Many years ago I wondered whether there was a less painful way of pricking my finger to obtain blood for my blood glucose tests. I perform 4 plus tests a day as part my regime in managing the Type 1 diabetes I have had since 1957 when I was 6 years old. I would like to explain the method I now use.

The most commonly advocated method of obtaining blood for blood glucose testing involves using a spring-loaded device and penetrating the finger at sites on the front tip of the‑finger.  I have been using the back of my fingers and thumbs since the early 1980's and found this to be an easier and preferable site. I do not use a spring-loaded device, partly because it results in more injury and pain than necessary.  A lancet with a shorter space between the needle tip and the plastic base is suggested as a new product for use in this way. The plastic part would stop any further penetration and be much easier to use.         

I simply place the opened lancet on the back of the finger at various positions around the U‑shape where the nail meets the finger.  The needle penetrates the skin gently 1 to 2 mm from the nail. The pain is less because one is in total control of the amount of pressure applied and depth penetrated, and there are less nerve endings in these positions.  I have found the least painful position to be at the bottom area of the U‑shape rather than the sides. There is some variability involved and it is important for the individual to experiment to find out what is most satisfactory.

Having done this for over 20 years, I am obviously a strong advocate and suggest that it be promoted as an alternative to pricking the backs of the fingers.  Keyboard operators, musicians and other people who use their fingers a lot may find this suggested site and technique of particular use. In my view many people who do not fall into these categories would find this site and technique far preferable. It can of course also be used in a rotating fashion, to give the fingertips a rest.  It has a role in more frequent blood testing, in line with the results of the DCCT.   Appropriate marketing is important to its acceptance.

We are all creatures of habit and often people are resistant to new ideas. Change can involve apprehension until it again becomes routine and the norm, and is found to be preferable through direct experience.  Perfecting the new technique may take a few days. For example, slightly scraping the skin (which is virtually painless) may result in more blood than by pushing more deeply. So I would suggest that people trying the new technique, experiment with it for a few days and on different fingers, rather than just basing their judgement on doing it once or only a few times.

Here are some interesting facts about the size of the puncture made by lancets. The needle diameter of a 30 gauge lancet is only 0.317 mm and therefore has a cross sectional area of 0.316 square mm, whereas 21 gauge lancets, which are still commonly used, have a needle diameter of 0.8 mm and a cross sectional area therefore of 2.01 square mm. This means that the size of the puncture made by the 21 gauge needle is greater than 6 times the size of that made with the 30 gauge needle! The comparison for a 21-gauge needle compared to a 28-gauge needle is about 5 times larger and that for a 21 gauge compared to a 25 gauge is about 2.5 times the area.
 
You may think I is difficult to obtain enough blood with the 28 or 30 gauge lancet. I use the 28-gauge lancet and am able to obtain enough blood quite easily. Drawing blood can be more difficult when the fingers are cold, just as keeping the arm in an upward position, compared to flat or downward also has a bearing on  obtaining blood, but this of course applies to whatever technique is used. In practice this is rarely an issue, particularly with the strips that require less blood.

Getting the blood onto the strip may require turning the finger over after the drop is obtained and again, perfecting this technique comes with practice. With some of the more recently introduced strips this is not necessary.

The ease and virtual painlessness of this technique has certainly contributed to my testing my blood more often, and I am also aware of others who have enthusiastically adopted it. In fact an author of a book on diabetes in America put a Stop Press on his book so he could include it!!

Ron Raab B.Ec.
President, Insulin For Life Incorporated
Vice-President, International Diabetes Federation
Member, International Diabetes Federation Insulin Task Force