talking versions of their monitors available to those diabetics who need and want them. NFB Resolution 97-12 (adopted at the 1997 annual convention in New Orleans, Louisiana) calls on monitor manufacturers to make their meters speech-compatible.

Hints and Tips

If an insufficient amount of blood is placed on the test strip, most meters will indicate "not enough blood." You may even have to prick your finger again! There are several possible explanations for this frustrating occurrence:

A. THE INITIAL DROP OF BLOOD WAS TOO SMALL: Some folks don't bleed enough. They can get more blood by holding hands below waist level for about 15 seconds, shaking them, and/or washing/soaking hands in warm water for a few minutes before the test. Warm water stimulates the flow of blood to the fingers. A slightly longer lancet, with deeper penetration, may help some. "Milking the finger" (squeezing it gently) can also help, as can wrapping a doubled rubber band between the first and second joint of the finger to be lanced. This will help cause the finger to become engorged with blood. Hold the rubber band down with the thumb while lancing. Remove the band as soon as you lance.

B. THERE MAY HAVE BEEN ENOUGH BLOOD, BUT IT WAS PLACED ONTO THE WRONG PART OF THE TEST STRIP: Some folks bleed fast, and may lose the blood off the finger before they're ready. By the time they get the finger to the test strip, the blood has fallen in the wrong place. A fast bleeder needs to work closer to the test strip, and perhaps to employ one of the blood placement aids discussed in this article. Users of the Diascan Partner should try bending up the tail of the test strip as an aid to location and placement.

C. SOME ENTHUSIASTIC PEOPLE, PLACING THE BLOOD ON THE STRIP, PRESS DOWN TOO HARD AND PUSH THE BLOOD OUT OF ITS CORRECT POSITION, SQUISHING IT ONTO THE WRONG PART OF THE STRIP. It is best to very gently deposit a hanging drop of blood onto the test strip. Marla Bernbaum, MD, writing in "The ADEVIP Monitor," offered the following suggestion, pertinent to diabetics with severe neuropathy (who wouldn't feel the otherwise painful fingertip "stick" she discusses here):

I have discovered another way to apply blood to the LifeScan test strip, which has been useful for several of our patients. This method allows them to stick the tip rather than the side of the finger. We use the same platform modification [described below], with a dot of Hi-Marks or t-shirt paint on each side of the strip guide near the depression where the blood is to be applied. For this approach the meter should be turned sideways. The patient can then place the pad of the finger on the raised dot perpendicular to the length of the strip and rock the finger forward so that the tip of the finger lines up with the depression on the strip and deposits the blood droplet in the appropriate place. This method increases the portion of the fingertip that can be used, and is preferable for some patients, particularly for those who bleed slowly and therefore must place the blood drop in precisely the right location.

LifeScan Modifications

If you use any of the LifeScan "One Touch" series glucose meters, some blood placement problems can be solved by modification of the Test Strip Holder (LifeScan Part #043-123, and note this same part fits all LifeScan "One Touch" meters). The idea is simply to provide tactile locating aids for finger location and placement of the blood sample on the test strip. A raised dot on either side of the test strip will work for some, but diabetics with limited sensation in the fingertips may find a U-shaped guide more useful. Most diabetics puncture the side of a fingertip, but those with severe neuropathy, who can't feel the lancet, and who prick the center of the fingertip, may be helped by the U-shaped guide. With practice, and the use of such tactile cues, blind diabetics can correctly place blood samples on the test strip.

(EDITOR'S NOTE: Thanks to Ann S. Williams, MSN, RN, CDE, for providing the modified LifeScan Test Strip Holders discussed here.)

The Test Strip Holder is detachable, and modifications as described will in no way interfere with the operation, accuracy, or cleaning of the LifeScan meter. LifeScan's Technical Services Department (phone: 1-800-227-8862) will provide a spare Test Strip Holder upon request, without charge. It is recommended that the modifications be to this spare.

The dots and U-shaped ridge were created with t-shirt paint, of the type that stands up sharply from a fabric surface. Upon application, the paint spreads a little, so apply sparingly. Best results come from "tack-painting," applying a small amount, then letting it dry (minimum 12 hours), with subsequent applications to build up the height. Practice first on some other material (posterboard or paper plate), as the paint can come out quickly. Be sure to have the Test Strip Holder OFF THE METER when applying the t-shirt paint. For best results, insert a test strip in the holder as an aid to placement of the dots or U-shaped ridge. T-shirt paint is inexpensive and is available at most craft and fabric stores. Although a full spectrum of colors is available, bright, contrasty colors like orange may aid in low vision situations. Brands and types vary; find one that gives you a nice hard tactile ridge. Some paints feel too rubbery. "Puffy paint" flakes off too easily. You may have to experiment.

Several vendors offer commercial alternatives to modifying the test strip holder. One slips over the LifeScan meter, and the other attaches directly to the test strip holder. Both devices aid in proper finger placement, and serve to guide the drop of blood more surely to the test strip. Science Products (address above, telephone: 1-800-888-7400), makes the Sure Drop, which slips over the body of the meter. The special Teflon-like coating on the surface of the device helps direct the blood, but can be damaged by bleach or a hard brushing—clean with mild soap and warm water. A Sure Drop made for the One Touch II will not fit the Profile, and vice versa. The unit for the Profile appears well-made and easy to use. Both units are priced at $24.95 each.

SMART DOT, 2655 West Central Avenue, Toledo, OH 43606; telephone: 1-800-984-1137: The Smart Dot clips directly to the test strip holder of ANY LifeScan "One Touch" meter. The same device fits Basic, One Touch II, and Profile. This plastic platform is easy to clean (both devices should be cleaned before the blood dries) and convenient to use, but there have been cases of it detaching from the meter in mid-test.

Don Kramolis and Gary Allman, Manual Skills Specialists at Blind Rehab Clinic, VAMC, Waco, Texas 76700; telephone: (817) 752-6581 ext. 7489, have developed the Waco-U-Finger Guide, which, like the Smart Dot, fits any LifeScan Meter. Much like the t-shirt paint described above, the Waco Guide helps finger orientation. The guide's other features help tactile strip insertion. Its designers do not sell finished guides, but offer plans and advice to interested individuals.

I have discussed the strengths and weaknesses of the blood glucose monitoring systems with voice enunciation currently manufactured. This evaluation should help blind diabetics and those losing vision, who are just as capable as the sighted of independently testing their blood glucose levels, and performing all the other tasks of daily diabetes self-management. Both blind and sighted diabetics are encouraged to consult with their health care team, and with individuals experienced in use of glucose monitoring equipment.

Choosing the most appropriate home blood glucose monitor is an important step in diabetes self-management. As blind diabetics increase their participation in the mainstream, efficient glycemic control is needed to maintain good quality of life. The Diabetes Action Network of the National Federation of the Blind, a support and information network, welcomes your input on blood glucose testing.