So I had my appointment with the diabetes doc. He’s one of only two docs in the whole city (population around 580,000!) who are certified to run the insurance company’s type 1 diabetes program, and, well, I would not pick him as my doc if I had a real choice. He’s just not the type you feel could be your buddy or your partner with treatment. I don’t know what it is, but he just doesn’t make me feel comfortable at all.
Well, I presented him with my findings and then got the expected speech about how meters are never 100% accurate and one meter varies compared to the next, blah, blah. No kidding. I got the impression he thinks I’m just lying and trying to make excuses for high blood sugars. I’m not!!! I really want to get to the bottom of why my meter says everything is better than it’s been for 3 years and yet my a1cs are much higher! Something doesn’t compute. Something (my hemoglobin, the lab or the meter) is messed up!
Here’s the kicker. He wants me to come in at 8am for a new a1c (good) and also a finger stick to compare the lab’s glucose value to my Ascensia Contour. THEN… he wants me to do the same every two hours for the rest of the day. Lab to meter comparisons. So, at 8, at 10, at noon, at 3, at 5. I’ve never even heard of anything like this just to see if a meter is accurate! That’s a lot of lab work, isn’t it?! And that’s an entire day off, hanging around in a neighborhood where there’s nothing to see or do for 8 hours or more. (We don’t have a car and his office is so far out of the way that I couldn’t get anywhere and back with pub trans in time.) Agh! This couldn’t be worked into my schedule until September 6th.
The problem is, I don’t know how to take this. What’s the motivation? Why wouldn’t he have just said, “ok, so you think the Ascensia is junk. Well, I seriously doubt it, but sure… we can give you Accu-Check strips next time instead.” What’s the big deal? Why the 5 lab tests? I figure it’s one or more of the following:
1) He has a contract or deal with Bayer (a German company, after all), the maker of Ascensia meters, and wants to prove that I’m crazy, not the meter
2) The insurance company has an exclusive deal with Bayer and he would need to prove something’s wrong in order to get me something else
3) He doesn’t believe me and thinks this is a convienient way to catch me with bad blood sugars all day (plus prove that the great Bayer is to be trusted)
If I felt like I could actually talk with him, yes, I would have asked further. However, I felt more judged and under suspicion than warm and fuzzy. I had a better relationship with my docs in America than with any here. I have found that in Germany there tends to be a more “I’m the doctor, you’re the patient, so just do what I say and don’t ask questions” attitude. It’s frustrating. (Other expats have mentioned this phenomena, too, so it must not just be me.)
And now there’s a dilemma. The Ascensia reads only 10 to 20 points lower at good numbers, but up to 50 points lower when it gets over 180. If I go in and do everything I can to keep my glucose levels in the 80 to 120 range all day to show what a good job I can do, the variance might be too small to say there’s anything much wrong with the meter. The only way to see how much of a difference there really is is to test over a larger range of sugars. So, I want to see what it says when I’m at 200, not just at 100. My plan is to under-bolus at lunch or drink a little Pepsi or something to insure a couple of 180+ readings. This is risky (if #3… trying to catch me with bad numbers… is true), but how else will we see how accurate the meter really is? I plan to do this and make it very very clear to them all that I purposefully went high because I wanted to see what the meter would say. I don’t see what else I can really do. It feels like this is some kind of a game that I’m doomed to lose. Has anyone else ever had a doc do testing like this just to see how your meter compares to the lab?!
Of course, I’ll post updates later for my own record and for any others who actually read my long-winded complaining, lol. Just don’t have anywhere else to ■■■■■ about this sort of thing, you know!
I really doubt he’s doing the testing to see how your meter compares to the lab. I think he’s trying to show that you really have high numbers by testing you a lot in one day.
I wouldn’t go high on purpose if that was the case, because if he is suspicious, he probably won’t believe you!
I had a very bad meter, but it was reading way high, not low, and even when it was 50 mg/dl off from the lab, the meter company explained it was “normal variance.” It was 25% higher than the lab reading, which didn’t even fit their lousy standard!
I have run into doctors who make it clear they don’t believe that what I’m saying can possibly be true. It’s an unpleasant experience and I’ve usually dealt with it by finding new doctors. But I have also been in the captive patient situation–Kaiser–so I know sometimes that isn’t a possibility.
Just stick to your guns! Eventually they’ll write nasty things about you in your medical records but they’ll give you the care you demand!
He might want to see if it’s consistantly off in the same direction; if it is, you can adjust for that.
I use Accu-Chek, and it was 20% high at the last comparison, 30% high the previous time, and about 15% high the time before that. My actual sugars ran 87-93, but my meter read 101-112.
Both meters are plasma calibrated, yes.
I’m wondering more now about what you said, Jenny. That’s more my suspicion, too. I would like to hope that what Jonah said is more accurate, though! I hate to have to feel so untrusting, but that’s the vibe I get from the doc.
I’ve been dieting and exercising with constant vigilance for several months now (lost over 25pounds so far) and with low calories and low carbs, my blood sugars range from 80 to 140 in a day usually. Of course, when you don’t eat much (1200 calories/day), it’s much easier to control blood sugars, lol! I test every 2-3 hours, so have a pretty good idea. I also drink so much water that I have to pee at least once (sometimes twice or three times, lol) overnight, so no one can tell me I must be at 300 all night and unaware of it. I test everytime I wake up. It’s usually around 95. Now, I DO have those occasional “what the ___?!” moments that we all get when it shoots up to 280 for no reason… bad absorption from a new infusion set, someone sneezed on me in the elevator and my body is trying to keep me from getting sick, it’s an odd post-exercise high… but I correct immediately. I tend to over-correct now on purpose and even do correction-boluses for numbers like 115 because I got bitched at so much for my a1c’s rising. I’ve had a lot of lows lately, actually, just because I’m trying to keep it in SUCH tight control. My numbers haven’t been this good since I was in my honeymoon phase several years ago. Back then my a1c was like 5.9 to 6.2. But, oh yeah, sure, now it’s 7.4, right? Right.