“Self-monitoring of blood glucose (SMBG) can be a useful tool in the management of diabetes mellitus. Patients with diabetes often measure their blood glucose to detect hypoglycemia and to adjust insulin dose as needed. Others utilize SMBG to help establish a profile of blood glucose levels and response to nutrition and pharmacotherapy. The American Diabetes Association (ADA) initially established guidelines for SMBG in 1987, and current recommendations suggest regular SMBG in persons with diabetes based on each patient’s needs. Records of SMBG can also be used during consultation with diabetes health care providers to titrate blood glucose-lowering agents and to guide physical activity and food intake.”1
“Millions of people with diabetes lance their fingers many times daily as a starting point for performing self-monitoring of blood glucose (SMBG). Current recommendations suggest that all individuals with type 1 diabetes measure at least 3-4 times/day. For other types with diabetes (e.g., insulin-treated people with type 2 diabetes), differing approaches are recommended, while for individuals with type 2 diabetes and no insulin treatment, recommendations for SMBG are very controversial (i.e., ranging from recommendations for frequent testing to no SMBG testing at all). Self-monitoring of blood glucose is required to adjust the prandial insulin dose based on the current blood glucose (BG) level and carbohydrate intake while employing an intensified insulin regimen. In addition, SMBG allows detection of low BG levels for prevention of hypoglycemia. Over time, SMBG results can be analyzed to detect diurnal patterns in patients’ glycemic control, for adjustment of the diabetic treatment regimen.”2
A lancet is a small sharp needle that is inserted into a lancet device. This device is used to poke the tip of the finger so as to get blood samples and monitor glucose in blood. There are other types of lances which are used for incising in surgical procedures.
“It is over 40 years since Anton Clemens at the Ames Research Division, Miles Laboratories, in Elkhart, Indiana, USA, developed the first blood glucose meter. It combined dry chemistry test strips (Dextrostix) with reflectance photometry to measure blood glucose. The concept of dry chemistry would be elegantly developed later for the analysis of other analytes. Consequently, the first blood glucose meters represent an important landmark technology, which influenced the extensive growth of point-of-care (POC) testing in the mid-1980s. Great progress has been achieved in the development of blood glucose meters and this continues to be an active field of study and research.”3
The gauge of the lancet greatly determines the dimension of the cut. If higher numbers are chosen, then the incision will be larger. On the other hand, if a lower number is chosen, the incision will be smaller. Lancets with higher gauges are the preferred choice, since these are more convenient and cause a minimum amount of pain or no pain at all. Although it may sometimes become difficult to obtain an abundant quantity of blood for the sample and it may take various attempts before getting the desired amount.
The lancing device includes a spring that allows the lancet to puncture the tip of the finger. After fulfilling its task, the spring immediately returns to its initial position. This item allows the user to set the deepness of the incision by selecting the desired measurement. This greatly helps to decrease pain and uneasiness while taking a blood sample. However, selecting an inappropriate measurement may result in more than one puncture hence more pain.
Strip and Meter Handling for Self-Monitoring of Blood Glucose
- “Meter and test strips should be handled with clean, dry hands.
- Test strips are for single-use and unique for each meter. Test strips must be kept in the original canister, as any moisture can affect the integrity of the strip, and the containers should be kept closed. Check for expiration date.
- Strips can be tested for accuracy with control solution provided initially with each meter and should be checked for expiration date. The control glucose range for the strips appears on the canister.
- Some meters require coding with each canister. Many of the newer meters do not require coding.
- The amount of blood required is usually very small. Many meters easily pull the blood drop into the end of the strip. Inadequate sample can be a source of error.
- Keep meter and supplies in a cool, dry area, not in the car or in sunlight.
- Bring meter into office visits with diabetes educator or primary care provider to test the accuracy comparatively.”4
There may be times when getting the desired results won’t be possible. If that is the case a different size of the lancet can be used. Specialists also recommend washing the hands with warm soapy water and performing a small hand exercise. This exercise consists of shaking the hand before attempting to prick the finger again. By doing this, blood circulation in the fingers will be stimulated and bleeding will be more abundant.
Lancing devices contain a maximum of five configurations. Specialists advise selecting the third one located in the center. When the device has been set on the superficial setting (5) the user will need to apply more strain and effort to make the lancet prick the finger. Once this happens it is a sign that the lancing device has become weary and needs to be replaced.
Lancing Procedure for Self-Monitoring of Blood Glucose
- “Site preparation: Clean area with warm, soapy water and dry. Food residue can be a source of false high blood sugar values.
- Lancet devices to obtain blood can vary and all use a lancet to prick the skin. Thin, sharp lancets are more comfortable. Lancets should not be reused or cleaned, as they quickly become dull.
- Depth setting on the lancet device controls the penetration of the stick and can be adjusted for best comfort and size of blood sample. Most meters require very small samples—less than a small teardrop.
- Lancet should be applied firmly to the clean, dry finger, but not with force.
- Sides of the finger should be used, as there is less pain. Use of the third, fourth, and fifth digits may be preferable to spare index finger and thumb.
- Alternate test sites (upper arms and thighs) are approved for many meters. Fingertips or the outer palm are preferred and are more accurate.
- Obtainment of blood sample should be a gentle “milking” from the base of the finger to the lanced tip. Pressure directly on the site of lancing is not recommended.
- Disposal of lancets and SMBG testing supplies should be done according to local laws for sharps. In many locations, a hard plastic container with a screw top can be disposed of in the household trash.”5
It is not advisable to reuse a lancet. These items are meant to be used only once and then discarded, otherwise they might lead to health complications. Because of its thin structure, a lancet can deteriorate very easily when utilized more than one time.
“The first blood glucose meters are now on the market that combines a lancing device with the meter. This eases handling of the measurement procedure, but does not alleviate the pain while pricking the finger. Other systems in development (one has been on the market, but was too bulky and tricky to handle) for the most part combine all of the steps of SMBG. Once the device is placed on the skin, the skin prick is initiated automatically, an appropriate blood sample is collected by the system, and the measurement is initiated. The patient has only to read the measurement result and to act appropriately. That many patients do not analyze the current blood glucose value and translate them into appropriate therapeutic actions is a different but important story (see the aforementioned survey). You might hope that increased use of continuous glucose monitoring will end the need for finger pricking. However, insertion of the glucose sensors is associated with at least some pain as well and—more importantly—all sensors available today require calibration of the measurements by at least one conventional blood glucose measurement per day.”6
The lubricant added to the lancet does not extend its lifetime since this will also wear off after the first use. By following these guidelines the user will not have to worry about infections and injuries related to using a lancet with limited lubrication more than once.
“Disease management efforts, on their own, play an important role in a patient’s compliance with recommended therapy regimens and may help individuals accept or endure technical and inconvenience hurdles (e.g., lancing pain). Sometimes, however, improvements in compliance can be accomplished more easily and efficiently with disease-management-based behavior modifications. Therefore, any company considering an investment in improving therapy compliance through technology advancement should consider an investment in disease management as a real alternative to avoid going overboard with advanced technical developments. Nevertheless, lancing plays a ‘gate keeper’ role in the overall glucose monitoring cascade. One can argue that, today, it represents the key barrier to patients’ compliance with their prescribed SMBG regimen. Eliminating this barrier has a lot of merit and could significantly benefit today’s diabetes management.”7
“In relation to blood glucose (BG) meters and test strips, lancing has been a ‘stepchild’ with regards to commercial attention and development efforts. Nevertheless, significant technological improvements have been made in this field to address key customer needs, including better performance (regarding pain, wound healing, and long-term sensitivity), reduced cost, and higher integration with other components of BG monitoring (e.g., integration of the lancing device with the glucose monitor). From a technical perspective, it is apparent that highly comfortable lancing can be accomplished; however, this still requires fairly advanced and complex devices. New developments are necessary to achieve this level of sophistication and performance with less intricate and costly system designs. Manufacturers’ motivation to pursue these developments is compromised by the fact that they might not recoup their development cost on commercial advanced lancing systems through direct profits, but only through its positive influence on adherence and increased more profitable sensor utilization.”8
(1, 4, 5) Self-Monitoring of Blood Glucose: Practical Aspects. Kirk, J.K. & Stegner, J. Journal of Diabetes Science and Technology. 2010. https://journals.sagepub.com/doi/pdf/10.1177/193229681000400225
(2, 7, 8) Lancing: Quo Vadis?. Heinemann, L. & Boecker, D. Journal of Diabetes Science and Technology. 2011. https://journals.sagepub.com/doi/pdf/10.1177/193229681100500420
(3) A history of blood glucose meters and their role in self-monitoring of diabetes mellitus. Clarke, S.F., & Foster, J.R. British Journal Of Biomedical Science. 2012. http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.468.2196&rep=rep1&type=pdf (6) Finger Pricking and Pain: A Never Ending Story. Heinemann, L. Journal of Diabetes Science and Technology. 2008. https://journals.sagepub.com/doi/pdf/10.1177/193229680800200526