I've got a friend whose had diabetes 34 years (since age 12) and she is on multiple injections (MDI) using 3 types of insulin to maintain an A1C of .... 4.7% (I've never gone below 5.7%). She injects (with needle - not pen needle - ouch) about every 1/2 hour to maintain "perfect " BG's. Now for me, that's way too much - but for her - she's had some complications over the years with not taking care of BG's - and this is the route she took. For myself, I couldn't do this.
When I was in my 20's (I'm turning 49 tomorrow - pat on the back to moi <lol>) I didn't give much notice to my BG testing / insulin coverage like I have done over the last 6 years. So, obviously .. FOR ME ... remember we're all different in how we maintain our diabetes - my hit/miss with BG testing, insulin coverage worked for me. I think where you know something is wrong with your D is when you start to not heal properly, get infections, yadda, yadda, yadda.
Did my not testing that frequently effect my internal organs? So far no, touch wood (darn my furniture is from IKEA - no wood <lol>), but maybe with time, since I've been diabetic so long it might. I just don't look at the evil side of diabetes ... << most of the time >>. I've been a sclump lately because of not getting my BG's below 8 / 144 (I'm on an Animas 2020) but it happens to all of us sometimes - stress, whatever. Anyway, after having a talk with my Mum the other day where she still can't believe I want to sail across the ocean because "what will you do for insulin, etc." - I told her diabetes doesn't stop me from accomplishing anything - it's just the $$$ bit that does. Please leave me wads of money when you kick the bucket (only kidding, I hope my Mum spends it all before then - and enjoys life to the fullest).
BTW, I live in Canada, so here our blood meter strips are pretty well covered, it depends on the province (aka State) - some have better coverage then others. Where I live in QC, we're pretty socialistic - like France - so we've pretty well covered - even if you are not making big bucks.