Changing Lancets for Diabetes Fingerstick Checks

How often do you change your lancet for a fingerstick blood sugar test?

Responses to that question vary greatly, depending on who’s being asked.

Most medical professionals and experts insist that lancets (the little needles in glucose testing kits) should be changed after each finger poke. That is what the Food and Drug Administration (FDA) literature says, and what those teaching diabetes care are supposed to emphasize.

But the reality is very different for most people with diabetes (PWDs) — especially us long-timers who’ve been sticking our fingertips since the early days of home glucose monitoring in the 1970s and 80s.

Many respond to this recommendation with eye rolls and dark humor: Who actually changes lancets? Aren’t they supposed to be blunt?

So goes the D-Community on the issue of changing lancets, though some newly diagnosed and more “by the book” PWDs occasionally point out that they follow the rules diligently.

Also, one effect of the COVID-19 crisis seems to be that some PWDs are paying more attention to lancet changes, along with the call for diligent hand washing to ward off the risk of infection.

Why you should change lancets

The Centers for Disease Control (CDC) strongly recommends against reusing any lancet, particularly if it happens to involve more than one person. No kidding. Sharing needles is, of course, a whole different ballgame: Just don’t do it.

Years ago, the FDA considered re-classifying lancets to ensure more regulatory review, but that was more focused on lancets used in clinical settings than those for individual personal use, and it didn’t go anywhere.

When it comes to reusing our own personal lancets, whether at home or at the office or somewhere else, the risk is rather unclear.

Dr. Karen Cullen, a registered dietician and diabetes care and education specialist (DCES) at Baylor College of Medicine in Texas, says there really isn’t any evidence that reusing lancets on a daily basis causes any higher level of infection of any kind. But reusing dull lancets definitely can lead to scars and callused fingers that make it more difficult to test.

In reality, the little lancet needles in glucose testing kits don’t puncture the skin too deeply — in fact, it’s barely enough to draw a droplet of blood. The needle lengths typically range from .85mm to 2.2mm. The pain is generally quite minimal, although those of us with experience know that it can hurt more at times, and every now and then we get a so-called “gusher” that bleeds a lot.

“As long as fingers are clean when poking, changing the lancet is really more about comfort,” says Jane Dickinson, a DCES and director of the Master of Science Program in Diabetes Education and Management at Teachers College of Columbia University in New York; she also lives with type 1 diabetes herself. “A lancet will get duller with each use and, after a while, it hurts and isn’t as effective at drawing blood.”

Ironically, lancet needles are the one diabetes supply item that most of us have stockpiled, since they cost so little and insurance companies and third party suppliers always seem eager to send us more, alongside the far pricier glucose test strips. So, it’s not a financial hardship to change your lancet often.

Reasons we don’t refresh needles

Diabetes psychosocial and behavioral health experts say this isn’t a highly researched area. In fact, it may just be extremely low on the list of priorities for most PWDs.

“What research there is out there, it doesn’t show that it’s that big of a concern,” says Martha Funnell, a DCES at the University of Michigan in Ann Arbor. “It really doesn’t come up very often with our patients.”

Even in her earlier career days before continuous glucose monitors (CGMs) were more mainstream, this still didn’t come up very regularly as a big issue, she says. Sure, there have always been questions and guidance about lancets in general, but how often to change them has not been a huge topic of discussion.

The biggest recommendation she shares with her patients about fingerstick glucose testing is to make sure they have clean hands before poking their fingers, she says.

Across social media, PWDs often share jokes about how infrequently they change lancets. A few years back, some folks in the online patient community even created a faux rock band called BlüntLancet to poke fun at this issue.

“Is it more important to test than change a lancet? That’s what we focus on,” Funnell says. “If you can do both, that’s great. Life is a whole list of risk assessment when it comes to diabetes, and things like injecting insulin or rotating infusion sites are more pressing than changing a lancet.”

She adds, “Because of COVID-19, some may be changing their lancets more regularly and people are generally just washing their hands more. That’s an interesting byproduct of all this, that lancets may be getting more attention than they normally would.”

Tips to avoid ‘hurt fingertips’

Dickinson says that having a rotating finger-site routine is something that helped her personally over the years, and she advises her patients to do the same.

The principles of fingerstick site rotation are:

• start with the pinky on one hand and poke the outside
• next time, use the inside of that same finger
• then move to the outside of the ring finger
• then the inside of the ring finger
• and so on

Dickinson says she avoids the outside of either pointer (index) finger and also does not poke her thumbs. She goes through one hand and then moves to the other, so each finger has a few days to “recover” before starting over.

“I poked many times a day for decades and never had scars or calluses,” she says. “I believe having a rotating habit really saved my fingertips! Now I use CGM with no calibrating, so it’s a little harder to remember which finger I’m on when I do a fingerstick blood glucose check.”

Diabetes medical experts including Dickinson also recommend healing hand creams made with aloe or vitamin E, especially for those who live in dryer climates. Sometimes those products can help keep “holes” from getting raised and rough, they say.

Keeping syringes and pen needles sharp

Likewise, the FDA and needle manufacturers recommend against the reuse of syringes and insulin pen needles. The latter are generally so tiny that it’s almost impossible to reuse them because they so easily bend after first use.

Insulin pen needles range in gauge (thickness) from 12.7mm to 4mm, with the lower number actually representing the thicker the needle, which can be a little confusing. In any case, we’re encouraged to use a fresh needle for every poke.

If you do happen to reuse syringes or lancets, the UW Health at the Universtity of Wisconsin-Madison recommends some very precise precautions to take:

• Put the cover back on the needle after use. The safest way to do this is to place the cover and syringe on a flat surface and slide the cover over the needle without letting the needle touch either the flat surface or your fingers. Only the inside of the cover should touch the needle. Do not hold the syringe straight up; you may accidentally stick yourself.
• Do not clean the needle or lancet with alcohol. Alcohol removes the silicone covering on the needle, causing it to become dull.
• Store the syringes at room temperature. It is best to store them with the covered needle pointing up to prevent insulin from blocking the needle opening.

Rotating infusion and injection sites

The recommendation to rotate sites for needle pokes of course also applies to MDI (multiple daily injections) and insulin pump therapy.

This is important because using the same spot over time can cause lipodystrophy, that annoying skin condition in which fat either breaks down or builds up, causing lumps or indentations that interfere with insulin absorption.

To avoid that, check out ishonest’s guide on where and how to inject insulin.

You can still access their Accu-Chek infusion set management guide, and find additional Do’s and Don’ts of infusion site rotation here:

• AADE site rotation toolkit
• Diabetes Forecast
• InsulinPumpers.org
• Medtronic Loop blog
• Waltzing the Dragon blog

This content is created for Diabetes Mine, a leading consumer health blog focused on the diabetes community that joined ishonest Media in 2015. The Diabetes Mine team is made up of informed patient advocates who are also trained journalists. We focus on providing content that informs and inspires people affected by diabetes.

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