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[IPk] Dave: re monitoring

I do hope that you manage to get things sorted soon without damaging the
relationship with your GP
I see your logic for staying put re hospitals and GPs. Clearly educating those
responsible is a better long term solution, rather than taking yourself off
somewhere else and leaving those less assertive or knowledgeable about their
condition to suffer as a result
The comments about control of DM amounting to only a small fraction of costs
vs treating complications is very valid. I believe the World Health
Organisation advise multiple daily testing for patients with type 1 DM and
patients in the intensively treated group of the DCCT tested at least 4 times
per day
I'm not sure about more recent publications but there was a bulletin
suggesting that frequent testing is of  use IF the person testing knows how to
act on the results, which is of course what anyone on a pump or MDI should be
I think part of the problem is that even those with type 1 vary vastly. It's
almost as if there are different subtypes with the various insulin and testing
regimens needed to attain control. I've seen people on 4 injections per day
who have not had a prescription for a single packet of strips in the last
year, with an A1C in the mid to low 7s and no prescriptions for glucagon or
history of being rushed into  A and E for treatment of a hypo
So I suppose it can be difficult to comprehend that some people need to put
far more effort and resources into their management
But if I was on MDI and even stable and still hypo aware I would still want to
test 3 or 4 times most days. On odd occasions (with the slight risk of DKA
removed) if I felt well/ wasn't doing anything where a hypo would be
disastrous I might miss a day or half a day
Some doctors do seem to separate intensive insulin from intensive testing( I
mean unfortunatley 3 or 4 times not 6 to  8)
and do not seem to understand the rationale for the latter or recall that
insulin is a dangerous drug
I remember a publication from the BMJ some years ago which was a study of
number of test strips. Not surprisingly most people with DM used less than one
per day  and more strips was linked with better control. A medical stuent
wrote in suggesting that this does not prove that more testing meant improved
control and that more intensive regimens/ better compliance and diet may have
been responsible.
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