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Glucose Monitoring at the Arm
Open accessAbstract
OBJECTIVE—We have examined whether rapid changes in blood glucose (BG) result in clinically relevant differences between capillary BG values measured at the forearm and the fingertip and whether local rubbing of the skin before blood sampling can diminish such differences. RESEARCH DESIGN AND METHODS—Capillary BG samples were collected every 15 min for 3–5 h from the fingertip and the forearm of 17 insulin-treated diabetic patients and analyzed with different glucose monitors (FreeStyle, One Touch Ultra, and Soft-Sense). In a subgroup of patients (n = 8), local rubbing of the forearm skin was performed before blood sampling. A rapid increase in BG was induced by oral administration of glucose, and subsequently, a rapid decrease in glucose was induced by intravenous administration of insulin. RESULTS—In the fasting state, the BG values at the fingertip and at the forearm were similar (7.8 ± 2.4 vs. 7.2 ± 2.3 mmol/l, P = 0.06). However, during rapid increase in glucose, BG values at the fingertip were consistently higher than at the forearm (maximal difference 4.6 ± 1.2 mmol/l, P < 0.001). During rapid decrease in glucose, lower BG values were recorded at the fingertip (maximal difference to forearm 5.0 ± 1.0 mmol/l, P < 0.001). At the forearm, BG was delayed by a median of 35 min (P < 0.01) in relation to the fingertip. Rubbing of forearm skin decreased the observed differences but with a large intraindividual and interindividual variability. There were no obvious device-specific differences. CONCLUSIONS—To avoid risky delays of hyperglycemia and hypoglycemia detection, BG monitoring at the arm should be limited to situations in which ongoing rapid changes in BG can be excluded.
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“When glucose concentrations are rising or have just risen sharply, fingertip capillary glucose concentrations are greater than those in capillary blood from other sites including forearm, thigh and abdomen (Ellison et al. 2002;Jungheim & Koschinsky, 2002;van der Valk et al. 2002), with variable differences in repeated tests on the same subject (Ellison et al. 2002);”
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“conversely, when blood glucose concentrations fall, fingertip capillary glucose concentrations are lower than those on the forearm (Jungheim & Koschinsky, 2002).”
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Citations
Cites
Gray's Anatomy: The Anatomical Basis of Medicine and Surgery
Gray, H., Williams, P. L., & Bannister, L. H. (1996) · Medical Entomology and Zoology · Cited by 943
Sensors for glucose monitoring: technical and clinical aspects
Koschinsky, T., & Heinemann, L. (2001) · Diabetes/Metabolism Research and Reviews · doi:10.1002/dmrr.188 · Cited by 288
Self-citationGlucose measurement in patients with diabetes mellitus with dermal interstitial fluid
Bantle, J. P., & Thomas, W. (1997) · Journal of Laboratory and Clinical Medicine · doi:10.1016/s0022-2143(97)90044-5 · Cited by 128
Microvascular Blood Flow, Volume, and Velocity Measured by Laser Doppler Techniques in IDDM
Rendell, M., Bergman, T., O'Donnell, G., Drobny, E., Borgos, J., & Bonner, R. F. (1989) · Diabetes · doi:10.2337/diab.38.7.819 · Cited by 125
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Comparison of Glucose Levels in Dermal Interstitial Fluid and Finger Capillary Blood
Stout, P. J., Peled, N., Erickson, B., Hilgers, M. E., Racchini, J. R., & Hoegh, T. (2001) · Diabetes Technology & Therapeutics · doi:10.1089/152091501750220046 · Cited by 76
FreeStyle ™ : A Small-Volume Electrochemical Glucose Sensor for Home Blood Glucose Testing
Feldman, B., McGarraugh, G., Heller, A., Bohannon, N. J. V., Skyler, J. S., DeLeeuw, E. R., & Clarke, D. H. (2000) · Diabetes Technology & Therapeutics · doi:10.1089/15209150050025177 · Cited by 70
Tanizawa, Y., Matsuda, K., Matsuo, M., Ohta, Y., Ochi, N., Adachi, M., Koga, M., Mizuno, S., Kajita, M., Tanaka, Y., et al. (2000) · Diabetes · doi:10.2337/diabetes.49.1.114 · Cited by 66
Risky Delay of Hypoglycemia Detection by Glucose Monitoring at the Arm
Jungheim, K., & Koschinsky, T. (2001) · Diabetes Care · doi:10.2337/diacare.24.7.1303-a · Cited by 62
Self-citationUse of an Automated Device for Alternative Site Blood Glucose Monitoring
Fineberg, S. E., Bergenstal, R. M., Bernstein, R. M., Laffel, L. M., & Schwartz, S. L. (2001) · Diabetes Care · doi:10.2337/diacare.24.7.1217 · Cited by 59
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Metadata
- Authors
- Jungheim, K., & Koschinsky, T.
- Affiliations
- Deutsches Diabetes-Zentrum e.V. (DE)
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2002-06-01
- Volume
- 25
- Issue
- 6
- Pages
- 956-960
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- OpenAlex
- W2082028634
- Cited by
- 114
- References
- 22
- Citations by year
- 2026: 1 · 2025: 3 · 2024: 2 · 2023: 1 · 2022: 1 · 2021: 1 · 2020: 3 · 2018: 5 · 2017: 2 · 2016: 3 · 2015: 4 · 2014: 2 · 2013: 9 · 2012: 3
- FWCI
- 6.93
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Diabetes Care (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Health Professions › Medical Laboratory Technology › Clinical Laboratory Practices and Quality Control
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hyperglycemia and glycemic control in critically ill and hospitalized patients
- Keywords
- capillary blood glucose, hyperglycemia detection, hypoglycemia detection, insulin-treated diabetes
- MeSH terms
- Awareness, Capillaries, Fingers, Forearm, Humans, Hyperglycemia, Hypoglycemia, Insulin, Blood Glucose Self-Monitoring, Reproducibility of Results
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