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Do You Have to Waste that First drop?

Discussion in 'General Discussion' started by sszyszkiewicz, Jan 15, 2014.

  1. sszyszkiewicz

    sszyszkiewicz Approved members

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    So my 11 year old son was just recently diagnosed. I have a basic question about finger sticks and glucose testing.

    in the hospital they said we should do the stick, squeeze, wipe away that first drop, squeeze to get a second drop and test that drop.

    Thats fine during the day when your kid is awake.

    At night, when I am trying to get the job done when he is asleep, I really just want to use the first drop. The squeezing is what wakes him, or he tends to pull his hand away when I start trying to squeeze.

    I have tested both drops several times and they seem to be about the same, so these past few nights I just grabbed the first drop and got out of Dodge while the getting was good.

    I just need to know.......is it really necessary to waste that first drop?
     
  2. Sarah Maddie's Mom

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    I don't think I know of a single CWD who does that. They tell you lots of things at the hospital that just don't apply to the 24/7 reality of D. :wink:
     
  3. RomeoEcho

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    I was never told to do that. In fact, at some point, I was told to lance deep enough that you didn't have to squeeze. Squeezing can push out some intercellular fluid with the blood. I've done it a couple of times when I knew my hands were dirty but had no water, hoping the blood would "clean" the skin.
     
  4. Amy C.

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    We were taught that in the hospital as well, but stopped it when we got home.
     
  5. StacyMM

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    Doesn't happen here.

    FWIW, I whisper, "I need to check your number" and the kids, even when asleep, seem to hear it and relax their arms and hands. My daughter will even stick her hand out from under her covers for me. They aren't awake and have no idea in the morning that they were poked, but the words seem to be a warning to their subconsciouses and it works. If I forget, a tuging battle ensues while I try to pull their hand toward me and they try to bury it under themselves in fists...at which point I remember :)
     
  6. mom24grlz

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    we've never done it that way. We've always used the first drop. The only time her BS is tested in that fashion is when we're at the endocrinologist office.
     
  7. C6H12O6

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    I was never taught this technique.

    I believe that the first drop is more likely to have more interstitial fluid in it, which may change at a different rate then capillary blood.The result that you want is from capillary blood, especially if you are calibrating a CGM.

    Also, if your finger has something that is going to contaminate the sample on it whipping the first drop away and then re squeezing lessens the impact of the contaminant.

    I do not promote this method; I am just personally adhere to it.

    No diabetes clinician has ever recommended it to me. I just looked into it after I saw so many bedside nurses use this technique.
     
  8. Michelle'sMom

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    They don't even wipe the first drop at our endo's office when doing the A1C.
     
  9. TheFormerLantusFiend

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    Wiping off the first drop is a reasonably effective way at washing off the finger- if you don't wash hands before poking, the first drop is the one with the little bits of whatever was on the skin.

    If he goes to bed with clean hands, it really shouldn't be an issue.
     
  10. sszyszkiewicz

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    Thanks everyone!

    My next question is, and I am having a discussion with my 11 year old over this.....is it better for the long term to not use an alcohol swab on your finger before the stick (just wash hands prior to the stick?).

    It seems the repeated use of alcohol will dry the skin.
     
  11. TheFormerLantusFiend

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    Correct- neither good for you nor necessary to use alcohol wipes.
     
  12. susanlindstrom16

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    the alcohol wipes aren't necessary but I do find that its convenient to carry some with us for when we're out and about or not near a sink.
     
  13. Mommy For Life

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    We used alcohol wipes in the begining, but eventually good 'ol water and soap became the go to step prior to bg tests. If we are out...I have baby wipes in car or we find a bathroom to wash hands.

    Also we never used the second drop of blood for testing. I actually never heard of this until I read your post. :cwds:
     
  14. kiwikid

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    I think if you have to squeeze enough that its annoying an asleep child - you need to increase the depth of the pricker.. One good prick should do it.. NO alcohol...
     
  15. Cookie Monster

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    Sorry I'm coming to this a week late but I did a little research on this a while ago.

    Here in New Zealand last year the government agency that funds glucose meters and strips stopped funding all the tried and tested, trusted brands in favour of a sole supply agreement with a supplier of low-cost meters to cut costs. There has been widespread concern about the reliability of these meters and many people have reported wildly inaccurate readings, missed hypos and overdosing of insulin due to artificially high readings. Among the reasons the supplier has suggested for the inaccuracies are that people are using the first drop or that people are squeezing out interstitial fluid. Being more than a little sceptical that people who had been successfully treating their diabetes for decades had suddenly lost the ability to test their own BGLs I looked for some evidence.

    Not entirely surprisingly it turns out to be nonsense. This brief study from a group in Germany a few years ago deals with both issues. Unfortunately it is behind a paywall but I'll summarise the conclusions (while trying to avoid any copyright infringement:)).

    Interstitial fluid is quite tightly bound so actually requires a lot of squeezing to get even a small amount out. Also the finger tips are highly perfused so the interstitial fluid should actually have a very similar glucose level to the capillaries. In the study they tested a bunch of individuals either by making very shallow skin pricks which necessitated squeezing the heck out of the finger or by deeper ones that required no squeezing. In short there was no significant difference. They also got a second group of volunteers and tested first blood drop versus second blood drop. Again no real difference.

    So providing your fingers are clean then the first drop should be fine, even if you have to squeeze quite a bit. Making deeper skin pricks is only likely to increase pain and may lead to increased scarring. So just do what you're doing and you should be fine.
     

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