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Comment by daeken | Hacker News Reader

> I don't know a single diabetic who cares about injections and blood sugar tests.

I'm diabetic and the sole reason I don't check my blood sugar (unless I think something is drastically out of whack) is that it takes me upwards of 30 minutes to do a finger prick for testing. My anxiety skyrockets and nothing I do can tell me that it's not going to be excruciating. Most of the time I end up having my wife do it, which isn't a fun process for either of us.

It's not the worst thing, but it's deeply, deeply unpleasant for me. Come at me with a 10ga needle, I won't flinch; come at me with a 30ga lancet and I'll be a mess. I'm going to be switching to a CGM purely for this reason.

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I was on a CGM (Dexcom) for about 3 months until my new insurance would not cover it. Even though it's convenient, it comes with its own set of problems - having to restock every month (with copays) got tiring and somewhat expensive compared to strips. I also had false low reads a number of times. And the amount of wasted plastic (the applicator gun) is concerning if you are environmentally conscious.

As for lancets, you might want to try the AccuCheck fastclix. It's a pen shape device with a cartridge that holds 6 lancets. One cartridge can last me a couple months as I tend to use the same lancet 10 or more times (I know, probably not recommended). It's also the most painless lancet I've ever used and it's easy to carry around.

I second the AccuCheck fastclix. The needles are silicon coated so they don't tear tissues -- so very little pain. I hated using the other brands of lancets. The needles are encased in a cartridge, so you can throw them away in a trash can and don't have to worry about anyone getting a stick or punching through a trash bag.

I third the FastClix. My biggest problem is that they charge about 10x the cost of the cheap lancets. I also reuse them to keep the cost down.

I had one of those for a while, and it does say you should only use each lancet once. Realistically, I don't know if there are any real risks to reusing them though?

I have been mostly reusing (up to a point) both the lancets and insulin pen needles. I don't go overboard, i.e .weeks, but ... how much contamination is possible? well... i never reused syringes, however. The idea of doing that makes me wary.

I reuse them until it becomes mildly discomforting at which time I know the lancet has dulled. Of course AccuChek prefers that you use it once;)

> I tend to use the same lancet 10 or more times (I know, probably not recommended)

I'm not a diabetic or anything else that needs to use needles regularly, so I can only vaguely imagine the economic downsides of only using a needle once. Especially when your insurance doesn't cover them.

But this picture kind of freaked me out and would me make think twice: https://i.imgur.com/Sh8lteI.jpg

It shows microscope pictures of a needle after 0, 1, 2 and 6 reuses.

Thank you for that. I re-use them myself - I justified it as a harm-reduction technique because I test and inject myself more regularly then. This will make me take the extra effort.

If you were on the G5, you might want to look at the G6 if/when your insurance begins to cover it. I've had both, anf the G6 seems much more accurate. Plus, you never need to poke yourself to calibrate it (I still do sometimes, but you don't _need_ to)

Blush. I hardly ever change my lancet. Maybe every other month (about 100 sticks per month).

I'm using Freestyle 14 day and yea the waste for each sensor is pretty amazing. For a tiny sensor the size of a fat nickel I end up with a box of waste that's huge. Reminds of Amazon shipping. 8-)

I've been pretty happy with the accuracy compared to blood sticks - within 10% so far for each reading.

I also have a needle aversion. A couple things that helped me.

1) Playing the guitar helped me build calluses big enough that I can't feel my finger tips anymore on my left hand.

2) I like to put an ice cube on the skin about an inch away from where I give himself a shot in my stomach. For me my brain really focused on the cold sensation from the ice and I notice the needle much less. It's nice too because the ice melts a little and I can use that water on the skin to wipe away any blood that drip out after the injection.

Are you aware of monitors like this https://www.freestylelibre.us/? A friend of mine has it and is really happy about it.

I used Freestyle for awhile and was mostly happy, but then had to deal with a series of them that were so inaccurate, it was a waste of money despite the replacements. The less than ideal accuracy was a bit concerning, but for understanding larger general trends, it was good.

Have you tried alternative test site meters? I test on my forearm and it doesn't hurt and mostly takes a couple of quick lanceting. I use Freestyle lite test meter with a multiclix lancet. No finger damage, no mess, just have to have forearms visible. Easier for your wife to do too since lancet placement is trivial (anywhere on forearms). Hope the CGM works for you ofc

Have you tried using the intermediate segments of the finger instead of the fingertips? It makes a big difference for me in pain perception. Drawing blood is a bit harder sometimes but I still prefer that over having to prick the sensitive tips. (Not that I fret over it. Luckily I lost that within a week of doing regular measurements.)

Hospital staff is surprised when they see where I draw blood but so far none told me to change it. I still let them prick the fingertips so they don't have to change their routine.

The suggestion in the manual of the lancet I used was to use the fingers on the less dexterous hand. It seems logical (but may not actually be correct) that you have more precise/sensitive feeling in the dominant pair.

...more sinister hand

The paw further down south.

I used to alternate hands, but I dislike pricking my tips on either hand. Using the other two segments of the finger doubles the amount of available segments so now I only prick the right hand, as I'm somewhat left-handed.

And as we're deep into the nitty-gritty: My device (Accucheck Mobile) shows the count of remaining strips when turning it on. If I take modulo 8 of that number I always know which segment to use, so I automatically distribute wear. Except that the cartridges start at 50, which means my index finger gets more pricks. I should really lobby Accucheck to make a cartridge with 56 checks! :-)

Just so you know, those days there are ways to monitor glucose levels without finger pricking, google: glucose monitor without needle.

source:RN

Most (maybe all?) CGMs need to be calibrated regularly with finger pricks. In fact in the case of both the Dexcom G5 (haven't known anyone on the G6) and Medtronic Guardian sensors they can occasionally sort of derp out and ask for multiple calibrations in a row for utterly mysterious reasons. I just asked and my partner says the most times she has had to test to get a Guardian sensor back to normal was seven times in two hours.

Of course this is anecdotal, but the point is that your mileage may vary.

Freestyle Libre isn't strictly a CGM, but it doesn't need calibration.

Dexcom 6 doesn't need to be calibrated anymore. Well, it still needs the first calibration when you insert it, but none other than that. Lasts for some 2-3 weeks before sensor needs replacing.

The Dexcom G6 system does not require any calibration, insertion is remarkably pain-free, and it lasts for 10 days. I've had it for a few months (after a couple of years of using the G5 system) and I can't imagine living without it.

Yeah I like it too, but it still asks me for the 2 calibrations right after insertion.

To be fair, that could be just xDrip+ that wants calibrations.

Apparently there's a problem with the Guardian transmitter that causes the multiple calibration requests. Minimed is taking orders for free replacements: https://info.medtronicdiabetes.com/bgcheck

I switched to the Dexcom G6 though. It's amazing. I'm using it with open source closed loop pump software for iOS called Loop. There's also a Linux based solution called OpenAPS.

Have you talked with a mental health professional about your anxiety? They may be able to help you with techniques to reduce it.

Yeah, I've done a good bit of therapy (which I never found effective) and I'm on a cocktail of meds (which are remarkably effective, but they can only do so much). Anxiety's effect on my life has been drastically reduced over the years, but there are some areas where it's still quite bad; this is one of them.

A few responses have brought up alternate site testing. Have you tried the palm of your hand? The bottom of 1/4 of your palm, below the pinky. It was life-changing for me. Rarely painful (at worst a sting if my palm is sweaty or my skin is dried out), as accurate as a finger prick, and it bleeds as easily as my fingers. I had the same anxiety for years, and now it’s like nothing. You need a special cap (usually clear) for your lancet device. Sometimes it’s included, sometimes you have to call and ask for one.

Although I'm type 2 I just starting use a CGM (Lifestyle 14 day) and it's a revolution in data collection for me. I had no issue with finger sticks but you miss a lot of data. Now I get a full and complete set of blood sugar reading for a full 8 hours even if I don't scan the sensor.

It's really helping me decide how much medication I need and when it's most effective. And it's not economically difficult - if I finger stick 3 times a day then I need about 100 strips which costs me about $30. 2 14 day sensors covers a month which cost about $15 (insurance) and since I can read it with my iPhone the actual meter is optional.

I find the sensors read within 10% of a blood stick which is perfectly fine for me. I don't know if that's acceptable to Type I.

Nicely FreeStyle has an online website to access the data from the sensors and it has full download capabilities of the raw data so one can do all kinds of stuff with it.

I have a strong aversion to needles but I’ve been a type 1 diabetic for many years. I use an older Medtronic pump and want to move to a CGM soon

My checks take about 5-10 seconds but I can see where after a while it can make you hesitant.

Why do diabetics use one of the most sensitive parts of the human body for blood testing? Why not prick your forearm, or your leg, or anywhere else?

Apparently there are accuracy problems when testing other sites (though they can be used).

> "The downside to using alternative test sites is that the readings may not be as accurate under certain circumstances. In particular, if blood glucose levels are changing rapidly — as would be expected after a meal, after an insulin injection, or during exercise — there may be a significant difference in the blood glucose level measured in a fingertip sample and in an alternative site sample. Therefore, using a fingertip sample is recommended if you are monitoring at these times."

(source: https://www.diabetesselfmanagement.com/managing-diabetes/blo...)

Better source, WebMD:

> "When the amount of sugar in the blood was rising or dropping rapidly, only the finger prick testing accurately caught these rapid changes. It took about 30 minutes for the forearm values to catch up to those reported by the finger prick tests."

(https://www.webmd.com/diabetes/news/20010709/accurate-blood-...)

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CGMs are great for this.

Also, try a Freestyle Libre. It’s closer in behaviour to a finger prick but still gives the trend info.

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