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March 1, 2012

Daily Care

Question from Memphis, Tennessee, USA:

I have been a type 1 diabetic for 48 years. I am using Humalog and Lantus pens. I need to know how many times a type 1 diabetic should check their blood glucose. I want to check more, but my doctor thinks that if you check more than four or five times a day, it is the patient that has a problem. After 48 years, I have NO problems, I began exercising and, now, if I am limited by the number of glucose strips I use, then I need evidence from other diabetics or diabetic educators that checking more is a good thing. I like this doctor, but may have to switch doctors if it comes to having glucose strips or the glucose strips being rationed. Help me. Most type 1 diabetics on various blogs check seven to 10 times. Could you share any evidence you have with me, including the best times to check?

Answer:

This is directly a result of pressure from insurance companies. When physicians write prescriptions for more than “usual” amounts of daily strips, it requires a special letter indicating what the circumstances are that would justify more than the “usual” number of strips used per day. For most, the usual number for a patient with type 1 diabetes is four to six strips. This would be about the same number used by a person on an insulin pump. A nice compromise is to talk to your doctor, explain to him how you use your strips. If your doctor can help you determine a more efficient use, everyone wins. If not, and it appears you are using home checking to keep good control and prevent hypoglycemia, I think that is also reasonable. The cases where my patients use too many strips tend to occur when they are frequently or inefficiently giving supplemental bolus insulin or when they are frequently testing post-meal blood sugars. I am not saying you are doing that. However, there are alternatives. For persons who want immediate information, there is the possibility of using continuous glucose monitoring.

JTL