When does our vigilance, our attempts at "control" become too much, a mental condition per se? Can we test "too much"? If we literally will not leave the house without testing is THAT too much? If we won't let little Timmy, or young Mary from our sight without testing them first is that too much? How many times per day can one test before it becomes major Type-A behavior which evolves into something far worse?
When does our testing become something irrational? When is the testing over the top?
It's not at all irrational to test. If you aren't sure, test. If you don't have a CGM and want to be sure, it's not a bad idea to test again in 15-30 minutes to track your delta. If you practice, you can get to where you can estimate where you should be fairly well but I disagree with anyone saying that someone is testing too much. I wouldn't put control in quotes either.
The medical insurance industry likes to portray us as out of control because that justifies a short medical "leash" and lots of guaranteed income for doctors for appointments, CDEs for appointments, labs for tests, pharmaceutical companies for supplies, etc. At the same time, people who seem to succeed and achieve decent results are so far outside of "their" (M-I industry...) "bell curve" that they (we?) are looked at as freaks and castigated, even gently for doing something wrong ("too many lows, you should run higher than a person without diabetes...").
The biggest problem with the "state of diabetes" is not the "cure" or the "artificial pancreas" but using tools we already have in our possession to progress towards goals, one step at a time. Since "failure" is the assumption doctors make, it's not susprising that so many people are able to achieve it? Unfortunately, I didn't go to medical school so I have no standing to make a proclamation like this however I have to call it like I see it.
The biggest barrier to achieving success is testing enough, whether it's because patients themselves are discouraged from testing because "it hurts" or "it's inconvenient" or "it doesn't matter anyway" or because some actuary sees "obsessive" testing as an opportunity to achieve some sort of "prowess". None of the doctors who have suggested patients are "obsessed" with testing have been brave enough to drop by to explain themselves however I would be happy to tell them that I think they are full of crap. To me, the anti-testing sentiment pervading members' reports is a huge concern. Whether it's a doctor or a CDE or running into a barrier to test, I don't think this is at all appropriate to a disease that obligates you to test.
I agree 100% with everything AR said...and I also think there is such a thing as "obsessive testing". While I hate to even use the term since it is the way doctors dismiss us and our wisdom, I do think there is a line that can be crossed. I don't think it's possible to quantify it with a particular number because we all have different needs, but there is a characteristic I can describe.
In Abnormal Psychology one way we describe what is abnormal is with the four D's: Deviance, Distress, Dysfunction and Danger. Just one of these alone doesn't point to abnormality, but all of them combined. So applying the question to "obsessive testing": Deviance does just what I said we don't do: quantify. But if your average Type 1 tests 8 times a day and someone is testing 30, they deviate significantly from the norm. Dysfunction: If someone is so fixed on testing their blood sugar (and worrying about the numbers which is the precursor to excessive testing) they probably are having some negative impact on their lives such as poor work performance and negative impact on their relationships, maybe financial impact from buying extra strips. Danger? This is the only one that's a bit of a stretch, but if somebody is testing while driving (it's distracted driving month!) that's dangerous. I saved distress for last because that's the most important one here. If someone is filled with anxiety, worrying about going too high or too low, and consequently testing every hour but still not feeling reassured, or obsessing over a marginal number they are experiencing significant distress!
Finally, I think testing with a purpose is kind of key. The traditional test times: waking, before and after each meal and at bedtime all have a purpose and we use the results to make treatment decisions whether immediate or long term (as when we see patterns and change basal or recognize a food we can't eat successfully). If we test after correcting, we are seeing if we've been successful. Testing before driving keeps us (and everyone around us) safe. Etc. If we are testing "just to test" or because we are anxious, then something else is going on.
But again, I think for the most part doctor's cries of "obsessive" testing are ignorant and harmful defense of their own egos.
Thanks so much for this explanation. It's so right on the money! Lately, I've found myself moving toward what I considered being too obsessive and have been stopping myself before I test to ask what I will do with the information -- i.e., will it help me determine an insuling dose, will it help me decide what and when to eat, will it affect my exercise decisions, do I feel low and am testing to confirm, etc. If I realize I'm testing just because I feel like it and I'm not going to make any decisions based upon the information, then I put the lancent down.
That's a good point too, I think there IS a limit on testing, as there's the "time" factor, or only so many hours in the day? At my peak, when I was working out twice/ day, running and lifting at lunch and another 1 or 2 hours of Tae Kwon Do, usually six times/ week, maybe a bike ride on my "day off...", I was averaging 17x/ day. That was pre-CGM and some of it was testing and then testing 20 minutes later, right before I'd work out, to make sure what my BG was doing at the time as there always seemed to be a chance that something would come up that would push it. At the same time, there wasn't really any reason I could think that I'd have needed to test more than that as I seemed to cover my bases ok at that maximum but I might have hit 20 a couple of times? I haven't run into any posts from people saying "I test every 37 minutes" though?
The only documentation of obsession is people being called that by CDEs, endos, insurance companies and occasionally posters bewitched by one of the previous 3 suspects into believing that testing is a bugbear. I don't understand a push to test less and run higher. The goal isn't a number of tests but testing is a path to control, no quotes needed.
All of us should be prepared to move our targets when we reach them and work to continuously improve things. I kind of picked that up studying Tae Kwon Do but it is very applicable to diabetes. It also is a relatively "low cost" leap of faith, try to test more, see what you can do. If you can't do it, you can still learn things about food, your body, the way astrological activity influences your BG, etc. with the addtional data you have obtained. There's no reason to stand any accusation of "obsession" to my mind, unless you are testing like > maybe 25 times/ day and I would also say that in some sort of unusual situation, 25 may be very appropriate?
Perhaps I pushed some buttons by using the word "obsession" which is the one used by some idiot doctors who don't understand what good control entails for a Type 1. I am not in any way shape or form suggesting less or minimal testing. I think the word obsession in the way I'm using it (see my description above) is when the person themselves is experiencing undue anxiety or stress, and diminishing returns from testing that is driven by this anxiety, not by the need to have information with which to make considered decisions. I think this situation is a small number of us, and certainly not the ones the doctors call "obsessed", but it does exist. I myself know I sometimes come close to that line and I recognize what it looks like for me, which may be different than the next person.
The OP asked "when does our vigilance become too much...something irrational...over the top? That was the question I was responding to.
Yeah, I sort of read between your lines, as I'm sort of aware of your background but I also have noted Stuart's posts for a while. He seems to have a sense of oppression although he also sort of does "drive by" posts and then leaves and doesn't respond until a couple of weeks later when he comes back. Which is ok, as he's not violating any "guidelines" or "rules" but I don't agree that there's a point at which there's too much testing. I'm also not entirely finding the "tags" really credible, in light of what members have reported.
I have seen zero members reporting "I am testing 40x/ day and keep running out of strips..." but lots going "I am having numbers all over the place but my doc only rx's 5 strips. I had to beg or he would have only written 4..." type of scenarios. I would think that with 20K members, we'd see a couple clinically diagnosable with a problem with overtesting and anxiety but I can't recall seeing any of them? The only people saying there's a "problem" with obsession are the "bad guys" on the other side. Which is almost eerie, given that people get obsessive about all sorts of stuff and, with the mental health implications of diabetes, one would think a few folks would understandably be going off the deep end. So where are they? Or am I it?
Maybe it's just you and me, AR..lol. Perhaps I am overestimating the number of people who "obsess" too much because I do it sometimes myself. I wasn't necessarily only talking only about people who are being treated for clinical Anxiety, but to some of us who at times cross that line.
I didn't recall anything about the OP but did think it was an interesting topic. But I also see your point and that of the others who are saying "doctors tell us we're obsessing and we shouldn't let them influence us" and also it's maybe more important for newbies reading for us to convey the importance of "test/don't guess" rather than talk about a small number of people like me who have the ability to drive themselves nuts! (For example, I don't want a CGM because I know myself and I would stare at the thing every two seconds and drive myself nuts seeing it bouncing up and down. I'm the same way about watches, I don't wear one because I'd look at it too much as in "what time is it?" "five minutes since you asked last!") But I still think CGM's are very valuable tools for most people.
But sure, I hear you that you don't agree there's a point at which there's too much testing. Perhaps I'm alone in thinking there is. I just find managing D in general a delicate balance between doing the work needed to have good control, and having a life that's inordinately focused on diabetes to the detriment of other things and to peace of mind..
...or maybe I just have too much time on my hands! LOL
Your observations about your own tendencies are interesting. I find the CGM to be a comfort, and have gotten to the place where I test only if I need to calibrate, or if the CGM shows a BG significantly out of line, or if I feel low, and at waking and bedtime. So I don't test as much as I used to, but I think I test at times when it is rational to do so.
If you're not using a CGM, then you should probably be testing more often than I do, but I think the important issue is always what are you going to do with the information. And if the test shows you are in a good place, and don't need to do anything, well that's great! :-)
I think there's lots of different tactics (testing, food strategies, exercising, various insulin "tricks of the trade", time management). If your goal is to test less, I'd think that you'd have to adopt a more stringent food tactical plan to meet a BG goal while testing less? The patient with diabetes should be the sole party who is allowed to decide "I should test less" rather than some actuary at an insurance company or the doctor/ nurse/ CDE whored out to the actuaries there. They have no business in the "number of tests decision". There are 20,000 members, many of whom have reported challenges with various mental health issues. Thsi thread has been up for a while and we *still* don't have an appearance from anyone who has indicated they are, in fact, testing more than they need to?
I don't think anyone's posted that they test more than they need to because people probably don't test more than THEY think they need to. Someone who thinks they need to test 20x per day is doing it because they need to, though that's too much for me and I'm pretty OCDiabetic. Need is so subjective.
I find that I do test less with the CGM. I'm only testing maybe 7-8x a day when I know the sensor I'm using is usually pretty right on. I think we develop a 6th sense after a while. It has surprised me, though, the last few mornings when I woke over 140 (usally I'm around high 70s-80) and I felt fine.
I feel so much safer with it's alarms. I can sleep through the night without worrying about lows.
Problem is insurance companies worry about the bottom line. So my insurance company sends out a FreeStyle lite meter complete with 10 whole test strips and a new lancet and a letter saying use this meter or we will not pay for your test strips. Oh and by the way, you can only use 204 strips in a month. What a completely random number. I am still really pissed about it and did through some extra work get the number upped to 250 per month but it's entirely economics that drives the insurance companies.
It sounds like I do test more than you do, Natalie, since I don't have a CGM. I actually had heard they weren't all that reliable for the exact number, but only good for trends, but I really don't know much about them, so maybe that is inaccurate.I don't want one for a couple other reasons that I don't want two things to attach and I can barely afford my pump, let alone supplies for a second device. I definitely wouldn't want to have to check one machine with another one! That's kind of how I feel when people mention having two meters and continually checking them against each other. I did that for a few days when I got a new one, then realized it was crazymaking and picked one and put the other away.
As for how often I test: I routinely test on waking, I usually start breakfast pretty soon so I use that one for my before breakfast, than I test after breakfast, before and after lunch, before and after dinner and before bedtime. I sometimes test again right before sleeping if my number was a bit high or low when I got into bed to read. And of course I test PRN when I feel low, and when I correct either highs or lows to see if my correction was sufficient.That works for me. And yes, I absolutely agree that testing should have a purpose. When it gets excessive imho is when it is just driven by anxiety.
I have to admit perhaps for the first time on this board,I feel misunderstood in this thread. I never said doctors or insurance companies should limit our test strips - definitely not. Has anyone on this board admitted to "testing too much" in this thread? I seem to recall a few, though don't care enough to look back. But in general I think many of us have referred to being obsessive about our management, sometimes in the sense of it being necessary, sometimes in the sense that we are being too compulsive and driving ourselves nuts. I know I'm not the only one who ever said that. And to me being obsessive can take a few different forms, but compulsive testing is definitely one of them.
Or maybe I'm the only one out of 20,000 who has ever done or felt that. That would make me happy as I love being unique!LOL. Seriously, I was glad when this thread died and I should probably ignore it because I feel like I am repeating myself and I still don't feel understood. Oh well, I guess that happens sometimes.