Check Check One Two

I used to feel pretty guilty if I missed checking my blood glucose (bg). I used to. Lately, I’ve found myself ignoring, on occasion, the reminder from my insulin pump to check my bg two hours after a meal—and I don’t feel badly about it. Of course, maybe I do: At times I feel guilty that I don’t feel guilty about those occasions when I sometimes, just every once in a while…

intentionally miss a bg check.

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Eric Lagergren sometimes skips bg tests?

It’s true. And I know everyone else out there’s dedicated. And I know you are astonished to hear that I pass over some steps in my self-management routine.

So when do these opportunities to check my bg pass me by? When I’m busy at work. When I’m exercising. When I’m out at dinner with friends. When I’m getting ready to take the dog on a walk. When I’m too lazy to do anything, even get the insulin pump out of my pocket to press the “OK” button on my pump so it vibrates in its eight-beat interval until my wife tells me to do something about it (because couch + television + 10 PM = ignore insulin pump).

Medical experts say you can’t reliably predict your blood glucose; I recall reading somewhere that there is only a 50% chance you’d be correct, and it’s not worth it to take those chances.

I agree. It is difficult. But here…oops. Wait. As I’m revising this paragraph, during my writing of this blog entry, my pump just vibrated to remind me to check (I ate lunch two hours ago). Let’s check this out. I had a few pieces of pizza for lunch. What else? I walked across campus to have lunch with my wife (10-minute walk one way). I exercised last night. I’ve been running a bit low most of the morning.

So, I’m going to guess that my bg reading will be 153 mg/dl. (I won’t revise that figure, I promise.)

I’m checking…putting pump on desk. Test strip insertion into meter. Pricking finger. Blood to strip. Waiting. Blink blink…

I’m at 178 mg/dl.

A bit high, but this is only two hours after a meal, and it was some pretty good and unhealthy pizza. Oh yeah, that’s right: I remember now that I also put some regular Coke, about one quarter, in with my refill of diet Coke before I left the pizza place because I’d been a little low this morning (and I’ve been sipping on it for the past two hours).

To be honest with you, my first guess at my bg number before I wrote 153 was going to be 167 mg/dl. But I didn’t write it down; I wishful-thought my way back to a lower number. Should have learned my lesson on any number of tests throughout my school years: Go with my first instinct.

I’m pretty good at being within a couple dozen mg/dl either way. So if I’m not feeling a low at a certain time of day—when I wake up, for example—and it’s one of those rare mornings where I really don’t want to check my blood glucose, then I’ve come to think of it this way: Every morning for the past, oh, I don’t know, six months, I’ve been within the same 25-45 mg/dl between 6 AM and 8 AM. With all of the other things that could influence my blood glucose levels over the course of the night being the same (no major deviation in routine the day before), why should I stress out and think that if I don’t test that I’d be pushing 300, or that I’d be dangerously low? I do not not check each morning, but every few days I just don’t.

Is this part of the joy of having lived with Type 1 diabetes for a while now—letting some things slide, as it were? Or, is this the slippery slope into poor management? Am I descending into a dangerous diabetic hubris that could lead to complications down the line?

Because I haven’t checked as many times per day as I’m prescribed to, when I look on my diabetes supplies shelf at home I see two or three extra boxes of test strips. I wonder if I should tell my medical equipment provider that I’m not going to need that next shipment just yet, or not to include as many boxes this time around…

Nah. I’ll just stockpile. Because there are times when I overtest, and because the holidays are coming up I’ll be on the road and checking my bg a lot more. Oh, and I’m also exercising pretty heavily again, and typically during an hour of exercising I may test four to five times.

One last thing: For those of you who’ve been reading this and just can’t wait to comment and tell me how irresponsible I’m being, or how I may be putting myself in danger, etc.—don’t. What I’m talking about throughout this week’s blog entry is my easing up on some blood-glucose testing. I’ve been prescribed by my endocrinologist to test up to 10 times a day. If there are days when I only test 5 or 6 times, I’m still testing quite a bit.

  • Peter Mead

    I had the realization that one of the prime reasons I check my BG 6-8 times a day is to calibrate ME. Consequently, I am much more confident in my diet and activity choices throughout any given day. I pretty much know what the ramifications will be. And of course there is the biofeedback issue, that enables me to understand why I feel how I feel. Overall, astute testing eventually creates a kind of database by which to construct a reasonable lifestyle. And when you are moving in that direction, I think it is natural to find yourself easing up on the testing. I know some people who test 15-20 times a day and have for a long time. Sure, they have sub 6 A1Cs, but I kinda feel they need to kick off the training wheels and carry on.

    Peter

  • Minnesota Type 2

    I would like to test 3 to 4 times per day, but at $1.00 per test strip I limit myself to twice per day.

  • DDMJR

    I DON’T CHECK EVERY DAY BUT DO GET 3MONTH CHECK TWICE A YEAR IT SHOWS 6.3 OR 6.2 THIS PAST FEW YEARS. sO FEEL ITS ok i HAVE HAD tYPE 2 FOR ABOUT 30+ YEARS

  • Rocket

    I too will occassionally skip a test or two. I’m a Type II, and fortunately I’ve been able to keep my bg undercontrol with diet, exercise and a minimum of oral medication for the last three years. Like you I used too feel guilty, but if I’m actively engaged in an unusal activity, I may skip the test. No big deal, I’ll test when the opportunity presents itself later. I know its not as accurate, but my A1C’s are never over 6.2 and I rely on that data more as a marker of my program. Relax, save a strip, and have another slice of pizza on me.

  • Florian

    Do you ever get the feeling that you are testing your bg not to find how YOU are doing but to know whether or not your pump is working the way it should and doing what its suppose to do i.e. deliver basal and bolus insulin to keep your blood sugar normal.
    I feel that way lots of times especially when I’ve had problems with infusion sets and sites. I’m always amazed at how quickly my blood sugar goes up when there is a problem with insulin delivery because of the infusion set or site. I usually test every hour after a set change and sometimes I leave the old site in place until I know if the new one is working.

  • Jiminpcola

    I check my bg usually twice a day unless I’m feeling a little ragged. There have been times when I’ve checked it expecting it to be a lot higher and it was lower….and vice versa. Regardless, I recently started checking four times a day, 30 minutes before breakfest and dinner, and then about 2 hours after each meal to check my spikes. My A1c is done quarterly at my doctor’s office with my last one being about a 6.4.

  • CalgaryDiabetic

    Dear Eric and fellow diabetics.

    The post by Florian illustrates the hassle of insulin pumping and still the necessity of testing. So much for my hope of an artificial pancreas with continuous glucose monitor and a computer.

    Still I dont have a clue how the “normal” people keep their BG between 70 and 130 at all times. When I am about to eat tons of pasta I use feedforward control by injection 10 to 15 units, 15 minutes prior to the meal. Can normal pancreases predict the future? Could they do the stock market?

    Some states (called provinces, constitutionally they have jurisdiction over health matters) in Canada reimburse diabetics for their tests strips. This makes good sense in a purely capitalist way since one day in hostital can buy 2000 test strips. This alleviates the problem stated by Minnesota type 2. This feature is unavailable in our super right wing state the Texas of the North.