[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!

[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, 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.

Test strip provisions in the UK

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! 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".


[Hot Fuss ]

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 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?

Anything else?