February 9, 2004
Blood Tests and Insulin Injections, Insulin Pumps
Question from Dallas, Texas, USA:
I am on an insulin pump, and am the first patient my primary care physician has put on the pump. He and I have an on-going argument about testing, and I am having trouble getting him to write a prescription for enough test strips.
He feels that I should be testing only 4 times a day and wants to write the scripts for that. I know with the pump, I need to test at the very least in the morning, at night, and 2 hours after meals. I think I should also be testing at meals. I also have hypoglycemic episodes — so far always treatable — when exercising so feel the need to test at least before and after exercise.
So it seems to me, that I should be testing at least 6 times a day, and that’s if everything is perfect. That doesn’t account for testing after inserting a new set, or for any other types of problems and trouble shooting. Can you point me to documentation or research that specifies how many times an insulin pump user should test? Most everything I see says see your health care team.
Answer:
There is no absolute number of times a person should test. This depends upon the daily variability of blood glucose levels, goals of treatment, intensity of treatment, etc. If you are ill or problem solving, have problems with hypoglycemia unawareness, then you will need significantly more testing than someone who has more stable glucose control. You did not mention why the doctor wants to restrict your test strips. Many of our patients with difficult-to-control diabetes use an insulin pump and test 6-8 times per day quite routinely, with excellent A1c levels and frequent use of correcting factors.
You should go back to your primary care provider and find out why they are so concerned with frequent testing if it is helpful to you and your goals. If you still get nowhere, then switch to someone else who understands these needs or is willing to listen to you. Working with a diabetologist or diabetes educator would usually avoid such difficulties so that you are not wasting your time arguing about such nonsense.
SB
