Doc will only prescribe 100 strips/month

[reefedjib]

That's just over 3 strips/day. Everything i have been reading about injecting insulin for carbs, my next step, is to test before and after every meal and then sometimes at night for lows. That's 6 - 7 strips/day. That's over 180 strips/month. I think she ought to prescribe me at least 200 strips/month.

What's a reasonable number of strips/month when injecting for carbs?

[GeishaGirl]

If you're on insulin, you definately need more test strips. If the doc is being a dick (hee hee) then you need to switch docs, or pay for your own Wal Mart has pretty cheap generic strips that are decent.

[davef]

I would have thought that if you are doing bolus injections to cover carbs consumed you need to test before and after each meal. To be honest I would be an advocate of people testing before and after each meal even if they are not on insulin.

I'd talk to your Doctor again and ask her to explain how you are supposed to monitor and ensure you are taking the right amount of insulin for a meal if you can't test enough.

[reefedjib]

Thanks for the feedback. I'm gonna go see her right now and try to get this straightened out.

[morrisma]

Fact is that the more you test the better your control is.
If you are injecting, there should be no question about the extra strips.
Many T2s not using insulin feel that they get very little data from testing as their numbers rarely change. Even they should be testing 2 hours after a meal to confirm that they are handling the meal well (<140). Some folks are surprised when a heavy rice or pasta or pizza meal sends their blood sugar higher than expected. Just testing mornings and nights wont see that. For example, at least knowing that rice sends your sugar through the roof can help you make choices about that extra sushi roll in the future. If you don't test after meals, you don't know what's hurting you.
If the idea of knowing how much to inject for a meal is not enough to sway the doc's opinion on the extra strips, approach him/her with the idea of testing more to learn how certain foods affect your sugar. If that fails, find a new doc.
Mike

[yannah]

type 2's tend not to test much. so docotrs don't predcribe strips. there are even studies to show testing makes t2's control worse.

that is NOT because testing makes bad control.. that is because no one seems to arm them with the info they need for control. My doctor says, most people do not care, that they are not like me. well I am like I am because of DF and I would just be another T2 who is cluless if I had not came here. my docotr is always patting me on the back.

well he apparently doesn't even prescribe meters all of the time.

whatever doctor.

makes me mad.

[reefedjib]

Fact is that the more you test the better your control is.
If you are injecting, there should be no question about the extra strips.
Many T2s not using insulin feel that they get very little data from testing as their numbers rarely change. Even they should be testing 2 hours after a meal to confirm that they are handling the meal well (<140). Some folks are surprised when a heavy rice or pasta or pizza meal sends their blood sugar higher than expected. Just testing mornings and nights wont see that. For example, at least knowing that rice sends your sugar through the roof can help you make choices about that extra sushi roll in the future. If you don't test after meals, you don't know what's hurting you.
If the idea of knowing how much to inject for a meal is not enough to sway the doc's opinion on the extra strips, approach him/her with the idea of testing more to learn how certain foods affect your sugar. If that fails, find a new doc.
Mike

So, for argument's sake, we have two reasons to test more when bolusing for carbs:
1 - Knowing how much to adjust the bolus
2 - Understanding the effect of various foods

This is good ammo. It seems to me that in a way they are related - fine tuning the I:C ratio. I suppose GI makes an appearance here as well. I'm not to knowledgable about GI yet. I thought I would go ahead and get started bolusing for carbs first.

[reefedjib]

type 2's tend not to test much. so docotrs don't predcribe strips. there are even studies to show testing makes t2's control worse.

that is NOT because testing makes bad control.. that is because no one seems to arm them with the info they need for control. My doctor says, most people do not care, that they are not like me. well I am like I am because of DF and I would just be another T2 who is cluless if I had not came here. my docotr is always patting me on the back.

well he apparently doesn't even prescribe meters all of the time.

whatever doctor.

makes me mad.

Yeah, I bought my meter out of pocket - $80 or something. But I love it - it records all kinds of data. It's UltraSmart. But my doc didn't prescribe it, even when I asked her to. I'm tired of paying out of pocket for this disease...it's expensive!

[Moonglo]

That makes no sense to me... why would a doctor not write a prescription for a meter? It's not like we're talking about an addictive drug or something...

[yannah]

Yeah, I bought my meter out of pocket - $80 or something. But I love it - it records all kinds of data. It's UltraSmart. But my doc didn't prescribe it, even when I asked her to. I'm tired of paying out of pocket for this disease...it's expensive!

would they prescribe you a meter at all?

if not.....are you kiddding me? is there some kind of abbreviation we can start using for so sick of doctor politcal **** we are all individuals. SSODPCWAAI. somthing like that.

[reefedjib]

SSODPCWAAI.

:D Ok, what's that stand for?

[lgvincent]

Many of these doctors are idiots now. I looks to me like in medical school they are taught how important it is for us to regularly check our sugar. Vials come in strips of 100 so they are taught 100 strips each month is the magical number.

Some time back I asked my doctor for 150 a month, not an unreasonable number. He said he would send in the prescription and when I get the shipment from the company, I got 100 a month. I sent them back. I went to the doctor and I cursed the guy. We had a nasty fight but I did get my 150 strips a month. I hate that I had to do it but I was really upset because I check my sugar at least 12 times a day. I need the 150 but I depend mostly on buying strips on ebay.

I hope you can get your ignorant doctor to listen to you. It's time they learn we are people with a real disease that requires thinking, planning and effort, not just make-believe examples in a textbook that live happily ever-after thanks to the heroic efforts of being closed-minded for the last thousand years. I'm surprised doctors don't toss people accused of witchcraft into water to see if they are accepted or rejected by it to determine if they really are. The opinions of their profession doesn't seem to advanced beyond the middle-ages yet.

[yannah]

:D Ok, what's that stand for?

"sick of doctor political **** we are all individuals" -silly, dah!

I think we would use this abbreviation alot.

[reefedjib]

Many of these doctors are idiots now. I looks to me like in medical school they are taught how important it is for us to regularly check our sugar. Vials come in strips of 100 so they are taught 100 strips each month is the magical number.

Some time back I asked my doctor for 150 a month, not an unreasonable number. He said he would send in the prescription and when I get the shipment from the company, I got 100 a month. I sent them back. I went to the doctor and I cursed the guy. We had a nasty fight but I did get my 150 strips a month. I hate that I had to do it but I was really upset because I check my sugar at least 12 times a day. I need the 150 but I depend mostly on buying strips on ebay.

I hope you can get your ignorant doctor to listen to you. It's time they learn we are people with a real disease that requires thinking, planning and effort, not just make-believe examples in a textbook that live happily ever-after thanks to the heroic efforts of being closed-minded for the last thousand years. I'm surprised doctors don't toss people accused of witchcraft into water to see if they are accepted or rejected by it to determine if they really are. The opinions of their profession doesn't seem to advanced beyond the middle-ages yet.

So, I need to defend my doctor at this point. She has been fantastic in aggressively treating my high BG (diet and exercise, then Metformin and another drug, then basal insulin, then corrective bolus insulin, and now carb-based bolus insulin). My previous doc just prescribed me Metformin and didn't follow up. She has been very determined to get my BG under control and is happy with the direction my numbers are going in. She has followed up monthly or even weekly. She has given me scripts for everything but the meter...and now the full number of strips I think I need. My suspicion is that she is getting pressure from the insurance company to keep costs down. I trust her completely. She's Pakistani (educated there, residency here) and knows her business.

[reefedjib]

"sick of doctor political **** we are all individuals" -silly, dah!

I think we would use this abbreviation alot.

Could we abbreviate it? SDS? :)

[morrisma]

Rob,
I agree with you - work with your doc and see if she will respond to your very reasonable request for more strips.

She will be almost certainly following an insurance company guideline and very likely need to do the extra work necessary to override that guideline. Writing out your reasons may help her in this.

I'm glad you like your meter and sorry you paid for it at all. All the meter manufacturers offer free deals all the time. At this point, I'd keep my eye out for a free spare meter of the same type. If you test regularly, you tend to feel lost without that thing!

Good luck with tthe doc.
Mike

[gelbaugh05]

I count carbs also. I test before and after every meal and before and after I run every time, no exceptions. My Dr. wrote a prescription for 200/mo. and will write more if I ask. With Bayer's new cost saver plan, they cover my co-pay every month. End cost---Zero! Look into it.

[reefedjib]

I count carbs also. I test before and after every meal and before and after I run every time, no exceptions. My Dr. wrote a prescription for 200/mo. and will write more if I ask. With Bayer's new cost saver plan, they cover my co-pay every month. End cost---Zero! Look into it.

So that's like 8 a day. I was thinking 7 a day, 3 meals before and after and a nighttime check for lows. I haven't gotten into the exercise just yet. So it could be 9 a day. 270/month. I'm gonna ask for 200/day right now.

[e||ement]

do you have a DE who could write you a note (to your doctor)?

this is what i did... i had my DE write a note to my pharmacist because my insurance company didn't want to cover me for 100 strips every two weeks.

the letter stated that in order to maintain healthy blood sugars i required frequent testing of more than 6 times a day. no problems since.

[reefedjib]

I'm glad you like your meter and sorry you paid for it at all. All the meter manufacturers offer free deals all the time. At this point, I'd keep my eye out for a free spare meter of the same type. If you test regularly, you tend to feel lost without that thing!

Mike, I got it before I heard that you can get them for free. darnit! I have 2 Accu-Chek Compact Plus meters too, that I paid for. Anyone in the market? :)

[Moonglo]

Mike, I got it before I heard that you can get them for free. darnit! I have 2 Accu-Chek Compact Plus meters too, that I paid for. Anyone in the market? :)

How much do the test strips run for those?

[reefedjib]

do you have a DE who could write you a note (to your doctor)?

this is what i did... i had my DE write a note to my pharmacist because my insurance company didn't want to cover me for 100 strips every two weeks.

the letter stated that in order to maintain healthy blood sugars i required frequent testing of more than 6 times a day. no problems since.

So what is a DE? Diabetes Educator? I have one of those, but I don't know when I will be able to see her again....I could call.

I didn't get to see her today, I delayed too long. It's wierd because the doc gave me instructions on basal and corrective bolus injections (sliding scale I think). But she is leaving carb-based bolus instructions up to the Nutritionist. And now we have the DE writing affidavits on testing. Maybe I should get an Endo while we are at this. :confused:

Cheers!

[reefedjib]

How much do the test strips run for those?

I don't quite remember. I am real bad at looking at prices. I am guessing they are about $100 for 114 strips (6 drums of 19)

[reefedjib]

I spoke with my DE (Diabetes Educator?) about this issue. She told me that most insurance companies won't fork out for more than 100 strips a month. She recommended that I test 3 times before meals, and then every other week pick a meal and test 2 hours after to check I:C ratio and carb counting skill. She said this is the situation unless I have stellar insurance, which I don't.

It is what it is.

[xMenace]

That's just over 3 strips/day. Everything i have been reading about injecting insulin for carbs, my next step, is to test before and after every meal and then sometimes at night for lows. That's 6 - 7 strips/day. That's over 180 strips/month. I think she ought to prescribe me at least 200 strips/month.

What's a reasonable number of strips/month when injecting for carbs?

300+. I know an ex-member that gets 700.

[fgummett]

I was able to increase the strips I get each month after a letter from my Doctor to the insurance company.

If you are limited on test strips, it seems that testing AFTER meals has the best correlation to A1C.
The frequency of [self monitoring of blood glucose (SMBG)] should be determined individually, based on the type of diabetes, the treatment prescribed, the need for information about BG levels and the individual’s capacity to use the information from testing to modify behaviours or adjust medication.
For people with type 1 diabetes, SMBG is an essential component of daily diabetes management. In a large cohort study, performance of >=3 self-tests per day was associated with a statistically and clinically significant 1.0% reduction in A1C levels.The results of multiple tests each day provide information that is better correlated to A1C than fasting results alone. BG measurements taken after lunch, after supper and at bedtime have demonstrated the highest correlation to A1C. More frequent testing is often required to provide the information needed to reduce hypoglycemia risk, adjust treatment and make appropriate lifestyle choices. Canadain Diabetes assoctaion - 2008 Clinical Practice Guidelines - Monitoring Glycemic Control... (http://www.diabetes.ca/files/cpg2008/cpg-2008.pdf#page=46)

[reefedjib]

I was able to increase the strips I get each month after a letter from my Doctor to the insurance company.

I'll try this and see what happens.

[lgvincent]

You're right! I'm a complete idiot! Everything I say is garbage and in my presence cro-magnon man looks like Leonardo da Vinci. I guess how all these doctors come up with the same figure of 100 strips a month is one of the unexplained mysteries of time and space??? I hope you'll forgive a low-life worm like myself for trying to show you some compassion. It won't happen again.






So, I need to defend my doctor at this point. She has been fantastic in aggressively treating my high BG (diet and exercise, then Metformin and another drug, then basal insulin, then corrective bolus insulin, and now carb-based bolus insulin). My previous doc just prescribed me Metformin and didn't follow up. She has been very determined to get my BG under control and is happy with the direction my numbers are going in. She has followed up monthly or even weekly. She has given me scripts for everything but the meter...and now the full number of strips I think I need. My suspicion is that she is getting pressure from the insurance company to keep costs down. I trust her completely. She's Pakistani (educated there, residency here) and knows her business.

[DannyK]

reefedjib...

You need to realize that a lot of us here have NO insurance, and have to purchase everything "out of pocket". As far as I'm concerned, it would be a blessing to get 100 strips a month for free, or a very minimal co-pay.

Dr.'s appts., lab tests, strips, insulin.....all out of pocket (T1 insulin dependent), sounds to me, you've got it better than a lot of us.

[DannyK]

Yeah, I bought my meter out of pocket - $80 or something. But I love it - it records all kinds of data. It's UltraSmart. But my doc didn't prescribe it, even when I asked her to. I'm tired of paying out of pocket for this disease...it's expensive!


It's a bi**h isn't it.....

[reefedjib]

reefedjib...

You need to realize that a lot of us here have NO insurance, and have to purchase everything "out of pocket". As far as I'm concerned, it would be a blessing to get 100 strips a month for free, or a very minimal co-pay.

Dr.'s appts., lab tests, strips, insulin.....all out of pocket (T1 insulin dependent), sounds to me, you've got it better than a lot of us.

I do and I'm thankful for that. I don't even have a good idea what it would cost to pay for meter (free), strips, pens, vials, needles, syringes, doc appts, labs. Easily over $1000/month I would think. I feel for you all.

Which is why I have the opinion in favor of universal health care. If you want you can read about what I think in the last few pages of this giantthread (http://www.diabetesforums.com/forum/type-2-diabetes/41397-usa-senate-passes-healthbill.html).

It's a bi**h isn't it.....

It was starting to be. I paid for meter, strips, and syringes and it was a couple of hundred bucks. Like I said, I don't know how y'all without insurance do it.

Peace.

[reefedjib]

My suspicion is that she is getting pressure from the insurance company to keep costs down.

You're right! I'm a complete idiot! Everything I say is garbage and in my presence cro-magnon man looks like Leonardo da Vinci. I guess how all these doctors come up with the same figure of 100 strips a month is one of the unexplained mysteries of time and space??? I hope you'll forgive a low-life worm like myself for trying to show you some compassion. It won't happen again.

I'm sorry that is what you took away from my post, Brandy. I didn't talk about you or criticize what you wrote, just pointed out one exception. Even my doc has limits. She can't prescribe more than 100 strips, due to the insurance company limitations (unless I can convince her to write a letter evidently). She seems out of her depth when I start talking about bolus injections to cover carbs - she refered me to my Nutritionist. Still she has followed up with me and made sure I was on the right path.

I appreciate what you did write. There is a lot of incompetence out there.

Peace.

[lgvincent]

My name is Lowell. Brandy was my most loyal friend for 15 years.

I apologize for my earlier response. I was just angry that you had difficulties similar to mine in getting enough glucose strips.

[reefedjib]

My name is Lowell. Brandy was my most loyal friend for 15 years.

I apologize for my earlier response. I was just angry that you had difficulties similar to mine in getting enough glucose strips.

Hey Lowell. I'm sorry to hear about your friend.

Rob

[worm]

Could we abbreviate it? SDS? :)

I had three DR before I found one that works for me.
I think a DR is like a car keep test driving until you find one you like.

I have a few rules when finding a DR.

1. They must listen to what I have to say.
2. Late apointments
3. Must draw blood in their office.

The max on most test strips for insurance is 500 for a 3 month supply.

[Tribbles]

My doctor originally offered 125 strips a month based on four tests a day for thirty days (does the 100 limit come from a test every meal for a month?) but when I complained he just asked how many I felt I needed and gave me that. I'm not aware of any limit in my policy.

Next year I might go down the DME rather than prescription route for strips.

[foxl]

Many policies have limits.

Many MDs accept multiple policies. Hence they are not always aware of what an individual policy will accept. I HATE that it is time-consuming, but the best thing to do unfortunately is call your insurance company with specific questions BEFORE you call your MD.

I found out that the copay for 100 of one type of test strip was 75 bucks, and for another, it was under 20. My MD would NOT know that. And that is just for starters ... I also found out local retail copay on some of my prescriptions was less than the mail order copay! I had to call the mail-order prescription processor and ask. AFTER calling the insurance company.

I feel for the MDs on this one -- yes they are making money and seem like cold-hearted SOBs, sometimes. But on this one, imagine ALL the clinical info they are expected to keep in their brains. Now add copay matrices, for perhaps 4 or 5 different insurance companies, with VARIOUS contracts, for ... how many conditions???

[Tribbles]

It's cheaper for me to get insulin from the local pharmacy than it is from my insurer's mail order arm. On the other hand the maximum cost of an order of strips is capped at $75 for three months supply from mail order and that's not an offer I can refuse!

[foxl]

It's cheaper for me to get insulin from the local pharmacy than it is from my insurer's mail order arm. On the other hand the maximum cost of an order of strips is capped at $75 for three months supply from mail order and that's not an offer I can refuse!

Not to mention you know how your insulin has been handled ... not left on the front porch in the sun!

[Tribbles]

Not to mention you know how your insulin has been handled ... not left on the front porch in the sun!

Yeah, that got me to swear off buying strips on ebay...

[reefedjib]

I just found out from my health insurance website that the limit for test strips is 300/month (OneTouch Test Strips (http://notesnet.carefirst.com/formulary/formulary.nsf/vwwebbycategoryql/2a0651b6074ff2bb85256b1e007041c5?OpenDocument))! I printed this out and I will take it to my doctor. Thanks to someone for suggesting I check with the insurance company first!

[butterflykisses]

recently when my docs PA was filling out paper work for my pump she asked me how many times a day I test. I said around 10. She says "I don't think they'll let me prescribe that many". Ummm, that's how many I've been getting!!! She said they usually limit it to 7 a day. I told her that I have been getting 300 a month for a long time now with no problems. I thought it was strange that she would argue with me over it. What does it matter to her? She should be happy that I'm testing like I should! If someone, like me, tests before and after meals and before bed...that is the 7 tests. However, that doesn't include having to do multiple tests when low or high, or replace the freakin error strips!!! So after this discussion I have to get OneTouch strips filled to use with my Ping. What do they call in? 150, test 5 times a day.:mad: Freakin morons! Because I was in a hurry and didn't want to wait I just took them and have been supplementing with my Freestyle. It just irritates the **** out of me!!!

[networkguy]

I just found out from my health insurance website that the limit for test strips is 300/month (OneTouch Test Strips (http://notesnet.carefirst.com/formulary/formulary.nsf/vwwebbycategoryql/2a0651b6074ff2bb85256b1e007041c5?OpenDocument))! I printed this out and I will take it to my doctor. Thanks to someone for suggesting I check with the insurance company first!

I was about to ask if youve talked with your ins company yet. To be, as others have said, NOT prescribing what you need is bullsh1t. I would shop for a new doc if it were me. I personally wouldnt tolerate it. Im lucky in that my doc gives me whatever I need and doesnt balk. But, Im also more knowledgable than most hehe.

I get 300 strips/mo, Freestyle, with a minimal copay.

[sarahspins]

Most PRIVATE insurance will allow up to 300 a month.. doesn't matter what type of D you have. Almost all will cover as many as you want/need with a letter of medical necessity.

Always check your Rx benefits... your doctor doesn't know the specifics of YOUR plan.

[worm]

Most PRIVATE insurance will allow up to 300 a month.. doesn't matter what type of D you have. Almost all will cover as many as you want/need with a letter of medical necessity.

Always check your Rx benefits... your doctor doesn't know the specifics of YOUR plan.

I live in Michigan and they have a law here that all insurance must cover diabtec supplys at the same rate as other scrips so check on your state law.

[EeyoreButterfly]

I don't know how kosher this is, but I had that issue and my pharmacy (a local one) just went into the computer and doubled it! They really took care of me, it is the one thing I miss about Kirksville. When I switched companies the doc did write me the script for 200 but then said I only tested twice a day so of course insurance denied. My pharmacy came to the rescue again. Maybe your pharmacy can do that for you. (And they volunteered to do this because they noticed I was coming in before I could renew.)

[RobinP]

Seems to me these insurance co's would rather us test more and have good control, so as to prevent complications later that they'll have to pay a fortune for.

[sarahspins]

Seems to me these insurance co's would rather us test more and have good control, so as to prevent complications later that they'll have to pay a fortune for.

You'd think so... I switched insurance just over 3 months ago, and my new insurance has happily paid for all of my prescriptions (nearly $3k worth) yet they are balking at covering 2 REGULAR dr's appointments, bloodwork, and a CDE appointment totalling about $900. Apparently I have a "pre-existing limitation" on my policy, even though they never informed me, and I have not had a lapse in coverage recently (was on COBRA for 18 months).

[foxl]

^%$##@& myopic morons ...

[Tribbles]

Seems to me these insurance co's would rather us test more and have good control, so as to prevent complications later that they'll have to pay a fortune for.

The insurance companies reckon you will be someone else's problem by the time complications come along, odds are if you change jobs you change insurance, so money spent now is wasted from their view point.