Diabetes Self-Management Blog

Two weeks ago I asked how often you self-monitor your blood glucose. Many readers answered, “A lot!” OK, but HOW do you monitor? Doesn’t it hurt? Fingertips are among the most sensitive places in the body. How do you reduce the pain and discomfort of monitoring?

I’ve long wondered why it was necessary to use fingertip blood for self-monitoring. What’s so special about fingers? They are full of nerve endings and are an important way of exploring and enjoying the world. It’s a loss if we scar them too much.

In an article posted on this site, Marie Rosenthal, MS, quotes David L. Horwitz, chief medical officer of the Johnson & Johnson Diabetes Institute: “In people who have been testing for a long time, the fingertips get sore and callused, and they can lose their sense of touch.”

Rosenthal said that would be particularly tough on musicians and surgeons. But what about tailors? What about lovers? If we don’t have to abuse our fingers, we shouldn’t. Are there other ways to monitor?

According to the makers of the Accu-Chek brand of meters, monitoring from the sides of the fingertips is less painful and just as accurate as monitoring from the pads of the fingers. And what about the rest of the body?

According to Rosenthal, you can check from alternate sites including the palms, arms, thighs, and calves. “You should only check your blood glucose using sites that have been specifically approved for use with your meter,” notes Evan M. Sisson, assistant professor at the Virginia Commonwealth University School of Pharmacy. Meters usually come with an insert or user guide that gives you the approved sites.

The question for alternate ways of monitoring is, “do they give results that are as accurate as a fingerstick?” Meter manufacturers must test their meters to find out. For a site to be approved, the results must be within 20% of what a laboratory blood test would show.

Because fingertips have better circulation than arms or legs, a fingertip result will be more up to the minute. According to this BD Web page, an alternative site might give you your blood glucose level as of 20 or 30 minutes ago. If your blood glucose is changing fast, like after eating or exercising, after taking fast-acting insulin, or when you’re sick, it’s better to use a fingertip. Most experts say fasting and premeal sticks can be from alternate sites but postmeal sticks should be from fingers.

It can be a problem to get enough blood from a less-painful site, although newer meters need less blood. It helps to wash the area in warm water, slap the skin, rub the area briskly, probably exercise the arm, and push up and down on the lancing device after inserting it.

What has been your experience with alternate-site testing? Does the discomfort of fingertip monitoring keep you from checking as much as you would like? What other options are there?

Monitoring Without Punctures
Several methods have been developed to minimize or eliminate fingersticks entirely. Some continuous glucose monitors allow people to insert sensors as little as once or twice a week.

The sensors analyze glucose from the tissue fluid under the skin, not from blood. It seems they’re not totally reliable and have to be frequently checked against blood readings anyway — they’re not meant as a replacement for traditional blood glucose monitoring. But they can give a continuous reading of glucose levels. And they do save fingers.

According to an article by German scientists in the journal Diabetologia, a promising approach is the use of optical sensors that can analyze glucose levels with a sensitive camera attached to the skin. The authors write that this “novel approach makes use of the fact that the variation of blood glucose levels changes the light-scattering properties of skin tissues.” (The world is getting more like Star Trek all the time, isn’t it?)

Several companies have been working on these optical monitors for years. Eight different types of monitor (using different kinds of light and ways of analyzing them) are being studied and a number have been tested. At least one manufacturer, of the C8 MediSensors Optical Glucose Monitor, is taking orders from European clients and expects to start shipping the device this year.

Have any of our readers tried an optical monitor in a study? What about other types of noninvasive monitors?

Again, thanks in advance for any help you can give. I’m hoping to have a booklet on smart glucose monitoring by the end of June.

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Comments
  1. Being able to use an optical monitor would revolutionize my husband’s diabetes self-care. He was up all night worrying about getting his A1c bloodwork done because he’s afraid of needles. He is trying very hard to use alternative sites, but it’s extremely difficult for him, and fingersticks are out of the question. I don’t know what’s going to happen if he has to go on insulin.

    Posted by Deb |
  2. David ~ I have developed injection site nodules. One is right under my belt line and has become painfully sensitive when touched. I’m a 20 year T2 diabetic and none of my primary care docs have never checked for this or warned me. It would be a worthwhile future column. ~ Thanks for being there for all of us. ~ Ron O’Connor

    Posted by Ron O'Connor |
  3. I have five children with Type I diabetes. I welcome information like this to help monitor and control my kids’ blood sugars. Always hoping for better treatments, and ultimately a cure!

    Posted by Kirsten Schull |
  4. sticks goes with the territory it does ouch at times. But you do what you have to. I am not on insulin… type 2 with 3 meds. Seems though something affordable could be done for us. But money always talks loudly!!!!!!!!!!

    Posted by PAT |
  5. I hate needles!

    That being said I stick myself many times a day for tests or to inject insulin… after many years it has become routine and you do get to understand how and where to inject for no pain or just the odd exception.

    A few times I have got a bad needle or hit a nerve and turned the air blue with language my wife didn’t want to hear and she told me so too :) Most of the time it is a non-event and part of staying healthy.

    The real problem is ‘education’. If you know why you are doing this and how it will improve your health you do get to realize all this sticking is really a good thing! How many times have I talked to diabetics who take the ‘odd’ reading because their Doctor wants them too but “don’t know what the numbers mean”. This is treatment? But they trust their Doctor… hmm

    Of course there is always the question of cost. Why do these strips cost so much? This is a biggie… Surely this is the greatest road block to frequent testing even if you understand the benefits.

    If you’ve ever witnessed the end of life for a loved one with poorly controlled diabetes you will consider yourself very lucky indeed that you have the means to control your diabetes.

    Did I mention this stuff doesn’t have to hurt?

    Posted by John_C |
  6. I use the sides of the fingertips because they are less sensitive and produce blood faster and easier than the pads, which have thicker skin.
    Also, my brand of meter (One Touch Ultra) offers a thinner, less painful lancet called Delica. These are considerably less painful than their standard lancets (I often don’t feel the stick, and have to squeeze my finger a bit to be sure it worked). But you need a different lancet device (holder), which I found when I bought a second meter called the One Touch Ultra Mini (less than $10 at Wal-Mart).
    I have never used the other alternate sites listed with my meter for testing. I was told these are not as accurate as the fingers.
    By the way, I was told by the manufacturer that the allowable variation for their meters is +/- 30%, which seems ridiculous to me. But I asked a pharmacist at my HMO, and he told me he asked them and got the same answer. Also, he says he tested many brands against each other, and they all seem to vary widely in results. The fluctuation can be surprisingly large (up to 30-35 mg within a minute or two for the same meter at the same site).

    Posted by Bruce |
  7. Recently I discovered a lancet made by a company named Owen Mumford primarily in the U.K. You can go to their site, OwenMumford.com, to view their single use lancets. I ordered a box of 50 (unsure whether they’ll be covered by Medicare) for $18. shipped. I use the Unistik 3. The needle seems thinner.

    But you need to go to their site to read about the easy technique for minimizing discomfort, and also see the different models they have.

    Still, if my finger is a little blue & sore from previous sticks, there’s no denying that it still can hurt, but less often, so I’d order these again.

    This diabetes sure is a complex project. BTW, I’m pre-diabetic & trying my best to stay away from meds, as my one experience was dreadful. I’ve dropped 20 pounds with regulating food & exercise, within about the past 10 months.
    Good luck to all.

    Posted by Vera |

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Blood Glucose Monitoring
Blood Glucose Monitoring: Minimize the Pain, Maximize the Gain (08/15/14)
Potential A1C Test Alternative; Glucose Meter Recall (01/21/14)
Why Do Test Strips Cost So Much? (Part 2) (09/25/13)
Why Do Test Strips Cost So Much? (09/24/13)

 

 

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