Doctor's instructions are confusing me

[Janke]

I was given the metformin prescription for the first time 4/10/08 when my Alc was 8%. I am a retired military spouse and get my medical care through Tricare and I had just been assigned a new primary care manager. It is not unusual for military doctors to come and go. I did manage to have one PCM for several years, but then he retired from the military and went into private practice.

So, he wanted me to track my fasting BG for two weeks, twice a day, and report back to him. I will have another blood test and A1c 90 days from 4/10. I am going to a diabetes education class next week sponsored by the military. Hope it is better than the first one I went to a few years ago when they confused me about how to eat and silly me ignored the advice to lose weight and exercise more.

Today I got a message from a tech in the clinic who said the doctor had reviewed my BG levels (which ran the gamut of 100-170 for before and 2 hours after eating) and was told that I only now needed to test twice a week. I had asked for more test strips on my prescription so I could test at least 4 times a day until I can really see what various foods seem to do to my BG. TWICE A WEEK!! Seems way too low to me, especially since I don't really have a great understanding of my own bodily reactions to various foods.

So, I need to have a chat with my doctor (this stranger I just met last month who may be gone in a few months). Could this be a cost cutting measure by Tricare to limit the amount expended on test strips and my doctor is trying to keep his budget in line? Is he just behind the times in current medical research on diabetes (scary thought)? Am I reading too many web sites and absorbing too many opinions (now there's a no win question for all the people who post here)? Is my doctor more used to treating young military members and their younger families with acute problems and fewer military retirees with more chronic conditions?

OK, you can't answer those questions. But I am interested in hearing what others who have Tricare as their primary health insurance coverage have discovered about the type of care they get from the military health system when it comes to diabetes. I have never had a complaint about my health care until today. How many test strips can I get covered?

My younger sister has had diabetes for about 5-8 years and I think she has had the same doctor most of the time, but has to buy an individual health insurance plan, so I know she spends a bunch of money every month on her supplies, so I am grateful that I have insurance, but want to make sure I am getting the best care I can get.

The doctor and I will have a chat about this when I see him in early July. Unless he has PCS'd (changed assignments and moved).

[davef]

Janke,

I can't comment about Tricare as I don't know anything about it at all. I can only say that as a fellow T2 on Metformin that I have found testing to be very important to me. I suppose I could only test twice a week but I don't think I would have the same level of control that I have now. The only way I could try an manage with just two tests per week would be to eat the same things all the time and hope that my body's reaction to them wouldn't change. I feel I would also lose some freedom and the ability to allow myself some latitude from time to time, right now, if I feel like I'm about to go off the wagon, I'll test and if I have a nice number (90 or below), I'll allow myself a bit of splurge to satisfy the craving and while staying on the wagon. I would recommend you talk to your doctor, explain how you want and need to be in control and that one month in is way too soon to be cutting down your testing.

Reading too many web sites, too many opinions? I guess it depends on how you are on filtering/assimilating the information you are getting. Being honest, I really only visit this forum, from time to time I'll take a little foray into other sites but that's rare. I'm fairly good at filtering the information I get, I never assume that an opinion is necessarily right (or wrong), it depends on what works for me. At the same time if you have lots of people giving the same information, well, then there might just be something to what they are saying :)

Do talk your Doctor, my two cents for what it's worth, is that testing twice a week could make things harder for you.

[fgummett]

If you are willing to work on this problem (and it sounds like you are) then the only way to find out about your Diabetes is by testing. I'd go further and suggest you need to step it up to several times a day... especially 2 hours after each meal or at the very least keep it to twice a day and stagger when you test e.g. Fasting and 2 hours after breakfast one day, fasting and 2 hours after lunch the next and so on.

Your Doctor may be satisfied with your numbers, but I wouldn't be. I suggest your 2 hours after eating should be down to 140-150. My attitude to this is that the Doctor is part of YOUR diabetes health care team... some Doctors may not respond well to this, but in my experience if they see that you have stepped up, armed yourself with knowledge and are taking a proactive approach to helping yourself they usually come around.

The military really needs to take better care of its own and if he is unwilling to work with you I'd kick up a fuss. :cool:

[morrisma]

I agree with Frank & Dave. Testing is the key to this mess. If the military docs can't up your strip count, look on ebay or craigslist. Several folks here have gotten very good deals that way. Also, Wal-Mart is supposed to have a meter for about $30 and relatively cheap strips. Check that out too.

[w5wjp]

I am on Tricare too. They tried the "That's too many strips" thing with me too. My PCM called them and told them to maintain good control and save them money in the long run, testing was the most cost effective way. Now I get 300 a month with no questions asked. If your PCM won't do it, ask for a referral to an endo. Tricare will try to push you around until you start to push back.

[Scrabblechick]

I don't know much about Tricare either. I do know that frequent testing has helped me go from a 7.4 A1C to a 5.6 A1C in three months. I simply could not have done this without knowing my BG levels throughout the day.

I normally use the True-Track meter I got from Walgreen's. Strips are $48 for 100. After using 2 "name brand" meters, I've concluded it's accurate enough for me to "eat by my meter."

You want good control, you've gotta test. It's the only way to do it, and twice a week just isn't enough.

[steamfan261]

Military medical care can be quite entertaining, sometimes. When I was stationed in West Berlin in the 1970s, I broke my thumb while trying to close the hood on my car. Not unreasonably I thought this was a good occassion for a visit to the Emergency Room, and thus it was that my neighbor transported me to the US Army Hospital, Berlin.

There, I was seen by a physician from some strange country in the Far East with limited English skills. She read her responses and questions from 3x5 cards.

Me: Doctor, I think my thumb is broken. (Holding up swollen thumb)
Doctor: Haaaaow looooong haff youuuu had zees cold?
Me: I don't have a cold, my thumb is broken.
Doctor: Eeet eees a very baaaad cold. Two days bad rest. Goodbye.
Me: My thumb is broken, you silly twit.
Doctor: How long haff you had zees cold?

Shudder.

[Hammer]

I agree with Frank & Dave. Testing is the key to this mess. If the military docs can't up your strip count, look on ebay or craigslist. Several folks here have gotten very good deals that way. Also, Wal-Mart is supposed to have a meter for about $30 and relatively cheap strips. Check that out too.

Yes, the meter is a Relion and here's (http://www.walmart.com/catalog/product.do?product_id=3555238) a link to it and it's test strips at Wal-Mart.

[Deltagirl1976]

Just an FYI you dont have to see a millitary doctor just becuse you have tricare. My hubbie is retired from the millitary and we see REGULAR civillan doctors for our diabeties with out any problems. If it was me I'd STRONGLY suggest getting with a civillian doctor ect ect so that you know they will be there for you plus you will get better care.

[Achilles]

I got one of those Relion monitors the other day. At first I was having some doubts about it but today when I got a new set of strips for my One Touch Ultra mini, the two meters are reading pretty close to each other. Not too bad for a < $10 meter and 50 strips for < $22.

Still reads a tad bit higher than the One Touch Ultra mini but all relative.

Once I get enough data I can do a paired hypothesis test using statistics I learned at work to see if there is any significant difference between the two meters. :questionm

[jacobsam622]

I bought the Relion about 4 week ago the Machince was 10 bucks and the strips were 20 buck for fifty strip. I ran out of test strips about a week and a half before my Insurance would refill the script for the One touch Ultra and I spent 28 dollars for 20 strips. So I went out and bought the cheapest strips I could fine and then bought the machince to go with it. Right now I am on a high level of meds so I need know how well they are working. They dont want us testing its not cheaper for them If we maintain control. I mean come on look at the number of different type of doctors we need to be seen by, Eye doctors, dentists, foot doctors endos, Testing supplies, drugs, diabetes class's, etc, etc. I the long run its cheaper for them if we just die. If we were horses they would have already shot us.:eek: