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January 31, 2004

Blood Tests and Insulin Injections

Question from Connecticut, USA:

I am 20 years old and have had diabetes for 18 years. Since I was little I would get these "bumps" on my fingers (mainly on the joints) that caused discomfort. They were semi-frequently, usually not a lot would appear. I went to a dermatologist three years ago and he prescribed Clobetasol which did not help them so I just dealt with them as they occurred. He thought it was Dishydrotic Eczema. I just recently went back after a large outbreak over my hands with these bumps. Again, he said it was the same thing and gave me Elidel to try. How this is related to diabetes? The other possibility he thought could be I have a nickel allergy (which explains why "cheap" jewelry give me a rash) and perhaps there is nickel in the lancets I am pricking my fingers with. Again, these bumps only appear on my fingers, never on my palms. Do lancets contain nickel? If so, what are my other options for pricking my finger?

Answer:

I expect that the dermatologist thought that your finger lesions were due to an autoimmune dermatitis which is why he prescribed a topical immunomodulatory drug. This in turn would suggest that you have not simply Type 1A Diabetes; but a condition called the Autoimmune Polyglandular Syndrome Type II in which more than one other autoimmuune condition can occur with the Diabetes: the commonest are Hypothyroidism and Celiac disease. Dermatitis herpetiformis is an uncommon member of this group which only rarely shows lesions on the fingers. It is not clear whether these lesions are indeed due to finger sticking; but there are alternatives: one is to use a monitoring device that uses the forearm like the latest Freestyle unit (see www.therasense.com) and another would be the GlucoWatch (see www.glucowatch.com) which is expensive and cumbersome for day to day use. In a year or two I think that there are going to be infrared glucosensors that are simply placed on the skin and will be linked eventually to insulin pumps.

DOB