February 12, 2004
Blood Tests and Insulin Injections
Question from Dallas, Texas, USA:
I was diagnosed with diabetes at age 42. Family history has two generations of diabetes diagnosed within the same time frame (between 40-50), with father and both of his parents dying of cardovascular complications within 10 years (five years in the case of father). Thus, I am aggressive in treatment, but see a Primary Care physician rather than a specialist.
I am his first pump patient. We are disagreeing about what is a reasonable amount of testing. I feel I should be testing in the morning, before meals, two hours after meals, before, sometimes during exercise, and after and before driving — note that these time periods often overlap. Also, testing whenever I feel funny, or if I need to adjust things with the pump — new set, etc. According to the meters I download I’m averaging just over eight times a day. He thinks I should be testing only four times a day. Who is right and why?
Also, what hA1c value should I be trying for? He seems a bit disappointed that I am consistently just under 7.0 (6.8-6.9). I would like to go lower, but I don’t feel I can if I am trying to meet his testing expectations.
Answer:
I do not think that the number of blood sugars you are doing is excessive. This is especially true having started an insulin pump in the recent past. With time, I would anticipate that you would be able to predict what some of the values are and would not have to monitor so often. I would not criticize you for doing more than a usual amount, especially if it allows you to make good decisions regarding your management. The goal for control is an HbA1C < 7%. Hypoglycemia would be the limiting factor. A normal value would be great but not at the risk of recurrent lows. I would say you try to lower as much as possible toward normal until lows become a problem. Currently, your HbA1C levels are good. Trying to improve them will require some caution so as not to increase the frequency and the risk of low blood sugars. JTL
