New developments in technology and manufacturing techniques have brought a new level of sophistication among lancets. The consumer now has more questions than ever about choosing the right lancet. In light of this, DIABETES HEALTH has compiled a comprehensive look at the lancets currently on the market, and their differences.

There are only six major distributors of lancets: Sherwood Medical (which are manufactured in the United States), Owen Mumford (manufactured in England), Gainor Medical & Can-Am Care (manufactured in Japan), Becton-Dickinson, and Ulster Scientific (both manufactured in the United States). Most other companies that sell lancets are licensing one of these six brands.

Overview

To help you make sense of all the features and names, DIABETES HEALTH has prepared the lancet comparison chart, which gives some of the basic design information on each lancet by brand name and company. Additionally, each line of lancets is described in further detail, including special features and claims, in the paragraphs following the chart.

Reduce Pain

While insuring safe and effective performance is the main objective of lancet designers, reducing pain and wound size have become important considerations and are the reasons behind the multitude of different types of lancets. The difficulty lies in attempting to reduce the severity of the wound, and pain, caused by the lancet while still supplying sufficient blood for a glucose test. Although there are differing views surrounding the best approach to these problems, all agree there are four main factors involved: lancet gauge (diameter), speed of action, depth of penetration, and the angle of the lancet point.

One way to make a lancet less damaging and painful is to reduce the size of the gauge of the lancet, which is a measure of its diameter (the width of the wire that makes up the lancet). Like insulin syringes, the higher the number of the gauge, the thinner it is. The speed of action refers to the entrance speed, exit speed, and dwell time of the needle in the finger, and is more a function of the lancet device than the lancet. Depth of penetration is also determined primarily by the lancet device, although the length of exposed needle (which varies slightly between different manufacturers and products) plays a small part. The angle of the cut used to make the point affects the lancet's sharpness. The smaller the angle of the cut, the sharper the lancet is.

Not Just for Kids

In addition to the physical properties of lancets, 'distractors' can help reduce pain by shifting a person's focus and concentration. According to one study, young children are particularly responsive to 'distractors,' which can include brightly-colored lancets or toys. "Any method that gives control to the child, promotes relaxation, and reduces anxiety can be useful for reducing the pain of the sticks. Allowing the children to choose the site and when the stick will happen (by choosing a number between 1 and 10) is an easy and quick intervention that is often effective." ("Pain Management for Children with Insulin-Dependent Diabetes," The Diabetes Educator, Vol. 19, No. 6, Nov./Dec. 1993). Consequently, some companies, most notably Can-Am and Gainor Medical, have produced multicolored lancets primarily marketed for children. In addition, Gain-or Medical's Cleanlet Kids lancets include a toy figure, which can be used as a 'distractor,' in every box. An example of the effectiveness of colors to reduce pain can be seen in Can-Am's reports of "tremendous feedback" from customers who experience less pain with certain lancet colors than others, even though the colored E-Z Ject Junior lancets are identical to the uncolored ones. In the same vein, Ulster Scientific created their new, gentler Feather-touch image to help alleviate any anticipation of discomfort.

To Squeeze or Not To Squeeze

It's a controversy; even our medical board has differing opinions. Nancy Bohannon, MD says that the prohibition against milking the finger is a hold-over from the days of hematocrits (when testing was done using centrifuges to separate the plasma from the blood) and the presence of any interstitial fluid (fluid from the tissues) could invalidate a reading. This remains a problem when testing for substances like potassium, but glucose levels in blood and tissue should be similar, so milking or squeezing shouldn't provide any falsely low readings in most instances. But Dr. Daniel Einhorn suggests that milking may give inaccurate readings (see page 16-June). However, modern blood glucose meters require so little blood that if a person needs to vigorously massage a finger to get a large enough sample, they probably haven't prepared the finger or used the lancet device properly.

In the final analysis, lancet users should use the lancet which is the most comfortable and provides the correct amount of blood for accurate testing.

The Lancet Manufacturer's Showcase

Becton-Dickinson: New in the marketplace: the B-D Ultra-Fine lancet from Becton-Dickinson is the thinnest lancet currently available. Using improved needle point technology, the lancet point has been designed to help minimize penetration force. New features of the Ultra-Fine lancet include a 28 gauge needle and a new cylindrical design that will fit most lancet devices.

Boehringer Mannheim: The Soft Touch lancets are manufactured for Boehringer Mannheim to provide users of the Soft Touch devices with a sterile, easy to use lancet. Soft Touch lancets are of a universal design and are able to be used in most of the current finger sticking devices on the market. When used with the soon to be released Soft Touch II device, the Soft Touch lancets offer a virtually pain-free finger stick.

Can-Am Care: The E-Z Ject lancets, distributed exclusively by Can-Am Care Corp., are beveled at an 11¡ angle to reduce pain. The E-Z Ject Junior lancets are packaged in an assortment of four different colors to help reduce the psychological aspect of lancet pain. Can-Am was the first company to offer lancets in assorted colors, and E-Z Ject lancets are also very affordable. Can-Am also includes a number of coupons and rebate offers for a variety of diabetes products and publications in every box of lancets.

Gainor Medical: The Cleanlet line of lancets, produced by Gainor Medical, includes the Cleanlet 23, Cleanlet Kids, Cleanlet 23XL, and Cleanlet 25 lancets. All Cleanlet lancets have a protective disposal cap which twists off and can be snapped back on with one hand, completely enclosing the lancet needle for safe disposal. The Cleanlet Kids lancets are available in assorted bright colors and include a free Cleanlet Kids figurine. Gainor Medical also produces the Surelet and Surelite lancets. All Gainor lancets have bases that are completely enclosed to further secure the lancet needle in its plastic housing.

LifeScan: The LifeScan lancets are produced by Gainor Medical; they are identical to the Surelite lancets and include a cap imprinted with an "L" logo. The LifeScan lancet is designed for use with most lancet devices, including the Penlet and Penlet II Automatic Blood Samplers.

MediSense: The ultra TLC lancet is currently being produced by Can-Am Care corp., and is identical to their EZ-Ject lancet. The new ultra TLC lancet, produced by Gainor Medical and scheduled to be released this summer, is a repackaged version of the Cleanlet 25, including all of its features and the MediSense logo imprinted on top of the safety cap.

Miles: Miles makes two different lancets, each for use exclusively with Miles lancet devices. The Ames Gluco System lancet is used with the Autolet and Glucolet lancet devices, which are marketed to the public for general use. The Finger-stix lancet, which combines both lancet and end cap to improve safety by preventing accidental sticks and increasing infection control, is used with the Glucolet 2. The Glucolet 2 and Fingerstix were designed for institutional use.

Owen Mumford USA: The Unilet GP (general purpose) line of lancets can be used in most lancet devices. The standard Unilet GP is available in blue or yellow, while the Unilet GP Superlite comes in white. The Unilet line is designed exclusively for the Autolet and Glucolet lancet devices, or for manual use. The Unistik lancet devices are single-use devices designed for safety in a professional setting (like a hospital). The Unistik lancet is safely housed in a plastic casing both before and after use, with the point inaccessible. The lancet cap, which enables the lancet to be cocked before it is removed, is yellow if the device is designed to penetrate 2.4 mm and orange if it will penetrate 3 mm.

Palco: EZ-lets, from Palco Labs, offer a tri-beveled, gamma sterilized 21 gauge needle.

Ulster Scientific: Ulster Scientific was the first company to bring lancets and a mechanical lancet device to people with diabetes, and has recently developed a new lancet family, the Feather-touch. Ulster has long recognized that the psychological factors associated with capillary blood sampling may be much more important than all the various technical improvements-especially for new patients. The gentler image Feath-er-touch offers the patient a choice of white/fine or yellow/medium point lancet. Both are available in the general purpose style (which fits most devices) and in the safety style for the Autolet and Glucolet devices, or for manual use.