Endo is right ? Am I obbsessive or should I get a new Endo?

[mazea]

I had an appointment today and my endo said I test my blood sugar too much. She said 10 times in my appointment today that I am being too obsessive. My endo, who I find quite helpful apart from not being aware I have LADA (She thinks I am type 1) says I should test only 3 times a day and I should not divide my novorapid into 1/4's. My last HBAC1 was 5.5 and she was happy with this. Do you think I should listen to my endo and test only 3 times a day?

I do test my blood sugars before and 2 hours after breakfast lunch and dinner and before I go to bed. I divide my Levemir into 2 doses, one at 8.30am and one dose at 8.30pm. I also test at 9.00am recently which I have found successful to avoid lunch time hypos.

I told my endo that my blood sugar does wierd stuff and that is why I test 8 times a day. My blood sugar also does another wierd thing. My blood sugar drops 30mmol (540mgdl )points 2 hours after breakfast insulin at 8.00am. So I easily and every day eat at about 8.00 eat a 30g carb muffin to stop this drop from occuring. My blood sugar is stable between 9.00am and 12pm and the drops 3mmol or 54mgdl in 10 minutes right before lunch. If I eat 3 skittles to correct a low blood sugar level at lunch, my blood sugar has suddenly drop even further to 2mmol.My pancreas kept kicking in sometimes. So I use to just had insulin while I was low anyway and then ate lunch quickly. This eating lunch while hypoing wasn't working for me and made me feel sick every day so I decided to try something different.

I started testing at 9.00am to make sure my blood sugar is above 6mmol. I have since starting to do this have avoided these horrible lunch hypos.


I have morning phenomenon and on testing my blood sugar goes up 30 mmol in the morning if I fast and have no insulin.

If I have more than 20g fat like 2 slices of thin cheese on my sandwich, my blood sugar goes up 15mmol extra than if I have less than 20g fator 1 piece of cheese for lunch. When I get past lunch my blood sugars are pretty stable all afternoon and night.I wake up the same blood sugar as I am when I go to bed.
Am I obsessive:confused:

[notme]

I think it is really hard to argue with your A1c. If you are achieving a 5.5 without significant lows, if I were your doctor, I would be ecstatic with your success.

Testing 3x's a day leaves a lot of holes in your information. If you are happy with your doctor, I would certainly try to find common ground. If you think there is no hope and your doctor will not prescribe the test strips you need to continue your good numbers, I would start looking for another endo.

I would give anything to have your HBA1c. Good luck.

[Subby]

I have had this situation before and it DRIVES ME CRAZY.

Doc: "Look at your A1c. It's great isn't it?"

Me: "Well, yeah it's ok, I work a lot to get it".

Doc: "You test far too much! Why aren't you happy with your A1c?"

Me: "Hang on, it's because I test so much that I GET this A1c and can enjoy a quality of life"

Doc: "I think you test so much, you are obsessed, and you should cut it right down"

Me:........... .......... ........

(And we're not talking A1cs like yours Mazea, at the time it was more like 7s)

Mazea, well done on the brilliant A1c, I'd say you are not doing a thing wrong, if you feel your doc is not listening to you at all in this regard (and boy, I don't put up with such docs anymore) I'd feel completely justified in giving them a miss. I'm sure there are docs who are more reasonable and can more understand cause and effect.

What I think you should do, if you can, if you want to (if not, ignore this statement please) is look into getting a pump. A lot of your required micromanagement could possibly be dealt with with basal rates and variable I:C ratios.

Again, congrats on the great A1c and the obvious effort and attention you put into your health.

[AngelKitty]

Hi Mazea,

I think your Dr is trying to reassure you that you have "good control" and your A1c results are proof of that.
I think it's great that you have a daily regimen that works so well for you and you'd be crazy to change it, you've obviously worked very hard to reach that point and your sensational test result is testament to that.
I think you're Dr may think you're obsessing too much because you have a tried and tested regimen that yields good results and you have displayed astounding knowledge about how your body reacts to minor dietary changes - this is exceptional.
I believe your Dr is trying to reiterate that you have scaled a great height and you should now admire the view - Your Dr didn't tell you to change the way you are controlling your diabetes, but the way you constantly need reassurance that what the glucometer number shows you, is something you already know (judging by your above details).
At the end of the day you have to do what feels right and is best for you. If you feel you have lost some trust with your Dr, by all means change. However, if your Dr has been supportive of you all this time and is just trying to relay some advice for your greater emotional good, you should perhaps take it on board (maybe not all of it, the parts that work best for you).
Again, well done with A1c.

[soso]

Not sure I would get a new Dr.. I would just answer the "you are testing too much" with "I believe that is my decision" and leave it at that.

Good for you on your A1c..it's funny how people sometimes don't make the connection between good results and testing, eh? lol

[Gary_W]

I suppose it is hard for someone without diabetes to fully understand the little bits of our condition that make it such a complete box of delights. To many outsiders, the worst part of the disease 'must be' all those needles. A lot of doctors and diabetic nurses share this opinion.

On asked how I had finally improved my health by losing shedloads of weight, reducing my hypos and getting my HBA1c down below 6, I had the following conversation

Nurse 'How do you manage to do it?'

Me 'I blood test at least 7 times a day. Sometimes 10 or 11.'

Nurse (face wrinkled with compassion / horror (I couldn't tell, but didn't much care either so never mind) - 'Oh, that must be awful for you'

Me - 'Well, it's better than losing my legs in a few years isn't it?'

The comment went so far over her head it wasn't even funny. I put it down to experience and cheerfully ignore them. In the past, I studied little bits of psychology. Not to a very high level at all, but I did. I have far more insight on the subject than any diabetes nurse of doctor I have ever met. A lot of them get a 1 day course on it and think they are a qualified shrink. If they spent as much time trying to fix me physically as they do mentally I would have felt well for years as opposed to bloody awful. Rant over. I feel better now...

Whilst none of us exactly enjoy stuffing bits of metal into fingers, arms, bellys (add your own favourite), we all learn to accept it and for most of us the needles / blood tests become as natural as going to the toilet (another inconvenience that we must do due to bodily needs). The thing that makes the disease bad for me and many others is the days when you don't feel so good and the chances of complications later in life.

If you look after yourself on a daily basis with diabetes, you can lead a full, enjoyable life with a vastly reduced chance of anything nasty happening in years to come. To do so takes a lot of work and (IMO) requires testing before and 2 hours post each meal plus another test before bed. So that's 7 and that is the absolute minumum as far as I'm concerned.

As to obsession, these days I let my pump buzz me 2 hours after a meal. I always test before a meal anyway. In between buzzes and eating, blood testing does not enter my mind unless I feel ill. At least you get time off from thinking about it :)

[xMenace]

If you look after yourself on a daily basis with diabetes, you can lead a full, enjoyable life with a vastly reduced chance of anything nasty happening in years to come. To do so takes a lot of work and (IMO) requires testing before and 2 hours post each meal plus another test before bed. So that's 7 and that is the absolute minumum as far as I'm concerned.

Nice summary.

Now add in hypoglaecemic insensitivity, tests before driving, before, during, and after physical activity, tests when trying new foods, after alcohol, blah, blah, blah.

I'm sure there must be some more good comebacks ... another thread maybe?

[TommyC1]

Well I'd just about kill for yourA1c but no you are not testing too much.
When I told my doc I needed enough strips to test 10 x daily he he seemed a bit suprised, but he went ahead and wrote the scrip. I have the idea they just are not used to folks doing that.

If you like your doc AND your doc will give you the tools you need ie enough test strips, I wouldn't worry about the comments too much. If you doc won't give you what you need then you would be better off finding one who will.

Tommy

[davef]

No I don't think you test too much. I'm a T2 not using insulin and I test about 6 times a day. I was originally told to test twice a day, morning and evening, which while it's better than nothing would not enable me to control my diabetes.

I test morning, before/after lunch, before driving home, after dinner and before bed.

I would think that your testing has played a big role in getting that GREAT A1c result. If this is the only issue with your Endo, then I'd say simple agree to disagree on that point and stick with him, he may even learn something ;)

Congratulations on your great A1c.

[lorilei]

Hi Mazea...i couldn't even read the rest iof your post...i stopped at the first paragraph...it is your body...testing more is important...three times a day is ridiculous...it doesn't even make sense to me...if you don't feel comfortable with this basic philosophy, than perhaps a search for a new endo is in order....besides YOU are to be credited for your hard work..I'm sure you will do just as well with another endo who demonstrates a better understanding...

[Russell A.]

Mezea:

Let me first say, your AIC is incredible and shows you are commited to good control.

If you do not mind testing so much, go for it. On the pump, I test an average of 5-6 times a day when my sugars are stable. When I am out of wack I test as much as 8 times.

My endo has been a t1 for 40 years and been on a pump for a long long time. When I mention my basal rates or other things I do, he sometimes seems surprised but supportive if he thinks it works.

I think you may find as time goes on you will figure out (some) patterns and may not need to test as much.

You would be an excellent candidate for a pump especailly with CGMS.

Keep up the good work.

Russell

[orpy]

I tend to get this message from my endo at times...it's ridiculous...how can you obtain good levels unless you test...I am weary of the misinformation regarding diabetes from people who don't have it...and it's exasperating to have a doctor who admonishes a patient for doing a great job. On the other hand, I believe that many doctors practically give up on patients who aren't trying...I'd think they'd be thrilled to have an exemplary patient. Keep testing...obsessive is good with this disease.

[gettingby]

I test between 8-10x per day (sometimes more). My endo is very happy with that. He asked me once "If I told you that you were testing too much and to cut it down to between 6-8x per day, what would you say?" My response "I would tell you to go take a flying leap". I have never seen my endo laugh so hard at something as he did after I said that. I have to say that I have a really good endo. No, he's not diabetic but he understands more than any other doctor that I have seen for my D care. He told me that he wishes he had more patients like me who would go the extra mile to prevent complications.

With that being said, as long as you can afford to test as much as you do, I say "Keep testing". By not testing as much, you won't know where you are going if you don't know where you are at.:)

[LancetChick]

Your endo is a f***ing moron, as so many are. With diabetes, the proof is in the pudding, and if your way of doing things gets you a good A1c without driving you crazy, then it's The Right Way.

It's so utterly laughable how doctors without any training at all in psychology or psychiatry can determine what constitutes "obsessive" for people. An insulin-dependent diabetic testing only 3x a day is, in my opinion, a dialysis patient waiting to happen. Shame on your endo.

Edited to add: I test about 15x a day and have no complications. When I tested 4x a day, I had several complications, and woke up on a few occasions to paramedic faces peering into my eyes, asking things like "Do you know where you are?" and "Do you know what day it is?". The single most important tool in the management of diabetes is FREQUENT TESTING.

[jenb]

Keep on testing! It's working for you. As for being obsessive, how can one not be? Having diabetes requires that you make many treatment decisions every day - how can you make them without information? Your Endo needs to be educated.

Jen

[TommyC1]

As for being obsessive, how can one not be? Jen

LOL
I have this recurring thought that if I was more like Felix Unger and less like Oscar Madison, it would be easier to stay in good control.

Tommy

[jenb]

Tommy - what a hoot! But as we know, Oscar always came through in a pinch.

Jen

[Subby]

I test 8 - 12 times a day. Getting through the day, knowing the trends of my BG (which will change in the course of thirty minutes, to say 3 hours, max for me) is a simple necessity to keep making the right decisions, and also a functional necessity to be actually aware of my BG - and I see this as nothing to do with obsession, everything to do with gaining a little of what a non diabetic can take for granted every second of every day - that their BG is simply taken care of and will not impact their health and their day at any time.

If that has psychological ramifications, I see them as generally positive - a BG test provides me clear and present information to either be making the right decision in the next little bit, or allowing me to trust my body for the next little bit. It also might give me another 0.5% to the jigsaw puzzle about that situation, and situations do re occur.

If I didn't need all those tests to tell me that, if I could test 6 times and mostly get great numbers because the tests tell me that everything works fine as it should, guess what, I'd just always take 6 tests. If I could see stability and a great a1 on 4 tests, guess what... 4 tests, here I come.

No endo has believed me on that. More fool them, I say.

A couple of times way back I did "try" to cut down tests, and just found that things spun out of control if I said "no, don't test, GUESS, because I've been told 6 max (or the like)". I quickly went back to mostly testing as I need. Occasionally in the quest for CGMS like research, I'll double up for half a day or similar.