Beyond Frustrated Today

[CiContention]

Issues with the pharmacy and my doctor. Issues with everybody. I am new to this, a month in. But I've got to say. It's ****ed frustrating to do exactly what my doctors have been telling me: You're underweight. Eat more. Cover for your carb intake with this amount. Monitor your blood sugar this many times a day, and then to be blamed by the pharmacy for doing what I'm told, and then to refuse service. I wrote a heavily frustrated letter to my Diabetic Educator today. Please read:



Hi Jackie,

Thanks for the quick reply.

We went to get my prescription for the Novolog refilled today, but the new prescription that Dr. Powers sent in is for "Novopen", and still doesn't account for any carb in-take (ie, the prescription is still for the sliding scale I was given after being released from the hospital)...

The pharmacy won't fill the prescription because they are saying the insulin is completely different in the "Novopen" as to "Novolog", and that because the sliding scale hasn't been changed on my actual physical prescription, that the insurance won't cover it until my food intake is accounted for on my prescription. I was just wondering if you were of any of this as I knew you faxed some information earlier this past week to Dr. Powers office, and I perhaps forgot to take account of any changes?

I'm down to one Novolog pen, and I hadn't forseen this being an issue as Dr. Powers had told us the new prescription was sent it -- it just happened to be the wrong one, and with this being the weekend, I suppose I'll have to be especially careful for the next few days is all, but this is honestly a frustration that is becoming habitual with Dr. Powers, to the point that a change in physicians is being discussed. On that note, I'll keep you updated if anything does change. I would expect it to.

With that said, the pharmacy was also worried about my carb in-take. On this, I frankly don't understand. I understand it's unwise to continually intake high levels of unhealthy carbohydrates, but I wasn't at the pharmacy, the pharmacies have no knowledge of my body mass index or weight in relation to my height, and my daily carb intake is nothing above a level that a healthy, active person would have in the course of a normal day. To put it squarely: I have confidence in what I'm doing and don't think this is an issue. I find it a little discouraging that their best advice on short notice was, "eat less, less often". As though some sort of implication that I'm constantling gorging myself with foods high in sugars and trans fats: This is not the case. The simple issue of the matter is this: Everyone involved in the process of controlling my diabetes is aware that my insulin injections are more frequent, and aggressive, than the scale I was provided over a month ago. Yet the variable that needs to be addressed, which is accounting for carbohydrate intake on my prescription, remains unchanged. Whatever link remains unconnected in this loop of things needs to by sometime Monday or I'll be out of Novolog medication.

I don't know that it's anyone's fault and would digress away from really making a judgement as to that anyway. I simply don't care about blame. I care about my health and doing this the right way.

To help me solve this problem Monday, as I will probably have to make a phone call or my mom will to Dr. Powers office, yet again, there are a few things I need to know:

* If my carbohydrate intake is too high (I eat between 375 and 450 carbohydrates a day depending upon if I am exercizing or active in that day), I need to know. I have not counted my daily calorie intake, but I am willing to wager that, that number is within the nationally recognized range of 45 to 65% of daily calorie intake -- the recommended number in a healthy diet. The pharmacy seems to think I will take whatever they say will considerable weight, or that I should at least be expected to be utterly uneducated about my own body. Again: I am taking into account everything. This is not the case.
* If there is some 'limit' upon daily carbohydrates that I mustn't surpass in order to appease the pharmacy, the insurance company and my doctor, I need to know.
* If there is some 'limit' on blood sugar testing strips that I mustn't surpass in a day, I need to know. A few weeks ago we had an issue in which after being given the incorrect test strips, we were then refused service because they said I was using them too quickly. As though poking myself in the finger is one of my most enjoyable pasttimes...

Thanks again for your patience with this. I realize this is not your fault, nor problem. However, with the test strips being given to us incorrectly right before my trip to Bowling Green a few weeks ago, and now this, this is the second time that either my physician or her preferred pharmacy have put my immediate health (and progress in learning to adjust to things) in immediate jeopardy. Perhaps I'm not listening well enough. Two times in the first month however is enough to raise a serious red flag in my book.

Thanks again,
Matt


I have yet to do anything I haven't been told to do, and now, I'm ****ed angry. Has anyone else had similar problems? This is my first month with this disease, and if this is the frustration I should expect from now on: bickering with insurance companies and local pharmacies, waiting for two hours in docotrs offices only to be given the incorrect prescription anyway, then I'm going to go insane before any of it makes a difference anyway.

[lgvincent]

I think some pharmacies just look for a reason to not give a person the drugs they need. I once tried to buy some NPH from a local pharmacy and they wouldn't sell it to me, saying I needed a prescription even though one isn't required. I just went to a different pharmacy.

[Lex4153]

Unfortunately, the pharmacists at my store recognize me and kinda sigh and say, "What problem will we have today?" It seems as if everytime I fill something, there needs to be some override or different prescription or something else. My insurance company is the worst. From having to "pre-authorize" certains meds to not filling a new prescription until the month is over to getting the wrong dosage. A million things seem to go wrong.

The only thing you can do is make sure you fill your prescription a few days ahead of time, so that any problems you have won't cause you to go without your meds.

I sympathize with you. It can be really frustrating. Try to relax and know that it will work out somehow.

[HeatherP]

Hi Matt,

Unfortunately, the issues you are experiencing right now are not uncommon in the beginning. Learning to negotiate the subtleties of your insurance policy and synchronize the doctor, pharmacy and CDE/other parties involved can take a while. And it can make you want to scream that it seems to fall to you, the patient who is already upset by the dx, to make it all work.

First of all, just to be picky, what business is it of the pharmacy's what your carb intake is? None.

Second, when you are handed an rx by the doc, CDE, or whomever, make sure you ask what it's for, how much, how long, etc. and so on to make sure that it jives with what you're supposed to have. And although faxing from the doc to the pharmacy may be more convenient for you, for now it may be best for you to handle the rx's yourself, or at least get a copy faxed to you.

Third, NEVER get this stuff done on Fridays. Do it on Thursday, that way you have Friday to fix the screw-ups.

Hope some of this helps you,
Heather

[seacomp]

* If my carbohydrate intake is too high (I eat between 375 and 450 carbohydrates a day depending upon if I am exercizing or active in that day), I need to know. I have not counted my daily calorie intake, but I am willing to wager that, that number is within the nationally recognized range of 45 to 65% of daily calorie intake
That is a very large amount of carbs for a diabetic to consume. Some people, especially those on pumps, say they can do so successfully. As a diabetic what your boby does not do well is metabolise glucose; carbs are just various alternatives forms of glucose. It does make some sense not to attempt to do what is not easily done.

[JediSkipdogg]

Shop around for a new pharmacy. I had a problem once with a pharmacy that wouldn't give me the correct amount of Humalog. My prescription was written for 80 units a day, that is 2400 units a month. EVERY TIME I went in they gave me one vial, 1000 units, for a 30 day supply. EVERY TIME I had to ask for more because it wasn't filled right and they only said "I've never had anyone need more than one a month." Well, I needed 3 a month. They said my insurance won't cover 3 vials since it's not written that way and they have to use rounding rules (never heard rounding down in terms of medical care though.) So I finally had to ask my doctor for a new prescription for 80 units a day, 3 1000 unit vials a month. Well, the stupid pharmacy said each time I went in it would take 1-2 days for authorization for the 3rd vial.

So what did I do? I went to a different pharmacy and they filled it with 3 vials each month no questions asked and it was done in under 15 minutes.

So find a new pharmacy.

[CiContention]

That is a very large amount of carbs for a diabetic to consume. Some people, especially those on pumps, say they can do so successfully. As a diabetic what your boby does not do well is metabolise glucose; carbs are just various alternatives forms of glucose. It does make some sense not to attempt to do what is not easily done.

You're incorrect. The prescribed carbohyrdate intake for someone my age of my body weight, average, healthy american, is 370 carbohydrates per day. I'm underweight. So my doctor has asked me to eat a little more than that. I do what I'm told.

The effect of carbohydrate on your body is in a matter ineffectual with the proper coverage of medicines, as well as physical activity and monitoring. The main neurosis on this forum is an absolute fear and loathing of the carbohydrate. I don't fear food. I won't fear food.

It does not make sense for you to give me a nonsensical opinion about something for which you're obviously not in the same boat as me. I want to vent. If you want to criticize my carbohydrate intake, I'll go elsewhere. Plainly spoken: Your assumptions on carbohdrate intake, and my consumption specifically are incorrect.

[Cinnabon]

Hello Ci,
I am sorry, but I dont agree with that many carbs so I will not need as much insulin in my body. As long as I am covering correctly, according to my levels, I try to not over indulge in that many carbs so I will not have to take that much insulin.Carbs are what really affects our blood sugar most, moderation is good for me.

[Belinda]

depending on where you live you might could try another pharmacy. I have mine sent to me in the mail and have had very little trouble with it but before I went to Walmart and the pharmacists knew me by name, what I needed and how much with never a question asked.

[Penny]

depending on where you live you might could try another pharmacy. I have mine sent to me in the mail and have had very little trouble with it but before I went to Walmart and the pharmacists knew me by name, what I needed and how much with never a question asked.

The one thing I don't like about mail deliveries, is that I do not get to talk to someone when there is a problem. I used to walk the mile to Kmart and pick up my medicines, and the pharmacist always answered questions and made suggestions. We are told we can talk to a pharmacist if we need to with our mail service, but if you have ever waded through all those "choose a number" calls, you know how hard that is!

[JediSkipdogg]

You're incorrect. The prescribed carbohyrdate intake for someone my age of my body weight, average, healthy american, is 370 carbohydrates per day. I'm underweight. So my doctor has asked me to eat a little more than that. I do what I'm told.

The effect of carbohydrate on your body is in a matter ineffectual with the proper coverage of medicines, as well as physical activity and monitoring. The main neurosis on this forum is an absolute fear and loathing of the carbohydrate. I don't fear food. I won't fear food.

It does not make sense for you to give me a nonsensical opinion about something for which you're obviously not in the same boat as me. I want to vent. If you want to criticize my carbohydrate intake, I'll go elsewhere. Plainly spoken: Your assumptions on carbohdrate intake, and my consumption specifically are incorrect.

I want you to know that I agree with you there. I eat about 350 carbs a day myself, sometimes even more. I have tried eating less, and all it does to me is make me more tired because it really affects my metabolism.

Yes, carbs are what cause the BG to rise. Idealy maybe 20 carbs a meal would cause one's BG to not rise and they would achieve near perfect BGs. However, they aren't getting the energy their body needs then, so they start to get fatigued. And I am a personal example of that. If I skip a meal or just eat something like salad for a meal, I don't perform to well after that meal.

So Ci, I agree with you and I eat carbs till my heart's content. Do I have a perfect A1C? No, but I also am not living a lifestyle by this condition. I am treating the condition around my lifestyle.

Point over.

[seacomp]

You're incorrect. The prescribed carbohyrdate intake for someone my age of my body weight, average, healthy american, is 370 carbohydrates per day. I'm underweight. So my doctor has asked me to eat a little more than that. I do what I'm told. The prescribed amount from the AMA and ADA is just plain wrong IMHO. It is the line that has been pushed ever since the '60s but it's just a line. If you can control your BG on that amount of carbs, that's fine. But if the issue is, good BG control or that amount of carbs, it would be foolish not to control your BG.

[CiContention]

The prescribed amount from the AMA and ADA is just plain wrong IMHO. It is the line that has been pushed ever since the '60s but it's just a line. If you can control your BG on that amount of carbs, that's fine. But if the issue is, good BG control or that amount of carbs, it would be foolish not to control your BG.

That's not the issue. My blood sugar is almost always, with the few exceptions being new experiences and adjusting to them accordingly, healthy. You apparently misread or didn't read what my venting was about.

[JediSkipdogg]

The prescribed amount from the AMA and ADA is just plain wrong IMHO. It is the line that has been pushed ever since the '60s but it's just a line. If you can control your BG on that amount of carbs, that's fine. But if the issue is, good BG control or that amount of carbs, it would be foolish not to control your BG.

Type 1 vs. Type 2 makes a huge difference as well. I don't recommend that many carbs for a type 2 not on insulin. But anyone on a fast acting insulin I don't see why they can't eat what they want to eat. You can say you have peaks and such from the food, ok, point valid to an extent. Diabetics don't produce Symlin and well, now we have a created form of Symlin, so now the point of peaks is useless as well. I'd be very curious to hear what Cyborg's A1C is in one year from now.

[Cyborg]

Personally, I would do 2 things. First I would get my doc to write the prescription for the maximum amount of insulin I'd be using for a month, with refills. Then I'd, as someone suggested, find a new pharmacy if I didn't want to give them another opportunity.

The insurance companies and the doctor will "duke" it out to make sure the script is covered. The insurance companies put a lot of pressure on the pharmacies and they get caught in the middle. I've noticed more pressure being exerted over the last year. Stick with it, it can be extremely frustrating, but worth the effort. Ultimately, it's the insurance companies causing the frustration.

[Cyborg]

Diabetics don't produce Symlin and well, now we have a created form of Symlin, so now the point of peaks is useless as well. I'd be very curious to hear what Cyborg's A1C is in one year from now.

lol.. Always talking about me. One of these days you'll pm me. ;)

If all goes well, I'll be here in a year to report. :) I may actually back off the Symlin a bit since 20 units is causing a little nausea before eating. My goals are to get the A1c down to under 6.0 and to lose some weight.

[Harold]

The main neurosis on this forum is an absolute fear and loathing of the carbohydrate. I don't fear food. I won't fear food.

It would appear that way, but most of it comes from a couple dozen posters. For a 19 year old Male 375 carb grams sounds low to me. I remember 19, did not have diabetes, and I probably ate upwards of 3000+ calories a day. Which was probably at least around 500 to 600 carb grams a day with the rest in protiens and fats. At 19 you still have some growing to do. Don't expect to get much taller, but you have a lot of muscle mass to gain and your bones will become denser. Eat a balanced diet and you will do fine. Sometime around 30+ unless your extremely active you will notice a decrease in the amount of food you need to maintain body mass. Mostly because your not growing and it's much tougher to gain muscle and very easy to gain weight.