With all of the monitors in-hand and unpacked, it was time to inventory the included accessories and start setting up the meters for their initial tests. Most name-brand meters come packaged with cases, lancet devices, and starter-sets of strips, lancets, and control solution. There are occasional surprises -- Therasense's packaging of the original Freestyle and Freestyle Flash did not include any starter strips -- but for the most part, these are a "given". When we start to examine lesser-known brands and private-labels, everything changes. The Bionime Rightest 300, it seems, either uses a standard USB cable or includes the USB connector cable in the starter kit. On the other side of the coin, many off-brand meters do not include starter strips -- and some don't even include cases or lancet devices. The following table lists the accessories that did, or did not, come with each of the meters I am testing.
Provided Accessories
| Meter | Aviva | Freestyle Lite | One Touch Ultra2 | One Touch Ultra Mini | Keynote | Advocate Duo |
| Case | Yes | Yes | Yes | Yes | Yes | Yes |
| Lancing Device | Yes | Yes | Yes | Yes | Yes | No |
| Test lancets | 12 (2 6-lancet cartridges) | 10 | 10 | 10 | 10 | n/a |
| Control solution | Level 1 (low) only | Yes | Yes | Yes | Yes | No |
| Test strips | 60 (10 + 50) | 10 | 10 | 10 | None | None |
State of Device as Delivered
Except for the Advocate Duo, all of the devices arrived with batteries installed, but not protected. This can be an issue with retail-purchased meters, which may have been warehoused for months before being delivered to you. Fortunately, none of these meters has shown "low battery" issues so far.
Of all the meters, the Keynote was the only meter that did not require additional setup before it could be used. (Specialized settings -- alarms and hypo/hyper levels -- still needed manual setup.)
Setup Notes
- Other than the ready-to-use Keynote, the One Touch Ultra2 was the easiest to set up -- just follow the onscreen instructions, which conveniently pop up when you press the "on" button. I needed to consult the manuals of all of the other meters just to complete the basic set-up. Except for the Ultra2, all the meters needed me to consult the manual in order to adjust the time and date, to program the user-settable alarms, hypo/hyper alerts, and volume levels. In addition, the Advocate Duo, needed me to confirm the operating language and preferred units of measure (for both blood glucose and blood pressure measurements).
- The Advocate Duo was the most difficult of the devices to set up for a number of reasons: the dedicated "set-up" button is small, recessed, and needs heavy pressure to activate -- not at all user-friendly for the older, vision-impaired patient With peripheral neuropathy and/or grip issues. In addition, the dedicated "memory" and "on/off" buttons kept confounding my attempts to change the default settings.
- The Freestyle Lite was more challenging than I expected, coming from the Freestyle and the Freestyle Flash -- the new on-device analysis functions are accessed through changes in the user-device interface. Until I consulted the manual, I could not get the device to set up properly, or to shut down afterwards.
- Without a dedicated "next" button, the One Touch Ultra Mini challenged my patience by requiring me to wait five seconds (or longer) between menu items, and having to cycle back through the whole setup menu every time I missed something.
- I had some minor issues setting the batch codes on both the Ultra2 and the Ultra Mini.
Initial operation
Control Solution Calibration
The Aviva, Keynote, and One Touch meters are all able to automatically sense their control solutions and mark the readings appropriately. Control calibration tests still need to be manually entered on the Advocate Duo and the Freestyle Lite. On the Aviva and the Duo, control tests disappear from the scrollable memory.
Calibration Tare -- Sacrificing Strips to the Control Solutions
- The Advocate Duo uses two separate control solutions, requiring two calibration strips per vial. Combine this with 25-strip vials, and even with perfect tests, there is a built-in minimum calibration tare of 8 strips per 100. (Ouch!)
- The One Touch strips, also packaged in 25-strip vials, use a single control solution, resulting in a 4% minimum calibration-tare. While the Aviva has two separate control solutions, the intro kit contained only the "low" solution. Using the single calibration test, the Aviva's 50-strip vials would have a 2% minimum calibration tare; using both calibration levels raises that percentage up to the same 4% as the One Touch Ultra strips.
- Both the Keynote and the Freestyle Lite have single-level control solutions and 50-strip vials, resulting in a calibration tare of 2%.
Sample Collection
Perhaps it's because I'm used to meters whose strips stick out the bottom, I had some initial difficulty maneuvering the One Touch Ultra2 and the Advocate Duo into position to collect blood properly.
The Duo goes through a longer boot-up routine than the other meters, reporting not just the code number but also the ambient temperature, before indicating that it is ready to accept blood. The long set-up time caused me to waste an extra strip along the way.
For the most part, the 0.7 microliter sample sizes required of the Keynote, Aviva, and Advocate were not so much larger than my normal draw to cause difficulty filling the strips. The 1.0 microliter required by the One Touch Ultra strips is a slightly different issue -- the strip's capillary absorption has seemed to be so much slower than the device's maximum fill time that of 23 test attempts (over both One Touch meters), I've wasted six strips. I've had similar issues with the Aviva, wasting four strips over 14 test attempts. This behavior could pose an issue for people who have precision-muscle control issues -- people with arthritis or Parkinson's disease, and people shaking because they are dropping really low, really quickly.
Practical Features
The Freestyle Lite, Aviva, and Keynote have user-settable alarms which should (in theory) remind you to test. The volume, however, is low enough that the alarm is likely to be missed if the meter is in its case, and that case is tucked into your pocket, handbag, or desk drawer.
The Freestyle Lite, One Touch Ultra2, and Keynote all have backlights to improve contrast and to assist testing in lower ambient light. In addition, the Freestyle Lite -- like the Flash before it -- has a port light, illuminating the strip and the blood drop you are trying to feed into it.
The Advocate Duo and the One Touch Ultra2 both have English-or-Spanish language options.
The Aviva has a user-settable hypo alert; the Keynote has user-settable alerts for both hypo- and hyperglycemia. The Keynote and Advocate Duo both show ketone flags for blood glucose levels over 240 mg/dl.
All of these meters show temperature alerts when you try to test outside of the device's operating range.
Bells and Whistles
I've often used the "control" setting on the Freestyle Flash to mark a second reading when I've been unsure of the first one's accuracy. While I can't do that on the current generation of monitors, the Aviva allows me to attach a generic "flag" to a reading, and the Ultra2 gives me a number of pre-specified flags, plus preprandial/postprandial markings. The Keynote separates readings as "breakfast", "lunch", "dinner", and "bed", but the time slots are not user-definable -- not good if you work an evening or night shift, or if you travel a lot between time zones.
All of the meters except the Ultra Mini give a selection of averaged readings over 7-, 14-, or 30-days (or longer). The Keynote provides these graphically as well as numerically; it also provides average readings based by it's built-in meal-period time slots. The Ultra2 gives preprandial and postprandial aggregate averages as well as full-day averages.
All of the meters have the potential for data download to a computer for further analysis and permanent archiving.
Next up, we'll start looking at numbers.