Finger sepsis has been occasionally reported as a complication of home blood glucose self-monitoring (1,2). The use of automatic lancets with disposable needles should theoretically reduce the risk of infection. However, we observed two cases of finger sepsis in patients who used automatic lancets.
M.D., a 61-year-old women with BMI of 33.3 kg/m2 and type 2 diabetes duration of 21 years, was treated with insulin (82 units/day in four administrations) and 2,550 mg/day metformin. HbA1c was 14.0% (upper limit of normal 6.2%). The patient showed microalbuminuria with normal creatinine levels, chronic neuropathy with increased vibratory perception threshold bilaterally, and a neuropathic ulcer in the paramalleolar region of the left foot, whereas there was no evidence of retinopathy or macrovascular complications. The patient was also affected by hypertension, treated with enalapril and furosemide, and untreated hypertriglicerydemia and hypercholesterolemia. She was suffering from major depression, treated with amitriptiline and clomipramine. An abscess of the tip of the third finger of the right hand was observed; body temperature, measured at 2:00 p.m., was 37.8°C. S. aureus, S. agalactiae, and E. faecalis were isolated from the abscess. Despite general antibiotic treatment with teicoplanine, netilmicin, clindamicin, and ciprofloxacin as well as local antisepsis and drainage of the abscess, no significant improvement of the lesion was observed. The necrosis enlarged, and the results of a X-ray examination of the finger were compatible with the diagnosis of osteomyelitis. After 2 weeks, the third phalanx of the finger was amputated.
E.P, a 57-year-old woman, was affected by type 2 diabetes with a duration of 1 year, and her BMI was 27.6 kg/m2. The patient was treated with insulin (20 units/day in four administrations), 7.5 mg/day glibenclamide, and 1,200 mg/day metformin. HbA1c was 11.7%. She showed signs of neuropathy, with increased vibratory perception thresholds without any evidence of micro- or macrovascular complications. The patient also reported uncontrolled and untreated hypertension. Her mood was remarkably depressed. She showed an abscess of the tip of the third finger of the right hand, with extensive necrosis. Staphylococcus α-hemolytic, Candida nonalbicans, and unidentified anaerobial bacteria were isolated. Despite general treatment with teicoplanin, imipenem, and fluconazole, the lesion did not heal. The distal phalanx was amputated 3 weeks later.
Both patients were self-monitoring their blood glucose six times a week on average, using an automatic lancet. Although they had been advised to change disposable needles of the lancet each time, they both reported to have used the same needle for several weeks. Repeated use of a disposable needle could have contributed to infection. Poor metabolic control could have inhibited healing, contributing to the negative outcome. These two cases suggest that all patients, and particularly those with poor metabolic control, should be clearly instructed to change disposable needles of automatic lancets and to observe careful hygiene when self-monitoring blood glucose levels.
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Address correspondence to Matteo Monami, MD, Department of Critical Care Medicine and Surgery, Unit of Gerontology and Geriatrics, University of Florence and Azienda Ospedaliera Careggi, Via delle Oblate 4, 50139 Florence, Italy. E-mail: [email protected]..
