Diabetes Testing

Does your fear of needles makes it difficult or impossible for you to manage your diabetes? Do you have a child who is afraid of them? Many of us have this fear, but we now have a way to cope with it.

All of us who have diabetes need to draw blood regularly with lancets for our blood glucose meters and for A1C testing. Everyone who has type 1 diabetes and about one-fourth of people with type 2 need to inject insulin at least once a day. A growing proportion of us are injecting GLP-1 analogues like Bydureon and Victoza to help keep blood glucose levels in check.

But many adults and even more children don’t do this often enough because of pain. As a result, they needlessly suffer.

Now, an inexpensive device called the Buzzy can block that pain. Some hospitals are already using it, and you can buy one without a prescription to use anywhere.

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Unless we have a complication of uncontrolled diabetes, it’s not painful. But checking our blood sugar level sure can hurt. Some people don’t even check their blood sugar because they have needle phobia.

Injecting insulin or one of the incretin mimetics (like Byetta, Victoza, or Bydureon) rarely hurts, as I know from my own experience with Byetta. Diabetes can of course lead to painful complications, but by tightly managing our sugar control we are almost certain to avoid them.

Lancets and the lancing devices that hold lancets can cause pain. But they don’t have to.

I’m still amazed that we put so much emphasis on the meters that check our blood sugar while seldom giving a second thought to our lancets. This is where the rubber meets the road. Over the years I’ve seen lots of comparison of our meters, but not a single one comparing lancets.

Until now.

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It’s a myth. Did you really believe that you could manage your weight better when you step on the scales just once a week instead of every morning?

It’s a sad fact that most of the so-called experts tell us that it’s a mistake to weigh daily. “In most instances, weighing yourself every day is unnecessary and unhealthy,” is supposedly one of the “10 Common Mistakes” we make about weighing ourselves. Actually, suggesting that weighing daily is a mistake is itself one of the most common mistakes you can read about and hear.

When I learned I have type 2 diabetes, my doctors and nurses told me to weigh myself once a week because the inevitable daily fluctuations would discourage my weight loss efforts. They probably told you the same thing. They were ignoring two small studies “Charting of daily weight pattern” and “The efficacy of a daily self-weighing.” But they can’t ignore a large, new study that shows that daily weighing helps us take off the pounds and keep it off.

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By
Dr. Christopher Jacobs Ph.D.,
Biomedical Engineering
CEO, Genteel LLC

Transparency

Genteel LLC neither makes nor markets lancets; however, the company does manufacture and sell a vacuum-assisted lancet holder (poker), so it is in the company’s best interest for its customers to use the best possible lancet. Genteel undertook this study so its customers would have a better lancing experience; however, because Genteel uses regular square shaft lancets, it follows that what makes a lancet optimum with Genteel will, in almost every case, ensure it also works best regardless of which poker a person chooses. It is Genteel’s hope that use of a better lancet, which will lower pain and increase blood draw consistency, will encourage users to test more often, because the proper lancet will significantly decrease the discomfort and pain.

Figure 1: Genteel LLC engineer doing close-up examination of lancets to be rated

Background

At Genteel’s laboratory, we performed a “Consumer Report” type study on many brands and models of lancets, commonly referred to as “square shaft.” These are the most popular individual lancets, found worldwide(see Figure 2). If the shaft is viewed horizontally, as an arrow would fly, the base would appear to be square, with no flanges or rings. Genteel purchased and tested thousands of these, and after examination, found the need for considerably more reliable engineering and production quality control to make a really good lancet. There was sufficient difference found between brands and models such that the user could have a noticeably improved lancing experience just by changing to a better brand and model. While this study was undertaken on square shafts lancets, the knowledge gained could apply to many other types.

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Unless people with diabetes are taking insulin, they waste their time and money when they test their blood sugar.

I agree with the conclusions of a review from the Cochrane Collaboration, the most respected group that reviews scientific studies. The review concluded that among people who have had type 2 diabetes for more than one year and aren’t using insulin the effect of testing “is small.” And when they have diabetes longer it makes even less difference. Even worse: no evidence shows that testing “affects patient satisfaction, general well-being, or general health-related quality of life.”

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The usual problem with using one of our fingertips to check our blood sugar is that it hurts. Our fingertips need to have lots of nerve endings because we use our fingers as fine sensing devices.

That’s why people with diabetes got excited about using alternative test sites about 15 years ago when blood glucose meters that require just 1 microliter or less of our blood first became available. These sites have far fewer nerve endings, so any pain from testing there is uncommon. But researchers soon discovered that the alternative test sites we were using, like the forearm, had one serious limitation.

Our fingertips detect a change in our blood sugar level first, and these alternative sites can sometimes lag by more than a quarter of an hour, as I reported in an article, “Lag Time in Alternativeland,” on my website in 2001. While that wouldn’t matter much when our blood sugar is steady, if it were falling into the hypoglycemic range, the consequences could be serious. That’s why some meter manufacturers have generally recommended since then that we don’t use alternative sites if our blood sugar is likely to be falling. Unfortunately, we are unlikely to know if we are going hypo unless we test.

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