¾ Remove a test strip from its container. Close the
container immediately. The cap contains a drying
agent which ceases to function if the container is left
open, rendering the test strips unusable
¾ Check the round control window on the back of the
test strip against the color scale printed on the test strip
container. The color of the control window must match
that of the color interval at the top (mg/dL). If the test
strip shows a different color, do not use it
¾ Hold the test strip so that the application area and
arrows are facing upwards. Gently push the test strip
in the direction of the arrows into the test strip guide
of your Accu-Chek Active meter, until you hear it click
Inserting the test strip automatically puts the meter in
Test Mode. Please remember that your Accu-Chek Active
meter automatically turns off after about 1-2 minutes of
non-use (i.e. when no button is pressed). If this happens,
remove the test strip and repeat the procedure described
Now watch the display (Figs 17.3 and 17.4):
¾ The meter performs a display test lasting 2 seconds.
Check that all the segments making up the numerals
(“888” or “88.8”) are properly displayed. If a segment is
missing, test results may be displayed inaccurately (e.g.
through 9 being confused with 3). If this happens, call
your customer support and service center.
¾ The current code number then appears in the display.
Is this the number printed on the test strip container?
If not, check that your really did insert the coding chip
from the new pack. If “code” is flashing and you see
three horizontal bars (—) instead of a number, you
have not inserted the coding chip. You can still do this
now (while the display is flashing)
¾ Check that the correct date and time are displayed.
When the display test has been successfully completed
and the code number matches, your Accu-Chek Active
meter is ready for testing. The display screen that follows
¾ That the test strip has been inserted
¾ The flashing drop symbol is your cue to apply the
control solution (blood in the case of a real test).
To make quality control results stand out later from
blood glucose test results, you can place what is known as
a “flag” against them (Fig. 17.5)
with the letter “C”). You can insert the flag at this point.
If you pressed the S button inadvertently, you can press
it again (before testing is complete) in order to remove
FIG. 17.2: Test strips and controls and the instrument FIG. 17.3: Code key insertion
FIG. 17.4: Display with various symbols
application area of the test strip
¾ Your Accu-Chek Active meter beeps briefly to
acknowledge application of solution and to announce
¾ After 5 seconds a second beep signal indicates that
testing is complete, and the result appears in the
display. If you have not already flagged this quality
control result, you may do so now.
The value displayed here is an example. The result shown
on your Accu-Chek Active meter will not necessarily agree.
Now check that the displayed value is within the
permitted range. Examine the test strip container and
locate the “Accu-Chek Active Control” table (Fig. 17.6).
The table has two rows listed as “1” and “2”, as well as
two columns giving ranges in mg/dL and mmol/L.
¾ If you performed the test with Accu-Chek Active
Control 1, see row 1 for the permitted range
¾ If you performed the test with Accu-Chek Active
Control 2, see row 2 for the permitted range.
If the result is within the stated range, all you need do
still is carry out a visual plausibility test. It is important that
this check be performed within 30-60 seconds after control
solution was applied. Any later than this as comparison is
no longer possible owing to excessive discoloration of the
If the result is outside the stated range, perform a
second quality control test. If the second result is still
outside the range, please call your customer support and
¾ Pull the strip out of the meter. The result is saved as a
control reading (which is ignored when the averages
are calculated), and the meter switches off
¾ Turn over the test strip to reveal the circular control
¾ On the label of the test strip container is a color scale
with blood glucose values printed alongside. Select the
blood glucose value that best approximates the reading
¾ Compare the color of the control window with the color
you selected on the label (Fig. 17.7).
The colors must be a fairly close match. If there is a
great disparity, repeat the test. If you cannot obtain a close
match even after several attempts at testing, please call
your customer support and service center. If the colors are
a close match, quality control testing of your Accu-Chek
Active meter has been successfully concluded. The meter
is now ready to perform further blood glucose tests.
If the measurement optics or any other part of your
Accu-Chek active become soiled during testing, please
clean the meter as instructed in ‘Cleaning The Meter’
FIG. 17.6: Range reference values
Diabetes Mellitus: Laboratory Diagnosis 451
The standard power-on display test checks the most
important display elements. To verify that all of the
elements are functioning correctly, you can carry out a full
¾ Press and hold down the M and S buttons together for
¾ All the elements of the liquid crystal display (LCD) are
shown at once. Either “mmol/L” or “mg/dL” will be
visible depending on the country-specific setting
¾ Press any key to terminate the display test and turn
off your Accu-Chek Active meter. If you do not press a
key, the meter will shut off automatically after about 2
Your Accu-Chek Active meter has no moving parts and so
will not suffer any mechanical wear and tear. As with any
precision instrument, however, you will need to look after
it carefully to keep it as its best.
A potential infection risk exists. Medical staff and other
persons using Accu-Chek Active to test blood glucose from
more than one patient must be aware that any item coming
into contact with human blood is a potential source of
infection. (Please see “Protection of Laboratory Workers
from Infectious Diseases Transmitted by Blood, Body
Fluids, and Tissues”; Second Edition, Tentative Guideline,
1991, Document M29-T2, National Committee for Clinical
Accu-Chek Active utilizes an optical measuring method
that relies heavily on all of its components being clean. Be
sure to clean the meter, therefore:
¾ Whenever it is showing signs of soiling, however slight
(especially on the test strip guide or the measurement
¾ Whenever you open a new pack of test strips
¾ Every 2 months at the latest.
Clean the measurement optics carefully with nothing
other than cold water, soft lint-free cloths and cotton
swabs. For disinfection you may use 70% alcohol. Any
other cleaning agents may damage the meter or impair its
measuring function (Figs 17.9 and 17.10).
¾ Slide off the test strip guide towards you (see illustration)
¾ After removal of the test strip guide from the meter,
¾ Afterwards you may wipe the test strip guide with 70%
FIG. 17.8: Power on display of the instrument
FIG. 17.9: Maintenance—opening the cover
FIG. 17.10: Maintenance—cleaning the optics
guide and allow it to dry thoroughly
¾ Wipe the measurement optics components with a
soft lint-free cloth and/or a cotton swab. The cloth/
cotton swab may be slightly moistened. Make sure that
no liquid enters the meter itself. Avoid scratching the
measurement optics, as this will impair the measuring
¾ When all of the components are thoroughly dry, you
may slide the test strip guide back onto the meter.
Ensure it clicks back into place. Then perform a quality
¾ Do not carry out a test where the meter and test strips
are exposed to direct sunlight
¾ If the light is too bright; a symbol will appear in the
display of your Accu-Chek Active meter
¾ If you see this symbol, find a shady location to carry out
the test, or use your own body as a screen
¾ Avoid measuring in places where the light level is very
changeable. Flash photography, for instance, can affect
¾ Relative humidity must be below 85%
¾ Sudden changes in temperature cause condensation
within the meter. You may find that you are unable
to turn on your Accu-Chek Active. Allow the meter to
return slowly to room temperature, and never keep it
in a room that is likely to harbor condensation (e.g. a
¾ Strong electromagnetic fields (found, for example, near
mobile telephones, CB stations and microwave ovens)
may affect the meter’s performance. Accu-Chek Active
detects this type of interference and displays an error
message. Indoors stay at least 2 meters away from such
sources of interference; if necessary, move somewhere
DCA 2000 Plus Analyzer (Figs 17.11A and B)
Accuracy, Precision, and Reproducibility with the
Convenience of In-office Results
The DCA 2000+ analyzer is a point-of-care diabetes
management platform that performs both hemoglobin
A1c and microalbumin/creatinine tests in minutes.
The DCA 2000+ allows healthcare professionals to
make immediate diabetes management adjustments.
Quantitative measurement of HBA1c in blood allows
effective preventative treatment to reduce the risk of
retinopathy, nephropathy and neuropathy in patients with
diabetes. The system also measures low concentrations of
albumin, creatinine and albumin/creatinine ratio in urine.
The method permits decentralized testing using random
urine samples, enabling early detection of complications
associated with renal disease.
FIGS 17.12A AND B: DCA 2000 plus analyzer
Diabetes Mellitus: Laboratory Diagnosis 453
¾ Totally self-contained reagent cartridges-no reagent
Intensive Management Improves Glycemic Control
¾ Maintaining average blood glucose levels (120 mg/dL;
6.7 mmol/L; HbA1c 6%) lowers risk of complications
¾ Three to four times daily blood glucose monitoring is
¾ Establish and follow a coherent approach of combined
nutritional counseling, self-management training, and
possible hospitalization for therapy initiation.
Reduce the Risk Monitor HbA1c Levels
¾ HbA1c results monitor glucose control over the
¾ Complete normalization of glycemia levels may prevent
¾ Quarterly HbA1c determination recommended for all
¾ Recommendation also includes test for handling
¾ Sample collection capillary holder is an integral part of
¾ No costly, time-consuming calibration-factorycalibrated instrument eliminates all wet calibrations
¾ Screen displays all instructions, calibration status, and
testing information and results
¾ Up to 16 results stored in memory for convenient record
Laboratory-Accurate Results Just Minutes After
¾ Review during patient visit, adjust blood glucose
control regimen as appropriate
¾ Conforms with current guidelines for effective
¾ Guide and reinforce your patients to maintain target
¾ Quantitative HbA1c value in 6 minutes from capillary
¾ Monoclonal antibody method provides outstanding
¾ Correlation study shows 99% agreement with the HPLC
Microalbumin/Creatinine Ratio…in Minutes
¾ Achieving and maintaining near normoglycemic levels
will delay onset of microalbuminuria and clinical
¾ One reagent cartridge provides results for both
microalbumin and creatinine as well as an automatic
calculation of the albumin to creatinine ratio
¾ Quantitative results and calculated ratio displayed
within 7 minutes using random urine sample microalbuminuria and others, as indicated.
Detect Early Stages of Diabetic Nephropathy—
Protect Your Patient from Complications
¾ Intensive diabetes management delays the onset of
microalbuminuria—an early indicator of renal disease
¾ Microalbumin-to-creatinine ratio from a random urine
sample is as valid an indicator of microalbuminuria as
¾ Persistent microalbuminuria (30 to 300 mg/day)
indicates the earliest stage of diabetic nephropathy
¾ May also signal presence of hypertension and the need
to begin antihypertensive therapy
¾ Test for microalbuminuria should be performed yearly
on postpubertal patients who have had diabetes for at
100 V to 240 V (0.4 A) 50/60 Hz.
Ambient Operating Temperature Range
Ambient Operating Humidity Range
Liver Function Tests can be Classified as
a. Tests of excretion by the liver
b. Evaluation of synthesis in liver
c. Evaluation of enzyme activity.
Liver function tests are most often employed to
determine: (i) the presence of liver disease, (ii) the type of
liver disease, and (iii) the extent and progression of liver
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