Text message reminders

Jean, I like all your terminology!

Kim, have you (and also acid rock) always operated that way? I’m really trying to figure out how to help folks who just don’t think that way, it’s frustrating not to be Abe to help as we all know how important and necessary testing is.

I have been testing pretty frequently since the early 90s, running about a dozen/ day. When I was getting close to getting my black belt (2009...), I'd lift weights and run 2-3 miles@ lunch and then work out at the dojang @ night for 1-2 hours 5-6 nights/ week and was testing 17 times/ day. I sort of backed off (both working out and testing...) as I moved and switched gears to running and got a CGM but the doc still rx'es 17 and BCBS covers 14. I figure that the following schedule is "reasonable" at 12 but can need a few more here and there?

1) wake up, test bg
2) before eating test BG
3) before driving to work test bg
4) 2 hours after eating test bg
5) lunch test BG
6) 2 hours post lunch test bg
7) drive home test BG
8) get home, run 3 miles...oh wait, don't forget to test your bg!
9) post-exercise maybe, maybe not, maybe eat dinner and, you guessed it, test BG
10) 2 hours post BG, test BG ****AGAIN****
12) stay up late? Maybe squeeze in another one, what if you have errands to run, what if you want to exercise more (when it's nicer out, I'll run 6-7 miles during the week, more on the weekends...a lot of times, I'll run a long run on Saturday and then a 20ish mile bike ride for fun, speed and recovery on Sunday...there's several extra strips in there...).

Ok, so did you have T1 before the 90’s? If so how often did you test before the 90’s? What was it that made you test more? Wanting the info?, not wanting to go low?, how old were you at dx? And how old when you started testing more? Sorry to pry, but I’m wanting to understand both sides (testers, and non-testers)… thanks for letting me pry.

I was dx’ed in 1984 when 4x was de rigeur. I think it went to 7 for a while and then a dozen and it seems like working out " a lot" (moderate compared to people who really work out a lot but more than the average bear?) Will get docs to rx 14/ day but I might’ve had that since befor I worked out a lot? Sorry I don’t recall exactly. To me, I want to know what my blood sugar is. The CGM is useful but the meter is essential, along w/ enough strips to fill it. I don’t get “non-testers” at all, whether it’s oblivion, contrived oblivion or acutely described fear of the alleged pain.

I think for relatively young newly diagnosed diabetics, esp if not on a pump yet it might be a neat idea. Younger people especially always seem to have their cells close by. I do think though for people who are serious about good control. The habit to test will develop within a few weeks of consitently testing.

As others have stated on here, we all seem to be a group very motivated for good control, with most of us testing at a minimum of 8-10 times daily, some even more. It's become second nature to us, and we do it without even really thinking about it.

I don’t think it has anything to do with the pain, it’s more of a “head game” thing… The number is more than data, it’s a reflection of the person, it means someone was a ‘failure’,(not that’s that really true, but it becomes true in some people’s heads) I think the data/numbers become something bigger than data and that just messes with some people’s psyche.

Some people complain about it here. Not that there's anything wrong with it but my lust to know what my blood sugar is obliviates any incidental pain. They always cite "testing 8-10" times/ day in JDRF ads and stuff like that too. I think that if you don't test enough to "control" it (ha ha, rough patch lately...), tests will end up being more like "slot machines" that could be anywhere? I think the other way around the "frequency" issue is to be really conservative and deal with known quantities but that's not for everyone either. Maybe if the "slot machine" seems unpredictable, without the "missing data" from the holes in one's chart, it is counterintuitive to test more, due to the cost issue, communication with doctors, having to push insurance companies, etc. Since there's not a widespread cultural push to "fill in the blank spaces between tests with real, intelligible data and use it to improve one's control", no one thinks of it as a solution. It's more like it's conceived of as a punishment.

It's on the Ping too. Mine is off, I guess it's just situations that 'alarm' me to test, or just habit. Got an internal alarm LOL

"...conceived of as a punishment."

Exactly! If you don't know how to USE the data in order to achieve improvements, more data just becomes a form of torture. "Oh God, please make it stop." rather than, "Hey, cool, I know what to do about this number...take THAT diabetes!"

Avoiding testing seems like the logical outcome of how most T2's are "treated". Once I got on Lantus AND Novolog, started counting and restricting carbs, and learned how to USE the numbers when planning my meals, and calculating my basal, bolus and corrections, a light-bulb switched on, "Oh, this is why I'm poking myself so much!"

Before it was just something my doctor looked at casually, if at all, and there was nothing I could DO about it, really, except feel bad/guilty/ashamed/hopeless.

Testing, testing, testing when ALL the numbers are bad, for months on end -- and you have no tools or support to make them better -- feels like an enormous, pointless drag.

I can see where a newly diagnosed person may have a difficult time remembering...

I haven't had an issue at all remembering, though. I was just diagnosed on February 10th, but I know how bad it is to have glucose running as high as mine was and I didn't need 'time' for it to sink in that I was going to have to check it a half dozen times a day or more at least for now until I know how many carbs is going to do what..

But I already had a good understanding of diabetes (IDDM and NIDDM) in animals.. and the complications are similar and SCARY.

With all that being said, I wouldn't want to use a text messaging service, I find that a little annoying; but that may be the best option for someone without a smart phone. I have a droid and I use dbees.com to track everything. I have a reminder set up in the evening so I can give my Lantus at the same time every night. That's the easiest for me.

I totally “get” that a majority of this forum is comprised of you all who have motivation, mindset, whatever it’s called to self manage diabetes EXTREMELY well and I applaud you all! I know it just seems like second nature and like Nike says you “just do it”. helping folks change their internal drive, motivation etc., is my task and asking the experts at it (you all) is a way for me to try and learn how you got to that place so
i. can try to help those (there are many) who are not able, for whatever
reason, to ‘see and understand and do’ what you all have figured out about managing your diabetes. It’s interesting, challenging and frustrating and
I’m glad there are you all out there to ask. I also realize that you all probably have your own struggles and “days”, just because diabetes in general is demanding in many areas so again thanks to you ‘role models’!

How did you get your internal alarm? Where did that come from? I see hundreds of folks in a year, many on pumps (all manufacturers, even an old Cozmo!) and the psychology of testing, or getting people to understand or internalize that testing is a key to management necessity is an ongoing challenge for me. I haven’t found any one strategy that works consistently for helping people have their own internal alarm.

Thanks everyone for allowing me to engage in a conversation with you about your own strategies on testing. I really appreciate the insight and the conversation and the gratefulness I feel that there are role models ‘out there’ to ask advice/insight from. I see every day those who struggle to gain the inner motivation to get to where you all are. Thanks tons!

Practice, I guess. I'm fairly OCDiabetic, I just don't like being outside my goal range (80-120). My standard deviation last week was 28.

I don't think you'll ever be able to 'make' someone check their BG or anything else, however giving them good information is definitely the way to go.

Good discussion, thanks!

Send them to TuD :)

Hi Kara,
I just want to applaude your dedication to your job. You sound like a very passionate person that wants to help your pts. Getting advise from people that actually have diabetes and not just relying on text books says a LOT about you.

Hi Kara, I too appreciate that you're making such an effort to understand what drives these decisions to act or not. I was diagnosed Type 1 about 25 years ago. I now test at least 10 to 12 times a day, more depending on highs/lows, but I haven't always tested that often as I went through a period of denial during my younger years.

I agree with bits of what previous posters have said with respect to the state of mind in those who don't test as often. For me, it was due to not knowing what to do with the data once I got it and if it was bad, it was a constant reminder that it was bad and I was failing and I didn't know what immediate actions to take to "fix" it so why do it?

I think more education in how to use the data fosters more testing. However, my experience has been that many doctors, including endos, and CDEs don't necessarily want the PWD using the data to make decisions and make changes on their own. If they did, I think it would lead to better self-care and allow the PWD to understand that *they* can make a difference in their own care.

Instead, many CDEs and doctors seem to assume that the PWD isn't capable or they don't want the PWD to make those decisions so the docs err towards a more standardized format or formula for the patient to follow and not wanting the patient to deviate from that. For example, instead of explaining what ISF is and how to use that factor in making corrections, they will give you a chart with a set of ranges and correction doses for you to use like a robot with no understanding. When I realized that my ISF wasn't the same at different times of day, I thought I was some freak of nature (until I came here!) because the correction *schedule* did not take that into consideration.

Like most here, I have learned what I know about self-caring for my diabetes from other people with diabetes, not so much the medical community. I've had my CDE and endo tell me "you know more than most medical professionals because you live with it 24/7" but one could look at that as a cop out too. Sometimes I feel like they *assume* that you know everything already and they shouldn't make that assumption.

But back to your original question about text message reminders, I think the reminders are only going to be as good as the internal motivation to test. If someone is motivated to test because they want the data and know how to use it, then the reminders probably aren't necessary but might be helpful if they are busy during the day and want that distraction to make them stop for a second. If someone isn't motivated to test, I'm not so sure a text message reminder is going to change that but that person probably wouldn't sign up for such a reminder anyway.

I have an app for my iphone called "My Medtronic". I don't remember if I got it off of Medtronics website (maybe I should get a reminder for that! LOL).

It has a tool to set reminders for your infusion sets, bg's, sensors, supply orders, and a custom reminder. I have all of them set to off. I only use my pump for alerts and at certain times when those are annoying (usually when it disturbs other people)I'll turn them off and turn them back on later.

Wow!!! SD of 28 within target range is amazing!! You go girl~