by Tim
The perils of alternative site testing
8:00 am in Kit & equipment, Living with diabetes by Tim
I recently had cause to look at my fingers. Not a high octane thrilling experience, I’m sure you’ll all agree. But I did notice the array of tiny dots caused by the last zillion, or so, blood tests that my poor, ravaged fingers have had to endure. While I can never take a break from diabetes, I thought that my mangled fingers could do with a rest and so I decided to give alternate site testing a go.
My first meter, along with the myriad that I’ve used since, came with the obligatory finger poker. Said finger poker came with an alternate clear bit to shove on the end for what the guidebook described as “alternate site testing”. “How thrilling”, I thought, as I chucked the apparently useless bit into the bin.
However, last week I dug through the rancid, rotting fish bones in the bottom of my bin and pulled out said clear finger poker bit and gave it a go. Incidentally I’m not really sure why finger pokers have a clear end bit for alternate site testing. Answers below if you have any idea.
Anyway, back to the article; with my poker ready to poke I started with my palm. The first thing I noticed, pretty quickly, was that it hurt. Quite a lot. Maybe my crusted fingertips are so covered in scar tissue that I can no longer feel anything through them – not even a sharpened piece of metal being thrust into them. (Bang goes a career in delicate eye surgery). But, whatever, it seemed more painful than the fingertips.
I also noticed that a bleeding palm is quite difficult to give a squeeze to get that little extra bit of blood out as you do with your fingertips. As a result I failed to fill up three test strips and my meter moodily displayed its nagging “You haven’t put enough blood on, eejit!” message (I have a very rude meter).
The palm being a failure, I then moved on to inflict some misery on my forearms. The fatal flaw with my arms is that they’re quite hairy. Not exactly the matted fur of a gorilla, but certainly enough hair to be going on with. Said hair just made things trickier but, bravely, I persisted.
Much like the palm, the arm isn’t very squeezable and so getting that all important extra drop of blood out was quite difficult. So I increased the depth gauge on the poker until I could swear I could hear the lancet scraping against bone every time I attacked myself.
Finally the mission was accomplished and I managed an alternate site reading. However, I then observed, with mild revulsion, how much your arms actually bleed after being stabbed with a full-depth lancet. After my five or six attempts I looked like I had enjoyed a jolly evening of self-harm but, hey, at least I had my reading.
So will I continue to alternate site test? Probably not. It generally seemed like a pain in the arse and wasn’t very successful. However, because of the post-test self-harming-look I might save the arm-tests for Hallowe’en parties.
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Tim,
I have had similar problems with alternative site testing…luckily no gorilla fur to deal with either! One place that did work quite well was at the nail base of my fingers…a good bleeder for very little pain. I’m not sure if this is technically speaking what they mean by an alternative site…since it’s just the other side of my finger! But at least it gave the battered areas a bit of a break!
Thanks Tim for that valuable piece of research. The thought of testing on my arms has always made me feel slightly sick. When I was little and bored of finger pricks we used to sometimes try my toes or ear lobe which worked quite well but aren’t really practical for daily use (as I write this I realise I sound like I was abused my lancet wielding parents intent on pricking my every limb, but it was quite fun to be honest!). I’ll stick to my fingers.
One of the girls on my DAFNE course tested on her forearms, and she had little bruises all the way up. The clear bit on the end is upposed to hep you draw the blood up I think. The girl on my course used to lease it on for a few seconds after she clicked the button, and sort of pushed it into her arm til she saw enough blood. Something to do with vacuums or something like that… I’ve never been able to do it, the idea freaks me out a little!
Glad to hear it, Clare!
@Alison You tested on your ear lobe? Are you mad?
Hi Tim,
I’ve just read the article and found it quite interesting. I prefer to test using my forearms. There is hardly any pain at all and I get enough blood to do the tests. Using this area is so much more convienient than using my fingers, as they were permanently sore from all the testing. The only time that I do use my fingers for a test is when I feel that I am going low and having a hypo, so it’s not very often. Maybe 3 or 4 times a week.
@Tim From what I remember it didn’t hurt
@sandy Only ‘quite’ interesting :’-(
I think there’s probably a knack to arm testing – one which I clearly haven’t developed!
@Alison Fair enough. I might start ear-testing when I’m in the pub. Anything’s worth a go to try and sicken my friends
I test on my hand right at the base of my thumb. I click and push down using the clear tip so I can see how much blood has balled up. While it did hurt to test here.. it was only during the first week. Now I do not feel really anything. LOVE it. .. but now I have another worry…
Say I fly somewhere.. and I get my hands swab by the airline TSA… will just plain soap and water or the package cleaning cloths, do the job of removing whatever they swab onto my hands? I am worried it might mess up with my reading.
While it’s literally been years since the last time, I do agree with Alison, using your ear lobes for testing actually is not painful at all – though it can be a bit tricky to practice if you don’t have a set of helping hands or a mirror to assist you in getting the droplet to actually hit the target of the test strip
As for alternative site testing, I do practice it, though only for my “during-the-night” and “first-thing-in-the-morning” tests. I use the side of my palms, opposite to my thumbs, and while it sometimes hurts a bit, I’m quite comfortable with it.
Oh, and the clear bit for the finger pokers to be used with alternative site testing, I think is a matter of convenience to allow you to see if you’ve got enough blood out. My trick is usually to keep the clear head of the poker firmly pressed towards my palm, generating sort of a “vacuum” around the poke, which helps greatly in “pushing out” enough blood to do the test
The not being abe to squeeze problem is the reason for the clear cap. If you look at it closely, you’ll see that the hole through which the lancet projects is actually much large than on the conventional cap. The ides is that you place the device against your alternate site and release the lancet. The without lifting the device up you apply downward pressure until you cn see you’ve got enough blood. You can do it with a conventional cap, but you can’t se how much blood you’ve got and because the hole is smaller it can get messy!
I tried alternate site testing on the inside of my forearms (avoid the hairy bits!!!) for a very brief while. Between the not being able to use it when your blood glucose is changing rapidly, and the being advised to double check suspicious low and high readings with a conventional site test, it wasn’t much of a goer. Plus it made me look a bit like I had a drug problem… Not a good idea when you’re a dentist who has to be “bare below the elbows” at work!
Well, I think we’ve solved what the clear cap is for – hurrah, I can sleep at night now without wondering… Thanks all!
You’re all mad! Mad I tell you! It reads like a textbook for self abuse (is it self abuse or is that something different?) I’m not going anywhere near my hairy arms with a lancet, it’s bad enough going to see Nursie for my Hb1Ac or whatever the hell it is. She took three stabs at it last time, I got particularly worried when she held my hand, not because I thought she was attracted to me, (Hah! I should be so lucky!) but because she was eyeing up the veins on the back, hairy paws like black balloons are not good. Coward that I am, I shall stick to my poor ravaged digits and leave the experimentation to you youngsters.
Anyway, my poker never came with a clear cap, so alternative site testing for me is using it on the pristine parts of my right hand fingers. Just as a matter of interest, if I tried to get blood out of my earlobe using a mirror, if I actually managed to lance it, it’d be dried up and crusted before I got near it with a test strip!