Endocrinologist & problem testing

3330 Views 13 Replies 6 Participants Last post by btyler, Oct 13, 2010

Strawberry

Discussion Starter · Oct 7, 2010

My current Endocrinologist tells me I am testing "too often" because I asked for a prescription for testing 10 times a day. I figured that if I test upon waking in the morning, before and after each meal, and at bedtime - that is a minimum of 8 times a day. I also prefer to test before I get behind the wheel to drive or when I am not feeling well.

This doctor is not an ignorant person, but he seems to not understand what it takes to have good diabetes control. I don't enjoy asking for a prescription for new test strips because it always means a somewhat heated discussion.

If test strips were not so expensive I would skip the Endo request to have my insurance help pay a little on the cost.

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Emmab

· #2 · Oct 7, 2010

What? ? ?

Are you a pumper and a CGMS user?
You have to be kidding! Having the former requires you to test often, especially if you are having pump clogs or problems and need to troubleshoot them.
Having the latter, from my understanding, means you have to check even more to work with calibrating the thing.
My endo gives me 300 per month, for which I am grateful, with no arguments. I usually go through them in four to five weeks.
You need to educate your physician.
They should never be questioning ten per day!

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Strawberry

Discussion Starter · #3 · Oct 7, 2010

Yes, I am a pumper and a CGMS user. I pay 100% out of pocket for my CGMS sensors, receiver and transmitter. Medicare helps pay for the pump and supplies plus I have a co-pay.

When I first started going to this Endo he thought I should be testing 3 times a day. I didn't argue with him, I just went to the drugstore and bought what I needed for one month - until I had my next appointment with him. Then we had another 'discussion' and he agreed to me testing 6 times a day. Now I'm trying to get him to authorize 10 times a day..but who knows what he will do next?

Testing 10 times a day is minimum for me. What do you do when you have a low or a test strip that gives an error message? This morning I got the "no delivery" message on my pump.......so that meant another test strip used. Sigh.................

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Vytautas

· #4 · Oct 7, 2010

I personaly test 5 times a day. That's the so called required number for good controll. Sometimes I make due with 3-4. If you want to lower the usage of test strips one thing you can do is stop messuring when it's low and learn to feel when it's really a low and understand how low it is by sense. For example: the only low BG in my glucometer memory are the ones I didn't feel (just a routine check after sports or something) or in the morning. That's it. If it's a low I skip the test and go straight for a counter. Same goes for a high. I notice an unusual thirst I immediately check my pump for any air bubles etc and make sure the insulin is flowing and inject some. After 6 years of diabetes you kind of learn to just do it by feeling (Oh, it feels like the BG is too high... here's 2 units for a counter, an hour later check to see where you are at)

However that's not something you want to do if you are not confident you can controll since you can slip into hypos pretty easy. At first I did that often, but only had 3-5 hypos in the past 2 years...

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Adjitater

· #5 · Oct 7, 2010

When I have a sensor in use I only test 3 or 4 times a day otherwise I test like 10 times a day

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Strawberry

Discussion Starter · #6 · Oct 8, 2010

Adjitater,

I envy you to have a sensor that is quite accurate. In spite of trying to limit my carb intake, my BG can be quite erratic. If I eat a small amount of carb at any one time, it seems to help my BG to stay within target. Do you have any suggestions for helping keep my BG stable?

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Adjitater

· #7 · Oct 8, 2010

The key to that is to get your basal insulin set right is the big key. the other part is to never eat anything without covering it with a bolus. You have the best pump on the market if it was me I would switch to mm cgms as it works in conjuction with your pump. The biggest mistake that you can make with sensors is to over calibrate them.

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onaughmae

· #8 · Oct 8, 2010

Strawberry said:
Yes, I am a pumper and a CGMS user. I pay 100% out of pocket for my CGMS sensors, receiver and transmitter. Medicare helps pay for the pump and supplies plus I have a co-pay.

When I first started going to this Endo he thought I should be testing 3 times a day. I didn't argue with him, I just went to the drugstore and bought what I needed for one month - until I had my next appointment with him. Then we had another 'discussion' and he agreed to me testing 6 times a day. Now I'm trying to get him to authorize 10 times a day..but who knows what he will do next?

Testing 10 times a day is minimum for me. What do you do when you have a low or a test strip that gives an error message? This morning I got the "no delivery" message on my pump.......so that meant another test strip used. Sigh.................

My endo gives me a script for strips X 10 a day. Your endo needs some education. I cant imagine why they would not want their patient to test often and have good control.

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onaughmae

· #9 · Oct 8, 2010

Vytautas said:
I personaly test 5 times a day. That's the so called required number for good controll. Sometimes I make due with 3-4. If you want to lower the usage of test strips one thing you can do is stop messuring when it's low and learn to feel when it's really a low and understand how low it is by sense. For example: the only low BG in my glucometer memory are the ones I didn't feel (just a routine check after sports or something) or in the morning. That's it. If it's a low I skip the test and go straight for a counter. Same goes for a high. I notice an unusual thirst I immediately check my pump for any air bubles etc and make sure the insulin is flowing and inject some. After 6 years of diabetes you kind of learn to just do it by feeling (Oh, it feels like the BG is too high... here's 2 units for a counter, an hour later check to see where you are at)

However that's not something you want to do if you are not confident you can controll since you can slip into hypos pretty easy. At first I did that often, but only had 3-5 hypos in the past 2 years...

You cant always assume you will feel a low. Sometimes they give you no symptoms until it is already very low. Most of the time I feel it...but not always. I have been diabetic for most of my life and I cant always by feel. I would certainly never bolus myself with insulin without actually checking my blood sugar. It just isnt safe. There have been times when I thought I was low and I wasnt...and times I thought I was high and wasnt. The best way to maintain control in my opinion is to test.

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Emmab

· #10 · Oct 8, 2010

CGMS aside, a pumper needs the freedom to test and test a lot.
You have to, you cant always tell a low and you cant always detect a high. Personally, after 40 years of this, I dont have too may signs of lows anymore (never needed any medical assistance though) and I dont get sick from highs.
Occasionally I have lows that take awhile to go up, and I need to test more often before I leave the house and get in the car, or go off to sleep at night.
This is just plain weird. Ten times a day is pretty much status quo and dont make any excuses for it.
It's necessary.

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btyler

· #11 · Oct 8, 2010

I agree

I agree with everything Pam wrote.

I also cannot imagine why the doc cares that you are testing 10 daily, my average is about 8 per read out, but only because it takes the good days with the bad and averages them. I may only take fasting and 2 for pump calibrations, then check because of symptoms 2 times, then tomorrow I may check 15 times because the pump is reading "low" and I cannot eat constantly, there is just not room in my stomach, so I treat with glucose, especially if it is one of those days that it is just going to keep dropping no matter what I eat, like last night, I stayed in 50's,60's all evening. I am thinking these little tasty corn popper things at restaurant were full of sugar, sugar is everywhere as you know and I cannot tolerate over about 5 gms without spiking and dropping, so I just avoid all I can. It is hard enough figuring out the protein to carb mix on the meal.

Always find it strange when a medical professional makes you feel like we are begging, if it is not an unsafe practice, what skin is it off of their teeth. I can say this because I am a nurse LOL. It is like the patient who asks for both pain pills at once, who cares, it is written and agreed upon with their physician, JUST GIVE IT.

Beverly

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Strawberry

Discussion Starter · #12 · Oct 8, 2010

Recently I've read about figuring this 'protein to carb mixture on the meal' on various forums. However I must be totally ignorant but I just don't understand it. I'm not a big meat eater so how would I figure my protein content to carb mix?

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Vytautas

· #13 · Oct 11, 2010

Well, my base and bolus are set rather well and I adjust it pretty fast so testing less might not work for just anyone, however a great many diabetics here test only up to 5 times a day and still have a normal HbA1c

Also I did have a very high ammount of lows and I guess I just got used to it. I've even got used to the point where I can feel if it's let's say at a normal level of 5.5mmol/l however draping rapidly if I had too little harbs or too much insulin or already a low (can't explain it in words, but it just feels different).

Also this is only valid with other healh issues asside. So if you have a cold feeling is definetely not the way to go and even I resort to much more testing than ussual. However a good understanding of what you eat and good balance of base and bolus can remove the need of the test 2 hours after the meal.

So I have only 4 scheduled tests:
early morning - breakfast
mid-day - for dinner (busy schedules might make me miss this one)
evening - supper
midnight - before bed

Sometimes if I am completely unsure of what I ate or how my organism will react (like various intakes of alcohol) I do test extra as well.

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btyler

· #14 · Oct 13, 2010

Your endo would not like me, when I am low I retest, and retest sometimes, even while I am sitting there eating to correct it. It is how my brain acts without glucose. It is like it says "check that again, check it again, it could not be that low", I cannot make myself stop it, I just do it, sort of a panic behavior I think?

I do not want to beg for care, sorry you are going through this. Can't you find a new doc?
Bev

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