Devices for diabetes (Formularies)

TAM (Treatments and Medicines) NHS Highland
NHS Highland

Different meters on the market all require different testing strips/devices. Stocking many types of meter is potentially wasteful and can be confusing for patients and health-care professionals. The guidance given below is intended to help match glucose meters to individual requirements, bearing in mind that many of the type 2 diabetes population DO NOT require a multi-function meter. Therefore it is recommended that the  meters listed below are used in NHS Highland.

 All meters are subject to inaccuracies arising from:

  • Poor technique: lack of hand washing can lead to contaminated samples giving an inaccurate result. Wash hands with soap and water before taking a sample. Using just hand sanitiser may alter the blood glucose result.
  • Insufficient blood on the test strip: all of the advised meters use a capillary fill system so the strip ‘sucks up’ the blood rather than it being applied to the top of the strip. If the blood is incorrectly applied the meter will not work.
  • Temperature: meters and strips are designed to be most accurate at room temperature. If the meter is too cold it may not function.
  • Humidity will also affect test strips. They should be stored in the container with the top closed and used within manufacturers’ recommended time after opening.
  • Disposal of blood glucose meters Spirit Healthcare are able to collect old blood glucose meters (both their own meters and other companies' meters).  They recycle the meters and ensure none go to landfill.  The email address to contact is: cs@spirit-healthcare.co.uk
Avoid comparing results from different meters as different meters will provide varying readings leading to confusion.

Which patients should have glucose monitoring?

Patients who SHOULD monitor glucose Patients who should be CONSIDERED for glucose monitoring

Patients who do NOT need to monitor glucose
  • Individuals with insulin treated diabetes or being considered for insulin
  • Individuals with type 2 diabetes at risk of hypoglycaemia
  • Individuals who require to undertake blood glucose monitoring under DVLA regulations (www.gov.uk/diabetes-driving)
  • Pregnant women with diabetes
  • On steroids
  • At risk of hypoglycaemia
  • Elderly on sulfonylurea
  • At initiation of therapy
  • Renal impairment
  • High alcohol intake
  • Agreed management plan

Patients with type 2 diabetes managed with:

  • Diet and exercise
  • Combinations of:
    metformin, pioglitazone, SGLT2 inhibitors (dapagliflozin, empagliflozin) DPP-4 inhibitors (sitagliptin, linagliptin) and GLP-1 analogues (liraglutide, exenatide) in the absence of medication known to cause hypoglycaemia, ie sulfonylureas and insulin

Inappropriate glucose monitoring should be changed and stopped, if it is not required.

How often to test?

Testing UPTO 4 times per day 

 Testing MORE THAN 4 times per day

Is appropriate for:

  • Patients with type 2 diabetes using or being considered for insulin injectable therapy
  • Patients advised on an individual basis by an appropriate health care professional
  • Patients requiring short-term glucose testing.

May be required for: 

  • Patients with type 1 diabetes
  • Children
  • Evidence of impaired hypoglycaemia awareness
  • During pregnancy (including gestational diabetes)
  • Patients managed with a continuous subcutaneous insulin infusion (CSII by pump)
  • Control is poor or unstable; reduce testing frequency again when control is improved
  • Specific patients as advised by the specialist team
  • Patients who are carbohydrate counting
  • Other selected circumstances, eg for occupational reasons.

Capillary blood glucose monitoring (BGM)

For patients with type 1 or type 2 diabetes NOT on an insulin pump

Meter
Supplied by company.
GP practices to keep a stock of Accu-chek and CareSens meters.  

 Indication

Strips & lancets
To be prescribed

Accu-Chek Instant

Best for a basic economical blood glucose meter. 

  • Can be linked to MySugr app to support review of blood glucose levels remotely by healthcare professionals. 
  • Colour grading on meter to support patient knowledge of target range of glucose levels.
  • Includes FastClix finger-pricker for FastClix lancets. 
  • Adults with type 2 diabetes
  • Gestational diabetes

If patients are unable to use, eg visual problems, contact specialist services for an alternative. 

Accu-Chek Instant glucose strips

FastClix lancets

  • Enclosed in drum to minimise sharps injury. No need for separate sharps container.
  • Sharps container only required if prescribed non-safety needles for insulin.

CareSens Dual Meter

Tests blood glucose & ketones
  • Adults with type 1 diabetes
  • Children with diabetes
  • NOT for use in neonates

If patients are unable to use, contact specialist services for an alternative.

CareSens PRO strips

KetoSens strips

Adults: supply CareSens lancets

Children: supply (reusable) FastClix finger pricker and FastClix lancets 

  • Lancets are enclosed in drum to minimise sharps injury. No need for separate sharps container.
  • Sharps container only required if prescribed non-safety needles for insulin.

FreeStyle Precision Pro meter

  • Blood glucose monitoring: all hospital locations
  • Blood ketone monitoring: specialist areas only.
  • Hospital inpatients

FreeStyle Precision Pro glucose strips

FreeStyle Precision Pro ketone strips

  • Only as directed by Biochemistry

Vitrex sterile safety lancet

Continuous glucose monitoring (CGM) systems

MHRA advice: Insulin pumps and continuous glucose monitoring (CGM) equipment: guidance for users on reporting suspected adverse incidents and safety concerns to the MHRA’s Yellow Card scheme (October 2024) (www.gov.uk).

Continuous glucose monitoring measures real-time interstitial glucose levels.

CGMs are Specialist recommendation only, as per the eligibility criteria below.

Adults:

  • GPs can ONLY prescribe CGM for individuals identified by the Adult Diabetes Team who are eligible based on clinical need and the eligibility criteria below

Adult eligibility criteria:

  • Individuals with diabetes who are attending diabetes specialist services and treated with intensive insulin therapy, with multiple daily insulin injections, or insulin pump therapy, who are already performing multiple (5 or more) fingerprick blood glucose tests per day.
  • Individuals with recently developed impaired awareness of hypoglycaemia who are not yet candidates for (more costly) continuous glucose monitoring systems.
  • Women planning pregnancy.
  • Those who required a third party to perform monitoring, or where dexterity or disability denote that conventional testing is difficult or impossible.

Other criteria: 

  • Deemed by the team to have the required knowledge and skills to effectively self-manage their diabetes. This may include having undertaken a recognised diabetes structured education programme (eg HEIDI), and/or 1 to 1 carbohydrate counting.
  • Completion of the on-line Libre Academy modules at: https://freestylediabetes.co.uk/freestyle-libre/academy. Agreement to attend a locally provided flash glucose monitoring education session, or an on-line equivalent, if appropriate.
  • To agree to review glucose a minimum of six times per day.
  • To use sensors as recommended.
  • To agree to share glucose monitoring data with the diabetes clinic and complete any associated clinical questionnaires.

Ongoing prescription: 

  • Determined by the specialist diabetes team at review appointments.
  • Requires effective use of the technology to improve self-management, eg, reduction in hypoglycaemia, improvement in HbA1c, reduction in hospital admissions.

Paediatric patients:

  • GPs will be notified by letter by the Paediatric Diabetes Team if a specific patient has met all the requirements for these to be safely prescribed as per NICE NG18

Tel: 01463 701321 or email: nhshighland.childdiabetes@nhs.scot for any enquiries.

  • Offer real-time continuous glucose monitoring (rtCGM) to all children and young people with type 1 diabetes, alongside education to support children and young people, and their families and carers, to use it.
  • Monitor and review the child or young person's use of CGM as part of reviewing their diabetes care plan, and explain to them the importance of continuously wearing the device. 
  • If the child or young person is not using their CGM device at least 70% of the time
    • ask if they are having problems with their device.
    • look at ways to address any problems or concerns to improve their use of the device, including further education and emotional and psychological support. 
  • Commissioners, providers and healthcare professionals should address inequalities in CGM access and uptake by:
    • monitoring who is using CGM
    • identifying groups who are eligible but who have a lower uptake
    • making plans to engage with these groups to encourage them to consider CGM.

When prescribing CGMs, continue to supply blood glucose monitoring strips (on repeat or acute prescription) for the patient to order when needed, as the patient will still need to perform finger prick testing of blood glucose levels. 

Patients with type 1 diabetes, or who require to ketone test, will still require a supply of blood ketone testing strips.  

CGM system

  • Device is based on patient choice. The devices use different adhesives and therefore patients may find one device sticks better than another.
  • All CGM devices are water resistant (eg shower, swimming)
  • FreeStyle Libre 2 PLUS is licensed for use on the back of the arm only.
  • Dexcom ONE+ is approved for use on arm and abdomen (all ages) and the upper buttock (2 to 17 years).

FreeStyle Libre 2 system

  • 2-month supply: 2 x 2 FreeStyle Libre 2 PLUS sensors
  • Can be used for up to 15 days

Most patients will not require a 'reader' as monitoring can be done via mobile phone. Readers can be ordered for those patients who do not have a compatible mobile phone.

When a new ‘reader’ is ordered an envelope will be sent to return the old reader/ meter to Abbot for recycling. For further information, see: website.

Dexcom ONE+ system

  • 2-month supply: 6 x Dexcom One+ sensors
  • All-in-one sensor/ transmitter. No need for a separate transmitter
  • Can be used for up to 10 days, with 12 hour grace period for sensor replacement

Info:

Dexcom ONE CGM system This product is now discontinued.

For existing patients only. NOT for new patients
If changing to Decom ONE+ patient will need to download the relevant app

  • 3-month supply: 1 x transmitter and 3 x 3 sensor kits
  • Dexcom ONE Sensor: Can be used for up to 10 days.
  • Dexcom ONE Transmitter: (also to be prescribed)
    • Lasts 90 days, to be re-used across multiple sensors
    • Individuals alerted via the app when a new transmitter is required.

Info:

Patient with type 1 diabetes on insulin pump

For paediatric patient enquiries: contact the Paediatric Diabetes Team directly.
Tel: 01463 701321 or email: nhshighland.childdiabetes@nhs.scot 

Pump

 Indication Strips & Lancets

Medtronic 780G insulin pump
  • Adults with type 1 diabetes
  • Children as advised by the Paediatric Diabetes Team

Accu-Chek Guide Link meter

AccuChek Guide strips

FastClix lancets

  • Enclosed in drum to minimise sharps injury. No need for separate sharps container.

Ypsomed insulin pump
  • Adults with type 1 diabetes

No specific meter linked to pump

Medtrum insulin pump 
  • Adults with type 1 diabetes

No specific meter linked to pump

Medtronic 640G insulin pump 
  • Adults with type 1 diabetes

For existing patients only. NOT for new patients

Contour Next Link USB meter 

Contour Next strips

Contour lancets

Omnipod insulin pump
  • Adults with type 1 diabetes

For existing patients only. NOT for new patients

Omnipod handset

FreeStyle Lite strips

FreeStyle lancets

 

FreeStyle Libre 3 CGM system

  • For individuals using a compatible insulin pump with hybrid closed loop functionality eg Ypsomed / CamAPS FX.
  • 2-month supply: 2 x 2 FreeStyle Libre 3 or FreeStyle Libre 3 PLUS sensor kits

Sensor kit

  • Can be used for up to 14 days
  • Is water-resistant (eg shower, swimming)
  • When a new ‘reader’ is ordered an envelope will be sent to return the old reader/meter to Abbot for recycling.  For further information, see: website.

Adults with type 1 diabetes who use carb advisor

There is no longer a specific device for those 'carb counting'. Consideration can be given to mobile apps eg. My Sugr app and MyLife app.

Urinalysis

Ketostix test strips

 for detection of ketones in urine

Insulin pens

Lilly Insulin pen compatibility chart

Needles for pre-filled and reusable pen injectors

Place in therapy

Needles

 Notes

FIRST LINE

Most cost effective

BD Viva 4mm/32 gauge

  • Pack of 90
  • For adults who self-administer their own insulin.
  • For individual paediatric cases as determined by the paediatric team.

SECOND LINE

Those unable to use first line option

BD Micro-Fine Ultra 4mm/32 gauge

  • Pack of 100
  • specialist recommendation only
  • Diabetic team recommendation only for those patients who are unable to use BD Viva needles. 
ALTERNATIVE 

Less cost-effective 

BD AutoShield Duo 5mm/30 gauge 

  • Pack of 100

Only to be used:

  • In settings where third-party administration is required, eg, administration by district nursing or family member. 
  • For paediatric use where safety of exposed needles are a concern, eg, school environments. 
  • Where dexterity issues or fear of needles makes injecting difficult with standard needles. 

Editorial Information

Last reviewed: 24/04/2025

Next review date: 30/04/2028

Author(s): Endocrinology, Paediatrics.

Version: 1.6

Approved By: TAM Subgroup of the ADTC

Reviewer name(s): F Wilson, Diabetes Specialist Nurse, Community, M Sutherland, Diabetes Specialist Nurse, Community, F Ballantyne, Diabetes Specialist Nurse, Paediatrics, H Peel, Diabetic Nurse, Secondary Care, A Delaye, Diabetes Specialist Nurse, Pumps, K Maclean, Health Protection Nurse Specialist, Gestational Diabetes.

Document Id: F395