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.
Do you have access to the articles because you are interested in diabetes or because you are a scientist yourself? Just curious? I look at the precis on the pages and am like "interesting..." but haven't ever "bought" access to them.
Thanks for the links. I'm looking forward to checking out the articles and may end up forwarding some more information to the doc. It's absolutely crazy to me that they are attempting to discourage someone from testing because it "might lead to burnout." That's like telling someone who exercises regularly that they should do it less because they might burnout and then stop doing it completely. Crazy!
OK, sorry. I'm on a roll tonight. I found this too, from the AACE:
3.Q8. When and How Should Glucose Monitoring Be
• R33. A1C should be measured at least twice yearly in all patients with DM and at least 4 times yearly in patients not at target (Grade D; BEL 4).
• R34. SMBG should be performed by all patients using insulin (minimum of twice daily and ideally at least before any injection of insulin) (Grade D; BEL 4). More frequent SMBG after meals or in the middle of the night may be required for insulin-taking patients with frequent hypoglycemia, patients not at A1C targets, or those with symptoms (Grade D; BEL 4). Patients not requiring insulin therapy may benefit from SMBG, especially to provide feedback about the effects of their lifestyle and pharmacologic therapy; testing frequency must be personalized (Grade D; BEL 4). Although still early in its development, continuous glucose monitoring (CGM) can be useful for many patients to improve A1C levels and reduce hypoglycemia (Grade D; BEL 4).
I don't like "testing frequency must be personalized" as that implies that testing frequency is "fixed" and, of course, determined by a doctor, which is how insurance companies prefer it-- "your doc said you can have _____ test strips" whereas it's my foot on the gas pedal of my pump and I should be testing whenever the heck I want to or need to, unless I am clearly evinced to have some sort of OCD situation and am testing every 5 minutes or something ridiculous?
I think many of us who have been doing this for awhile would disagree with this, "official source" notwithstanding. "More frequent SMBG after meals or in the middle of the night..." are required not only for the reasons they state. Aside from catching lows, it's also very important to catch and correct highs. The longer you spend at high numbers the more likely you will develop complications. Then there are all the times you are low or high and need to re-check to see if your corrections have worked.