LifeAfterDx--Diabetes Uncensored

A internet journal from one of the first T1 Diabetics to use continuous glucose monitoring. Copyright 2005, 2006, 2007, 2008, 2009, 2010, 2011, 2012, 2013, 2014, 2015, 2016

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Location: New Mexico, United States

Hi! I’m William “Lee” Dubois (called either Wil or Lee, depending what part of the internet you’re on). I’m a diabetes columnist and the author of four books about diabetes that have collectively won 16 national and international book awards. (Hey, if you can’t brag about yourself on your own blog, where can you??) I have the great good fortune to pen the edgy Dear Abby-style advice column every Saturday at Diabetes Mine; write the Diabetes Simplified column for dLife; and am one of the ShareCare diabetes experts. My work also appears in Diabetic Living and Diabetes Self-Management magazines. In addition to writing, I’ve spent the last half-dozen years running the diabetes education program for a rural non-profit clinic in the mountains of New Mexico. Don’t worry, I’ll get some rest after the cure. LifeAfterDx is my personal home base, where I get to say what and how I feel about diabetes and… you know… life, free from the red pens of editors (all of whom I adore, of course!).

Saturday, March 31, 2012

Med-T’s BGL meter: UltraLink or UltraCrap?

(Alternate title: Everything you ever wanted to know about the UltraLink but were afraid to ask.)

Brew some coffee boys and girls, this is a long post.

I think that as a society we’ve finally admitted that size really does matter. And that’s the first of a great many complaints I have about the Medtronic-branded OneTouch UltraLink blood glucose meter: it’s too damn big.

It is, in point of fact, larger than the frickin’ pump. That’s just wrong. It’s every bit as heavy, too, at 3 ounces with batteries. And it’s thick. And clunky. And to add insult to injury, with all this size and bulk it doesn’t even sport a backlight.

All it does is check your fucking blood sugar.

Oh yes, and it sends that info to the pump. But that’s nothing new. Med-T meters have been talking to their pumps for years. Before BD pulled out of the test strip biz, they made a meter that talked to earlier generations of Med-T pumps. Of course, BD strips were absolutely miserable, especially on the low end, so Med-T is well rid of them.

But, with no more contract with BD, a clean slate—and with Abbott, AgaMatrix, Bayer, Roche, and a dozen more to choose from—this is all the better they could do? Do you really think a meter needs to be almost an inch thick to hold a radio transmitter? I doubt it.

So is there anything I like about the UltraLink? Let me think for a minute. Ummm… No. Nothing. Nothing at all.

It should be small, light, and sexy. It should match the color of your pump. (UltraLink only comes in one color: silver and navy blue.) It should have a screen backlight at a minimum, and preferably a strip port light à la FreeSyle Flash and 2nd Gen OmniPod. It should have an audio tone to let you know when it has enough blood on the strip, especially as the screen is darker than Hades at midnight during an eclipse, and we type 1s frequently need to test our blood sugar during the night and wee hours of the morning. And it should be a real self-coding meter.

Let me expand on that last point. If you wanted to own an industry (as in have all the money they make deposited directly into your Swiss bank accounts on the hour every hour), two desirable industries jump to mind. The first is the inkjet printer ink industry: the makers of the most expensive liquid on the planet with the exception of some cancer/chemo drugs. Yeppers, inkjet ink is more expensive per ounce than aged Scotch, French Perfume, whole blood, or Fiji Water—the last one arguably over-priced but very yummy and one of my personal favorites. The second industry that jumps to mind as desirable to own is the test strip biz, as strips can retail as high as a buck a pop, have a built in customer base who will literally die without the product, and is heavily subsidized by Medicare and most private insurance.

Of course, insurance companies are greedy bastards who don’t want to pay for anything, are quick to cut back-room “exclusive” deals for discounted prices, limit the number of strips a member can have and other nasty tricks. So what’s a poor strip maker to do to maintain their grotesque profit margins?

The historic approach has been to make the strips in a sloppy way, milking a few extra pennies of profit out of each strip. This makes an already inaccurate product even more inaccurate. The workaround is to “code” the strips. A code is simply a measure of how bad the quality control of a batch of strips is.

Coding can be done either with a “coding chip” that comes with each box of strips that plugs into the back or side of the meter (Roche style); or by entering a code number printed on the strip vial into the meter using the meter’s “Up” and “Down” arrow buttons (FreeStyle and OneTouch Style). The code communicates to the meter how much to alter the test results by to offset the sloppy production. Simply put, a code might tell the meter, oh this batch is reading 30% low; or that batch is reading 15% high.

I. Hate. Coded. Meters.

They’re the bane of my professional existence. Why? Because when a coded meter isn’t coded right, the results can be breath-takingly off. And I guarantee, any patient with a coded meter will, sooner or later (usually sooner), neglect to code it right. And that results in lots of lost time and effort, significant frustration, and a high risk of therapy errors that can hurt people.

Maybe even kill them.

Now the folks at OneTouch (a division of little company called Johnson & Johnson) are no fools. There were fighting the Abbott folks (FreeStyle) who jumped on the code-free band wagon early; as well as newer and smaller upstarts like AgaMatrix/Wavesense who were taking a bite out of J’n’J’s market share. But, of course, creating a self-coding meter also requires a fresh FDA approval. We all know what that means. Time. Lots and lots and lots of time. And wheelbarrows full of money, too.

So OneTouch did a fascinating workaround to turn their coded meters into no-code meters. They now only make Code 25 strips. Remember the movie Demolition Man where all restaurants were Taco Bell? Yep. J’n’J now only makes Taco Bell strips. So you code your meter once and forget about it. No more coding errors.

So why am I still sore about it? Well, because my time is valuable. Even seven seconds of it. And that’s exactly how long the stupid UltraLink presents me with a “Check Code” message before I can test my blood sugar. My old Presto meter was ready for blood in about a second-and-a-half after I put the strip in it.

I know, it doesn’t sound like that big a difference, but I can’t tell you how many OneTouch test strips I’ve ruined in the last couple of weeks by touching the strip to the blood before it was ready (and mind you, I stick the strip in the meter, then lance my finger).

Oh, but speaking of lancing, the cute little stubby lancing device that comes with the Med-T branded UltraLink is top-notch. I love this little one-handed wonder and have actually been using them with whatever other meter I’ve been using since they first came out. Best lancing device ever. It wins my Pulitzer Prize, Nobel Prize, and whatever honor I can find to heap on it.

But back to the miserable meter: I do actually appreciate the fact that UltraLink takes a pair of AAA batteries, rather than those crazy button batteries. AAAs can be found worldwide, even in the depths of the Amazon Rain Forest, should you find yourself there and your meter batteries kick the bucket. Now I recognize that my desire for both a small meter and one that takes AAAs may seem at odds, but a meter powered by a single AAA could still be very, very, very much smaller than the pump.

Another bummer is the UltraLink’s operating range, temperature wise. The manual states the meter will work from 43 to 111 degrees Fahrenheit. It does get above 111 at my house occasionally, but not very often. But this rules out leaving a meter in your car during the summer months for anyone leaving in the south or southwest. And on the low end, plenty of us d-Folk find ourselves needing to check our blood sugar below 43 degrees in the winter months.

The meter will read down to 20 mg/dL and up to 600. If you’re outside that range you’re in a world of fucking hurt anyway. Outside this range on the top you’ll get the friendly “Hi” greeting from the meter, and on the bottom it will announce “low.” Note that the sensor screens on the pump and Sentry will only tell you that you’re above 400. I guess once you’re in that DKA-friendly territory, it really doesn’t matter is you’re 500 or 600: You have an emergency on your hands.

The meter does have a bevy of other features that you’ll never use. So much so, in fact, that it comes with its own 82-page manual. The meter can be downloaded to a computer, but why would you want to? The data is all sent to the pump. You can download the pump data (delivery, alarms, overrides, etc.); the CGM data; and the meter data all at once, and have it all together in a single CareLink Report. UltraLink also lets you flag readings as being before or after meals, or add comments. Again, these features might be nice for someone using an insulin pen, but I don’t think they’re of much use to a CGM-enabled pump user. I would rather have had a backlight or a beep, thank you very much.

Speaking of features, the one useful feature that most meters have is the ability to scroll back across the last few readings. This is very handy during such adventures as severe blood sugar drops. It’s nice to be able to double check those last few readings before deciding how many more Butterfingers to stuff into your face. But this is no easy task with the UltraLink. First you have to turn it on with the “OK” button (pressing the “Up” or “Down” arrow buttons has no effect when the meter is off). Then you have to scroll down to “All results” and select it. God help you, if at this point, you make the mistake of pressing the “OK” button again, as now you are trapped in the comment menu. All three pages of it, including too much food, hard exercise, stress, menses, and vacation.

Give me a break, I just wanted to see my last several readings.

Now, I also want to take a moment to trash-talk the case the meter comes in. At least it has a belt loop. Many meter cases don’t any more. But that’s about the only good thing I can say about it. The belt loop itself is poorly designed with a half-inch of Velcro to hold it closed. I only used the factory belt case for about three hours and the meter fell off twice. The case is rather large at about four inches wide and six-and-a-half tall. It feels more like a courier bag on your waist than a cell phone case. It’s large, flaps as you walk, gets in the way of your arm, and is just basically annoying. And it’s ugly. It sports an outside pocket for a log book, as if any of us are actually going to write any readings down—they’re stored by both the meter and the pump.

Inside, the case features a very clever soft plastic molded meter holder that firmly grabs the meter (no more nasty clear plastic sheet over the meter’s screen!). There’s also a second contoured soft plastic holder for a vial of test strips, and an elastic loop for the lance. The UltraLink is a top-feeder, and the case is set up with the strips at the bottom. The whole rig could be used in situ without having to take anything out.

On the inside of the cover is the ubiquitous mystery zipper compartment all meter cases come with. What it’s for is anyone’s guess. Some people carry spare lancing needles in them. Why bother? You change your lance but once per year with your smoke detector batteries, right?

Oddly, there’re also two thick pads sewn on the top of the zippered pouch. They seem to serve no function, but perhaps they protect the meter’s screen from being scratched by whatever you might choose to put in the zippered compartment.

Back on day one, the 16th of this month, one of the first things I did after leaving the clinic was to drive over to Santa Fe and go to BestBuy. There I bought a Swiss Gear “Small Camera Case” measuring three inches wide by four and a half inches tall. The meter, lance, and strips all fit in quite nicely. It’s much smaller on the waist, and has a much more robust belt loop that’s sewn, not Velcro’d. The meter and the lance stand inside side-by-side and the vial of strips sits on top of them. I find it no problem to unzip the case and remove the gear when I need to test. If I acutally owned the meter, I’d probably Velcro the lancing device to the meter to make it even that much easier.

 So the bottom line is that there’s nothing “Ultra” about the UltraLink. It’s an astounding blend of a device that is supremely over-engineered on one hand, and missing even the most basic features a BGL meter should have on the other hand.

Oh, and it only gets worse.

Next time: looking at UltraLink’s strips


Blogger Jessica said...

I've used the UltraLink with my minimed pump. I have found it to be extremely accurate, at least when compared to my other onetouch meters - usually when I have a wtf reading and am sure the meter is on the fritz. Accuracy is just about all I care about, so I've been pretty satisfied but it does take up a hell of a lot of room the my purse.

And Wil, if you hit the little OK button when the damn code 25 screen comes up, it goes away immediately. Thanks for all the info!

5:04 PM  
Blogger Mike Hoskins said...

I use the UltraLink and do find it more accurate (more = key word) than other meters I've used. Love the syncing ability, but that's really just about it. I'm a creature of habit and just don't care to change. Meter so needs a backlight, and pretty much everything you've mentioned. Sooner rather than later, I hope...

4:16 PM  
Blogger Sara said...

The UltraLink WAS going to get a backlight in the 2nd generation of the product.

What? You never got a second generation UltraLink?

Yeah, blame that on the exclusive relationship between MiniMed and LifeScan ending.

6:39 PM  
Anonymous Anonymous said...


Your an idiot. After reading the start of your post and the F bomb comes out I stop reading. Any idiot can swear. You should stop bragging and clean up your mouth


9:55 PM  
Blogger Wil said...

Tom, if profanity upsets you so much, perhaps you should avoid reading blogs with titles such as "Diabetes Uncensored." Oh, and by the way, it should be "You're an idiot." Not "Your an idiot." If you are going to insult someone by calling them an idiot, it's a good idea to use proper grammar to avoid looking like one yourself. But that's just my fucking opinion.

8:09 AM  

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