finger is pricked, gently push the blood from the finger’s base to the tip of the finger until the blood sample is the correct amount 7 . Figure 2. Phlebotomy-Drawing Blood With a Lancet
From Ganguly, B. (2011). Blood glucose testing by blood glucose meter.(https://commons.wikimedia.org/wiki/File:Blood_Glucose_ Testing_-_Kolkata_2011-07-25_3982.JPG). CC-BY-3.0. To reduce the discomfort of BGM, patients sometimes consider using alternative testing sites like the palm, upper arm, forearm, or thigh. There is, however, a wide discordance between blood glucose levels from fingertips and alternative testing sites related to the higher velocity of blood flow through the fingertips. When blood glucose levels change rapidly, the lag between alternative testing sites and fingertips contributes to inaccurate assessment of blood glucose levels. The use of alternative testing sites can provide accurate results when blood glucose levels are not chang- ing rapidly. Box 2 highlights situations when alternative testing sites should not be used. Box 2. Situations Where Alternative Testing Sites Are Not Recommended • Patients who are prone to hypoglycemia • During and after exercise • When the patient suspects they are ill • Before driving • During pregnancy • Anytime blood glucose levels are rapidly increasing or decreasing (within 2 hours ofingesting food)
From USAID. (2013). Phlebotomy-drawing blood with a lancet. (https:// commons.wikimedia.org/wiki/File:Phlebotomy- drawing_blood_ with_a_lancet.jpg). In the public domain. After obtaining an adequate blood sample, touch and hold the edge of the test strip to the drop of blood. Figure 3 is an example of applying blood to the test strip. If there is not an adequate blood sample, the meter will provide an error message signaling the blood sample is not large enough. If a patient reports this happening, the healthcare provider can ask them to demonstrate their meter technique and provide advice. Do not squeeze di- rectly at the site that has been pierced. Squeezing could cause interstitial fluid to leak into the blood sample and lead to a false reading. If an adequate amount of blood is not obtained, the lanc- ing device used to pierce the finger may be too shallow. Most lancet devices offer a choice of lancing depth. Adjusting the lan- cet device to a deeper setting can help produce a larger blood sample. Clarify with patients having trouble getting an adequate blood supply if they are changing their lancet each time; with re- peat use the tip may become dull and result in a less successful finger stick 7 . It is important to note that most meters are slightly different. Always refer to the meter’s user manual for specific in - structions prior to the first use. Figure 3. Blood Glucose Testing by Blood Glucose Meter Frequency of blood glucose monitoring When to prescribe BGM and the frequency of blood glucose checks depend on several factors. There are no universal guide- lines or evidence- based research associated with the ideal fre- quency of BGM. Determining when to test blood glucose levels is individualized for each patient; however, recommendations are available for patients based on medication regimens. The Ameri- can Diabetes Association (ADA) and the American Association of Clinical Endocrinologists (AACE) have standards of care and rec- ommendations that are revised and updated regularly. The 2022
ADA Standards of Medical Care in Diabetes highlight essential information on BGM in the context of therapy and specific goals related to different patient profiles 3,4 . Table 3 summarizes the ADA recommendations for the frequency of BGM.
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