Is Your Meter Out of Control?

Patient Expert

Your doctor probably never told you that you need to check your blood glucose meter regularly with the control solution made for it. The chances are that you don’t use a control solution, and in fact, you may never have heard this term before.

Our doctors and other medical professionals rarely discuss using a control solution. It usually doesn’t come with our blood glucose meters. And your local drug store probably doesn’t carry the one that your meter uses.

But the U.S. Food and Drug Administration, the International Organization for Standardization (ISO),  and the American Diabetes Association all recommend that we often check our meter with its control solution.  Probably every owner’s manual for all of the blood glucose meters on the market has the same message. Something is seriously out of whack here.

A control solution is a solution that mimics blood and that is used to test the accuracy of a blood glucose meter and test strips, says the Manual for Pharmacy Technicians. It is specific for a particular meter and may come as low, normal, or high control. The solutions can be categorized as “Level 1” or “Level 2,” representing low or high control. The expiration date of the control solution varies by manufacturer and can range from three to six months.

Most Never Use Control Solution

A survey of 18 people in the Bay Area of California who have type 1 diabetes or parents of children with it showed that 58 percent of them never used a control solution. Note well that these are people who rely on insulin, which requires rather precise blood glucose meter readings.

Only the abstract of this survey, “SMBG Out of Control: The Need for Educating Patients About Control Solution,” in the September-October 2013 issue of The Diabetes Educator is online. But a friend sent me a copy of the full-text.

Another survey, “An Evaluation of the Barriers to Patient Use of Glucometer Control Solutions,” this one of people with diabetes in Tulsa, Oklahoma, showed that only 23 percent of the 60 people with diabetes use a control solution. This survey was presented at the 2014 annual meeting of the American Association of Clinical Educators. Two-thirds of the people in the survey said that they didn’t use it because they didn’t know about it.

Almost half – 44 percent -- of the 29 doctors who responded to the survey said they never recommend using a control solution. They aren’t sure that it’s needed with newer blood glucose meters, or they check the meters against the clinic’s instrument, or they didn’t think about it.

14 Situations to Use Control Solution

Checking a meter against one in a clinic or lab is one of three ways that the FDA recommends to see if the meter is working well. Another is to rely on the electronic checks built into the meter. But this agency of the U.S. government that is responsible for the country’s blood glucose standards recommends that you “test your meter regularly with control solution.” The FDA suggests that you use a control solution:

1. Every time you open a new container of test strips

2. Occasionally as you use the container of test strips

3. If you drop the meter

4. Whenever you get unusual results

Added to this list are eight more situations when you need to use a control solution, according to what six of the major meter manufacturers recommend:

5. Check monitor performance to make sure it is working properly

6. Results do not seem accurate or reflect how patient feels

7. Confirm that test strips are working properly or to check whether they are not working properly

8. Practice testing without using blood or for proper technique

9. Vial of test strips is damaged, left open, exposed to extreme temperatures or humidity

10. New monitor

11.  Once per week

12. Advised by health care professional

As if this isn’t already enough, I found yet two more recommendations

13. Occasionally as you use the vial of strips

14. When the machine has just been thoroughly cleaned

We have a big disconnect here between what the organizations and meter manufacturers say to do as this recommendation is funneled down through our doctors to the people with diabetes that it directly affects. To help resolve this issue I turned to two good friends of mine who work on the front lines with us.

A Recommendation to Use Control Solution

The best way to make sure our meter and strips are working properly is to test it against a big lab equipment at the same time, notes Margaret Leesong, a vice president of i-SENS, which makes blood glucose meters and test strips. “But this is not easy for us to do, while control solution testing can be done at home. Aside from any error messages that the meter shows, control solution is the only thing we have to check if we can continue to count on our meter and strips.

“I think that control solution testing is like wearing a seat belt,” Margaret continues. “Even when we are not likely to have an accident, we take precautions.”

A Recommendation to Recheck Blood Glucose Instead

On the other hand, Karen LaVine, a Certified Diabetes Educator in Albuquerque, New Mexico, is less supportive of using a control solution.

“I rarely talk to patients about using a control solution,” she told me. “But I do frequently discuss what to do if someone gets an unexpected blood glucose result.

“I recommend the following steps,” Karen continues. “Recheck your blood glucose, following the recommended procedure exactly. Wash hands well (even if it's a second time), dry with clean paper towel, put fresh lancet into lancet device, and recheck blood glucose with a fresh strip, being careful to obtain an adequately sized sample easily. If the second reading is significantly different from the initial reading, then recheck your blood glucose one more time to help estimate your current blood glucose.

“Having to use two to three strips occasionally is almost always going to be a lot quicker than fiddling with a control solution. That's because once you open a bottle of control solution, it's only good for three months. So if you get a questionable blood glucose result and want to run a control test, your current bottle is highly likely to be expired.”

Karen’s conclusion is that for patients testing at home the use of a control solution could be helpful only very rarely. I tend to agree, but think that some people will benefit from using it in some situations.

When a doctor told me almost 22 years ago that I have diabetes, he didn’t even mention that such a thing as a control solution for blood glucose meters exist. In the many years since then no doctor or other medical professional who I have seen as a patient has ever said anything either. Maybe this is because I have never used insulin.

Should People on Insulin Use Control Solution?

After considering all aspects of this knotty situation, my feeling it that I don’t think that we should go to extremes and say that everyone who has diabetes needs to check his or her blood glucose meter in all of or even most of these situations.

But certainly all people who uses insulin to manage their diabetes have to be sure that the blood glucose meter they use is reasonably accurate because too much insulin can lead to a dangerous low blood glucose level and too little to a dangerous high blood glucose level. Those of us who rely on insulin do need to be sure that the blood test results they get are as accurate as possible.

I’m not so sure about the rest of people with type 2 diabetes who aren’t on insulin. Does anyone with diabetes who is reading this far and isn’t on insulin regularly use a control solution with his or her blood glucose meter?

See more of my articles about how to manage diabetes:

How Often Should You Check Control Solutions for Blood Glucose Meters

_Comparing Diabetes Blood Glucose Meter Accuracy _

Operator Error in Diabetes Testing

Don’t Waste Your Time and Money on Diabetes Testing