Lancets, bloody lancets
Those of us living with diabetes think a lot about technology choices. Which blood glucose meter is smallest, coolest looking, fastest. Will a specific continuous glucose monitor work for me. Should I be thinking about a pump?How about the humble lancet? Here's a device that someone with type 1 diabetes could use between 1,200 and 4,000 times a year. It injures our fingers for the sake of a tiny drop of blood and it's probably the biggest physical pain involved in diabetes management. I've spoken with many parents of children with diabetes and they all tell stories of the challenges of blood testing due to the pain of lancing their child's fingers.
So why is it that most of us just use the lancet that comes in the box with our blood glucose meters? Frequently these lancet devices have been built cheaply to improve the profit for the meter, and they vary widely in quality. Right now, I can recommend two specific makes of lancet devices based on personal experience.
But before we get there, let's talk about wire gauges. The wire gauge for lancets typically ranges from 28 to 33. The bigger numbers mean finer lancets. So all things being equal, you should be choosing a lancet with the bigger possible number. Unfortunately not all lancets carry gauge sizes on the box. My advice, don't buy it unless you can confirm the gauge in advance. Almost all lancet devices now provide depth adjustment, so this is a less important consideration when choosing what's right for you or your child.
The picture above is from the BD site, makers of one of the Ultra-Fine 33 lancets that I recommend strongly. They are truly almost painless, when I first started using them many years ago they were a pleasant surprise. Note: BD also make an Ultra-Fine 30 lancet, these are not as pain free. So make sure you pick up the box with the Larry Bird number on it. A box of 100 lancets costs about $10 and are available over the counter. They also fit many other lancet devices, check the BD page above for pictures of some compatible ones.
In the last six months I changed to the Accu-chek Multiclix after hearing from other d-bloggers about the success they'd been having with it. Although it's 30 gauge lancet size is bigger than the Ultra-Fine 33, it does seem less painful overall. This lancet device comes with many Roche meters. The Multiclix uses a cartridge device with six lancets, so you don't have to carry around as many spare lancets. The cartridge design does not allow you to ever injure yourself, because the lancets themselves are never exposed (and I've tried). And you choose when to rotate to the next lancet in the device so, although it's not recommended, you can choose when to move onto the next lancet. While it's generally painfree in use, it does seem to produce more longterm fingertip damage for me. The lancet device costs about $24 over the counter and a box of 34 cartridges (204 lancets) is about $20.
The BD Ultra-Fine 33 and the Accu-chek Multiclix share first place in my recommendations. They're relatively inexpensive and readily available across the US.
The other contender that I have to mention is the Pelikan Sun.
This high-tech and elegant looking device comes highly recommended by my d-blogger friend David Mendosa. But it's expensive at $199 for the device plus 50 lancets and $15 for each disk with 50 lancets. I cannot recommend personally because I have not been able to try one out, despite repeated requests to Pelikan Technologies. If you're a user, please comment and let us all know how this works and whether the bigger cost is worthwhile.
One thing I've not mentioned here is alternate site testing, where you can take a blood sample from somewhere besides fingertips. Lancet devices for alternate site testing usually have a transparent lancet cover with a larger opening. I don't use alternate site testing, so I can't tell you if any of these devices will work on alternate sites.
Please leave comments if there are other lancet devices that have worked well for you. This is one area where diabetes management can be greatly improved for as little as $30.
Update: I've been reading the book Dr. Bernstein's Diabetes Solution. In chapter 4 he describes how to use the knuckle side of your hand (dorsum) to get blood for glucose testing. I've highlighted the areas suggested on my hand below.
Dr. Bernstein attributes this technique to Ron Rabb of Insulin for Life. Since reading about it yesterday I've tried this a few times and couldn't feel anything.Labels: diabetes, lancets, pain, painfree
posted by Bernard @ 10:03 AM
8 Comments:
Hi my son uses the pelican sun and it has made a big difference in our lives. It is virtually pain free and nowdays my son never complains when he has to test. I really recomend it especially for young children
Hi Bernard!
I've always been curious about the pelican sun device, but like you mention, it is SO expensive! It also looks pretty big and difficult to carry around.
Hi Bernard,
I thought I'd mention an alternative to consider. I gave up using lancing devices three years ago and find it less painful testing without them. Originally I did this so I would have fewer items to carry around. I have found that it also makes testing faster. I'm right handed, so I hold the lancet between my thumb and index finger on my right hand and mostly aim for my left pinky.
Just a thought...
Thanks,
Brian
Having tried the softclix, multiclix, and the BD and OneTouch lancing devices, the multiclix wins hands down. The other devices tie for last place. I have used a plain old lancet at times but find that my own hesitation makes that a painful choice.
Question: why would you prefer the smaller needle if the goal is to get blood? Doesn't a bigger needle get more blood more effectively?
Jonah
It seems that the OneTouch meters are preferred by insurers, presumably because of OneTouch's clout. This means that a lot of people are used to meters need 1.0 microliters of blood.
But many new meters only need a sample one-half or one-third that size. I figure a finer needle would still give me enough blood to work with my current meter (Keynote). And I think the 33 gauge really feels less painful especially for kids.
We've been having lancet problems. And one of dd's teachers had a needle stab would with one when taking it out of the machine after a test. That was one big mess to deal with for weeks afterwards. As a result the diabetes nurse went on a hunt. And she has reissued every school child in town with the ACCU CHEK muliclick lancets. The prickers are inside a cartridge and prevent the repeat of the accident. Dd also tells me that it hurts less than the other devises we have used.
Hi Bernard,
I did a "Pelikan Sun Challenge" test a while ago and came to the same conclusion - elegant but expensive:
http://www.diabetesmine.com/2008/04/gentle-pelikan.html
The other one you didn't mention is the Renew Lancing device - also nice, but expensive for frequent testers:
http://www.diabetesmine.com/2008/01/alternative-pri.html
I've tried the Multiclix and it's nice, but doesn't do as well for forearm testing (which is the only site that will get me enough blood in winter, and the more accurate site for me most other times) as standard lancet devices. It does have advantages for on-the-road (don't have to worry about sharps disposal). I've tried the Renew. It will not reuse a lancet, so if you don't get enough (or any!) blood the first time, you've wasted a lancet on the ring device. Its "alternate site" setting does NOT get close enough to get any blood from my forearm. And the device is so huge for lugging around with you. In short, impractical-to-useless.
Even if I'm using the Multiclix, I carry around a few standard 28- or 30-ga lancets with me: you never know when someone is going to need to deal with a splinter, or to lance open an insect bite/sting.
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