Am I being unreasonable?

[shiftzor]

Well I just got back from my doctor, who recently decided to change my prescription from 200 test strips per month to a 100 per month without informing me. Naturally i soon discovered this when i went for my next prescription.

I have just spoken to her, apparently I am being unreasonable, and out of all the diabetics she has none of them ask for 200 test strips a month. She cannot give me more than 100 if I want more in a month I will have to go twice a month however she will not do this forever. She has offered me a batch prescription which means that every 2 weeks 100 test strips will be issued for a finite period.

So am I being unreasonable? I really don’t know anymore, I try to look after myself the best I can and according to her I have tight control (A1c 6.1) (testing on average 8 times a day at the moment), but without these test strips I will have to back to guessing and thus the fun continues. So what do i do? Option A: world war 3, threaten to leave and find a new GP who will offer me what I want or Option B: give in, conform to the norm and accept that I am being unreasonable.

[Subby]

I have always tested more than the norm and I do get doctors telling me to stop. All I can say is "get in my shoes first please" before making such an imposing restrivtion on my ability to control and be comfortable with my diabetes. Some draconian limitation on tests like 3 (!) a day you doctor is imposing is simply counter-therapy in my book.

100 in one month is only about 3.3 tests a day. Too little unless maybe you are one of the "lucky" ones (diabetes who seem to get good, reliable control. May as well be another species to me).

200 is about 6.6 per day. I think this is better but still restrictive. What about sick days? days when things go rollercoaster? I can hit 12 tests on those days and NO I don't think that is unreasonable to want that much "insight" into your blood sugars. Whether it be for trends and research or just so you bloody know what is going on at the time!

So my response is, yes, I think your doctor is being unreasonable to not let you define how many tests you are comfortable doing, and supporting you in your approach to your management. We all know they try to limit strips but I think within reason (say, below 12 or something, I don't know) if you are using them and they help you, you should have them - that's appropriate!

Another argument, if we only somehow "needed" 3 tests a day, how can there be any market or excitement for CGMS? And yet it IS an exciting new development because it gives more insight into bloodsugars far and away above fingerstick tests. To want to do a little above the normal 4 a day is just a sign you want to keep on top of this thing!

So what to do with the doctor: I don't know, but she does seem a little inflexible, yes! I have had quite a few endos and usually they will write me a letter for the NDDS (different system for dispensing here) to allow me a higher amount of strips than the norm. They may have been a little confused as to the reasons but they were prepared to support me on something that really is not a huge burden or unreasonable.

[princesslinda]

Its YOUR life, YOUR body, YOUR diabetes. I vote for "A" find a new physician who understands the need for frequent testing and will give you what you need to keep control of YOUR health! If you test less and end up having less control YOUR DOCTOR won't be the one having to deal with all with problems. How aggravating!:mad:

[morrisma]

I keep very accurate logs of my 6-8 test a day using excel. I have a summary page that shows how many strips I use each month. I bring those summary pages with me to the office and have had very little problem justifying my 700 strips per quarter. Don't give in or give up. Testing is crucial.
Mike

[gettingby]

I currently have a script for 250 strips per month. I believe this is my insurance company's limit but my endo has said that if I need more, he will write my insurance company a letter to get them to allow me more strips. :)
I would go with Option A if it is possible. Like all have said. It's YOUR LIFE, YOUR HEALTH, and YOUR WELL BEING at risk here !!!!!!!
So........NO, you aren't being unreasonable in your request.

[xMenace]

Ask her how many of her type 1's have a 6.1% A1C or better. Ask her what your A1C was before you tested this much. Ask her, don't tell her. Send her or show her this presentation (http://www.diabetesnet.com/diabetes_presentations/AdvDevices-JWalsh-0705.ppt), especially slides 13 to 15. Follow up strongly with slides 11 to 12.

If this fails, go to war!

[Scratch]

A thread started by DeusXM should likely help you get the strips you want in the UK.

http://www.diabetesforums.com/forum/diabetes/14060-test-strip-provisions-uk.html

If you're doing basal/bolus type of treatment, I'd say at a minimum you need 6 strips a day, more ideally 8 strips, and probably 10x would be even better.

[bryan42]

:) I had this same problem with my doc. Why are these test strips such a "guarded" issue? Is there a potent drug inside that people are smoking them? what gives??? You can buy 300 bullets a month,and nobody questions you, but try to get a test strip, and they want to know, who,what,where,when and why! :mad: No, I dont support guns, I was using that as an example :)

[belyro]

Wow. I use typically about 8 strips per day...sometimes more. That's well over 200 strips per month.

On 3-4 strips per day I may as well give up on my diabetes. I know for some (lucky) people it can work, but I could never ever do it.

[Alice]

I feel those test strips are what keep me out of the ER and from embarassing situations...so I test all day long! I'd find a different doctor that shares your view. Driving alone...that takes quite a few "safety strips"... The older I get, the more I believe in testing before driving.

[Jan B]

Interesting . . . test strips are a necessary tool for good control. It can become a little addicting though, but what better "addiction" to have? I think a doctor should be very happy their patient is trying to manage so well. This is definitely a cause that another type 1 doctor should understand. I can see how a non-D doctor would think testing more than 6 times a day might be excessive. But any doc ought to know that only testing 3x daily isn't going to cut it. Unless they believe a report about no matter how much we test, we can't change the "inevitable".

I don't want my test-strips limited in any way, and they never have been. The only way I could see that a doctor might limit, would be if a person tested every hour, every day. Docs might find that a bit unhealthy.

[davef]

shiftzor,

No you are not being unreasonable, you are working to control your diabetes, which seems to be a **** of a lot more than can be said for your doctor. Why the H**l should she care, it's not like she's paying for them, you taxes do that, as far as I can recall it's the same in the UK as it is in Ireland and you get you strips on NHS? Altough I think you guys have problems changing Doctors, over here we have to pay the Doctor (unless you are on a very low income) so we get to decide who we go to.

Don't give in, you have a good A1c becuase you do what you do, perhaps ask her what she will do if your A1c starts to rise, will she accept medical and legal responsibility?

[JJM335]

Shiftzor:

First of all, as already stated, check out the thread from DeusXM - the link is in Scratch's post.

I have checked the NICE guidelines (which you can easily find using Google). Page 46 states

Adults with type 1 diabetes should be advised that the optimal frequency of self-monitoring will depend on:
*The characteristics of an individual's blood glucose control.
*The insulin treatment regime.
*Personal preference in using the results to achieve the desired lifestyle

I have outlined the critical part in red. Clearly it is up to you to test according to your personal preference.

FWIW my GP is happy to prescribe me 350 strips at a time, representing one month's supply.

Joel

[tanyatype1]

I use roughly 250 per month - you're definately NOT being unreasonable, and this really makes me angry at your doctor!

[shiftzor]

Well test strips are expensive, as you probably all know and currently the county I’m in is having funding issues. This has just filtered through to individuals such as me. I will only be in these parts for another 3 months; changing GP isn’t really worth it. So I go to war with her and hope she makes me a special case, "sorry funding issues are not my problem is the message".

http://www.towntopics.com/apr2507/cinema.jpg
[Hot Fuss :D]

Plan of attack:

Print out of my Winglucofacts for the last month.

Maintain A1c (take in my old A1c + new one)

Inadequacy of 3 tests every day (even 6 tests a day is low).
6 x 50 = 300 / 30 days = 10 per day - Ideal
5 x 50 = 250 / 30 days = 8.3 per day - Good
4 x 50 = 200 / 30 days = 6.6 per day - Acceptable
2 x 50 = 100 / 30 days = 3.75 per day – Might as well move into ER now save me time later.

1 test at each meal + 2.5 hours later = 6 tests a day without playing sport or having any problems

I have got in contact with more diabetic people than she has at her clinic and most are shocked by what you are suggesting.

NICE Guidelines stating that i should dictate how many test strips i get.

Printout err on second thoughts its bit long (100 slides), USB pen :D with those nice Slides (thx xMenace) I doubt she will read them (pessimist that I am)

Ask for denial of provisions letter from GP.

And finally I will ask her to choose a mode of death? :cool:

Anything else? ;)

[davef]

Looks like you have it covered, perhaps if all else fails ask for her solicitor's name and who handles her malpractice insurance!

[xMenace]

Do you have a national diabetes association? They may be able to provide some help or guidance. There is also a national doctors union, or whatever it's called. Inquiries there will be full of red tape, but it's an avenue.

[Metermaid]

I don't understand, what's it to her?? Is she paying for them? My insurance limits me...not my doctor? I don't get it...get a new endo!!

[Subby]

Printout err on second thoughts its bit long (100 slides), USB pen :D with those nice Slides (thx xMenace) I doubt she will read them (pessimist that I am)


I havn't downloaded them to see but xMenace suggested a few slides. Print the best couple. Sweet and short is best. If she wants a further look have the usb pen on standby.

I too echo the "get a new endo" cry. There may be a funding shortage but then again another endo may likely shrug their shoulders and give you the appropriate amount. A good endo will ensure you are supported for this life threatening illness and be ****ed with funding issues and politics.

I also respect you giving this a go if you decide to. It's your life and the best thing is you make your own decisions. Good luck.

[morrisma]

Excellent plan. You seem to have everything covered! :D
Mike

[shiftzor]

Thanks for the support and encouragement guys, when I came out of that place after seeing that GP i didn’t know if I should laugh or cry. Well I’m a bloke so I didn’t cry :D but couldn’t bring myself to laugh. :( Really not happy with them, the pharmacy was really supportative about this. Tomorrow I shall return to the battlefield fully prepared this time and I hope to put a stop to this "problem".

[Subby]

Confronting doctors can be traumatic. I have been in tears before courtesy of idiot doctors, and yes I am a bloke. The biggest thing to remember is you are not wrong or foolish or crazy for wanting to test more than 3 or 4 times a day. She is the one not giving you adequate care if she thinks 3 tests are enough and won't modify her views. Remember though that firm and diplomatic is the best way to get to your aims. For all the talk of suing etc, you are better off keeping it civil.

No matter what happens, just be solid in the fact that you are perfectly justified in wanting and expecting a decent handful of strips a day. If she doesn't supply I am sure someone else will.

[Stuboy]

whoa, i'd go ape if they told me i could only test a certain amount a day.

If you need 200 strips to control your diabetes well, then you should get 200 strips.

I currently get 204 (drums of 17strips for the accuchek compact plus) and im not sure that'll be a months worth i just got then to up it from 51strips to 204 on my repeat prescription.

I'd print the NICE guidelines out, or just quote them with confidence to their face and see what they say... she probably takes you as just another patient who doesn't know his rights.

The only person being unreasonable is the doctor!

[Funnygrl]

Nope, not unreasonable at all. I'd be ticked. I'd go ape too!

[SueM]

Thanks for the support and encouragement guys, when I came out of that place after seeing that GP i didn’t know if I should laugh or cry. Well I’m a bloke so I didn’t cry :D but couldn’t bring myself to laugh. :( Really not happy with them, the pharmacy was really supportative about this. Tomorrow I shall return to the battlefield fully prepared this time and I hope to put a stop to this "problem".

Take in the NICE guidelines also type a letter for her to sign saying that she has refused you the test strips which are needed to control your diabetes. Thus she will be held responsable for any future complications you get due to poor control. Also point out to her that as you drive (if it applies) you need to test before you get behind the wheel of a car. (This is a legal requirement). I would also point out to her that as she has restricted your strips to 100 at a time this means loss of income as you have to take double the time off work to collect the prescription.

[silverfrost]

I also test a lot more than my doctor suggests, and the nurse at my endo is always SHOCKED that I test a lot. Um, how the heck else can we get good control? What an odd thing to be so put off about...

[viranth]

Here in Norway they want us to test a lot. When I go to get more strips, the people behind the counter always go "how many do you want?" I say "not sure" and they just give me everything they have!

I usually test about 7-8 times a day, on average. Some days I test more, but I never test below 7 times.

If I only got 50 strips a week or something, I'd go nuts.

[UpNorth]

I'd definitely go for option A :D

[shiftzor]

Take in the NICE guidelines also type a letter for her to sign saying that she has refused you the test strips which are needed to control your diabetes. Thus she will be held responsable for any future complications you get due to poor control. Also point out to her that as you drive (if it applies) you need to test before you get behind the wheel of a car. (This is a legal requirement). I would also point out to her that as she has restricted your strips to 100 at a time this means loss of income as you have to take double the time off work to collect the prescription.

That’s a good point about driving, problem with writing a letter for her to sign is that I am not a lawyer and therefore it’s hard to make it legally binding, instead GP can write a letter to me in which I will spread about to her disadvantage. Unfortunately as a student I am not working otherwise I would definitely use that. Thanks all again for the help.

Option A it is. ;) with a diplomatic stage in between.

[DanG]

Um, how the heck else can we get good control?

I cannot argue against testing often.
But, the notion that testing gets control is not reasonable.

Testing only provides information which must be acted upon.
High bs says your action must be to take a bit of humalog.
Low bs says your action must be to drink a cup of OJ.

So, I don't really test very often. I only test when I have an action that can do something about the test results. i.e. prior to eating a meal, I take humalog in an amount to cover my bs reading and the meal I am eating. Otherwise, the information is not useful. I rarely test prior to bed, as I do lantus in the AM and by night, any lingering lantus effect isn't going to sink me during my sleep, as it often did when I did lantus in the evening. Doing lantus at night time is stoopid to my way of thinking.

[Gary_W]

That’s a good point about driving, problem with writing a letter for her to sign is that I am not a lawyer and therefore it’s hard to make it legally binding, instead GP can write a letter to me in which I will spread about to her disadvantage. Unfortunately as a student I am not working otherwise I would definitely use that. Thanks all again for the help.

Option A it is. ;) with a diplomatic stage in between.

SueM's method is the one I've quoted before at my previous doctors surgery (my current ones are great about this and dish out 300 strips whenever I ask). The DVLA REQUIRE you to test before going behind the wheel and regularly on long journeys. For that reason, I have at least 4 tests every single day to comply with the law of the land, and that's before I've even worried about meals.

The Hypocratic oath has, at its core, the line 'First, do no harm'. As there is research out there that states that every 1 point rise in HBA1c above 6% gives an increase in your chances of complications of 40% and I would defy anyone to get close to 6% without test strips, I would argue that she is going against the very prinicipals that she took an oath to...

Good luck. I do enjoy a good fight when I'm in the right, and I'm sure you will too.

Gary

[RyanN]

I test A LOT everyday (about 10 - 12 times).
One way I can afford to do this is that I DON'T live in
the US (my home country). One box of 50 strips there
costs me $40-$50 (no insurance).
Here, the EXACT SAME BOX of 50 strips costs $18 and sometimes the lady gives me a discount.
This is all with no insurance too!!!!!!
This is the same for all my diabetes supplies.

What is the deal with those crazy US prices??????????

[ant hill]

Well I just got back from my doctor, who recently decided to change my prescription from 200 test strips per month to a 100 per month without informing me. Naturally i soon discovered this when i went for my next prescription.
Hey that's just 6.5 strips per day!! as we test more than that MMmm.... Go doctor shopping. :D

[xMenace]

I cannot argue against testing often.
But, the notion that testing gets control is not reasonable.

Testing only provides information which must be acted upon.
High bs says your action must be to take a bit of humalog.
Low bs says your action must be to drink a cup of OJ.

So, I don't really test very often. I only test when I have an action that can do something about the test results. i.e. prior to eating a meal, I take humalog in an amount to cover my bs reading and the meal I am eating. Otherwise, the information is not useful. I rarely test prior to bed, as I do lantus in the AM and by night, any lingering lantus effect isn't going to sink me during my sleep, as it often did when I did lantus in the evening. Doing lantus at night time is stoopid to my way of thinking.

Testing is not just about compliance. Many of us use testing to learn how we react to food, insulin, and activity. It gives us informaion and information is power!

One can get by without testing often under certain conditions. They
- don't vary meals or activity
- have enough experience (with testing) that they know how foods are going to behave
- have no absorption issues
- have flat-lined and very predictable basal profiles
- have developed an ability to sense their own sugar levels
- have bodies that don't change as they age (also known as being dead).

The rest are just fooling themselves.

[Stuboy]

i stopped testing a 6 months (not complete, but only testing sparsly) and look what happened to my HbA1c!! :(

Im back on track now tho and im going for another tomorrow!

it will prove that a good HbA1c comes with the power of information through testing!

[shiftzor]

Well I had my meeting with her today and to bring closure to the topic I thought I should tell you what happened.

Basically GP told me that she can’t give me more than 2 x 50 on one prescription, so she gave me 3 prescriptions of 2 x 50. She told me to come back for another prescription for the last few months, before I move surgeries. It will do in the short term; thank goodness I won’t have to put up with this for much longer. ;)

[davef]

Well at least you got some form of resolution and the supplies you need. Don't understand the whole thing of not being able to give a prescription of more than 2 x 50, my Doctor just asks me how many I need and right the prescription accordingly. I always thought that Ireland and the UK were similar in that way, guess not, or maybe my Doctor is even better than I thought.

[shiftzor]

Well at least you got some form of resolution and the supplies you need. Don't understand the whole thing of not being able to give a prescription of more than 2 x 50, my Doctor just asks me how many I need and right the prescription accordingly. I always thought that Ireland and the UK were similar in that way, guess not, or maybe my Doctor is even better than I thought.

Apparently it’s a funding issue with Hillingdon/Uxbridge in Middlesex (London). Don't know if it affects others as well. Its a stupid situation, oh well.

[Stuboy]

i still dont understand why she "can't" put more than that on the prescription... i get 204 on my repeat prescription and i use the Accu-Chek drums... i bet they ain't cheap!!

[1type2go]

Well I just got back from my doctor, who recently decided to change my prescription from 200 test strips per month to a 100 per month without informing me. Naturally i soon discovered this when i went for my next prescription.

I have just spoken to her, apparently I am being unreasonable, and out of all the diabetics she has none of them ask for 200 test strips a month. She cannot give me more than 100 if I want more in a month I will have to go twice a month however she will not do this forever. She has offered me a batch prescription which means that every 2 weeks 100 test strips will be issued for a finite period.

So am I being unreasonable? I really don’t know anymore, I try to look after myself the best I can and according to her I have tight control (A1c 6.1) (testing on average 8 times a day at the moment), but without these test strips I will have to back to guessing and thus the fun continues. So what do i do? Option A: world war 3, threaten to leave and find a new GP who will offer me what I want or Option B: give in, conform to the norm and accept that I am being unreasonable.

Just wanted to share this and let Ya know my mother (Dx in 2006)was told 100 per month by her Dr. as well...Mabey they think we're sellin' em



The cost of diabetes*

Individuals and families bear the cost of diabetes through medical expenses, inconvenience and deteriorating health. These personal burdens translate into significant cost for Canadian society as a whole.
Diabetes resulted in $884 million in direct health care costs in 2000.
Indirect costs in lost productivity and premature death added another $1.7 billion, for a total cost of $2.6 billion to the Canadian economy.

............Increased since 2000?? Could have Hey!!

[MeadowLark]

sigh... I got the same run with my Dr here in South Carolina. Wonderful ****! I'm going online to buy a cheaper meter and teststrips for the "extra times that I want to test." this sooo stinks. It is one of the reasons I slipped into some depression issues.. cuz my doc doesnt care about "me."
Huggles
MeadowLark

[shiftzor]

sigh... I got the same run with my Dr here in South Carolina. Wonderful ****! I'm going online to buy a cheaper meter and teststrips for the "extra times that I want to test." this sooo stinks. It is one of the reasons I slipped into some depression issues.. cuz my doc doesnt care about "me."
Huggles
MeadowLark

Don’t be depressed about it, come up with a plan of attack, go straight back and demand what you need, change doctor if you have to. Seriously don’t stand for it, I didn’t and I got the quantity I wanted even if it means a little more effort i.e. prescription every 2 weeks instead of 4 weeks for a finite period (until I move GP). It’s not easy but neither is living with the lack of strips.

[Emm]

WOW! Not unreasonable at all. What's up with your doc??! A type 1 - or anyone using insulin - should have access to as many strips as they need.

I get 300 - 400 a month, and I need every single one. How could it ever be wrong to test lots and stay on top of diabetes? What's up with doctors these days sheeeesh!

[ant hill]

WOW! Not unreasonable at all. What's up with your doc??! A type 1 - or anyone using insulin - should have access to as many strips as they need.

Doctors seem to think that enough strips for your control. Doctors in my view are just perscripton pushers and say take this and see me again in the morning or to a specialist that they think would suit you. :mad: and I think see an Endocrinologist as short for endo. ;) Doctors know jack s***e on diabetes needs. :( as they just line their pockets of your hard earned cash. ;)

[timmyp]

I can so relate. Like you I test around 8 times a day (often more) I had the same thing with my doctor who basically told me I was taking advantage and that my average usage was much much higher than his other patients (probably includes T2). He said the most he would give me was 3 boxes and said that unless I was a tri-athlete would not consider increasing this. I was rather upset and found the whole experience rather un-sympathetic.

I am now getting treatment by the diabetic clinic in the hospital and they totally understood that for me control = testing so they now issue 4 -5 boxes per month. This may very well change but I will happily fight for what I need.

Where about in the UK are you?

[Subby]

Xmenace seems fond of saying that there are good doctors in the world, and I agree, there surely are and we have to be positive and open to good partnerships. But then there are many that STINK and the best move is be strong and get away from them. Besides medical imcompetence/lack of advocacy for you, it is also a relationship, that can be very emotionally harmful.

I completely relate. I have had doctors like this. The worst thing is the air of authority (hmmm, may I say arrogance?) they can give while being completely incompetent in their analysis of the situation, and even downright abusing their position as part of your _support_ team.

timmyp, good on you for moving on to better things, that is exactly the kind of story anyone currently with a lousy doctor needs to pay attention to. :)