This evaluation was originally done in March, 2000, and is re-posted
here with the permission of the author. Since this evalutation was
completed, technological evolution has rendered this meter as not
advisable to most people that have tried it.


As I promised earlier, I have gotten one of the new At-Last meters as
seen
in "Parade" this past Sunday.  I have thoroughly studied the
documentation
and instructions twice and viewed the instructional video twice and
talked
with Amira Medical's help line twice.  I have tried the meter
sufficiently
so that I can offer the following report and analysis of my experiences
with
it.

OVERVIEW

The hype that the At-Last meter eliminates finger sticking is something
of a
myth.  While it is true that finger sticking is not required, a lancet
is
required to penetrate the skin in other body parts to support the test.
Those named parts are the upper forearm, the upper arm and the thighs.
This
was a real disappointment to me, because I doubt that anyone dislikes
finger
sticking more than I.  In addition, the lancet required by the device is
considerably thicker (larger gauge) than the lancets I currently use
with my
present lancet holder.  Not being one to leave a penetration site
without
first sterilizing it, I still had to use an alcohol swab with this
device,
and, while it is true that this procedure produces less pain than a
typical
finger stick, the residual burning, stinging sensation leaves you aware
that
your skin has been penetrated.  Later in this report, you will read
that I
tried to use the device at several different locations, and it was quite
apparent at some of those locations that the lancet had been used --
much
more so than marks ever left by finger sticking.  My overall evaluation
is I
would not recommend the At-Last meter.  You may continue reading if you
wish
to see the supporting details I developed to support my recommendation.

THE TESTING PROCEDURE

The device is designed so that the lancet holder and test strip holder
are
integrated as a part of the overall system.  This is somewhat more
convenient than having a separate lancet holder and needing to
manipulate
two devices as a part of the system.  The system comes with two lancet
holders to provide different penetration depths.  I tried both and
didn't
detect appreciable differences between the two.  A calibration strip is
included in each package of test strips and must be inserted into the
meter
and left there as insurance that the proper strips are being used.  I
initially had difficulty in inserting the calibration strip, and called
customer support, and we finally decided to open a new package of test
strips and try the calibration strip from that package.  It worked, and
we
were another step closer to testing.
Producing the blood sample is another matter.  The user's manual suggest
that you start with the middle part of the forearm.  That should have
been
my first clue: the "start with" part, because there was more.  The
device
needed to be cocked or loaded to cause the lancet to pierce the skin.
The
test strip was inserted and the meter turned on.  The next step was to
locate the device on the selected test site and release the lancet.
After
hearing it click, I held it for nominally three seconds.  Following
that,
and not removing the device from contact with my skin, I "pumped" it up
and
down very slowly from four to seven times.  The instructions said five
times, but customer service provided the additional window.   If all
worked
well, when the device was finally lifted from the skin, a test droplet
of
blood remained.  Then, I positioned the "beak" on the test strip
to "sip"
the sample into the meter.

MY EXPERIENCES

After a number of frustrating attempts to get the test procedure to
function
as suggested by the manual, I called customer service.  They suggested
that
instead of the top of my forearm I try the inside of my forearm.  I
did, and
the penetration there hurt more than any finger stick I ever had.  And
today, 14 hours later, the marks from those three attempts are still
visible.  The customer service representative next suggested that I try
my
upper arm or thighs.  I told her that was not acceptable because I was
unwilling to unclothe (even partially) in order to take a glucose
reading.
We went back to the forearm, and she suggested that the reason that site
didn't work was the hair on my arm.  I do have fairly thick hair on my
arms,
and that apparently caused the sample to smear and not properly form.  I
complied with here suggestion that I shave a part of my forearm.  But
before
that, having spent considerable time wondering if the meter would work,
I
did a finger stick and used that as the test sample.  The meter seemed
to
work just fine, producing results in about 15 seconds, so I knew that in
order to use the full system I had to master the sampling procedure.
With
renewed vigor, I went to the shaved test site and repeated the
recommended
procedure.  Voila!  The sample was finally adequate, and the meter
produced
my reading.  Total elapsed time from beginning the test until getting
the
reading was about 25-30 seconds -- 10-15 seconds to manipulate the
lancet
and 15 seconds for the meter to respond to the sample.  Given that this
was
a totally new procedure, it may appear more cumbersome than it would be
if I
were doing this on a regular, continuing basis.  In all fairness, the
user's
manual says that certain medications can affect the amount of blood
produced
for the sample.  It says that people on heart medication (and I am) may
need
to regularly use more press and release (pumping) motions and, in
addition,
may need to massage or warm the area using warm running water or a warm
cloth to bring more blood to the site.

SO, WHAT'S NEW?

About the most radical thing I experienced that was new and different
was
the procedure for getting the test sample -- and having to shave the
hair
off the test site on my forearm.  The small sample requirement of 2
microliters is not new and is the requirement of at least one other
meter
from a major manufacturer of which I am aware.  The integration of
lancet,
test strip, and meter was also new to me, but of marginal significance
at
most.

SO, WHAT'S MISSING?

I was sorely disappointed that the meter had no more recording/reporting
flexibilities than it does.  It has no time and date indicators for each
reading, and while it allegedly will produce a 14 day average of
tests.  It
will display only the most recent 10 individual readings.  It has no
ability
to transfer the readings to a computer or for other information such as
insulin amounts and exercise/activity amounts to be associated with a
particular reading.  These latter capabilities are available on some of
the
more advanced meters (admittedly at higher costs) in the marketplace.
While
I was writing this, I called customer service and asked how many
reading in
total could be retained in memory.  The answer was 100.  I asked, then,
how
the meter knew out of a potential of 100 readings, how many were
required to
produce the 14 day average.  They don't know, but are "researching it
and
will call me back."  I have written a ton of computer programs over the
last
39 years, but so help me, I can't figure out how they are able to do a
14
day average if there is not some internal clock to indicate which
readings
are done on each day.  It would be even more egregious if your testing
schedule changed from day to day, say one test today, four tests
yesterday,
and six tests tomorrow.

SO, WHAT DID MY DOCTOR SAY?

I told my endocrinologist about this "new breakthrough" in glucose
testing.
He said that the long-term solution to finger sticking rests in totally
non-invasive or minimally invasive technology, and that the At Last
meter is
neither.  He called it "gimmicry."  Having spent a great deal of time in
procuring and testing this system I reluctantly and regrettable must
agree.

SO, NOW WHAT DO I DO?

While finger sticking is still no party, I will continue with my present
lancets and meter.
My recent discovery of Becton-Dickinson's B-D Ultrafine II lancets has
been
a godsend.
The lancets fit my lancet holder, as they do many such holders, are very
thin (28 or 29 gauge) and have taken much of the pain and soreness out
of
finger sticking.  I use an alcohol swab both before and after the finger
stick, which seems to have lessened the soreness and the tell-tale
marks on
my fingertips.  My meter requires on two microliters of blood to
operate, so
that also reduces the need for a "colossal finger stick"  I used to use
what
looked like a gargantuan lancet that felt like a railroad spike going
into
my finger.

SO, IS THIS THE END?

Finally, and I'm sorry it took me so long to say so little.  :)
.

--
Try gentleness and kindness -- it comes with a
30-day money back guarantee.  If, after that time
it doesn't work, you can return to being your
mean, ugly self !!!


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Before you buy.