Diabetes Self-Management Blog

Have you looked at test strip prices and thought, “These should be made of gold?” Well, they are made of gold, along with other costly chemicals. But some cost 16 cents apiece; others cost $1 to $2. Why this range? What price is right?

Spurred by some comments from DSM reader John C, I decided to research test strips, and they’re amazing. In fact, I will need two columns to explore them and the issues involved in their best use.

To understand how test strips work, you would need to know quantum mechanics and electrochemistry (whatever that is), and I don’t. Here’s the part I could understand:

Modern strips work by measuring the electrical energy in glucose in the blood. According to an article by Erika Gebel, PhD, in Diabetes Forecast, Electrochemical test strips, the world standard today, employ enzymes…that convert glucose into an electrical current. That electricity…is read out by the meter as a glucose concentration.” It’s much faster than the old way, which was based on reading a color change, and requires much less blood.

Apparently, working with enzymes is hard. “You want hydration around the enzyme to keep it active, but not too much because that will lead to degradation,” says Selly Saini, the worldwide director of strip products for Johnson & Johnson. “That’s a fine balance.”

Because they use enzymes, strips are delicate. According to Dr. Gebel, exposure to humidity or temperature extremes can damage the enzymes, reducing accuracy. But “strip makers have partly tamed enzymes and increased their life span by incorporating chemicals that stabilize them.”

So the colored patch at the end of the strip includes absorbents to soak up blood and enzymes to turn it into electricity and stabilizers to protect the enzymes. Then the electric current goes down circuits printed on a thin film of gold to the meter, where a computer chip turns it into a numerical reading.

It makes you wonder why strips don’t cost more than they do. But according to David Kliff, founder of DiabeticInvestor.com, “To manufacture the most advanced test strip is no more than 15 cents per strip.” Kliff, who has Type 1 diabetes himself, estimates that manufacturers reap a 70% to 80% profit on strips.

Strip makers don’t think that’s a fair way to look at it. Todd Siesky is a group manager of communications and external relations at Roche, the company that makes Accu-Chek brand products. He says,

The cost of our strips includes their research and development, state-of-the-art production, comprehensive quality processes, verification, clinical and analytical performance studies, continued process improvements, and ongoing compliance to all regulatory and government standards.

Roche’s plant in Indianapolis, turns out over 4 billion test strips a year. And that’s just one manufacturer. Other strip manufacturers are in North Carolina and Florida, so at least they are made in America. You can see a promotional video that shows strip production here.

How accurate are they?
The Food and Drug Administration requires meters to be accurate, but not that accurate. For results at or above 75 mg/dl (4.2 mmol/l): 95% of meter test results must be within plus or minus 20% of the actual blood glucose level. So, if your meter reads 100, that could mean anywhere from 80 to 120.

For results below 75 mg/dl: 95% of test results must be within plus or minus 15 points of the actual blood glucose level. So a reading of 70 means 55 to 85.

That sounds like a wide range, but Donald Powers, PhD, chairman of the technical committee at the International Organization for Standardization says,

Meters are pretty much at the limits of their technology. They’ve tried to make [them] as small and easy to use and painless as possible. There are trade-offs between performance and convenience. Unless these things are painless and convenient, people aren’t going to [use them].

It seems that most or all brands of strips are close to equally accurate. According to Powers, most test strips have similar designs and are made in roughly the same way. Even so, they’re different enough that using one meter’s strips in another meter will likely give an inaccurate result.

Even the same brand of strip will vary from batch to batch and even within the same container. If you read reviews of almost any kind of strip, you’ll see some raters saying they’re excellent and consistent. Others say their numbers are “all over the place.”

Some companies’ products will have good quality for years and then one or several batches will be recalled for inaccuracy. It’s confusing.

The ways we use them also affect accuracy. According to DSM editor Ingrid Strauch, “Improperly used or stored strips are one of the biggest sources of error in home blood glucose monitoring.” Using expired strips or using strips made for a different meter are other sources of error.

Because you never know when you might be getting a bad strip, experienced testers like our reader John C “always keep a second meter for ‘quality control’ if I don’t believe the reading I’m getting. As a serious tester I find this important.”

Then there are the questions of price, why prices vary so much, what insurance will pay for, and what doctors will order. Also, how many do we need? These issues are as complicated as quality.

I’m out of space, though so we’ll have to address these next week. To help out, please let us know your views on meters, strips, and their prices.

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Comments
  1. Hi,

    I’ve been testing for over 10 years - primarily using a name brand. One thing I found was that my morning reading never came close to the morning lab reading taken within 10 minutes of my own reading. Also my A1c did not track closely with my averages. In the past year I switched to the WalMart ReliOn brand with consistent results, even taking a reading at the same time from a new container. Persons paying cash may want to give this a try and see if they’re results match or are more consistent than what they’re using.

    Posted by oliver |
  2. As long as a product it for diabetic use–the price goes up. Prices of strips are way too high and after a lot of looking up these things–the company is making tons of money selling them. We’re all be gouges by all the greedy companies.

    Posted by A. Ryan |
  3. I’ve been testing my blood sugar for over 33 years and my how meters have changed in that time. Thank God for that. I am also currently using Walmart’s Reli-On meters as my husband lost his job and our insurance was dropped. I find the Reli-on meters to be just as accurate, and nothing beets their price. Even with my current insurance coverage name brand strips would cost me more. So I choose to stay with what is affordable.

    Posted by Kathy |
  4. I do not personally have diabetes but my boyfriend of 3 years does. I have learned a lot from this experience. Before my relationship with him, I have a cousin and her husband who received a patent on a machine to measure blood sugar levels without needing a blood sample, it was all done through the skin. AMAZING development, but was shot down by many companies because of it’s “non-revenue” producing capabilities. You didn’t have to buy anything except the first initial investment, which made the companies less profitable. Never went into production and most like won’t ever be produced. It’s sad to me that its only about the money and not about the people with the disease. Also, I find it agrevating that there is no generic brand of insulin. Once again, not about the people with the disease.

    Posted by tammy |
  5. This information needs to be widely known. It explains why my glucose readings are sometimes way off from my expectations. In general, it is my daily readings that are not consistent with the A1c tests in the doctors office, but the overall average of my individual readings generally corresponds to the A1c lab reports. So even though individual readings may disappoint and alarm me, over time the results are fairly consistent. In future I will view some of my highs and lows as possibly incorrect, and not become so alarmed. The consistency of individual readings over a week should help me know how the glucose control is trending so I can regulate my eating, rather than a daily guide. I have used three different brands of meters over 18 years as a type 2 diabetic and not noticed any significant differences in the brand accuracy.

    Posted by Juanita |
  6. Medicare has changed their way of patients getting test materials.
    You used to be able to get them through your regular rx source but now you have to get them from a contracted supplier.
    Good luck on that.
    I have tried several of the available vendors and none are making my AccuCheck Aviva Strips available so they all want to change you to another device.
    And I believe things are going to get worse with Obama Care.

    Posted by Jock A. Soutar |
  7. Excellent column, I appreciate this information. Regarding pricing, it seems to me that with the quantity manufactured, since diabetes is at epidemic proportions. the price could be lower, but being a cynical person,I think that pharm. companies will reap the rewards as much as possible.
    Enjoy your newsletters.

    Posted by Cathy |
  8. In my experience different meters are different in their ability to give accurate readings at hypoglycemic ranges. The only one that I have used that has been reasonably accurate is the one touch meter. The accucheck meter got me into serious trouble because of its inaccuracy at hypoglycemic ranges which sent my blood glucose bouncing like crazy. It would tell me my BG was 90 when the one touch meter that I was using to calibrate my new cgm said it was 40. No wonder that when I relied on the accucheck meter I was getting so many extremes. Switching back to a one touch meter was a major help in stabilizing bg. Ever since I test any new meters I try against the lifescan meter. When I ttold this to my dr she told me that the lifescan meters were the only meter (at that time) that was reasonably accurate at hypoglycemic ranges.

    Posted by msheriff |
  9. So if each strip has a “thin strip of gold” in it, is there a way to turn in the used strip for recycling and maybe get back a few cents per say 10? My son’s testing 10 plus times a day and those used ones pile up. Is it ok for us to put them in the trash with the “chemicals” in them? At least these meters are better/more accurate than the old system of drops of urine in a test tube with that solution my Mom had to do 60 plus years ago. Thanks for the info!

    Posted by Winona |
  10. I always used the Accu check meter that used the drums and was so handy. Now I can no longer get the drums and had to go to a new meter. I was told that I had to pay for the new meter on Medicare and they charged $68. That same meter cost $14.98. That is disgusting. Nothing like taking advantage of diabetics.

    Posted by Ferne |
  11. If all glucometers test results are different, then who’s to say what is accurate? I had 4 different meters at one time and one day sat down and tested my blood sugar with them all at the detriment of my poor fingers. Of course, I received 4 different readings. So, again, what is accurate?

    Posted by Dawn |
  12. I’m at the mercy of my insurance company for my testing supplies. They change meters a lot. I kinda doubt it’s because of accuracy.

    Unlike some, I seldom have very high or very low readings so accuracy is less important than consistency. It’s not like I look at my meter and say, oh gosh, I have to eat, or oh gosh, I should take some insulin with the next meal. For me, it doesn’t matter so much what a given number is as how the numbers are trending. Even if my meter is inaccurate by, say, ten points plus, as long as it’s consistently inaccurate I can still use it -like a watch thats always five minutes fast.

    Posted by Joe |
  13. Some comments:

    Comparing individual meters is tricky. One has to have two meters loaded with strip and then do a single hit of the lance and then quickly load both meters from same blood sample. Otherwise one has to average out readings for a while and then compare averages.

    Blood in the arteries/ veins are not totally consistent and in fact glucose content is usually varying quickly with time and the sources of glucose in body - intestines, liver et all do not load on even amounts of glucose and tend to shoot it in blasts and drops not evenly metered out. So with same meter one cannot get similar readings in short intervals of time.

    Another left unsaid lie is the fact that some meters and strips read only glucose D that body cells burn and some read all sugars in blood and provide a total reading which as long as man made sugars in your body do not escape past intestines/liver one can have readings 40 to 100 points or more off. That story is politely deleted and the guff peddled is all meters read the same.

    For me that is at fasting in early morning after intestines are doing nothing. Two hours after a meal is when the fun begins for me. On the non specific glucose d meter strip systems; I can see readings 40 to 100 points to high. Some meter strip systems have filters built in to block interferors as well as cope better with water and oxygen.

    For some of us who have blood systems that are running at the edge of ranges of a meter/strip of the water content, hemocratic ( red blood cells) and oxygen content may find some meters/strips read better-more consistently than others.

    Posted by jim snell |
  14. Are the companies sticking it to the Americans? Many drugs are cheaper in Europe, Canada, and Japan because the drug companies do not charge them for development. This needs to change.

    Posted by Dennis Tisdale |
  15. I agree with Kathy. The Reli-on test strips are very valid at an extremely economical price. My insurance deductible for the other strips is higher than the Reli-on brand. Additionally with my FBS’s and my A1c…they are very in line with the strips.

    Posted by Mike |
  16. I have been using a Breeze2 by Bayer for several years and appreciate the 10 test disc it includes…however like other meters I have used there can be variances. I am a senior on Medicare and find it unfortunate that they only allow one test a day unless we are on insulin. I thought the objective was to keep ones blood glucose in check so it did not progress to insulin and greater complications.

    Posted by Maridel |
  17. Interesting subject - thanks for posting it.

    I have not had any difficulty with test strips since their availability. Yes, occasionally I get a higher than usual result and just test again, with the same meter, and the result is within the range I thought it should be. Comparing meters is not the way to go in my view as when I used to do this my 2nd test was way off what the 1st one was. I stopped comparing and followed what my trusted meter said - no problem developed.

    Of course, on occasion, we will have a unusual result. Then we need to ask did we do something different today? Count our carbs incorrectly, ill of just goofed somehow? I think that any of the meters since I began using them [decades ago] have been accurate as much as possible. I work with the numbers I have before and after meters arrived on the scene.

    For 56 years I have lived successfully with Type 1 as I follow my doctors’ and CDE’s suggestions and they listen to me, also!

    Naturally, my way does not mean that others do not have a good method of control also. We must never forget we are individuals and the results may/will differ. Frequent testing, using one meter as often as needed is the answer, at least for me.

    As soon as test strips became available tracking BG levels became much more accurate. My doctors over the years told me to not compare meters. I tested this theory and found this to be true.

    I have a Medtronic insulin pump now, use One Touch meter and test strips. Recently I found out that the One Touch meter will be discontinued. So I switched to the Contour Next meter and test strips - working just fine.

    The bottom line: My meter works just fine as long as I stick to my method of control without too much variance. I sometimes cheat a bit on carbs, then must up my insulin amount accordingly and usually get by with my indulgence. but not always! :0((

    Therefore, it is not always the meters’ fault or my insulin pump when my BG is too high - its me! Stress, ill or big goof–up! Think we need to realize this more than than some of us do, at times?

    Posted by joan |
  18. I use only the one-touch as it works with my insulin pump as well as CGM. My insurance made me change last year to the freestyle…hated it! cheap… cheap …cheap. My control got worse. Then the insurance changed again (without bothering to even tell me) and I am now able to get the one touch strips again though a tad more exspensive. Very Happy!

    Posted by Don Irvin |
  19. why are readings differ on right hand and left .i use accuacheck

    Posted by luis v galan |
  20. Great job David!! Keep up the good work and I will be looking forward to your next column.

    I have had Type 1 diabetes since 1952 and have gone through urine testing, urine test strips and all of the “innovations.” I have my wild tests and I have just changed meters as my pump has requested, plus as Joan says sometimes it can be me.

    Posted by Roger Beathard |
  21. I got 7 meters all come up with different readings most like with 20 units…right now one touch is the one I use the most and KAISER ONLY USES THAT… STRIPS ARE $30.00 FOR 400 AND .80 CENTS FOR 100 LANCETS INSULIN IN $30.00 FOR 4 BOTTOLES OF R AND 4 BOTTLES FOR N NOT TO BAD ….

    Posted by WILDOMARMF |
  22. Thanks for the tip about the Reli-On meter. I will look into this for my second meter to compare results. My readings with my Bayer Contour have generally been substantiated by the A1C. However, never has my fasting reading agreed with the lab results taken a short time later. Generally the lab has a higher reading. However, before cataract surgery, the hospital took my fasting reading with a meter and their reading agreed with my own results before I left for the hospital. I believe they also used the same brand meter, which is the reason for the agreement, no doubt.
    Thank you for a very informative discussion.

    Posted by Lynne Nelson |
  23. I purchased a ReliOn meter and strips from WalMart recently. When compared to my two Accu Check meters, the ReliOn read 20 - 25 points below my meters. (the Accucheck ’s were within 5 points of each other at all readings. I called ReliOn about the discrepancy and they sent me a new meter that now reads within 5 - 8 points of the AccuCheks at all readings.

    Posted by William Flanigan |
  24. Medicare is the major problem. My Dr. suggested that I test twice a day. Medicare will only cover 1 test per day IF YOU ARE NOT TAKING INSULIN. I am only on Metformin, which I take after every meal or snack,therefore, Medicare will only cover the purchase of 100 strips every three months. That only leaves 10 strips for errors, etc. My secondary medical plan covers the balance that Medicare does not pay. I do not have any co-pays.

    With the change in Medicare suppliers, they only have 20 suppliers left. They have lost more than 90% of suppliers, including the one I used. I use Bayer Contour. I had trouble finding a supplier that handles them, so I wrote to Bayer and they gave me a list of their four remaining suppliers. I contacted Koell’s Pharmacy in Omaha, NE and they accepted my condition after my Dr. verified my prescription. It was quite an ordeal, so I hope no more changes will happen in the future. Thank you for the opportunity to discuss these problems.

    Posted by Charlie |
  25. HI:
    I was recently informed that the company that I was receiving my strips for the one touch meter were no longer going to be supplied to me.
    I was sent a Solus talking meter and new testing strips, I am not a happy camper.
    No.1 - I do not care for the talking meter and
    No.2 - My readings each time I test is much higher than they had been previously and my diet has remained the same.
    I really don’t understand this, but I truly believe there is a difference in the meter or strips.
    I truly miss my one touch ultra 2 meter and would like to know how I could get my strips for this?

    Posted by Helen |
  26. All my testing supplies are from outside the United States. I want to have them made in the United States. I need to have accuracy as I control my blood glucose level with diet. All meals are less than 19 grams of carbohydrate. I haven’t heard of an American made meter, and testing equipment, including lancets.

    Posted by Winnie Powell |
  27. to helen:

    Amen to that. I agree with writer’s concern and frustration.

    I ended up going to my Doctor for prescription specifying in prescription the meter, model and strips that work and ended up going to my local drug store and got it filled.

    I used to use mail order from a company in Florida and got nastily harassed for the last 2.5 years almost every 3 months attempting to reduce strip quantity and under new program set up by medicare on mail order I found they wanted to supply different meter. All meters are not the same and some of the cheaper stuff has issues. I do not understand why the government is butting in on this. My read is they can set their fixed reimbursement rate but we should be free to select the meter that works best for us and if necessary pay an extra premium.

    Posted by jim snell |
  28. I’ve used the same meter for the last 10 years.

    I don’t understand why so many people have so many different meters.

    Stick to one meter (no pun intended) If you stick to the one meter your readings are going to be what they are. Just go by what they say.

    Why try to create problems when in fact there is none.

    Posted by Lady Needles |
  29. To Helen and Jim:
    I have to do the same for test strips (specifying the meter brand, model and the test strips it requires). Ditto on the government staying out of my healthcare choices, when what I have been doing has been working and keeping me healthy.

    I use the one touch ultra meter and test 4-6 times daily. It is reliable. I too had difficulty in finding a test strip supplier. I’m new to Medicare and finally found that Kroger would do this for me. Medicare required my doctor to send a new script verifying that I need test strips and the quantity. (I’m still new to this, but I think the doctor has to send “info” to the supplier each time I order.)

    I use an insulin pump and I’ve not been able to get pump supplies. I’ve contacted Medtronic, who makes the pump, but no response from them yet.

    Seems as though this supposedly Affordable Healthcare Act IS NOT to our benefit??? From the comments from these postings, we are not only concerned with the cost of test strips, but would agree that all diabetics are not alike. (Of course we aren’t!) I believe we are being seen by as “cookie cutter” diabetics. One size should fit all???

    Posted by Donna R West |
  30. To Winnie:
    Check online for American made. Lots of brand names are mentioned in these posts. Maybe one would be right for you. Also, your doctor and/or dietician should have information to help you make the right choice.

    Posted by Donna R West |
  31. I’m responding to those using accu-check aviva meters & strips… CCS medical in Florida supplies
    both accu check and one touch strips.. No need to change.
    As a matter of fact, as a last resort you can complain to medicare..

    Posted by gerry c. |
  32. I found this article very interesting. I started using a BG meter about 3 years ago. I am a retired electrical engineer and in my work I did a lot of development of measuring instruments. When I saw that these BG meters are only +/- 20%, I thought this was outrageous. I talked to my pharmacist about this and he did not understand what my concern was. I would never have been satisfied with this kind of accuracy in any of my professional work. I felt +/* 3% was excessive, but it does depend on what you are measuring. And it is true that more accuracy equates to more money. I never worked in the medical field, so don’t know what would be the norm for that. I do get the calibration solution with each 90 day supply and use it when opening a fresh package of strips. They will vary from about 85 to 120 when the norm is supposed to be 100. But this is the way it is I guess. Just my two cents worth.

    Posted by BobC222 |
  33. This story from last year seems promising-

    Glucose testing in India for less than 4 cents per test. But it is too good to be true? It’s been over a year, and the product has not been released yet.

    “Blood sugar test for Rs 2, in 10 seconds”

    Kounteya Sinha, TNN Jun 29, 2012, 01.15AM IST

    http://articles.timesofindia.indiatimes.com/2012-06-29/india/32471571_1_blood-sugar-glucose-levels-diabetes

    NEW DELHI: India is all set to unveil a path-breaking test for diabetes that will save both money and blood.

    The Indian Council of Medical Research (ICMR) is almost ready with a new digital finger-pricking blood sugar machine that will not require repeated use of testing strips. Significantly, it will cost less than Rs 2 per blood sample and require 1,000 times lesser blood than what glucose meters use now. Even better, it will take only 10 seconds to know your blood glucose count.

    Being developed by professor of biological sciences at BITS-Pilani, Dr Suman Kapur, the test will undergo final evaluation by July 15 and is expected to be ready for mass production by December….

    Posted by Mark |
  34. Test strip accuracy from one mfg. to another is of no pressing concern to me, being a type 1 diabetic. I think if you stick with one you will be fine. What is disturbing is the profit drive of the industry. It seems that all terminable diseases are driven for profit instead of cures. Why does healthcare cost so much in the US as opposed to Canada, Japan. India and other countries? If we are the world leaders. Then why are we doing so poorly in helping our own in healthcare?

    Posted by Williv |

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