Self Monitoring and Pain

What is that ouch all about?

There are a lot of reasons why people with diabetes do not test their blood sugar as often as they should. According to the Journal of Diabetes Nursing, the physical and psychological discomforts associated with a finger pricker are two of the most significant reasons.

Do not underestimate the psychological part of that statement. Thinking about doing something that causes pain can raise your anxiety level—making the whole process a much greater ordeal. The pain can become a huge barrier in your mind. That is why it is so important to learn and apply smart strategies for easing the pain of fingertip testing. These will help you to better monitor your diabetes and achieve the blood sugar goals you and your healthcare team have set.

Thinking about testing can be worse than the actual test itself, so do not dwell on it. Just get your lancet device, click it and prick your finger. Remember, the pain is not caused by the meter or even the blood sample size. It is just the lancet. Next, do not get into the mind-set that testing is optional. This is especially important if you are caring for a child with diabetes. Do not bargain or negotiate. Treat testing as part of a routine - like brushing or flossing teeth. If you are afraid of testing a finger pricker with built-in lancets and no lancet handling, such as the Multiclix,could be an option for you.

Blood sugar testing is the single most important thing you can do to effectively monitor your diabetes. And that is a good thing, especially when you consider that 30 years ago people with diabetes did not have this capability.

Making testing less of a pain

Testing is not that much fun, but it does provide invaluable information.

A team of German scientists has recently proven that an increase in self-monitoring directly correlates to lower HBA1c levels (the long-term measurement of blood glucose control). Overall, self-monitoring of blood glucose may be associated with a healthier lifestyle and better diabetes management, which may in turn reduce the risk of complications of diabetes.

Why? Those daily blood sugar tests give you the opportunity to take positive steps toward better control. The researchers also found that people who tested more often had a greater sense of well-being, in spite of the pain of testing.

Still, it is easier to encourage yourself to test when you know there are ways to minimize the discomfort. That is why these helpful tips for reducing the ouch factor will come in handy the next time you test your blood sugar:

• Test the side, not the tip, of your finger. The pads of your fingers, where your fingerprints are most pronounced, are full of nerve endings. After all, this is the part of the body you use to feel things. For less sensitivity, shift your test over to the side of your finger. This will also reduce tenderness in the areas you use to touch, type and tap.
• Rotate fingers. Spread your tests out among your fingers and thumbs. Also, if you are using a lancet device and meter that allow you to test on other parts of your body, such as the palm, forearm, calf or thigh, you can give tender fingers a break. However, it is recommended that you talk with your healthcare team before deciding if alternate site testing is right for you.
• Use warm, soapy water to clean the test site. Over time, alcohol can thicken the skin, making it harder to prick. Warm water can also help draw blood into the hands, making it easier to obtain a sample.
• Keep skin soft. Applying lotion regularly will keep your hands soft, and it will be easier to test. Just remember to use an alcohol- and fragrance-free lotion. Ask your healthcare team for a recommendation.
• Let gravity do the work. Do not squeeze your finger too hard. Instead, hang your arm or shake your hands below your waist before testing to get the blood flowing to your fingers.
• Use the right lancet device. Choose a lancet device that is designed not to move from side to side, so it will not tear your skin. Both the ACCU-CHEK^® Multiclix and the ACCU-CHEK Softclix lancet devices are designed to minimize side-to-side motion.
• Do not go deeper than needed. The deeper you go, the more it hurts. So choose a lancet device that features customizable depth settings.

By putting these helpful tips and suggestions into action, you may be able to alleviate the pain and discomfort of lancing, which according to the Journal of Diabetes Nursing is a major barrier to regular testing for people of all ages.

If you want to want to read more about tips for gentle blood sampling click here to watch the interactive demo.

Saving your fingers for the right tests

While fingertip testing is one of the greatest advances in diabetes self-management, one of the next greatest seems to be the ability to test on other parts of your body, including the palm, forearm, upper arm, thigh and calf. There has been a lot of effort to determine when alternate site testing may be right for some people and when it may not be. Here are the answers to some frequently asked questions about alternate site testing:

Is testing on other areas of the body as accurate as fingertip testing?

It depends on the test. For fasting or testing more than 2 hours after eating, provided there are no other activities causing a rapid change in blood glucose, testing on alternate sites will be just as accurate as your fingertip. If you have recently exercised or eaten, only your fingertip will provide up-to-the-minute results. The readings at your forearm and other sites tend to lag and can be off by as much as 20 percent compared to your fingertip. If your blood sugar is well controlled, your doctor may agree that testing at other sites is fine, but only for routine tests.

When should I not test at a different site?

It is especially important to rely on fingertip results whenever you think your blood sugar may be dropping, if your blood sugar is not well controlled, or if you have a history of not detecting low blood sugar. You want to identify low blood sugar as soon as possible so you can treat it. A palm, forearm or thigh test may not be able to provide you with that information.

Does testing on other areas actually hurt less?

Alternative test sites, such as the palm, forearm or thigh, may prove to be less painful when compared to fingertip testing. Of course, choosing a site depends on your personal comfort level. With your doctor’s approval, you might want to try one of these alternate sites to see what works best for you. Once you choose a site, keep using that site as an alternative to your fingers.

Why does testing other parts of the body hurt less?

Your lips, tongue and fingertips are the most sensitive parts of your body. They have the greatest concentrations of nerve endings, or receptors. Each fingertip has about 30,000 receptors, each of which is specifically designed to feel pressure, heat, cold or pain. By contrast, your entire torso has only about as many receptors as one hand. So it makes sense that other body parts are less sensitive than your fingertips.

Are there additional places where you can test?

Researchers at the University of Pittsburgh Medical Center found that testing the tip of the earlobe can also provide reliable results. However, they acknowledged that this site may be too awkward to perform a test on oneself.

Can I use my regular testing system for alternate site testing?

Not all blood glucose monitoring systems are approved for alternate site testing. Talk with your healthcare team and ask for a recommendation if you are interested in testing your blood sugar on other areas of your body.

With careful consideration of these facts and the consultation with your healthcare team, you can decide if alternate site testing is right for you. But ultimately, your decision will depend on the comfort level you have with alternate site testing and whether it is practical for you.

Give your fingertips a rest from testing

This booklet will help explain what AST is, when you should use it and when you shouldn't. Click here to Download (224KB)

References

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Cradock, S, Hawthorn, J. “Pain, Distress and Blood Glucose Monitoring—Survey.” Journal of Diabetes Nursing (2002). Available at: http://www.findarticles.com/p/articles/mi_m0MDR/is_6_6/ai_95954400 (accessed February 1, 2007).

Bloom, AH. “5 Tips for Fingersticks.” From “Tips for Your Fingertips,” in Diabetes Forecast. © 1998 American Diabetes Association. Available at: http://www.findarticles.com/p/articles/mi_qa3689/is_199905/ai_n8850728 (accessed February 1, 2007).

Islets of Hope. “Diabetes Care Tips: Blood Glucose Monitoring—Section 1.” Available at: http://www.isletsofhope.com/diabetes/care/glucose_testing_tips_1.html (accessed February 1, 2007).

Martin, S, et al. ROSSO Study Group. “Self-Monitoring of Blood Glucose in Type 2 Diabetes and Long-Term Outcome: An Epidemiological Cohort Study.” Diabetologia 49 (2006): 271–278. Available at: http://www.profil-research.de/downloads/publikationen/ph19.pdf (accessed February 1, 2007).

Williams, AS. “Sore Fingers—How to Prevent and Treat Them.” Available at: http://www.nfb.org/Images/nfb/Publications/vod/vodfal0403.htm (accessed February 1, 2007).

Bina, DM, et al. “Clinical Impact of Prandial State, Exercise, and Site Preparation on the Equivalence of Alternative-Site Blood Glucose Testing.” Diabetes Care 26 (2003): 981–985. Available at: http://care.diabetesjournals.org/cgi/content/abstract/26/4/981 (accessed February 1, 2007).

Jungheim, K, T Koschinsky. “Risky Delay of Hypoglycemia Detection by Glucose Monitoring at the Arm.” Diabetes Care 24 (2001): 1303–1304. Available at: http://care.diabetesjournals.org/cgi/content/full/24/7/1303-a (accessed February 1, 2007).

Toledo , FGS, A Taylor. “Alternative Site Testing at the Earlobe Tip.” Diabetes Care 27 (2004): 616–617. Available at: http://care.diabetesjournals.org/cgi/content/full/27/2/616-a (accessed February 1, 2007).