We felt it was important to highlight a problem that we encountered with a bedside glucometer and a patient with end stage renal failure on continuous ambulatory peritoneal dialysis. Vast discrepancies between true venous glucose levels and those estimated by certain glucometers in this situation can be problematic and dangerous. Not all glucometers are the same: they differ in their ability to estimate glucose levels. The Advantage (Roche) and Accutrend Sensor (Boehringer MannHeim) glucometers both use the glucose dehydrogenase enzyme reaction to estimate glucose levels. Certain dialysates, including Extraneal (Icodextrin), contain significant amounts of long-chain non-glucose-reducing substances. Such substances are metabolized by glucose dehydrogenase and lead to falsely elevated glucose readings. Precision Q.I.D (Medisense) and Glucocard (Merarini Diagnostics) glucometers analyse glucose levels using a different enzyme, glucose oxidase. Long-chain non-glucose-reducing substances do not interfere with glucose calculations based on this enzyme.
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