Now I have to feel guilty for GOOD control?!

I recently came back from my quarterly check up at my endocrinologists. I should be very happy. He checks my A1c and it is 5.7. He asks me how many significant hypos I recently had and I reply "zero". He looks at me slightly confused, then goes on to mumble "..that is quite unusual..!" I smile and say:" Thank you!" Then I try a joke: "Well maybe I m not really a diabetic.." My attempt backfires. For a moment I can see him thinking, then he looks at the computer. "I can see we measured your c-peptide and antibody count, so I must assume you really are diabetic and dont come here to get prescriptions to later sell test strips over the internet!"

Now we arrived at his favourite subject matter: me and my test strips. Every time I see him he somehow manages to make me feel guilty about how much I am testing. Even when he tells me "you should be happy, not many diabetics are as fortunate as you with their A1cs and hypos", to me it sounds like "why do you believe you are entitled to a prescription of 200 strips a month when others have a harder time controlling their diabetes?"
This time he also tells me he recently got an email from some state health insurer recommending to only prescribe 500, not 600 test strips a quarter year from now on to Type 1s.
The problem is: They RECOMMEND it – the final decision lies with the endo. And he knows he has a budget for every one of his patients. (How it works in detail between insurer and doctor, I dont know. What I do know is the state health insurers in Germany continue to have more and more money available each annum, but keep making it harder for patients to get prescriptions they need. What I also know is, the more I test my BS, the better my control. The better my control is, less chances my health insurance will have to pay for my heart surgery when I m in my 60s – am I not being logical here???)

I refuse to feel guilty for the way I control my illness. I can live with "your insurance will only pay for 600 strips per quarter" – alright, I will buy some additional strips over the internet. But I cannot live with being afraid at any given moment my insurance could react to some new study which says "it is now actually enough for a T1 to test 3x a day" and my endo reacting by making it harder for me to get the prescription I have to be able to rely on.
I refuse to beg for what I need to manage my illness – in a country like Germany which is supposed to have a functioning social system with health care for everyone.
I refuse to feel guilty about being a responsible patient. And I refuse to apologise for my steady A1c in the 5 something region.
This is BSBS- (blood sugar bull shit)!

first great job on the A1c obviously you ( not your doctor) are doing a great job managing your diabetes on all levels. I highly agree that this is your diabetes and you are doing a great job being responsible, testing frequently has helped you with your success. not all patients nor their doctor are willing to put in the effort to achieve this. you should be praised as a model diabetic not chastised for spending so many insurance dollars. how utterly ridiculous the system is that is like someone with good management on MDI being denied a pump because clearing they don't need it. if the whole world lived with just a tiny bit more empathy what a world we could make acceptance and trust and support no judgment! you rock julez keep managing your D your way as this is your life!!!! blessings, amy

Wow, that's a tough situation but I agree with your position! I think that BG testing should be a civil right and am always annoyed by the doctors involved in these scenarios.

julez, good work on the excellent a1c.
i face the same situation here in spain. my endo is not an arseh*le like yours sounds, but i am faced with the strip dilemma. my endo praises me for all the work i do to keep my diabetes in check and behaving itself. but having very good control means i get no more than three strips a day and no pump. i get my mom to send me cheap strips from the usa whenever she can to supplement-i could never afford the ridiculous 84 euros for 100 accuchek strips at the pharmacy here.
when i told my endo last week about a bad night low she told me to test before i go to bed. and i said, well, can i have that fourth test strip then? she CANT give it to me because i have reasonably good control. it is ridiculous. we have to be completely out of control (be it from not caring or having some really unpredictable bg even when doing everything)to get the care that, hell, were paying taxes for. i wish they would think about preventive medicine now rather than the putting out fires theyre going to be doing for us in 30 years...

Congratulations on your excellent control. I know how hard you work and it shows in your results. Like you I have neither a pump nor a CGM, and find that testing a lot is critical to keeping a relatively stable BG.

If your doctor is able to listen to the opinions of others, you could try to print out this article by the American Diabetes Association LINKHERE. Maybe highlight the following important parts for him to read:

"Providers might reasonably suggest more stringent A1C goals (such as less than 6.5%) for select individual patients, if this can be achieved with-out significant hypoglycemia or other adverse effects of treatment. Appropriate patients might include those with a short duration of diabetes, a long life expectancy, hypoglycemia awareness, and no significant CVD."

"SMBG (self-monitoring of blood glucose) is especially important for patients with type 1 diabetes to monitor for and prevent asymptomatic hypoglycemia and hyperglycemia. Type 1 diabetic patients should perform SMBG prior to, and sometimes after, meals and snacks, at bedtime, before and after exercise,when they suspect low blood glucose, after treating low blood glucose until they are normoglycemic, and prior to critical tasks such as driving. For many patients, this will require testing 6–10 times daily, although individual needs may vary. For example, sick children may require up to 10 SMBG tests per day or more. A study of children and adolescents with type 1 diabetes showed that, after adjustment for multiple confounders, increased SMBG frequency was significantly associated with lower A1C."

"Individuals with type 1 diabetes need to have unimpeded access to glucose test strips for blood glucose testing. Regardless of age, individuals may require 10 or more strips daily to monitor for hypoglycemia, assess insulin needs prior to eating, and determine if their blood glucose level is safe enough for overnight sleeping."

One other thing. I hope he was joking when he said "I must assume you dont come here to get prescriptions to later sell test strips over the internet!". If there is any doubt in your mind, that can be easily cleared up by showing him your meter which will record the number of tests per week and make your testing regime obvious to him.

I feel for you on this. My doctor always gives me a hard time about lows, but I also don't have them. And this conflict about who should have access to treatments that cost money is complicated. It occurs often with T2. For instance the standard for T2 access to pump and CGMS technology is that you need be poorly controlled. It isn't about outcomes. Giving someone who refuses to manage their condition a pump and CGMS isn't about good outcomes. The reason you should be given test strips before someone who won't properly test and manage their condition is that you have demonstrated that you will have a better outcome.

And you should never beg for proper treatment, you should demand it.

Hey A1C buddy! I would say that I'm glad my endo doesn't do this to me, my endo is a type 1 himself and gets how the disease works on a personal level though. He's never been like shocked by my a1c he's proud of me because I can do it without severe/significant hypos. I've only had fairly mild episodes of hypoglycemia and it's usually only 1-2 a month at most. My endo likes that I test 6 times a day and asserts me that that is probably a big reason I have a nice A1C. I'm really into managing my diabetes the best I can and I test as much as I need and my endo always looks at my meter and can tell that's why. Frequent testing=a tool to better control.

I hate to read you're going through this, your endo needs to understand you are well controlled because you CARE and you're testing and using your insulin the way you should! It might be time to get a new endo, if you can.

Good for you! Your control is completely admirable! I’ve been a Type 1 for plus thirty years and I remember the days when I had to make a copy of every receipt showing test strip purchase, then send them to the insurance company at the end of the year accompanied by a note from my doctor saying they were “necessary for good control” just to recover the eighty percent payment from insurance. Being able to test blood sugar (instead of urine only) was such a grand improvement for diabetics, but insurance didn’t seem to recognize that for some time. It looks like they still refuse to consider what we are preventing them from having to cover years in the future (i.e., heart disease, surgery, amputation). It is a shame that your insurance company doesn’t send you a note of congratulations and thanks…keep up the good work!

I personally don't know how you manage to get such a good A1c with no (or few) hypos on just 200 strips a month. I use about 300 per month, pump and still have a large number of visits below 68. You're a marvel!

For some reason lots of people who should know better don't understand the relationship between good tools and sufficient supplies and good results. It's not that it isn't a logical relationship and it's not that there aren't studies establishing at least the correlation.

Don't let them make you feel guilty but don't refuse to beg on principle. We do what we have to do. Having to beg to preserve your health is nothing to be ashamed of although I hope it is nothing you'll ever have to do.


I think it's possible , as I manage on 200 a month as well. Mostly because I had to struggle to get to 200 and I don't think I can really easily get more than that . I'd like to have more but some days I do even test less than I should (not to say I lapse on taking care of myself but days I'm less active and my bg is very predictable and I'm not driving and not having hypos or highs that need a correction where I really only test before meals and before bed time) and I'm still fine. On an average day I do only need 6, any less prescribed would be a problem and any more might provide me with too much info and drive my anxiety up so kind of also a problem.

Studies have shown that the more you test your BG, the better control you will have. When I have a doctor complaining about the testing strips, I show them a standard BG testing form and walk them through it. Here is an example:

OK I am supposed to test when I wake up and go to sleep. Thats 2 strips. I also should test before and 2 hours after meals. That 6 strips if I eat 3 meals. I also exercise every day, which can be dangerous to my BG, so I test before, during and after exercise. That's 3 strips. So assuming nothing else weird in my day that's a possibility of 11 strips a day. Now doctor, explain to me what is wrong with the scenario I just walked you through. I am doing exactly what every diabetic guide says you should be doing, so why are you telling me I am testing too much?