I saw the Endo a couple weeks ago and I've been confused ever since. I'm honeymooning and my pancreas is covering my basal, so I only bolus. My I:C ratio is all over the map and I'm never certain when my pancreas might decide to dump some extra insulin, so I generally test my BG before meals and two hours after, primarily to make sure I'm not trending downward too quickly. Also, if I don't bolus in the evening, it's because I'm going to exercise, but I'll still test because I can crash during a workout even without bolusing. The Endo is a resident with a fellowship and she has to have the attending come in at the end of the appointment to okay everything. The attending told me I test too much. She said once in the morning and maybe after dinner is fine. I was too shocked to really say anything at the time, but as I continue to do my "excessive" testing, I'm wondering whether she misunderstood my situation. Perhaps she thought I was a T2 not on insulin? Does it seem right that an Endo would tell someone on insulin that they should not be testing after every meal for which they bolus? My understanding was that testing was pretty much standard operating procedure. How else am I going to keep track of my I:C and also make sure I don't go hypo? I intend to take this up at my next appointment, but that's not for three months.
I also test my fasting every morning because I know that will be the first sign that my honeymoon is ending.
The attending gave you very bad advice but if she didn't reduce your scrip for strips she didn't do any harm. Testing before every meal and two hours post is good standard procedure for the reasons you mentioned. Personally, I wouldn't raise the issue with the attending but would simply ignore her advice unless she complains about your overtesting after reviewing your logs.
There's nothing wrong with telling this person that she's wrong. If she's coming in with the wrong info (thinking you're a T2 without insulin) she should appreciate the correction. If she's arrogant, or thinks you're arrogant, she'll complain to the doctor who will set her straight.
It's your body and your health, and ultimately the person responsible is you. Don't be afraid to speak up.
I agree that it's very unnatural to tell doctors to buzz off. On several occasions, they get *very* snippy when you do. I think that it's important to stick to our guns though.
What an idiot! You are absolutely that testing before and after meals, as well as other times when your blood sugar might be out of range, waking, before bed and before driving all are important for a Type 1. I personally don't think it's any excuse at all if she thought you were a T2 not insulin. Why would she be giving treatment advice to someone without knowing their diagnosis let alone their individual situation? Testing is very important for any Type 1, and even more so when you are honeymooning and have variable numbers and still learning about how certain food, doses, ratios, etc affect your blood sugar.
Do not let the ignorance of much of the medical profession confuse or throw you. You sound like you are learning well and coming to trust your instincts. Keep up the good work. If you haven't gotten a book like Using Insulin by John Walsh, please do so. As you say you will not be seeing this provider for three months (which also seems odd for someone so new to insulin! Do they have you seeing a CDE, e-mailing your numbers, anything?? Personally, I shouldn't be surprised. Like most of us, you will learn that the vast majority of your D management which is 24/7 happens with you, with support from books like I mentioned and the wonderful people of TuD. As you learn and progress in your treatment, you might have questions for your providers, but what good is it if it's only every 3 months. I personally only use my doctor to write scripts and when I have a question I come on here or look in my books and get useful and meaningful information in moments. Hang in there!
I found a new endo and basically told him I needed him to update my scrips and try to assist in dire situations. He understood. We treat ourselves and the endo community is beginning to get an idea--we are basically better at determining our needs. but cannot precribe meds. I truly believe we are our own docs.
Not only that, but there are always wasted strips. I waste strips all the time when the number doesn't seem quite right, or when I forgot to wash my hands and some juicy residue was on my fingers, or when I don't get enough blood to fill up the strips.
And don't forget that your doc has to add one strip for every vial of test strips for the "control solution test". It's how the manufacturer tells you to use them, and we all follow those directions, right? (Everyone nod silently and try to withold sarcastic laughter).,
Testing twice per day? While injecting insulin? That's just...crazy-talk. How can you bolus/correct without knowing what your BG's are?
In general, this is what I do or have done:
Test upon first arising Test before breakfast (if it's very long after the first test)
Test before lunch
Test before dinner
Test before bed
Test after meals (one hour, two hours) until bolus values are perfected
Also:
Test before driving (if I didn't recently do a test for another reason) Test periodically while driving on long trips
Test before/during/after strenuous exercise
Test immediately at any time if I feel "weird" (seeing spots, feeling shaky, feeling oddly tired, unusual thirst, etc.)
I once had a doctor come into the room and start giving me "my" test results -- for a test I hadn't had. She had someone else's chart completely mixed up with mine!!! Boy, I've never seen a doctor blush so red! I was gracious about it, but I'm more careful now that they know who I am, what I'm there for, what's been done in the past, etc.
Sigh. I'm old enough to remember the days before drive-by medicine. It was better when doctors actually had time to spend with each patient. This new "efficient" method sucks.
The best diabetes clinics (or any specialty, for that matter) are often teaching institutions. The doctors are excellent, and the others you may deal with are students. They’re bound to make some mistakes as they build up experience, it’s how they learn. If this is the case, I’d let it slide, knowing that (after your letter) the mistake will stay in her mind forever and she’ll never make it again.
The attending assumed T2 without reading your history=unmitigated idiot. If anything, your waxing and waning pancreas means you may want to test more often than most T1!
It's not a pretty picture but you've done a good deed. There is a chance that the fellow will learn something here and be more aware of the variety of diabetic experience and methods of self-care.
Glad you expressed your feelings and were (sort of) heard. Yes, it is shocking. I expect (and get) the same comments about how unusual my control is, but that's because I only see a PCP and they have mostly Type 2's. (no offense to the type 2's who are in good control). My answer to that statement would be, "ok, what are you doing to change that fact?" But I, at this point, don't expect much from doctors.
Just one other thought. Even if your ratios become stable (as stable as things ever get for type 1's!), you still want to know if you are high so you can correct. I'm convinced that prompt correcting is the single factor that gave me my last low A1C. More importantly, it means I spend minimal time high to avoid complications. In time, I hope you find a solution to the later lows by tweaking your basal dose (or getting a pump!) Because 90 is a perfect number, and it is most likely the basal that crashes you down a few hours later.
Wow, I think I would do exactly as you have done if my endo was telling me I tested too much. It's my body and I'm the one that has to deal with this day in and day out so I'll test whenever I feel like it, thank you very much! I'm like you, just starting out on this journey and you're completely right. How are we supposed to know and figure out our I:C ratios if you're not testing often and especially after each meal with a bolus? I'm pretty stable (so far) and I still test 7-10 times a day usually because I want as few surprises as possible and to know how I trend at different times of the day. Luckily I think I have an endo who understands the testing. She doesn't have diabetes but, according to her, is obsessed with her BG levels. She'll test herself multiple times a day and wears CGMs from time to time. At least I know she knows how it is to stick yourself several times a day!
