Does Self-Monitoring Have to Hurt?

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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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