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Question:

From Bloomfield, New Jersey, USA:

My three year old daughter was diagnosed with IDDM over eighteen month ago. She has been doing four finger pricks each day since then. Now she often claims her fingers hurt when they are wet. Why it is necessary to prick her finger to get blood? Why not other places such as arm, leg, or back?

Answer:

The reason that finger tips are so much used when small samples of blood are needed is that they can easily be positioned both for the needle stick and for placing a drop on a strip. The pulp of the finger tip also has a rich blood supply which can be readily increased by warming and unlike, say the thighs, there is very little subcutaneous tissue which is less richly supplied with blood. The difficulty, as you point out, is that the same sites tend to be used over and over again and this may ultimately distort sensation in the area.

There are several things you can do. The first is to use the lancets on the side of the finger tip rather than on the middle of the tactile surface, the second might be to use the medial or inner surface of the ball of the foot as an alternative; hospital clinical laboratories do this a lot when sampling from babies and toddlers. Finally you might talk to your daughter's diabetic team to find out if you could do fewer than four samples a day. Many children tolerate this level of testing for long periods; but if she is in good control as judged by blood sugars and by the A1c test you might see if you can manage just as well with only two tests a day. Personally I would suggest always doing a morning test; but for the rest of the day you could vary the test time between, before lunch and supper, bedtime, occasionally in the middle of the night or if you suspect hypoglycemia. It would be an advantage to record all these readings in a notebook or better still in the memory of your meter so that the record can be printed out and reviewed, at least at every clinic visit. If she gets sick, of course, then you need to go back to doing lots of blood sugars.

DO'B

[Editor's comment: If you are not already, you might want to try one of the newer lancing devices and lancets. The Softclix lancing device uses special lancets to achieve precise penetration depth, which can make a difference for very young children. The Adjustable Soft Touch also allows you to adjust penetration depth and uses regular lancets. JSH]

Original posting 27 Nov 97

  
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Last Updated: Tuesday April 06, 2010 15:08:54
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