Thursday, March 30, 2006

How often do you test?

I caught the low, before he went low last night. He got to 84. This isn't low to most of you, but his insulin from supper hadn't peaked yet and I knew that he was heading down. He got a half a juice box and went up to 133. He was 202 at bedtime. Not too bad.

I spoke with the endo. last night after I posted. We went over all his sugars and did a little adjusting to his basals. He's been running lower at supper most nights. So, we decreased his basal a bit from 3-6 PM. She pointed out to me that his sugars aren't really all that bad. She was right. I need to learn to focus on the big picture and not just a few random sugars. This morning I went through his log book and wrote down his sugars according to what they are at specific times of the day. That way I can get a better picture. I am going to share and see what you think. This is over the past 7 days, the last number in the column is yesterday and then the next is Tuesday and so forth.

Pre-breakfast:
95
96
94
103
76
305 (rebound sugar)
151


mid-morning snack:
247
274
284
158
198
178
203

lunch:
98
203
199
53
225
153
157

afternoon snack:
262
152
272
259
135
170
265

supper:
310
72
234
61
53
127
104

bedtime snack:
106
192
209
219
221
281
202

2-3 AM:
220
152
211
88
56
312 (rebound again)
261

Ok, what's your opinion? Keep in mind that because of his age his range is 140-220 during the day and then 80-140 pre-breakfast and <190 for snack (or two hours after his meal bolus).

The endo. and I talked for a while last night. She was very encouraging. She is just very calming for me. After we'd discussed all of the sugars and tweaked some of his basals, she said, "Now do feel more comfortable to test less often?" I guess it was her subtle way to say I was testing too much. Can you test too much? How much is too much? How often did you test yourself/your child when you/they first started on the pump? I told her I wasn't comfortable yet to decrease how much I'm testing. I average testing about 13 times a day. Is this really too much while trying to get basals right? Even though the endo. is very nice and calming, when I got off the phone with her last night, I told Michael I feel like a freak. Like I'm overly cautious. I want your honest opinion. Am I testing too much? I told Michael last night, I need to determine if I'm testing for Riley's well-being or for mine. I'm asking your opinion because you've been there. She's looking at in from a clinical view. You are looking at it from a life's view. There is a difference in living with the disease and studying about it in school.

When I told the endo. that I wasn't ready to start testing less yet, she just said "Well, you'll get there. It will get where you're going longer and longer between tests." Then she told me he was doing fine and she was pleased with his sugars. I know it's important to test before each meal, at snacks, bedtime, and in the middle of the night. That's seven times. I guess 13 does seem like I'm overdoing it. I asked earlier how much you tested when you first went on the pump. How about now that you've been on the pump a while? I'm just curious how everyone else does it.

10 comments:

Sandra Miller said...

Penny,

We test A LOT -- averaging 12-14 tests per day.

Sometimes more.

Read this post and the comments to it, and you'll understand exactly why.

Now, Joseph's endo has no problem with all of this testing (though our CDE feels differently). The doc actually loves getting all of the data we provide as a result of all of this testing...

And Penny, I'm often amazed at how some people are highly critical of frequent testing, yet those same individuals would give their eye teeth for a CGMS.

Just this morning, I told Ryan that our frequent testing is sort of like what the Lantus regimen is to pumping (aka "the poor man's pump").

It feels like we're using the poor man's CGMS.

(BTW, looking at Riley's age, and these numbers, you are doing a terrific job!)

Hang in there,

Sandra

Megan said...

I did about 15 tests yesterday. I have done 2 so far today (100 and 203) and it's 3:45pm. Everyday is different for me.

I would test a lot if insurance were up to it though. My last endo hated how much I tested, but hey, I have hypo unawareness. So I keep testing a lot. And I got a new endo.

It looks like you are doing a great job.

SUPERMOM said...

Penny I think that 13 may be a bit much. We test at every meal and or snack. Then before bed. If she is good then we go until 4:30-5am. If she isn't ok at bedtime I stay up and do one last one around 11. That all comes to about 8-9 times. I think sometimes we do too much but I cannot let her eat something unless I know where she is at. I scedule playtime IE extra activity around snacks and meals so we don't need to really test more often for that. You will always have times that you need to do a bit more. A day outing with lots of activity etc but try not to overload. I know its hard but sometimes if you test too close you are not getting an altogether accurate reading due to food digesting /insulin working. So you may worry ourself over a number that will come down on its own soon. I think everyone has their own comfort level and approach to diabetes. Do what you feel most comfortable with. You are the one who knows your child best

Becky said...

Hey Penny

We test about 7 times a day - but when we were new on the pump we probably tested more like 10 + times a day. It felt like we were testing all the time! Our insurnace allows us 8 strips per day - but on sick days we use many more than that ....so it is hard. We have had to buy strips outright to have enough. I think Riley's numbers do look great overall - especially considering how you are still trying to master the pump. You are doing a great job!

On a side note we had Grayson's 3 month endo visit yesterday and had lab work done - this will be out first A1C since being on the pump full time - so I am curious (and a little nervous) to see how it will come back. Our last A1C was 7.4 and the one before that was 7.9 - so we are really hoping for something in the 7's - considering how many highs we had at the beginning I am not sure??!! Yesterday the endo indicated that we might could stop testing in the middle of the night - but then I would worry about those nighttime lows - so we still test. Funny too - how D affects your everyday decisions...we are moving to Nashville and building a house up there and would not even consider a "master on main" because of the sugar checking that goes on at night...I mean we would be up and down all night.....but then again - it would be good exercise??!!

Hang in there -- Becky

Kerri. said...

Penny -

When I was diagnosed at 6 years old in 1986, my parents tested me 4 - 6 times per day.

When I was in middle school and high school, I tested about the same, I think. At least before every meal.

College brought on my Extreme Rebellion, as my parents were divorcing and my life was tumultuous in all ways. A good day was testing about once.

Right after graduation, I reclaimed control. I now test about 12 - 20 times per day. Excessive testing? Maybe to some, but my bloodsugars are affected so much by my emotions and stress levels that, coupled with hypoglycemic unawareness at times, I feel safest handling my diabetes this way.

What works for you and your son is what you need to do. Your medical team educates and guides you, but this disease is in your house. You do whatever you feel most comfortable doing to keep things under control.

Good luck.

-- Kerri.

Val said...

Penny -
I test about 10-12 times a day. I have been testing a continuous monitor for 3 months now and still test 10-12 times a day because it has accuracy issues. Do whatever you feel comfortable with - you know your kid better than the dr's or other people who comment on how often you test.

Penny said...

Thank you everyone for your comments. I've just decided I've got to do what's best for Riley and me. And right now that's testing about 13 times a day (sometimes it's more and sometimes it's less) Maybe after we've been on the pump longer and are more comfortable with it, then maybe it will decrease, and maybe it won't.

I look at it this way. It doesn't bother Riley at all and I pay for the strips. So far, my insurance hasn't put a limit on the strips. I don't feel like I've put any strain on Riley or that I'm interupting his life in anyway with the testing.

It is 9 PM right now and so far we've tested 9 times (that includes the middle of the night checks), so we'll probably only test one more time before putting him to bed. So, today he only needed 10 tests. But who knows what tomorrow may bring.

Anonymous said...

We were told by our original diabetes team, Naomi Berrie Diabetes Center in New York, to test -- it turned out to be every three or four hours during the day and at midnight and 2:30 a.m. at night. She still has lots of lows, at least one per day, sometimes more. We adhere to what our first CDE Nurse Educator told us about testing. Before breakfast, lunch, dinner and snacks; before, during (if more than one hour) and after exercise (what young child doesn't exercise for a few hour every day); and at midnight and 2:30 a.m. At one point, they told us we could drop the 2:30 a.m. test if her numbers were good and we were too tired. We will do the 2:30 or 3:00 a.m. testing. Twelve times a day is the norm -- with the lows and exercise, it is often 16 times a day. I would go to palm testing to give her fingers a break if necessary. We maintain tight control only by testing every three or four hours and adjusting highs with insulin and lows with food. This is what we were taught to do and I am grateful we had top-notch instruction in this regard. If a child is on a pump and the flow of insulin is cut, in four hours they would be in trouble. So why would they recommend less testing? Seems odd to me.

caro said...

I think that sometimes doctors, who don't have diabetes themselves, think we test too much because they feel they can get the information they need from just some of our tests. They forget the very good reasons we have for all the other tests.

How much I test depends very much on circumstances, but as an adult it is around 8-10 times a day. For kids, you probably need to add more tests in because kids can't tell what they are feeling as accurately: studies have shown kids don't usually develop the ability to accurately sense hyper and hypoglycaemia until around age 12.

I did do a lot more tests when I first started pumping, and some of those I was able to cut out simply because I came to trust my basal rates, so was more trusting of my blood sugar staying in range so long as I don't do anything that might throw it out of whack. But then... so many things throw it out of whack...!

At the end of the day, so long as you are performing all the tests you do for good reasons, then testing frequency is up to you, not the doctor. Do whatever you think is best for you and your son.

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