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.
The attending assumed T2 without reading your history=unmitigated idiot. If anything, your waxing and waning pancreas means you may want to test more often than most T1!
The final follow-up on this situation. I wrote a letter to the resident and we finally just connected to discuss. I'm apparently an aberration. They "rarely see people in the clinic who are able to test as much as" I do. I test before and after meals and when I'm excercising, etc. She said if my ratios are stable, I can stop testing post-meal. My ratios aren't stable and the same meal & insulin combo can send me toward a low one day and keep me at a perfect level the next. For example, if I'm at 90 two hours post, I know I need a few g of carb or I'll go low. She didn't really get that. She responded that 90 is a fine number for two hours post. I explained again that, if I'm at 90 and don't know it, I won't know anything until I've actually gone low and I don't really want to wait until then because then it just puts me on a roller-coaster. She seemed to get it the second time, but I really felt odd having to explain to an endocrinology fellow at a major diabetes clinic why I test the way I do.
Their apparent concern is burnout. But I think I'd get burned out more if I were constantly going high or low and had no idea what was happening.
So there you have it. These docs treat thousands of diabetics a year and I stand out as someone who tests too much. There's definitely something wrong with this picture.
The final p.s., I have an appointment in May with a new endo at a different clinic.
It's not a pretty picture but you've done a good deed. There is a chance that the fellow will learn something here and be more aware of the variety of diabetic experience and methods of self-care.
I figured I at least owed her the opportunity to explain her thinking to me and I'm glad we discussed it. It further confirms that changing clinics is the best choice for me.
Glad you expressed your feelings and were (sort of) heard. Yes, it is shocking. I expect (and get) the same comments about how unusual my control is, but that's because I only see a PCP and they have mostly Type 2's. (no offense to the type 2's who are in good control). My answer to that statement would be, "ok, what are you doing to change that fact?" But I, at this point, don't expect much from doctors.
Just one other thought. Even if your ratios become stable (as stable as things ever get for type 1's!), you still want to know if you are high so you can correct. I'm convinced that prompt correcting is the single factor that gave me my last low A1C. More importantly, it means I spend minimal time high to avoid complications. In time, I hope you find a solution to the later lows by tweaking your basal dose (or getting a pump!) Because 90 is a perfect number, and it is most likely the basal that crashes you down a few hours later.
The problem is that I'm honeymooning big time and don't take basal. My poor tired pancreas likes to kick in with the insulin after meals whenever it feels like and for whatever amount it feels like. Other than meals, the pancreas is holding things fairly steady on its own.
Editing to add that the honeymoon also makes exercise a challenge. I never know when excercise will send me low even if I haven't had a bolus in hours. The meter is the one thing that's keeping me sane!
Whoops, sorry Shawnmarie, I lost track of your details. Yeah, that does make it more complicated. Whenever people on here talk about ways to "preserve beta cells for longer" I sometimes wonder if that is a great idea because it makes it harder to manage! As for exercising, I think everyone seems to have trouble with that. It's my "good" excuse for not exercising! But hopefully that will get easier with time as well.
Everything you say makes it more and more obvious how wrong that person was to tell you not to test after meals!!
I definitely have conflicted feelings about my honeymoon. Sometimes I wish the need for basal would kick in so I could start thinking about a pump. It would be so nice to be able to do tiny increments!
Wow, I think I would do exactly as you have done if my endo was telling me I tested too much. It's my body and I'm the one that has to deal with this day in and day out so I'll test whenever I feel like it, thank you very much! I'm like you, just starting out on this journey and you're completely right. How are we supposed to know and figure out our I:C ratios if you're not testing often and especially after each meal with a bolus? I'm pretty stable (so far) and I still test 7-10 times a day usually because I want as few surprises as possible and to know how I trend at different times of the day. Luckily I think I have an endo who understands the testing. She doesn't have diabetes but, according to her, is obsessed with her BG levels. She'll test herself multiple times a day and wears CGMs from time to time. At least I know she knows how it is to stick yourself several times a day!
Interesting that she tests herself that much. I'm not sure I'd think twice about my BG if I weren't T1, but that's great that your doctor understands what it's like.
Yeah, that strikes me as a bit odd as well; maybe there's more to the story, such as she is pre-diabetes, has multiple risk factors, etc. I like the idea of a professional who would test and/or wear a pump or CGM to increase their understanding, but testing multiple times a day??
Is she out of pocket or is she stealing the samples she's supposed to be hooking her patients up with? I'd avoided tapping that until recently when the Rx service achieved astonishingly low levels of customer service and my doc hooked me up, which I was pleased with. I hope your doc pays for her stuff...