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 awg0681 on -
I haven't the foggiest whether or not she pays for the stuff she uses or if it comes out of the office. I didn't really think about that until it was brought up here. Also didn't ask about pre-diabetes or anything like that. I kinda just took it as this was her field of work and an interest of hers so that got her to do the testing on herself. I agree with Shawnmarie, before I found out I was T1 testing my blood glucose wasn't even a background thought in my mind. Then again, I may think differently if I was faced with it everyday at work.
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Permalink Reply by Amy on -
Good for YOU!! Firstly that's a crappy endo to tell you not to test after meals. What if you ate a huge pasta dinner and were starting to go high? Or like you said you didn't eat enough and were low. On the weekend I thought I had enough insulin for my food - ends up I was crashing and quick. So I ate something for the low before it got too serious. Wouldn't have known if I hadn't have tested.
So glad you have another Endo. With the new one ask him/her some questions before you start giving them you history. Ask what they would recommend for a T1 in regards to testing. If you like their answer then give them your info, if you don't leave and find another one. It can be tough if you live in a smaller city like I do - we only have one endo. Another is a 4 hour drive away. :( Thank goodness he's good and likes my testing schedule.
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Permalink Reply by Shawnmarie on -
I'm truly lucky to live in a metropolitan area that has many endo options. I'm hoping the new one is the right one!
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Permalink Reply by Scott E on -
So the resident still doesn't fully "get it", but at least you now know the whole story. And since you're "honeymooning big time", that's all the more reason to stay on top of things.
A BG of 90 two hours post-meal would be a dream-come-true for me. But only if it meant I was also 90 three- and four- hours post. Unfortunately, even the most rapid of rapid-acting insulins have some efficacy left after 4 or 5 hours.
I'm looking forward to your update in May (you WILL update us, right?)
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Permalink Reply by Shawnmarie on
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I'll definitely update in May. Hopefully, it will be positive.
Yes, a 90 flatline without having to add insulin or carbs would be nice. For now, I'm trying to enjoy the fact that sometimes the 90 at two hours means I pop a piece of chocolate in my mouth!
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Permalink Reply by palomino on -
Sorry, but, LOL, are you kidding me? Give me a freaking break- if we want to test ourselves every hour of the day and we pay for the test strips, then don't be concerned about it. That's what I feel like sayin' to them.
It's pretty funny that the same thing was said to you as was said to me. And I read the responses below that affirm we are all hearing the same thing.
I would also prefer to know what's up before I crash and burn, so to speak- it's almost worse to have HYPOglycemia than it is to have HYPERglycemia.
All babbling aside, thank you. Seriously. I've been feeling like some sort of bad person lately for not wanting to go back to the endo that I've only seen once, since his PA told me I was micromanaging and will "burnout" with the number of tests I do in a day. FYI, I am going to write a letter to them as well- not scathing, not evil, not rude, not with the goal of getting someone fired- but a letter to let that office know that showing compassion and care for their patients instead of berating them for taking care of themselves would really make a big difference.
It's my finger, and I'll puncture it if I want to!
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Permalink Reply by Shawnmarie on
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I took the approach in my letter that I was trying to understand the advice I was being given. I'm glad I wrote it because I think it was only fair to give them a shot at seeing my side. It's unfortunate that certain assumptions are made about patients the minute they walk in the door. I think there are other docs at that clinic that understand things better than the two I saw, but the final straw that sent me to a new place was the fact that they told me they would not help me manage my hypothyroid condition. Why go to an endo if they can't help my with all the issues I have with my endocrine system? I want to be seen as a person, not as "Diabetes."
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Permalink Reply by palomino on
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I totally agree... :( I hope the new endo goes better. Unfortunately I don't think I'll be able to find another one until I move in a few years.
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Permalink Reply by Super_sally on -
Sounds like you are managing this exactly how you should. Shame that the medical profession seems to set the bar for management so low - which makes you stand out, when you should be typical.
Congratulations on how great you are managing. Keep up the good work!
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Permalink Reply by Shawnmarie on
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It seems the current thinking is to not scare people into thinking Diabetes is difficult to manage for fear that people might simply choose to ignore it completely rather than attempt to manage it. Someone close to me is a T2 who does pretty much nothing special other than take her meds and she always has an A1C below 6. She never tests and has no idea what her post-meal numbers are like. That works for her and it's her diabetes to manage. Mine is mine and I think I'll keep doing what I'm doing.
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Permalink Reply by palomino on
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Good for you! They've already proven that A1C is not the biggest determining factor regarding how long you live when you have T1. So it makes sense to monitor the numbers. A1C is not the end all beat all, and I'm sure as heck not relying on it 100%.
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Permalink Reply by palomino on
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In fact, here's an article talking about how having high glucose variability influences your HbA1C.
http://care.diabetesjournals.org/content/34/8/1843.long
More so at levels greater than 7, but obviously it's important.
I also thought this article was helpful too while I was looking:
http://tde.sagepub.com/content/37/1/85.long
Almost seems appropriate to forward these articles to the people who say we test too much.
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