Replies to This Discussion

Permalink Reply by Kara on February 22, 2012 at 5:59am

Thanks everyone for allowing me to engage in a conversation with you about your own strategies on testing. I really appreciate the insight and the conversation and the gratefulness I feel that there are role models 'out there' to ask advice/insight from. I see every day those who struggle to gain the inner motivation to get to where you all are. Thanks tons!

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Permalink Reply by Sportster on February 22, 2012 at 6:28am

Hi Kara,
I just want to applaude your dedication to your job. You sound like a very passionate person that wants to help your pts. Getting advise from people that actually have diabetes and not just relying on text books says a LOT about you.

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Permalink Reply by smileandnod on February 22, 2012 at 7:02am

Hi Kara, I too appreciate that you're making such an effort to understand what drives these decisions to act or not. I was diagnosed Type 1 about 25 years ago. I now test at least 10 to 12 times a day, more depending on highs/lows, but I haven't always tested that often as I went through a period of denial during my younger years.

I agree with bits of what previous posters have said with respect to the state of mind in those who don't test as often. For me, it was due to not knowing what to do with the data once I got it and if it was bad, it was a constant reminder that it was bad and I was failing and I didn't know what immediate actions to take to "fix" it so why do it?

I think more education in how to use the data fosters more testing. However, my experience has been that many doctors, including endos, and CDEs don't necessarily want the PWD using the data to make decisions and make changes on their own. If they did, I think it would lead to better self-care and allow the PWD to understand that *they* can make a difference in their own care.

Instead, many CDEs and doctors seem to assume that the PWD isn't capable or they don't want the PWD to make those decisions so the docs err towards a more standardized format or formula for the patient to follow and not wanting the patient to deviate from that. For example, instead of explaining what ISF is and how to use that factor in making corrections, they will give you a chart with a set of ranges and correction doses for you to use like a robot with no understanding. When I realized that my ISF wasn't the same at different times of day, I thought I was some freak of nature (until I came here!) because the correction *schedule* did not take that into consideration.

Like most here, I have learned what I know about self-caring for my diabetes from other people with diabetes, not so much the medical community. I've had my CDE and endo tell me "you know more than most medical professionals because you live with it 24/7" but one could look at that as a cop out too. Sometimes I feel like they *assume* that you know everything already and they shouldn't make that assumption.

But back to your original question about text message reminders, I think the reminders are only going to be as good as the internal motivation to test. If someone is motivated to test because they want the data and know how to use it, then the reminders probably aren't necessary but might be helpful if they are busy during the day and want that distraction to make them stop for a second. If someone isn't motivated to test, I'm not so sure a text message reminder is going to change that but that person probably wouldn't sign up for such a reminder anyway.

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Permalink Reply by Sportster on February 22, 2012 at 7:39am

I have an app for my iphone called "My Medtronic". I don't remember if I got it off of Medtronics website (maybe I should get a reminder for that! LOL).

It has a tool to set reminders for your infusion sets, bg's, sensors, supply orders, and a custom reminder. I have all of them set to off. I only use my pump for alerts and at certain times when those are annoying (usually when it disturbs other people)I'll turn them off and turn them back on later.

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Permalink Reply by MegaMinxX on February 23, 2012 at 7:21pm

Hi Kara,
you may find the following video helpful, Use of SMBG: The Human Factor
I found it quite interesting.

http://www.diabetes-symposium.org/index.php?menu=view&source=to...

Like others, I test frequently now, but did not in my younger days. The key changes for me was
1- I wanted to have better control, and reduce complications, (in my younger days, I was 'invincible', so of course believed complications only happened to OTHER people !)
2- I received education on carb counting and how to USE the BG information, with other data to make better choices. Made goals to reduce BG gradually, so felt I was successful at first getting X % under 200, etc, and then increasing %, decreasing upper limit.
3- I learned that I COULD achieve better control, and doing BG tests was confirmation of success rather than doom of complications.
Prior to that, testing/logging BGs was simply something the endo wanted.

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Permalink Reply by Kara on February 23, 2012 at 8:03pm

I've only watched halfway through this presentation at this point, but this health psychologist explains (in a somewhat roundabout way) Exactly why 'testing' can be so difficutl for some folks. Thank you SO much for posting this. I'm definitely going to share this with my entire team.......... thanks again!

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Permalink Reply by acidrock23 on February 23, 2012 at 8:18pm

I dunno, I don't get worrying about "unwanted disclosure". I don't get a bunch of stuff the dude in the video is saying. The biggest barrier I have is BCBS.

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Permalink Reply by momwith3 on February 24, 2012 at 10:07am

HI I just signed up for mycareconnect.com for my myself and my children. I can send them text reminders . You can use Blue Loop which is an app but you don't have to. You could set up your own account and send your own reminders I think, but it may be something you want to check out. As a mom I love the fact that they send me the results through text messages. I have a daily reminder sent to their phones everyday at certain times. Just started this site but so far I am impressed.

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Permalink Reply by Kara on February 24, 2012 at 2:27pm

Cool, thanks! I'll check that out.

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Permalink Reply by Kara on February 24, 2012 at 3:37pm

Thank you so much for introducing this site to me! It's perfect!! And I am so excited to share this with my pediatric colleagues to share with their families. Kudos to Pam Henry for creating the site...... And to you momwith3 for sharing!

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Permalink Reply by Erin Huff Carper on February 24, 2012 at 4:55pm

Hi Kara-
I will second what someone else said about using Google Calendar to send reminders: it's free and really easy to use.

In response to some of the other things brought up in this discussion:
I test about 10-12x a day now, but I didn't used to test very much for a few reasons, one of which was that I simply couldn't afford to test as much as my doctors wanted me to. Even if someone has good insurance, it still might seem like a financial burden to them to have to pay a co-pay or co-insurance for test strips. Price and financial considerations are things I find that health care providers forget about a lot when it comes to wondering why patients aren't more "compliant." (p.s., I hate that word!)

As an RN or CDE you've probably already taken classes about or studied health behavior change or health program planning. I have a degree in public health, and we had to study a lot of different theories of behavior change, all of which are slightly different, but could be very informative as to what your patients are going through, and why it is hard for them to change and make healthier decisions and choices. If you haven't come across any of them yet, it might be worth a look. You can just google "health behavior models" and find a lot of good info. Or I'd be happy to send you some good links if you want.

Thanks for being such a dedicated provider for your patients, it's refreshing to see a provider reach out to patients for feedback like this!

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Permalink Reply by Kara on February 24, 2012 at 5:11pm

Thanks Erin, I actually have an MPH also, but I find health behavior so fascinating and hard and frustrating that injust love getting real life perspectives instead of theory........ Which by the way the transtheoretical model (prochaska and diclemente) is my favorite! I also find it funny that I use google calendar myself all the time, but never thought of that... I guess I never realized that 'message' reminder was a text! Duh!!the new www.mycareconnect.com
mentioned above looks really cool as
well..... Many more options for parents/kids.
I totally agree about the cost of strips..... Sometimes I even try to
calculate if the cost of a cgm would decrease strip use enough to justify the
cost. I also hate compliant and even adherent which is supposed to be the
more 'pleasant version' of compliant. I throw lazy into words I dislike too!

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