Miscommunication about when to test?
I saw the Endo a couple weeks ago and I've been confused ever since. I'm honeymooning and my pancreas is covering my basal, so I only bolus. My I:C ratio is all over the map and I'm never certain when my pancreas might decide to dump some extra insulin, so I generally test my BG before meals and two hours after, primarily to make sure I'm not trending downward too quickly. Also, if I don't bolus in the evening, it's because I'm going to exercise, but I'll still test because I can crash during a workout even without bolusing. The Endo is a resident with a fellowship and she has to have the attending come in at the end of the appointment to okay everything. The attending told me I test too much. She said once in the morning and maybe after dinner is fine. I was too shocked to really say anything at the time, but as I continue to do my "excessive" testing, I'm wondering whether she misunderstood my situation. Perhaps she thought I was a T2 not on insulin? Does it seem right that an Endo would tell someone on insulin that they should not be testing after every meal for which they bolus? My understanding was that testing was pretty much standard operating procedure. How else am I going to keep track of my I:C and also make sure I don't go hypo? I intend to take this up at my next appointment, but that's not for three months.
I also test my fasting every morning because I know that will be the first sign that my honeymoon is ending.
Replies to This Discussion
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Permalink Reply by Scott E on -
Not only that, but there are always wasted strips. I waste strips all the time when the number doesn't seem quite right, or when I forgot to wash my hands and some juicy residue was on my fingers, or when I don't get enough blood to fill up the strips.
And don't forget that your doc has to add one strip for every vial of test strips for the "control solution test". It's how the manufacturer tells you to use them, and we all follow those directions, right? (Everyone nod silently and try to withold sarcastic laughter).,
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Permalink Reply by Shawnmarie on -
Nodding head silently as my eyes say, "um, nope."
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Permalink Reply by Shawnmarie on
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I haven't been connected with a CDE at all. I was diagnosed by a nurse practitioner and he had me email him everyday with numbers, which is how we figured out I only needed to bolus. A few weeks after diagnosis, I had my first appointment with the Endo at what I've been led to believe is one of the largest and most respected diabetes clinics in the country. The appointment a few weeks ago was my second. So that's the care I've gotten in the 4.5 months since my diagnosis. I don't really mind though since I've learned a TON from all of you here on TuD and I have Using Insulin, the Diabetic Athlete, and am constantly looking for other useful information. However, it does make me wonder about people who aren't so willing or able to jump into their own care.
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Permalink Reply by Amy on -
CHANGE ENDOS!!! Any endo who says you test too much is not someone I would trust with my life. Leave, get another, TODAY.
I test 10x a day. Every endo I've ever had thought that was great. And I've lived in Canada France and Australia.
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Permalink Reply by LaGuitariste on -
Testing twice per day? While injecting insulin? That's just...crazy-talk. How can you bolus/correct without knowing what your BG's are?
In general, this is what I do or have done:
Test upon first arising
Test before breakfast (if it's very long after the first test)
Test before lunch
Test before dinner
Test before bedTest after meals (one hour, two hours) until bolus values are perfected
Also:
Test before driving (if I didn't recently do a test for another reason)
Test periodically while driving on long trips
Test before/during/after strenuous exercise
Test immediately at any time if I feel "weird" (seeing spots, feeling shaky, feeling oddly tired, unusual thirst, etc.)
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Permalink Reply by Shawnmarie on
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That's why I started to think she may have been confused about my status. She sort of breezed in at the end with her advice for 60 seconds at the end of my appointment with the resident and then was gone. Because my I:C ratio changes so much and my pancreas is so unpredictable, I would never know if I'm going to go low until it happened if I didn't test after meals. If I'm at something like 90 two hours post, I know I better eat something because it's just going to keep going down. I can have the exact same meal two days in a row, inject the same amount of insulin, but one day I'll crash and the next day I'll be high. Testing is my friend!
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Permalink Reply by LaGuitariste on
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Yep, it sounds like you're on the right track.
I once had a doctor come into the room and start giving me "my" test results -- for a test I hadn't had. She had someone else's chart completely mixed up with mine!!! Boy, I've never seen a doctor blush so red! I was gracious about it, but I'm more careful now that they know who I am, what I'm there for, what's been done in the past, etc.
Sigh. I'm old enough to remember the days before drive-by medicine. It was better when doctors actually had time to spend with each patient. This new "efficient" method sucks.
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Permalink Reply by Shawnmarie on
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The doctor's "advice" has been bugging me every single time I poke my finger, so I finally took the bull by the horns and wrote a letter just to clarify whether (1) I misunderstood her, (2) she misunderstood my situation, or (3) she's just an idiot. Of course, I don't actually address the third possibility in the letter.
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Permalink Reply by Johanna Burton on -
Good for you. Maybe she'll infer #3.
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Permalink Reply by marty1492 on -
Thanks for the update, Shawnmarie!
I was wondering how things were going for you with this issue!
Here's hoping that the answer is #2, and that she gets up to speed on your situation and is useful!
Best wishes
Marty1492
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Permalink Reply by Scott E on
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The best diabetes clinics (or any specialty, for that matter) are often teaching institutions. The doctors are excellent, and the others you may deal with are students. They're bound to make some mistakes as they build up experience, it's how they learn. If this is the case, I'd let it slide, knowing that (after your letter) the mistake will stay in her mind forever and she'll never make it again.
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Permalink Reply by Shawnmarie on
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Unfortunately, it was the attending who gave me the advice, not the resident. That's why I think there was a possibility that she may not have had the full story. It's also why I decided to write the letter. I really needed to clarify for myself what their advice is based upon the actual facts before I decide whether they're giving me bad advice.
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