Alternate-site Blood Glucose Testing

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I had not thought to do a blog onalternative site blood glucose testing. I am doing this at the goodnatured ribbing I am taking from one of the people from the sitewhere I do some peer mentoring. She is a person that uses analternate site and is thankful I covered it for her and did give thewarnings about when not to use alternate sites. She sent me someURLs and said I had better use this topic. So for her I am writingthis blog.
I admit that I very seldom use analternate site because I use insulin and prefer the now factor in mytest results. Most of the alternate sites are shown in these images.
The above also shows other areas thatpeople do use for testing. I would say that you will need toexperiment to find out what works for you. Basically the hands givethe more accurate readings and are current. I have not run intoanyone that uses the marked areas of the earlobes so I cannot speakfor that.
The biggest warning is for thosethat have had hypoglycemia. Do not use alternative sites as thereadings are from 15 minutes prior on the arms and about 20 minutesprior on the thighs. The calf area is about 20 to 25 minutes prior. Why the lag time?  The BD dot com site gives thisexplanation, “With all meters, routinetesting on an unrubbed forearm, upper arm, thigh or calf gives a testresult that is 20 to 30 minutes old. We will call these sites'lagging' alternative test sites. The fingertips and the palm holdthe most recent 'memories' of your blood glucose. Fingertip and palmtesting tell you what your blood glucose level is right now.”
Basically this means if you are goinglow, the readings from alternative sites may be 20 to 30 minutes oldand not an accurate reading of where you are now. This you need tobe aware of, as relying on readings from these sites duringhypoglycemia, may delay correction and cause your death. So at timeslike these, rely on your finger blood glucose readings.
The U.S. Food and Drug Administrationgives these guidelines:“1. Peoplewith hypoglycemia unawareness should not use alternate site testingat all.
2. Don't use alternate sites when a seriously low bloodglucose might go undetected:

• When you have just taken insulin, or any time during or after exercise.
• When there are unknown variables occurring in your day, such as illness.
• Any time you just feel "low".
• Whenever you are about to drive.”

Like most sources say – talk to yourdoctor before using alternate-site testing and please, please ignorethe television ads that say you don't need to test on your fingersanymore. All they are doing is taking advantage of people that don'tstay in touch with their doctors and basically do little talkingduring an appointment. My endocrinologist did ask me about some ofthe TV ads about alternate-site testing and I explained that was afabrication as far as I could see and I would not test there becauseI am on insulin. The doctor thanked me for that and said he had twopatients that had fallen for the TV ads and wanted prescriptions forthe test strips. The office would not give prescriptions since theywere on insulin. Both doctors spent quite a lot of time going overthe problems if they were having hypoglycemia. They did not thinkthey had convinced them not to use alternate-site testing.
The FDA site also says the following. “Canyou test blood glucose from sites other than your fingers? Some meters allow you to test blood from sites other than thefingertip. Examples of such alternative sampling sites are yourpalm, upper arm, forearm, thigh, or calf. Alternative site testing(AST) should not be performed at times when your blood glucose may bechanging rapidly, as these alternative sampling sites may provideinaccurate results at those times. You should use only blood fromyour fingertip to test if any of the following applies:

• you have just taken insulin
• you think your blood sugar is low
• you are not aware of symptoms when you become hypoglycemic
• the results do not agree with the way you feel
• you have just eaten
• you have just exercised
• you are ill
• you are under stress

Also, youshould never use results from an alternative sampling site tocalibrate a continuous glucose monitor (CGM), or in insulin dosingcalculations.”
If you are a person with type 2diabetes and have it well managed, then talk to your doctor aboutusing alternate-site testing.  One last fact, alternate site testing can also be painful.