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'Discussion' with my doctor about glucose testing

Discussion in 'Type 1 Diabetes' started by secrettheatre, Jun 12, 2009.

  1. secrettheatre

    secrettheatre · Active Member

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    Well, not so much a 'discussion' as him telling me in quite strong terms that I'm testing too much, and that he can't tolerate me ordering so regularly. I admit I probably have been testing too often. But the doctor in the Diabetes clinic I saw last week told me that testing often is actually a good thing, as it obviously helps to keep sugars down... My GP says that 3 times a day is enough. Personally, I can't agree. I've never tested as few times as that. I think I'm losing a bit of hypo sensitivity, and that's partly the reason why I've been testing so often... Have other people had experiences like this? How many times, on average, do people test? And might there not be a better way of doing this - why do we have to be 'slaves to the test strip' all our lives? Apologies if there are other posts on this (I'm sure there are), but I just had to vent my spleen. :evil: :)

    Cheers,
    Chris
     
  2. totsy

    totsy Type 1 · Well-Known Member

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    hya,
    i was told i dont need to test 4 times a day but i do and often more if i feel hypo :)
     
  3. secrettheatre

    secrettheatre · Active Member

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    I've always thought that you just test after you've had food, when you wake up and before going to bed. At minimum that would likely mean testing 5 times a day - but that would just be 'on average', because of course there may be times when you just do need to test more. Testing 3 times per day like a robot is not something I can see myself doing... It's almost as if my doctor is trying to dictate my lifestyle to me (I know he's really not, but it feels like that)...
     
  4. janabelle

    janabelle · Well-Known Member

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    HI,
    it DOES sound like your doc's trying to dictate your life. If you drive apparently you're supposed to check before you drive, add to that keeping your children safe, excercise, hormones and normal life. Trouble is docs read from a text book and think they know it all. You know more than your doc about your own life, and he should not be forcing you to reduce testing and therefore taking risks with your life. You may also want to point out to your doctor that it is commonly known, and your doc should be aware, that people on synthetic insulins often lose 'hypo awareness'. Therefore you may not be aware when your blood sugar is low-see what he has to say then :evil:
    A lot of people on this forum have had same experience with their GPs, including me, and it's unnacceptable. Tell him so, and stick to your guns.
    Best of luck
    Jus
     
  5. secrettheatre

    secrettheatre · Active Member

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    Thanks Janabelle,

    I think I'm losing mine, and I did point this out to him. He said something like "Well you'll have to watch that, then."

    I feel a bit on the defensive about this whole issue, because I will admit that I've been testing too much. For years my BG levels would see-saw, and my control consisted largely of corrective doses rather than being based on a proper insulin/carb ratio. So my doc has a point. Now my care for and understanding of my condition is better, and I'm getting things sorted. So I want to test less, but I still think a max of 3 times per day isn't right. 5-6 times doesn't seem unreasonable.

    Thanks for all the replies so far, by the way.

    C.
     
  6. Sweet3x

    Sweet3x · Well-Known Member

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    move to France. They insist on at least 4 times a day, and have no problems with more if you want to. To be honest, I feel the care I get over here is far far superior to the care I ever got in the UK. It's one of the few bonuses of having to move here for work :)
     
  7. Sweet3x

    Sweet3x · Well-Known Member

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    Your fingers will start to hurt after a while doing that many. I think 4 a day is enough - when you wake/eat b'fast, before lunch, before evening meal, before you sleep.
    If you are sticking to your diet (amount of insulin v amount of food), there really isn't any need to do more. I think your biggest issue may be working out how much you need to eat, and what insulin you need to take for that amount of food, rather then simply doing lots of blood tests, and eating more food/taking more insulin when it's wrong. Testing itself doesn't actually mean better control. It just means you are more aware of when your balance isn't great. Sort out the balance, you're hypos will diminsh, and you won't have to concentrate all your time on checking yourself.
     
  8. secrettheatre

    secrettheatre · Active Member

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    So how exactly do I do that? :?: :? I mean, I've been carb counting for about two months, and it seems to have had some effect in balancing things; but I'm probably still in the grip of old (and bad) habits. I want to achieve very tight control, and testing frequently has helped me do this; but I suppose it's not the right way of going about it. It amazes me when I read some people's accounts of their ability to manage things, and yet they seem to be testing only a few times daily. How the hell do you get to that level of success?
     
  9. fergus

    fergus Type 1 · Well-Known Member

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    I'm with you Chris. I test 5 times per day minimum. Why else would they make 'em in strips of 5? :wink:

    fergus
     
  10. phoenix

    phoenix Type 1 · Expert

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    I have some days when I test only 4 times, before meals and bed. I don't know how you can get away with less than that. You need to know the premeal level to adjust the mealtime dose and at bedtime you need to make sure that you're not going to bed with too low a level.
    Most days I test more, for exercise, hypos etc. I get through 200 strips a month.
     
  11. chocoholic

    chocoholic · Well-Known Member

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    My specialist told me all Type 1's should be allowed to test up to 6 times a day if they need to.
     
  12. Carol11

    Carol11 · Well-Known Member

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    You're the only one who knows your own body and how it responds. Just keep plugging away at your doctor. I've never had that situation, yet, knock on wood!! Then again I don't live there but I've never had a problem regarding strips or any other D related items/meds. I could say buy an extra box yourself but that is a costly alternative unless your're rolling in money which all of are not. All the best, Carol
     
  13. caitycakes1

    caitycakes1 · Well-Known Member

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    Upon waking, before breakfast, before driving to work, before lunch, mid afternoon, before driving home, before evening meal, before bed. I couldn't possibly test any less than that and have no intention of doing so either. No way could I live my busy life on just 3 or 4 tests a day and I don't see why I should have to be hypo or hyper to save a few test strips. What really bugs me is that they quibble about test strips but happily hand out boob jobs on the NHS because of a sore back or low self esteem. Go figure!!!!

    Caitycakes x
     
  14. secrettheatre

    secrettheatre · Active Member

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    Thanks again to everyone for all the comments. One thing that I'm particularly interested in, however, which hasn't come up, is the possibility of alternatives to test strips. I seem to recall a news story from a few years ago about an electronic device that measured BG through the skin; there seemed to be some doubts about its accuracy, however... As far as I can see, there are three possibilities in this area:

    1. Something which reads BG through the skin, as above.
    2. Something reusable (how would that work?!).
    3. An implant of some sort, which maybe could be 'scanned' by an external device.

    I should leave it at that, lest I stumble upon something patentable... But seriously, given that it's already 40 years since we sent a man to the moon, can't we come up with an alternative to these annoying little pieces of plastic which are often oh so reluctantly extracted from their pots?
     
  15. Sweet3x

    Sweet3x · Well-Known Member

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    (sorry for length of this post :()

    the thing that bothers me is that your insulin doesn't work that quickly. if you are testing as someone above says 'when waking, before b'fast, before driving to work' - that can only be a space of an hour at most. Insulin works for around 3 hours after taking it - it peaks 1.5 hours after taking it. So for example, you get up at 8am. Do a blood test, take your Lantus. Get showered, dressed, etc. Prepare your b'fast, do a blood test, take the appropriate amount of insulin for your bs and food. Eat b'fast, clear up, get ready to leave for work. Do anther blood test - is this 3 hours after you've eaten b'fast? Or 30 mins later? The result you get will be affected.

    Maybe this only works for the insulin I'm on,though. As I said, I feel my treatment here in France is way superior to that I was getting in the UK. The doctor has no problem with me testing my blood as many times as I like. However, she has told me that testing before eating, and three hours after if it's felt necessary is ample.

    You should know your own body. You should be able to feel if you are running high or low. When you test your bs, and it's normal, make a note of how you feel. Do the same when you test and it's high/low. Once you know how you are feeling, you should know when you need food/insulin/nothing.

    I'm not having a go at any of you who prefer to test your sugars more frequently, but I can't help feeling it is a real restriction on your life, and how much you enjoy it.

    Try to speak to a nutritionist, and your doctor. They should be able to tell you how much insulin you need for the amount you are eating. Stick to the recommended number of carbs they are telling you to eat each meal, and take the appropriate amount of insulin for that amount of carbs. You should then be able to know 'ok, I had 30 carbs for b'fast, therefore I need * units of insulin' After a while, you'll find your sugar levels level out - eat the right amount of carb, take the right amount of insulin, and you will rarely need to adjust stuff, and will therefore not need to do the bloodtests so often.

    Although cost obviously comes into it, I know that my doctor is more concerned with my quality of life than how much I am costing the health service. To her, if I prefer to reduce the number of tests I do, and I am usually balanced ok, there is no need to 'hurt' myself doing unnecessary tests every half hour.

    Secrettheature - you need to speak to your doctor/nutritionist - find out how many units of insulin you need for the amount of carb, and how many units of insulin you need to reduce your blood sugar by a particular amount ie humalog (for me, anyway) 1 unit = 2,3 BS. I have no idea whether this is the same for everyone, but can't be far out.
     
  16. secrettheatre

    secrettheatre · Active Member

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    But the problem is if you're losing hypo sensitivity, as I am, your body is not giving you adequate warning of when you're going low.

    Actually I'm due to go on a DAFYDD course soon, which I hope will finally help me sort out the relationship between my carb intake and insulin dose. I have made an awful lot of improvements in the last few months after years of total mismanagement (leading to mild retinal changes). So I'm still learning, you see. :)
     
  17. Sweet3x

    Sweet3x · Well-Known Member

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    Hmm aren't there some devices out there that warn you when you are about to go hypo? they work on skin temperature or something? Might help you out a bit :)

    Have fun on the course :) I did that late last year - it was decided it would be useful for me, since I'm in a different country now, with different foods. I really enjoyed it, and found it gave me lots of info I didn't know before :) Hope you find it useful.
     
  18. secrettheatre

    secrettheatre · Active Member

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    Well, that's precisely why I've been testing a lot. :)

    I am looking forward to it. I just wish something like it had been available - or, if it was available, I'd been advised to go on it - when I was first diagnosed. But then, 'shoulda, coulda, woulda'...
     
  19. LittleSue

    LittleSue Type 1 · Well-Known Member

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    Personally, I find frequent testing is not a restriction, it's freedom. Since I did DAFNE and hence started testing more, my quality of life is better than when I tested twice a day. Because I have better control, with fewer bs swings, I feel better, have more energy, general health is better, and I am controlling my diabetes rather than the other way round.

    That's the theory. But in practice, things do change. Some women need considerable changes in basal and meal boluses due to their menstrual cycle. Testing frequently helps clarify if its the bolus or the basal that needs changing. I don't need to test so frequently every day, but I need to have strips available so I can test as and when I need. Someone with a history of sleeping through night hypos shouldn't assume a high morning reading means more basal is needed, they may actually need less, so need to test in the early hours.

    If secrettheatre can explain her reason for doing each test, and how the result was used, that's what matters.

    Twice a day is wasteful if you don't act on the results. 8-a-day is justified if you did them with good reason and used the results wisely.

    Do they impose an insulin dose we must take because that's what suits other people? No. Do they limit the insulin dose of a very insulin-resistant T2 on cost grounds? No and nor should they. So why limit tests that way? Everyone's different. T1s may do more tests than T2s, but we're likely to be using less insulin, so if cost is the issue they should look at the whole picture.
     
  20. susieq987

    susieq987 · Member

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    I agree that carb-insulin ratio is important but also that it doesn't always go the way you want.. Things like stress, excercise a meal out can all alter your levels. I have had diabetes now for 39 years have been very well controlled for at leas 25 of these, I can test my blood from anything between 3 and 8 times a day due to the fact that I work, I drive and also have young children aged 6 and 2.5 that need to be taken care of, taken to and from nurey and school etc. And as for someone saying that you should be aware of being high or low well they are wrong as I used to be able to tell but have lost awareness of hypos untill it is too late
     
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