Last week in our diabetes advice column Ask D'Mine, we tackled a couple of complex questions from pre-diabetic multiple amputee Cassi, who was having trouble getting blood samples for testing, confused about the results, and terrified about the future. Unfortunately, these experiences are not unique to her, but her raw emotions touched us strongly, and we felt she deserved the most detailed answers possible. These answers took more space than a single column can accommodate, so we're back this week with Part 2 of host Wil Dubois' response to her.Ask-DMine_button 


If you missed the first half of the conversation, be sure to check it out HERE.

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Wil@Ask D'Mine continues: As to your problems of getting blood to test, the truth is that it doesn't really matter where on your body the blood comes from, especially for a pre-diabetic like you. And while these so-called "alternate sites" will often display readings different from the fingertips, the readings aren't wrong because your entire body does NOT have the same level of glucose in the blood throughout the system. So anywhere on your body that you test will give you a different answer, even if your meter were magically perfect.

So how did the fingertips become the preferred testing location? First (sadly), unlike you, most people have ten fingers—OK, eight plus two thumbs—so there are nearly a dozen convenient places to test. But more importantly, the blood sugar level in the fingers just happens to correlate closely to the blood sugar level in the brain. This is important to anyone using medications that carry a risk of causing low blood sugars, because if the sugar in the brain goes too low, the lights go out. As it's not practical (or desirable) to actually sample the blood glucose in the brain itself, we use fingers for proxy.

Of course, fingers also have lots of nerve endings, so some people find fingersticks painful, and that's whyfingersticks the whole alternate site testing thing was developed. Better a less accurate test than no test at all. There are a limited number of these "approved" sites, usually palms and inner forearms, as you noted, but also upper arm, calf, and thigh. But these are only sites that were studied and submitted to the FDA; anywhere you can get blood, you can test. If you had toes, you could test your toes. We use earlobes for babies and for some elders.

While I don't generally like alternate sites, and often preach against them, we need to be practical in your case. If you have no fingers, you can't do fingersticks, now can you? And as you aren't on any meds anyway, you have no risk of a medicine-driven low, so what you are seeking from testing is general information about how your food and environment are treating your pre-diabetes. Alternate sites will be just fine for that.

Blood is blood. Any site will work. But to be honest, I'm not sure where to advise you to try. I can't imagine how you can even hold the damn device with only one thumb and finger numbs. I guess my advice would be to try the top of the thigh first. It's easy to get to and is a large enough target, but anywhere you can get a drop of blood out of your body will be fine.

Of course, for alternate site testing, you need to use the clear cap on the device and "milk" the site by pushing the device up and down on the skin after lancing to draw up a blood drop through the thicker layer of skin and fat that covers an alternate site.

There are lots of lancing devices in the world, so if you're having trouble with one, try another. Also, I find that a thicker lancing needle works better for alternate sites than a thinner one, so look for lancing needles with smaller gauge numbers. (A 23-gauge lance is thicker than a 33, for instance.) The trend in lancing devices is thinner and thinner, but really you don't want thinner than a 28-gauge needle for alternate testing.

To sum up, poke anywhere you can reach, use the biggest poker needle you can find (it will actually hurt less as it will do the job on the first try), use the clear cap, try a different design of lancing device if the one that came with your meter isn't cutting the mustard, and don't worry about the fact the numbers will be different from your fingertips, if you still had them.

But I also want to talk about your feelings about your pre-diabetes diagnosis. No terror allowed, Cassi. Scared to death will do just fine.

Seriously, I'm glad you're focused, but no fear. Fear will just raise your blood sugar. I suspect from the way you crafted your sentence that you already know this, but what I'm about to say bears repeating because I recently noticed (when looking over comments from a controversial piece I wrote recently on the low-carb debate) that many people aren't what you'd call attentive readers. So I want to spell this out beyond clearly: Unlike your flesh-eating bacteria, when it comes to diabetes it's not the disease that damages the body. Any damage, what youPolonsky Mug Front referred to as "side effects," and what's more often called "complications" in the diabetes biz, is caused by high blood sugar. Keep the sugar down and you keep the complications at bay. That's right, complications are the collateral damage of, to use your term "mismanagement." That's not to insult anyone with complications, some diabetes is easier to manage than others, but the bottom line for you is that I don't want you afraid of more suffering or more lost limbs. Your blood sugar problems were caught at the very beginning, which is a great blessing. You are focused, aware, and taking action at the outset. It's entirely possible you'll never even develop full-blown diabetes, and as much as I crave job security, I'm OK with you never joining our club. You've already given enough.

Lastly, although it's really written for people who have joined our club, I'd like to refer you a free download of a little book I wrote that will tell you more about how diabetes works. It's basically a first-year diabetes survival guide, and I think you might find it helpful in navigating all the confusion you've encountered.

Cassi, you are one strong lady. Please don't forget that. Dealing with the blood sugar will be easy compared to what you've already been through. You're not going to mismanage. You're not going to suffer any side effects. You're going to be just fine.



This is not a medical advice column. We are PWDs freely and openly sharing the wisdom of our collected experiences — our been-there-done-that knowledge from the trenches. But we are not MDs, RNs, NPs, PAs, CDEs, or partridges in pear trees. Bottom line: we are only a small part of your total prescription. You still need the professional advice, treatment, and care of a licensed medical professional.



Disclaimer: Content created by the Diabetes Mine team. For more details click here.


This content is created for Diabetes Mine, a consumer health blog focused on the diabetes community. The content is not medically reviewed and doesn't adhere to Healthline's editorial guidelines. For more information about Healthline's partnership with Diabetes Mine, please click here.