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Helping Your Patients Choose Alternate Testing Sites Wisely

Feb 22, 2015

About one and a half years ago I was evaluating the educational needs of a mid-30’s, female, hospital in-patient with diabetes mellitus type 2 (DM2).

She and her husband both had DM2. Both were slender, active, did carb counting and followed all the prescribed recommendations of living successfully with diabetes. However, her A1c was extremely high, possibly as high as 15. Her log looked awesome, so I asked her husband to bring in her meter, which was about two years old, to the hospital.

We checked her blood glucose (BG) using her usual site, the thigh, and compared it to the hospital’s meter. The reading was about the same at 67. She and her husband correctly identified it as a low and stated she would treat herself with one carb choice and follow the “rule of 15.” We then did a finger stick BG with her meter and ours. The value was over 305!

She and her husband were shocked and we decided together that she would not use her thigh as an alternate site ever again. I’m so very thankful to her and her family that this encounter happened. She was on a slippery slope toward diabetes complications. I use this example a lot in teaching both nursing staff and patients about the dangers of using alternative sites for checking BG.

Lessons Learned:

  1. When a patient’s A1c, blood glucose log, and meter don’t correlate, check the patient’s technique.
  2. Alternate site testing (AST) works for some, not for all.
  3. When AST and fingertip testing results are not in sync, assess why AST was chosen. If there are barriers to fingerstick testing, teach methods to get over the barriers.
  4. Recommend fingertip glucose testing when numbers are not as expected and as the AADE Practice Advisory recommends:

Test site location: side of fingertip may be used at all times; alternate sites may be used when blood glucose is stable, but not when it is changing rapidly (e.g. after eating or exercise, when hypoglycemic or ill).

Submitted anonymously

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