Voice of the Diabetic

Voice of the Diabetic

Back|

Next|

Table of Contents|

Home

FINGER STICKING TECHNIQUES

by Ed Bryant

Photo: Portrait. Caption:

Ed Bryant.

We know blood glucose monitoring

is important because it helps us keep our diabetes under control. You should

test often. How you test matters too, as poor technique wastes strips and can

give you inaccurate readings. Good testing techniques will also minimize the

number of times we must stick our fingers. If you have not achieved good finger-sticking

techniques, I recommend the old adage, Practice makes perfect.

I am a type 1 diabetic,

and I empathize with individuals whose fingertips are bruised and sore from

testing, and with others who have trouble getting enough blood from the puncture

site. Test strips are extremely expensive, and it is frustrating for people

who must stick themselves over and over while trying to get enough blood for

a good reading.

Finger Sticking Locations

You should use the sides

of your fingers for sticking sites. More nerves are present in the center of

fingers, so lancing in this location may bring more pain.

I use all ten fingers for

blood sugar testing, and on each finger I have four penetration sites. Some

people occasionally use the middle of a finger if the sides have become too

sore.

Ann S. Williams, MSN,

RN, CDE, herself a type 2 diabetic, chooses her test sites by day of the week

and time of day. Her left index finger is for Monday, left middle finger for

Tuesday, left ring finger for Wednesday, etc. On each finger, the side toward

the thumb, opposite the base of the fingernail is for suppertime, and the same

side, opposite the middle of the fingernail, is for bedtime. Any extra tests

are done in the area around the top of the fingernail.

She writes: "By using this

method, you end up lancing the same site only once a week. I like doing it this

way because I have such a hard time remembering where I last lanced, and this

way I can figure out where I am supposed to be by day of the week and time of

day."

Cleaning Fingertips

If possible, wash your

hands with warm, soapy water, which will, besides cleaning, bring additional

blood to the fingers. Rubbing alcohol can of course be used; but alcohol may

cause fingers to become dry, which might cause more pain when lancing. The fingers

should be totally dry before testing.

Ronald James, MD, has

had type 1 diabetes for 51 years. This diabetologist says, "If your finger is

dry and clean, I see no reason you have to use rubbing alcohol."

Note: Using a good skin

cream may help soften your fingertips, and will help with appearance. Apply

it after you test.

Blood Clotting

If the stick location

doesn't clot thoroughly, you may experience bruising and soreness. After putting

blood on the test strip, you should use a tissue and apply firm pressure directly

on the puncture site. Some diabetics will thoroughly clot after a few seconds,

while others may take longer. Once the bleeding stops, you should again use

a tissue and apply firm pressure directly over the puncture location. If blood

is on the tissue, you know bleeding is still occurring under the skin. So firm

pressure is needed a bit longer.

Once a diabetic (blind

or sighted) regularly tests his or her blood glucose, they will know roughly

how long they take to clot. Also, if blood is seeping from the puncture spot,

it can usually be felt because it is sticky. If you are not sure if the blood

has thoroughly clotted, you need only to apply firm pressure a short while longer.

Getting Enough Blood

When lancing, you should

strive for a sample just big enough, just enough blood to make your meter work,

thus minimizing pain and bruising. If you are a good bleeder, this works fine;

but if not, try altering the procedure. Instead of gently milking the lanced

finger, you may need to vigorously milk. By "milking the finger," I mean stroking

and pulling downward, from the base of the finger toward the tip and the sample

site.

One class of people, those

suffering from edema (excess fluid in the tissues) needs to be cautious with

vigorous finger-milking. As kidney problems are one cause of edema, check with

your doctor about this condition.

I have talked to many

diabetics who have trouble getting enough blood after the finger stick. If there

is not enough blood on the test strip, the test result could be skewed. I have

experimented several times, by very gently milking blood from my punctured finger,

and within two to three minutes I pricked another finger and vigorously milked

the sample site. Guess what? In every test there was no appreciable difference

in sample results.

The rubber band method

may be helpful too. Wrapping a doubled rubber band between the first and second

joint of the finger to be lanced will cause the finger to become engorged with

blood. This will help a larger drop of blood to form. Hold the rubber band down

with the thumb while lancing. Remove the band as soon as lancing is completed.

Many diabetics have for

a long time vigorously milked their fingers to get an adequate blood sample.

The clinical difference between gentle milking and vigorous milking is not significantly

different. If enough tissue fluid is milked out, blood may be more like a plasma

sample than like a whole blood sample. If you have a meter that reads "plasma"

values, that is not going to make any difference, and if you have "whole blood"

glucose monitor, the result in all likelihood will not be significant enough

to alter any insulin dosage. Again, we should try to get an adequate blood sample

by very gently milking the puncture site.

Many lancing devices allow

you to adjust the depth of penetration. Shallow penetration should minimize

any pain. The same thing can usually be accomplished by holding the lancet more

lightly against the skin. Use the shallowest penetration that provides you enough

blood for the test.

In the mailbox section

of Diabetes Forecast, December 1998, Adam Bloom, MD, discussed obtaining blood

samples by milking the fingers, and that the NCCLS, the National Committee for

Clinical Laboratory Standards, states one can enhance blood flow from the puncture

"by holding the puncture site downwards and gently applying continuous pressure...proximal

to the puncture site," but that (states the NCCLS) "Strong repetitive pressure

(milking) should not be applied; it may cause...contamination of the specimen

with tissue fluid."

Although such "zero-error"

considerations are important for the research scientist in his/her laboratory,

in practice, however, this mixing of tissue fluids with blood does not appear

to affect the readings obtained on home blood glucose meters significantly enough

to be of concern. "I know of no studies that have been done specifically to

prove this point (states Dr. Bloom), but I do know from experimenting with my

own meter that the readings I obtain when I milk, even vigorously, are not meaningfully

different."

Remember that even if

you use perfect testing technique, a glucose meter will most likely not give

you the same results twice in a row.

Wiping Blood Off After

Lancing

Many diabetics do not wipe

off the first drop of blood after lancing. Years ago, the health community recommended

the first drop of blood should be discarded, because it was believed impurities

or contamination from rubbing alcohol could affect the test. If your hands are

clean, there is no reason to remove the first drop, and if you use rubbing alcohol,

there is still no good reason to remove the first drop of blood, because the

difference between sample results is insignificant. Many health care teams who

deal with diabetes do not wipe off the first sample, but some do. As I said

earlier, if alcohol is used, you need to be sure the site is absolutely dry

before lancing.

Ronald James, MD, says,

"I think if your finger is clean, you don t need to wipe the first drop off."

Note also that folks who

find it difficult to get enough blood for the test will find it that much harder

if they wipe away the first drop!

Lancing Devices

Find which lancing device

makes finger sticking least painful for you. I like the Softclix made by Roche

Diagnostics, but there are many others on the market. Bloodborne diseases can

be transmitted by fingerstick, so never use someone else's lancet. Be aware

lancet points dull fairly rapidly, and if you re-use, things can get painful.

Health care practitioners

should show patients how to properly test for blood glucose, because many have

not mastered correct testing technique. My physician asks all diabetic patients

if his staff can show them proper blood glucose testing techniques, which include

finger sticking.

There is one lancing device

that does not require lancets. The Personal Lasette, from Cell Robotics, is

a laser lancet. It burns a small, clean hole sufficient for a blood test. The

company says there is no pain. This device costs $995. For information contact:

Cell Robotics, Inc., 2715 Broadbent Pkwy. NE, Suite A, Albuquerque, NM 87107;

telephone: 1-800-846-0590.

Another alternative is

the Microlet Vaculance, from Bayer, an unusual combination of lancing device

and small pump. Designed to obtain blood samples from sites other than the fingers,

it is not meant for finger use. The device costs $25, and is available from

Bayer Corporation; telephone: 1-800-348-8100; website http://www.glucometerdex.com

Several home glucose monitors

are designed to test sites other than the fingers. Bayer's Glucometer Dex actually

combines the lancing and testing operations. These newer meters also require

smaller blood samples than before.

Good finger sticking techniques

are an important aspect of diabetes self-management. Blood glucose testing should

be made as simple as possible because far more patients will test, and test

more often.

Back to Top