Reading of my glucose levels at the doctors office: what do you discuss with your doctor?

I went to see my endocrinologist last week. The nurse at the receptiondesk had a device on the desk, which can read out every glucosemeter and insulinpump. She asked me if I had brought my glucose meter and insulin pump with me and started scanning my omnipod and freestyle libre for “the doctor to see”.
I was caught off guard and felt like I was coerced into handing over “my” glucose readings. It’s a weird feeling. I didn’t want to make a fuss, but it didn’t feel good.
I don’t go to see my doctor to have her look at my glucosereadings, but I guess for a lot of people this would be the main talking point. I usually talk to her about what it’s like to have type 1 diabetes and how the outside world (including medical world and policy makers) regards type 1 diabetes. Also, we exchange the latest developments in treatment and technology.
What do you talk about to your endocrinologist?
(BTW my endocrinologist took a look at my glucose readings but couldn’t give any meaningful advice)

1 Like

I watch my blood glucose everyday, every hour or more. I do not mind for the doctor’s people to check my blood sugar trends. I know why they are so. I manage my own diabetes. I just use my doctor for my scripts.

In order to get Medicare to cover 80% of the cost of testing strips, I’ve had to turn in a complete record of my BG tests to my doctor ever since I got approval for more than four tests a day (on insulin). It has been roughly five years. So whether I print out a copy or the doctor got a record otherwise would matter little to me. Apparently now that I have a Freestyle Libre, the doctor no longer has to have this complete record in his file for the “Medicare police” to check. However, there are other requirements.

1 Like

I used to have all my readings downloaded at the Dr.s office but my current clinic which isn’t an endo doesn’t seem to be able to download my meter so that hasn’t happened for a few years. I usually end up talking about my blood work followed by possible new treatments for diabetes and getting my prescriptions renewed. Occasionally my Dr. will ask about my last few days of BG’s but not any in depth discussion on trends or anything like that.

I submit all my data (pump, CGM, meter) because I think they feel they need that to provide a minimum standard of care. I think that’s legit. Truth be told, I don’t ask for or seek advice on insulin dosing since my skill-set is so beyond their capability. In fact, I told my current physician assistant that as a general rule, I don’t need her advice on my insulin dosing. If I have a specific concern, I will raise the issue myself.

One of my pet peeves is when a doctor, looking studiously at the data, asks, “What happened a week ago Thursday when your blood sugar rose to 200?” Do they even realize how many “diabetes BG moments” we deal with every day? Picking one incident out of the 10,000 or so since my last appointment is unrealistic. I feel like asking a flippant question like, “Can you tell me what you had for dinner that day?”

I like to spend my diabetes doctor time with looking at my labs and talking about what Rx’s I need refilled. When something unusual comes up, like my recent steroid injection for my frozen shoulder, I like for them to comment on what I should expect with regard to increased insulin I’ll likely need.

The doctor usually reviews my record to make sure I’m up to date with flu, pneumonia, shingles, and other vaccines. I don’t mind a review of when I had my last dilated eye exam, when I last visited the podiatrist, and when I last saw the dentist.

I think I’m a relatively easy diabetes patient to follow but I do hold strong opinions about diabetes treatments and am not shy about expressing them. I think the doctor deserves respect but I also expect that respect to be mutual.

I would only see a diabetes doctor for routine visits once per year but Medicare requires that I see the doctors every 90 days or they won’t pay for my pump supplies. I think that’s silly but I’m willing to play the game.

6 Likes

I agree with Terry4 above about “playing the Medicare game.” We do that with my CDE plus we talk about our horses, cattle and calving. Small town. :slight_smile:

3 Likes

My wife and I play the same game. Our doc mostly BS’S during our visit. Sometimes we even talk about diabetes-related stuff. :slight_smile: We print out our Carelink, meter, and Clarity reports for his records.

Historically (going back nearly 40 years) I brought test sheets first with urine test results then (later) bg test results along with record of insulin doses.

The sheets were “standard issue” at all of the endocrinology clinics.

That was the way it was done, and I didn’t really ask why. I suppose for the primitive treatment regimens back then where the patient didn’t do active management there may have been some value.

Besides when I was a teenager I faked so many test results!

I think in recent years the docs have been more interested in A1C’s. I think it’s useful that our meters have an electronic downloadable record but my doc’s office doesn’t ask for a download of that.

1 Like

Hmmm… I wasn’t the only one?

1 Like

I guess there were three of us, then. I well remember filling out my logs the night before my appointment.

3 Likes

I put a lot of effort into collecting data prior to apt. Then I put it into a readable format for them. They might only look at it for 5 min. It might have taken me weeks to collect and organize for them. But, its there if they want it.

1 Like

I don’t mind that the doctors office downloads pump and meter data. It’s for their information, not me. But then I noticed additional billing charges for it, So now I only allow it once per year or bring in my download printouts.

They do an in office A1C, which has been stable for the last 8 years, and we rarely talk about day to day BGs.

Years ago, when I started CGMS and actively making pump setting changes, diet and activity changes, etc, then it was more helpful to review and get help from them. Now all I really need is RX renewals, and an occasional sounding board.

Weeks to collect? My goodness–just a few clicks on 3 apps for pump, meter, and CGM to print reports. Why is it taking you “weeks to collect” data? I don’t understand what the big deal is.

When I started with my new endo, I always brought two copies of an agenda with me. I still do this if I want to talk about something new. These days, my appointments are like what @Terry4 and @Dave44 have described.

I bring a recent copy of my Dex AGP report, as I am trying to get my endo to focus on having that as the “standard” report. Otherwise, no downloading!

I’m still a year shy of being on Medicare, so I only go twice a year. My prior endo I only went to once a year. I’m not happy about having to go 4X/year, but I will dance the dance.

You dont record everything you eat and do for several weeks leading up to the appointment? I do my own analysis. Of course, next visit my analysis will be: Numbers are good considering that I didn’t give a ■■■■ about diabetes. It seems to be managing itself well enough that I dont have to do much. But, I will still collect several weeks of data, which is a chore.

Is that a joke? I might have done that once or twice in my life, back in the 1970’s. That is neither necessary or helpful, after all these years of being diabetic. As I said earlier, just a few clicks in 3 apps on my PC to download the useful reports for my Medicare-required 90-day visit with my doc.

Eh, I wouldn’t do it for them. If you find it helpful, then that’s a decent reason. I’m not sure that I’ve ever recorded anything as in depth as you’re describing. I only record something if I thought I could look back at it later and be able to determine patterns… which usually just means looking at Dexcom reports.

I could see how adding carbs or exercise to those reports could be helpful to you. I just wouldn’t bother doing it for a doctor- especially if they barely glance at it.

1 Like

Exactly. My doc barely glances at the reports I hand him. Nor do I care–it’s just something to keep Medicare happy.

1 Like

I feel like asking a flippant question like, “Can you tell me what you had for dinner that day?”

I don’t think that is a flippant question, it is a valid way of explaining to a doctor what the real issues are with maintaining 80mg/l without the benefit of a built in insulin pump connected directly to a built in CGM. . Doctors need to understand this because there are an ever increasing number of T1Ds and, indeed, T2s face some of the same issues. . By educating a doctor we benefit both every diabetic and that doctor; zie becomes a better doctor and therefore can make more money or treat diabetic patients better.

John Bowler

2 Likes

Excellent response to the presented question. I read a saying someplace that went like this: “Respect is earned, not given.”