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meter can give a precise reading, it is particularly effective in reducing the likelihood of hypoglycemia.

During the last decade meter technology has raced forward. Today’s meters offer a number of features that make them even more valuable tools in diabetes self-management. Today, meters are portable and can be as small as a pen or credit card weighing between one to eight ounces. Many of the meters have memories that can record values such as time and date of test results, insulin dosages, one-to four-week averages, and even diet and exercise recordings. Some meters allow the user to download values into a computer. Some meters even act as an alarm clock with multiple settings while others come equipped with a modem. While the many features available for blood glucose meters serve to enhance a person’s control of diabetes, the critical element is that a person with diabetes can now know his or her exact glucose level at any minute of the day. In addition, these advances allow physicians to accurately assess their patient’s level of control by looking at the actual readings a patient has obtained on his/her meter. This data makes it possible for physicians to accurately assess an individual’s risk for problems that might impair his or her ability to operate a commercial motor vehicle.

Advances in insulin have also taken place in the last ten years, including the development of insulin analogs that reduce the risk of hypoglycemia. In 1996, the FDA approved new, rapid- acting insulin called Lispro. Lispro begins working very soon after it is injected; therefore, Lispro may be injected 15 minutes before a meal instead of an hour as is customary. This allows the Lispro-user to eat meals on a less rigid schedule than with other forms of insulin. In addition, Lispro is cleared from the blood after two to five hours compared to twelve or more hours with other insulins. Since it leaves the bloodstream more quickly, Lispro reduces the chances of hypoglycemia several hours after a meal.

Advances in the injection of insulin have also promoted healthier people with diabetes. People used to reuse steel needles until sharp, disposable needles became more readily available in the mid 1980’s. Today, injection devices are available that look like a writing pen and carry several doses of insulin. A variety of other injection methods are available today including automatic, button and jet injectors. In addition, the rise in popularity of insulin pumps has taken out much of the human error in maintaining healthy lives. Many people prefer to use insulin pumps over multiple injections because the pumps offer a continuous system of insulin delivery. This, in turn, offers better glucose control and a more flexible lifestyle.

Outside of the supplies available to people with insulin-treated diabetes, the training available has also continued to improve. In the recent past, few insurance companies reimbursed for self-management education and training for people with diabetes. The result was that fewer people with diabetes monitored their glucose effectively and even fewer received extensive education on how to manage their disease. This has changed. Today, forty-six states and the District of Columbia require state regulated insurers to reimburse for supplies, equipment, and



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Balanced Budget Act passed by Congress included a Medicare benefit for education. As a result, the number of people with diabetes who receive rapidly increasing.

self-management education is now


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