Confused about testing frequency

[ArtemisBow]

So I was diagnosed in October last year, put onto insulin and given a BG meter.

I've been going through a tough time with getting my insulin doses right because it all keeps changing due to the honeymoon phase. As a result to try and keep up with my fluctuating insulin needs, I test before and after each main meal - 6 times a day. In this way I can spot quickly when the needs are changing and adjust quickly.

When I saw my DSN last week she was disappointed with how much I was testing. I explained that I was trying to keep up with the changes and prevent hypos etc, but she said i really only need to test 3 times a day - I don't understand how I would get any control with this, if things were more settled and reliable then I could reduce but I'm not there yet.

Now I have had my repeat prescription for strips rejected by my GP. I know they are expensive, but I thought I was doing the right thing by trying to keep my levels as controlled as possible during the honeymoon phase.

Have you had similar advice from your DSN? If testing 3 times a day, which times would you do?

 

[Heathenlass]

When does your DSN suggest you perform these three tests ? Three tests a day is totally inadequate.

Is this a DSN at your hospital diabetes clinic, or a DN attached to your GP surgery ? You shouuld not have your tests strips refused as a Type !, and I would query why .

Signy

 

[robert72]

You need to do at least 6 tests a day. Ask you consultant to write to your GP explaining your situation.

Sounds like the GP and/or DSN doesn't really understand the problems of going through honeymoon period.

 

[forge]

Hello Artemis Bow

I am off insulin now but I was on it for many years. I am T2 so yours might be different.

Good control is all about establishing a routine and appreciating that the meters are very inaccurate, so tight control as per your meter will never happen.

Therefore, once you have established a routine and found your doses you should only have to vary your doses when your routine changes.

Your routine includes your activity and what you eat. Your insulin demand is varied by the amount of carbs you eat, if they are fairly constant your insulin doses need not change,.

What I did.
I used to check mine each morning (once per day) unless my routine had been changed, that worked out fine for me, Every now and again I would do up to 10 tests in a single day. If, for example, you are experiencing lows then be less ambitious with your desired readings, and obviously if your morning readings are OK and the 10 tests show big swings then you have to work out what to do.

Morning readings can be deceiving for some people (there are morning people and night people) Morning people get a boost of BS to get them up and running for the day and night people do not.

I went through 7 strips most weeks and if things were changing I would go through up to 20. (about 50 per month average max)

The bottom line is
1) Establish as much routine as possible with diet, activity - what you eat and when you eat it is important.
2) Set up a testing regime that will tell you what you need to know without too many unnecessary tests.
3) Remember the meters are not very accurate (the way we use them).

 

[ArtemisBow]

@Heathenlass it was a DSN at the hospital who I had not met before. I asked when she suggested those 3 should be and she said to do the pre breakfast one and just check a couple of times later in the day. I'm not sure whether she said something to the GP or if it's just coincidence.

@forge I'm afraid at the moment despite having a very stable routine it's all very up and down - I eat the same thing for breakfast every day, measured and weighed but if I look back I've had days when I've been dosing 0.5 units for it and other days when I've needed as much as 5. I now can see some trends emerging thanks to the testing, so yes I would agree I could reduce once things are more stable, but only because I have been able to do that analysis work

 

[ElyDave]

Your DSN may be spouting the received wisdom of the DAFNE course which would not advocate testing post meal beacause they think it will lead to you doing in apporpriate corrective doses and chasing the numbers.

Personally I think that's a load of tosh, and luckily so do my consultant and the DSN I talk to most often. For tight control pre and post meal and pre bed are pretty reasonable to test and then anything associated with driving or exercise. If you don't test, you can't build up that pattern of information and, as you are doing, understand the condition better.

I think your GP is being unreasonable here - have you spoken to them? I had the same thing and a 5-minute phone call sorted it very quickly

 

[noblehead]

Your DSN should know better that testing 3 times a day is nowhere near enough to control your diabetes. I would remind your gp of the letter that was sent out to them last year about restrictions on test strips for type 1's:

https://www.gov.uk/government/uploa.../Safe-care-of-people-with-type-1-diabetes.pdf

 

[ArtemisBow]

@ElyDave it may very well be DAFNE related as this came up during that conversation - I'm surprised they don't want post meal tests, how would you ever learn how to adjust your doses if you couldn't see what was happening? I understand the correction doses concern but making notes and learning for next time have got to be a positive.

I only saw the prescription decline last night so will have to call them on Monday - but thankyou all for giving me the confidence to do so as I was really concerned I was the only person testing like this!

 

[catherinecherub]

Hi,

You need to print this letter and show it to your DSN.

http://www.input.me.uk/wp-content/u..._Safe-care-of-people-with-type-1-diabetes.pdf

This article has some helpful hints.

In July 2012, the Department of Health published a consultation document called ‘Liberating the NHS: No decision about me, without me‘, which has been endorsed by the Secretary of State for Health. As the title suggests, healthcare providers need to engage in dialogue with patients regarding treatments to meet individual needs. On the other side of the coin, we as patients need to engage in a long-term partnership with respect to our health. You have a right to feel satisfied that you have had adequate consultation and reached an agreement with your healthcare provider, rather than being told what to do.

http://www.inputdiabetes.org.uk/glucose-monitoring/access-to-test-strips/


PS. LOve your Mucha avatar.

 

[Nyxks]

@ArtemisBow

I'm t1 n I test a minimum of 8 times a day. When I wake before eating n 2hr after plus when I go to bed. I'll test also if I'm feeling funny or out in the field working n before needing to drive. It's not uncommon for me to test 10 plus times a day.

My endroconologust said to test as often as I feel is necessary for me to have good control. Unfortunately my strips come out of pocket so there are months when I can only test the bear mine of 100 times in that month n not my 250 to 350 times which is more common.

 

[Charles Robin]

The advice on testing strips is driven by funding, not by sound medical practice. The NHS needs to wake up to the reality of the situation. We don't test enough, our control suffers. Long term, the NHS has to pay for more laser eye surgery, dialysis, and countless appointments with doctors. Short term, hypos increase in frequency, and the NHS gets the privilege of paying for paramedics to respond to completely avoidable emergencies.
By testing more, you can get good diabetic control, and that is the most important thing. Don't let this rest, if you make enough noise they will buckle. I remember one member of this forum posting regarding this. They said if they ran out of strips they would just go to A and E every time they wanted their blood tested, and treat it as an emergency. Strangely their GP started prescribing more strips soon afterwards.

 

[bonus]

Most people's fingers here must be raw! that's if they still have feelings in their finger tips.

 

[ArtemisBow]

Spoke to the GP yesterday, equipped with all your helpful information - got my prescription after a bit of grumbling from them, but don't think I'll have trouble again Thanks everyone!

 

[Ambersilva]

We

Most people's fingers here must be raw! that's if they still have feelings in their finger tips.

@bonus We have ten so rotating testing sites is not a problem.

@ArtemisBow You should test as often as necessary and at any time you feel odd or unwell.

 

[RidingHigh]

Hi @ArtemisBow. I know how you are feeling with both the levels being up and down and the rejection of repeat prescriptions for testing strips! On the first issue, I have had t1 for nearly 20years, so dont get to excited about finishing your honeymoon stage as your diabetes will more than likely continue to change! The reason for my ups and downs is stress right now (trying to get near on perfect control pre-pregnancy)! Secondly with the doctors, I requested to see another GP as the first was hopeless! Thankfully the second GP was more in tune with modern day practice and prescribed my more than enough strips to last a month! I hope everything gets sorted for you. Take care.

 

[Nyxks]

Most people's fingers here must be raw! that's if they still have feelings in their finger tips.

Don't see why they should or would be, I've been poking my fingers for 11 years now and they still have full feeling (can play the piano and other instruments without issue, plus read braile without issue).

 

[-Artemis-]

Hello fellow Artemis fan

.... This is a bizarre reaction and would make me very cross in your shoes. I am also a t1 in the honeymoon phase and would have no way of knowing what's going on if I didn't test at least pre & post meals and before bed... Often I test more than that - especially after exercise & after alcohol - as these things and many others affect us. Definitely question this and don't put up with any wishy washy replies... I'm possibly lucky as my GP's married to a t1 - but at times I've gone through 75 tests a week and no-one batted an eye at my regular repeat requests...

One more thing: the fluctuations in numbers could partially be down to your cycle - I only mention this as the difference pre and post period for me is pretty major - but obviously cyclical... Can't believe no-one mentions this to us ladies...!


Sent from the Diabetes Forum App

 

[ArtemisBow]

Hi fellow Artemis

I have noticed differences during the monthly cycle although to be honest I find the day of the week matters much more to me - I must get more stressed on Monday & Tuesday because levels are always naturally higher. I can only pick up on any of these trends though by testing, noting the results and then spotting patterns. I have no doubt that even If my honeymoon phase were over that things would still change a lot due to all the other factors, but I hope my testing methods will help me keep up with those changes!

 

[Kazzy Lud]

Stress and monthly cycle is when I will have a hypo. My diabetic nurse at the GP wanted me to test less often (4 times a day) to protect my fingers. My consultant wasn't impressed and wrote to my GP to up my repeat prescription to 200 strips. I usually test 6 times a day and feel I'm starting to get a better idea of what is going on. I was diagnosed in late May this year. If you drive you have to have tested within the last 2 hours if you are on insulin.

 

[Nyxks]

I never found when I had a cycle that it effected my glucose levels or control differently than when I wasn't having a cycle.