Those Impossible Blood Glucose Meters!

In the Stanton Migraine Protocol and the Keto Mild for Migraine groups, both of which are filled with migraineurs, I require the regular measuring of blood glucose and blood glucose and β-hydroxybutyrate (blood ketones), respectively.

The reason why I ask for the β-hydroxybutyrate may be evident; I really want to make sure that “my migraineurs” are safe and are within the nutritional ketosis range. Why I also ask for the blood glucose check, may not be obvious.

Migraineurs are geneticallypredisposed1-3 and also with all the medicines they take4,5, they are much more likely to get metabolic disorders than non-migraineurs. Metabolic disorders lead to dire consequences, so it is essential to prevent them or to reverse any that has already started. Insulin resistance is one of the first signs of metabolic disorders and so checking for it is critical. Seasonal insulin resistance is not a disease—ask hibernating animals that use seasonal insulin resistance to “fatten up” for the hibernating period of starvation. Only chronic insulin resistance is a disease, but it is fully reversible. I find that in my two Facebook migraine groups, so far 100% of the migraineurs who tested their blood glucose have some insulin resistance at various levels.

There are many at-home blood glucose testing meters on the market. One would think that getting a reliable meter is as simple as buying one; after all they are FDA regulated. The problem is that the FDA provided a guideline that contains the following requirement to at-home blood glucose testing kit accuracy:

This final guidance now states that 95% of the meter results should be within 12% for glucose concentrations greater than 75 or within 12 mg per deciliter for concentrations less than 75 and that 98% instead of 100 of the meter results should be within 15% or 15 mg per deciliter of the comparator method. In cases where data points fall outside of these accuracy goals …  a clinical justification should be provided in the pre-market submissions for each of these data points along with a description of any other proposed mitigations.” (see here) and a sample is presented as follows:

FDA Guidelines

FDA Guidelines

Table 1 is on page 32 here.

Reality: ±15% is 30% Uncertainty

What the above table shows is that any blood glucose measuring kit for home use is considered to be “accurate” if it shows up to ±15% different result from an actual blood test of the same blood taken at the same time in a lab. However, this is a double-edge sword. Assume that a laboratory blood test shows 100 mg/dL blood glucose. The same blood tested at home can be anything between 85 mg/dL to 115 mg/dL, and that is FDA acceptable.

While each measure is only 15% away from the actual lab reading, the real range of inaccuracy is 30%. That is because one strip can show 15% lower reading than it should and another strip (from the same finger with two separate pokes, so 2 different blood drops taken at the same time) can show 15% above what it should. So with a 30% spread, how can we know what the blood glucose really is?

This may seem like a ridiculous point, after all, who cares if your blood glucose measure is 85 mg/dL or 115 mg/dL instead of 100 mg/dL. However, it gets a bit scarier when someone gets a test result that is below the lowest normal bs reading of 70 mg/dL and cannot tell if the result is correct or not. It can also get hairy if the blood glucose shows too high. For example, <99 mg/dL is considered to be normal fasted blood glucose. If 15% over is acceptable, an at-home reading may be 113.85 mg/dL, which is considered to be insulin resistant fasted blood glucose reading. So if you are trying to reverse your insulin resistance, does it matter if your at-home blood glucose tester shows 99 or 113.85? You bet! Major difference.

I found it interesting that the American Diabetes Association doesn’t list healthy ranges of blood glucose levels on their website, though that was the first place I went to look to see what the lowest healthy blood glucose level is. According to The Diabetes Council and Diabetes Self-Management, the lowest healthy blood glucose is 70 mg/dL. If you measure your blood glucose at home and end up getting 59.5 mg/dL, is that a problem? You bet! Blood glucose falling below 70 is a concern. In the 60s range you can manage for a short time without organ damage but once you reach below 60 mg/dL, your life can be in danger. So how can you tell if your bs is within or out of range on the lower end if your meter has a 15% allowance of being out of range either below or over?

One of my migraine group members has been collecting her data for some time and is now using 3 blood glucose meters—as do I—to use an average of the many readings to get a single data point! We take 3 readings each time per meter. Below are a few lines from this migraineur’s data collection together with the name of the meters used. Can you tell what her blood sugar really is?

Blood Glucose tests

Blood Glucose tests

Table 2. Blood Glucose Meter Comparisons

Note how she must resort to taking several blood samples from each of her several blood glucose meters to test each time. Is this acceptable? I would have to say no.

Look at the last line!! Her blood glucose measures go from 58 (dangerously low) to 82 (normal) at the same time, from different blood drops, all pricked at the same time from the same finger. Moreover, not every line of data falls within the ±15% FDA regulation either! So we have absolutely no idea what her real blood glucose measure is at any given time.

Let’s start an FDA petition to improve the quality of at-home blood glucose testing kits for those of us not sick enough for the “built in” (under the skin) devices those can get who are very ill.


1          Salmasi, M., Amini, L., Javanmard, S. H. & Saadatnia, M. Metabolic syndrome in migraine headache: A case-control study. Journal of Research in Medical Sciences : The Official Journal of Isfahan University of Medical Sciences 19, 13-17 (2014).
2          Bhoi, S. K., Kalita, J. & Misra, U. K. Metabolic syndrome and insulin resistance in migraine. The Journal of Headache and Pain 13, 321-326, doi:10.1007/s10194-012-0416-y (2012).
3          Sachdev, A. & Marmura, M. J. Metabolic Syndrome and Migraine. Frontiers in Neurology 3, 161, doi:10.3389/fneur.2012.00161 (2012).
4          He, Z. et al. Metabolic syndrome in female migraine patients is associated with medication overuse headache: a clinic-based study in China. European Journal of Neurology 22, 1228-1234, doi:10.1111/ene.12732 (2015).
5          FDA. Topamax Highlights of Prescribing Information, (2012).

About Angela A Stanton, Ph.D.

Angela A Stanton, PhD, is a Neuroeconomist focusing on chronic pain--migraine in particular--, electrolyte homeostasis, nutrition, and genetics. She lives in Southern California. Her current research is focused on migraine cause, prevention and treatment without the use of medicines. As a forever migraineur from childhood, her discovery was helped by experimenting on herself. She found the cause of migraine to be at the ionic level, associated with disruption of the electrolyte homeostasis, resulting from genetic variations of all voltage gated channels that modulate electrolytes and voltage in the brain, insulin and glucose transporters, and several other related variants, such as the MTHFR variants of the B vitamin methylation process and many others. Migraineurs are glucose sensitive and should avoid eating carbs as much as possible. She is working on the hypothesis that migraine is a metabolic disease. As a result of the success of the first edition of her book and her research and findings after treating over 4000 migraineurs successfully world wide, all ages and both genders, she published the 2nd (extended) edition of her migraine book "Fighting The Migraine Epidemic: Complete Guide: How To Treat & Prevent Migraines Without Medications". The 2nd edition is the “holy grail” of migraine cause, development, treatment and prevention, incorporating all there is to know. It includes a long section with for medical and research professionals. The book is full of academic citations (over 800) to authenticate the statements she makes to be followed up by those interested and to spark further research interest. It is a "Complete Guide", published on September 29, 2017. Dr. Stanton received her BSc at UCLA in Mathematics, MBA at UCR, MS in Management Science and Engineering at Stanford University, PhD in NeuroEconomics at Claremont Graduate University, and fMRI certification at Harvard University Medical School at the Martinos Center for Neuroimaging for experimenting with neurotransmitters on human volunteers, and is currently studying Functional Medicine. Dr. Stanton is an avid sports fan, currently enamored by resistance training and weight lifting, which she does three times a week with a private trainer. For relaxation (yeah.. about a half minute each day) Dr. Stanton paints and photographs. Follow her on Twitter at: @MigraineBook
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