Home Glucose Monitoring

NHSL Medicines Guidance
NHS Lanarkshire

General Notes

Due to the regular introduction of new products to the market, whether new technology and / or cost-effective systems, clinical staff involved routinely with teaching home blood glucose monitoring e.g. Diabetes Specialist Nurses, may assess meters which are not currently on the formulary. As such, there will be occasional requests for blood glucose strips that do not appear on this list. It is the responsibility of the requesting health care professional to highlight reasons for such requests.

GlucoRx Nexus Voice® (using GlucoRx Nexus® strips) is the preferred talking meter in NHS Lanarkshire.

Blood glucose monitoring 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 educated in the use of blood glucose monitoring systems and to take appropriate action on the results obtained if, for example, there has been a change in medication or lifestyle. Inadequate understanding of the normal fluctuations in blood glucose may lead to confusion and inappropriate action.

Blood glucose monitoring should be reviewed as part of an individual’s diabetes annual review to determine whether or not it provides a useful adjunct to therapy/education.

In patients with Type 1 diabetes, it is important to test for blood (or urinary) ketones where there is a significant risk of ketoacidosis, such as may occur with significant intercurrent illness e.g. infections. More frequent testing of ketones may be required during pregnancy. Test strips deteriorate rapidly if exposed to the atmosphere and have a limited shelf life.

All monitoring equipment should be subject to regular quality control testing to ensure accuracy and reproducibility of results.

Patients can register with diasend to download their blood glucose meters and obtain a profile of their results. The technology required to do this is available from the meter companies on request by the patient. If they also register with My Diabetes My Way (MDMW), their blood glucose profile can be viewed by their health care professional to help inform their consultation with them.

Basic Blood Monitoring

Contour Plus® test strip

  • Indication: Type 1 diabetes. Type 2 diabetes, where monitoring is appropriate as per NHSL guideline.
  • Meter: Contour Plus Blue or Contour Plus
  • Manufacturer: Ascensia

TEE2® test strip 

  • Indication: Type 1 diabetes. Type 2 diabetes, where monitoring is appropriate as per NHSL guideline.
  • Meter: TEE2+
  • Manufacturer: Spirit

Performa® test strip

  • Indication: For patients who received a Performa meter before December 2021. Type 1 diabetes. Type 2 diabetes, where monitoring is appropriate as per NHSL guideline.
  • Meter: Performa. This meter has been discontinued (December 2021), test strips remain available.
  • Manufacturer: Roche

Blood Monitoring for Paediatric Patients, or for Patients Who Require FastClix Lancing Device

Instant® test strip 

  • Indication: where use of the FastClix lancing device is required, as per Specialist Diabetes Team advice, for Type 1 and Type 2 diabetes. Type 2 diabetes monitoring as per NHSL guideline. Also used by paediatric diabetes service.
  • Meter: Instant
  • Manufacturer: Roche

Complex Blood Monitoring

Accu-Chek Mobile® colorimetric cassette 

  • Indication: Type 1 and Type 2 diabetes. 
  • Has built-in strip cassette plus attached finger pricker therefore recommended for patients with visual problems i.e. ease of use.
  • Meter: Accu-Chek Mobile
  • Manufacturer: Roche

Accu-Chek Aviva® test strip

  • Indication: For limited use in Type 1 patients who are carbohydrate counting; specialist staff recommendation only. 
  • Previously preferred meter for NHSL’s Type 1 group education programme.
  • Meter: Accu-Chek Aviva Expert
  • Manufacturer: Roche

The Aviva® Expert meter has been discontinued. Aviva® test strips remain available.

For NEW paediatric patients or paediatric patients requiring a replacement meter, the option is the Instant® meter. Please refer to information above.

Patients Who May Require to Ketone Test

GlucoMen® Areo Sensor for blood glucose

  • Indication: Type 1 and in pregnancy and on insulin
  • Both blood glucose and ketone strips are used with the same meter
  • Meter: GlucoMen Areo 2K/GlucoMen Areo GK
  • Manufacturer: Menarini

GlucoMen® Areo β-Ketone Sensor for ketones

  • Indication: Type 1 and in pregnancy and on insulin
  • Both blood glucose and ketone strips are used with the same meter
  • Meter: GlucoMen Areo 2K/GlucoMen Areo GK
  • Manufacturer: Menarini

The GlucoMen Areo 2K meter is being discontinued. Any new patients will be commenced on the GlucoMen Areo GK meter. The blood glucose and ketone strips remain the same for both meters.

CareSens PRO®for blood glucose

  • Indication: Type 1 and in pregnancy and on insulin
  • Both blood glucose and ketone strips are used with the same meter
  • Meter: CareSens Dual
  • Manufacturer: Spirit

KetoSens for ketones

  • Indication: Type 1 and in pregnancy and on insulin
  • Both blood glucose and ketone strips are used with the same meter
  • Meter: CareSens Dual
  • Manufacturer: Spirit

Patients on Insulin Pump Therapy

Contour Next® strips

  • Indication: Type 1 patients on insulin pumps
  • Meter: Contour Next Link
  • Manufacturer: Ascensia

Accu-Chek Guide® strips

  • Indication: Type 1 patients on insulin pumps
  • Meter: Accu-Check Guide Link
  • Manufacturer: Roche

Flash and Continuous Glucose Monitoring

Specialist initiation (S1): 

FreeStyle Libre 2®

  • FreeStyle Libre 2® is the preferred device for eligible individuals with diabetes who intensively manage their condition with multiple daily insulin injections or insulin pump therapy.
  • Use should be restricted to those who agree to attend a locally provided flash glucose monitoring education session, agree to scan glucose levels no fewer than six times per day, and satisfy their clinical team that they (or carer) have the required knowledge/skills to self-manage diabetes; for example, having attended a recognised diabetes structured education programme.
  • People with Type 2 diabetes are eligible if the above criteria are met and if they have recurring or severe hypoglycaemia and/or hypoglycaemic unawareness, and/or they have a condition or disability (including a learning disability or cognitive impairment) that means they cannot self-monitor their blood glucose by capillary blood glucose monitoring but could use a flash glucose device (or have it scanned for them), and/or require to test frequently.
  • All patients who use the FreeStyle Libre 2® will still require to finger prick test on occasion, such as periods of intercurrent illness.
  • Freestyle Libre 2® is not indicated for patients whose condition requires continuous monitoring of blood glucose.
  • A maximum of 26 sensors will be prescribed per patient per year.
  • If sensors are defective or fall off, patients should contact the manufacturer on the same day to obtain a replacement by calling the Abbott Customer Careline on 0800 170 1177. Specialists and GPs cannot issue prescriptions to replace defective sensors or those that have fallen off. 
  • Short video tutorials on FreeStyle Libre 2® can be found here.

MHRA alert for FreeStyle Libre 2®:

FreeStyle Libre flash glucose sensor – Use of barrier methods to reduce skin reactions to the sensor adhesive

 

Dexcom ONE®

  • On the advice of a specialist diabetes practitioner only, Dexcom ONE® may be prescribed as an alternative to FreeStyle Libre 2®. Eligibility criteria therefore is identical to FreeStyle Libre 2®.
  • Restricted to patients identified as being unable to use FreeStyle Libre 2®. Reasons for this may include, but are not limited to, skin reactions and/or patients not achieving glycaemic targets despite the use of flash glucose monitoring. 
  • Dexcom ONE® transmitters and sensors are available on prescription. The sensors last 10 days and the transmitter 3 months. A maximum of 37 sensors and 5 transmitters will be prescribed per patient per year.
  • Short video tutorials on how to set up the Dexcom ONE® device and apply the sensor can be found here.
  • Any patients who are experiencing issues with their sensor, transmitter or reader should contact the Dexcom Technical Support Team using the Support Request Form via the Dexcom website (here) or by telephone on 0800 031 5761. Specialists and GPs cannot issue prescriptions to replace defective sensors.

Up-to-Date Costs/Sizes

For up to date costs/sizes please see Scottish Drug Tariff (SDT).

NHSL Joint Adult Formulary Key

To indicate the category of a formulary medicine, updated sections adopt the following key:

Preferred list (P): First-line formulary choices.

Total list (T): Alternative choices when preferred list options not effective/not tolerated, or not indicated.

Specialist initiation (S1): Specialist initiation, or on the advice of a Consultant or Specialist Practitioner in this therapeutic area. Continuation in primary care is acceptable.

Specialist use only (S2): Supply via hospital, Homecare Service or a hospital based prescription (HBP) for dispensing by community pharmacy. Not prescribed in primary care setting.

Editorial Information

Last reviewed: 31/01/2022

Next review date: 31/01/2025

Author(s): NHSL.

Version: Please refer to the introduction section for an explanation of the review dates above.

Approved By: ADTC

Reviewer name(s): ADTC.