Hi Dr. Doughnut,
I spoke with CDE today and will be reviewing with her on Monday how our family can learn to use fewer test strips. She suggested that if I shared our information with you directly I might be better able to understand how to reduce our usage to 300 tests/month.
I actually think we need 450 strips/month. 450! On a typical day, we are using 15 strips. Some days more, some days less.
While I don’t yet see how we could be testing less often, I am very willing to try. But even once we learn the directions for testing less often, I don’t understand the harm in our having extra strips. It is not as if we are asking for an antibiotic to treat a virus—this is more like keeping an extra box of tampons in the linen closet.
What’s being conveyed to me through CDE is that you feel strongly that we should test less often. I hope that you can see from our point of view, as his caregivers, frequent testing is allowing Bubs *more* freedom (in terms of going out for bike rides by himself and not having to leave recess at school because he’s feeling low) and is making diabetes *less* of a burden to him.
Even if it is only done to humor us while we learn how to test less often, I hope you will increase our test strip Rx to 15x/day. Thanks for your attention.
This is a typical day of testing, taken from an actual day in the life of Bubs:
1AM: 264 correction bolus
3AM: 156 (checking to make sure correction is working, because it doesn’t always)
6:30AM 118, eat breakfast, bolus
8:30AM 179 (not checking because it’s 2 hours post-pran, only checking because he leaves for school on a bicycle. If under 100, I give him a graham cracker with peanut butter.) (I could cut out this test if I trail him on my bike, but it seems less of a burden to the nine-year-old child to take the test than to have a mother following him.)
10:30AM 116, eat snack at school, bolus
11:45AM 75 (checking to see if needs a snack before recess at school. Over the course of the school year so far, he is just as likely to be high at this time, there is not a pattern of lows at this time.) 10g uncovered snack, recess.
12:35 59 (checking before lunch.) 12g glucose tabs (there is not a pattern of lows at this time–he is equally likely to be high before lunch at school.)
12:50 63 (checking after low), 8g glucose tabs
1PM 131 (checking after low) eat lunch, bolus
3PM 113 (checking before leaving school on bicycle)
4PM 67 (checking before snack)
4:15PM 99 (checking after low), eat snack, bolus
6PM 107 (checking before dinner), eat dinner, bolus
8:30PM 101 (checking at bedtime to see if a snack is needed)
11PM 68, 10g CHO
1AM 212 (checking to make sure not low after the 90)
Update: here’s what I got back! You can’t fault our endocrinologist for speed!
Cc: CDE, Other CDE
Sent: Friday, September 14, 2012 12:50 PM
Subject: RE: Bubs test strips Rx
I understand you want to test because you are worried, but 15 tests a day is actually excessive, so it’s not like having “extra” if you need it. 8-10 tests a day is more than every 3 hours around the clock: if he actually NEEDS to test more frequently, then we aren’t using the pump capability to its maximum effect, i.e., keeping BS relatively stable for at least 3-4 hours at a time or anticipating variability. Testing an hour after eating just because of activity is unwarranted. If there are periods in the day that BS are widely fluctuating, then we need to adjust his basals. The danger of too many tests is not only the extra medical costs but too many numbers can lead one to focus so much on the numbers that life is constantly interrupted to test.
I cannot medically justify more than 300 per month at this time. Let’s try it for a month or 2 and let’s use the numbers to make adjustments so that you feel more confident that BS aren’t widely fluctuating. I agree that following him on his bike is not an option, but 5 tests in under 3 hours is excessive. Even when we start a person on a pump, we don’t test more than 10 times a day. If you still feel constrained and worried and more tests seem medically necessary, then I am certainly willing to reconsider.
I look forward to seeing you later this month. Diabetes care is a work in progress- so let’s reassess and change plans later if needed.
And then I said this…
Thank you for the quick reply.
For the near future…we are adjusting his basals to attempt better control with the pump. This has been challenging, especially with the school year starting. There is no way we will use under 300 strips this month, having already been going at a rate of 15+/day.
For the long term…I hope you know that I respect your expertise, but as his caregiver, I do believe we need more than 300/month. I don’t think this is about me being overly worried. Our usage is based on our very specific knowledge of Bubs and his diabetes. We know that *sometimes* he is low from activity, and other times not. I do not feel worried that he will die at recess or on his bike ride home. I don’t think a low is the worst thing in the world. But if it can be so simply avoided, it seems worthwhile to test.
I will ask for CDE’s help in determining which six of the tests listed in the example day should have been avoided.
And then she said
I am happy to help with adjustments- let’s see how things go with 300 per month and reassess-
Jean will mail you another 50 tests strips to help with this month
have a good weekend
And then I said