[Hammer]

I read the thread about the test strip problems in the UK, and wasn't sure if I should post this in there, but this is what I'm facing here in the US, so I thought I shouldn't hijack that thread to discuss my problem.

I just got a call from my doctor's office, and they said they were filling out the form from the insurance company as to what testing supplies I needed. I told them I was testing 7 times a day......before and after each meal, and before bed, which was usually 6-8 hours after my last meal. This last test I feel gives a better fasting BG level than a morning reading, since the dawn phenomenon doesn't affect it.

They said that was too much testing and that I only needed to test 3 times a day. They said that since I was on Lantus, then one test is needed to get my fasting BG level. Since I was on Byetta, I only needed to test two hours after lunch, and two hours after dinner or before I went to bed.

Their logic is that since I'm on Lantus and Lantus only controls your basal BG levels, that obtaining one fasting BG reading a day will let me know if I need to adjust that dosage. Okay, that makes sense. But then they said that since Byetta is taken in either 5mcg or 10mcg doses, then no matter what your reading is, one or two readings a day after meals will indicate if you need to be on the 5mcg dose or the 10 mcg dose. With Byetta, since you don't adjust each dose before each meal, you don't need to take readings that often.

I asked them, if I don't test before and after each meal, how am I supposed to know how the food I ate is affecting my BG levels? By knowing how the food affects my BG levels, I can determine which foods to avoid and which are beneficial to me.
They said "That's not important."!

I then asked them some questions about my Lantus dosage, and when they heard that my morning readings were 120 -130, they were satisfied. They continued to assert that as long as my fasting was in that range and that my spikes were below 180, that I had control of my BG levels. I asserted that based on what I've read here, that 120-130 and 180 were too high. It should be under 100 for my fasting levels and under 140 for my spikes. They said that levels in that range were for non-diabetics and that they weren't realistic for diabetics.

Okay, being the super logical person I am, I asked, well if 140 is normal for a non-diabetic and 180 is too high for a non-diabetic, then why isn't 180 too high for me too? If a reading of 180 can cause damage to a non-diabetic, why isn't it going to cause damage to me? They had no answer and said I needed to talk to the doctor.

So now, I'm only going to get enough test strips to test 3 times a day, and according to the doctor's office, this is what the insurance company considers normal for someone on Lantus and Byetta. The insurance company is setting this amount based on the medical profession's recommendation. How can you fight against this? They control the misinformation, they control the money, and they determine what you'll get, so how can you fight that?

As a side note, I experimented with foods, and the main one was mashed potatoes. Most people with diabetes have problems with their BG levels if they eat them, so I tried something. I took my Byetta like always, but I also took two of the Prandin tablets that I still have left over from before. I switched from two Prandins before each meal to Byetta twice a day, so I still have a bunch of Prandin tablets left over. I took the two Prandin then had a bowl full of mashed potatoes with dinner. I tested two hours after dinner and my BG readings were only 14 points higher than my before meal levels. I tested two hours after that, and my levels were about the same as my pre-dinner levels, indicating to me that the Prandin was effective in preventing a huge spike in my levels.....something that I wouldn't have known if I only tested three times a day.

[xMenace]

Get an A1C now. Eat lots of fudge. Get another in 3 months. Sue their ****ing asses!

[Hammer]

Originally Posted by xMenace

Get an A1C now. Eat lots of fudge. Get another in 3 months. Sue their ****ing asses!

Well, I like my doctor and have a lot of respect for him. He's not your typical doctor in that he doesn't just read about the latest developments in medicine, he studies the raw data and uses that when he makes his medical decisions.. The only problem with that is that he's using data collected by the very sources that are putting out the wrong information, so he's going along with what he thinks is accurate info. It's not really his fault....it's the medical community's fault as a whole.

I like your suggestion though....get the A1C reading now, which should be low, then eat the wrong things to make sure the next reading is high. What would probably happen then is my doctor would probably switch me to a different insulin....one that requires you to test more often.

Something that always irritates me is that people think that because a doctor said it, it must be God's word. I am just the opposite. If a doctor told me something, then I'm going to investigate it, and determine for myself if he's right or wrong. My doctor's office alluded to this when I told them about the BG levels. When I said that the people in the forums indicated that my levels should be lower than what the doctor said, she immediately used the old line, "Are these people doctors?"

I answered her with, "No, is the doctor a diabetic? Has he lived with diabetes for years like these people have? Has he suffered from the complications that these people have? These people live with diabetes every day of their life, and they know what things affect them and how they affect them. Does the doctor know this? No, he reads it out of a book, right? While I have the utmost respect for the doctor, I'm going with the information from those who are living with diabetes since it's from real life experiences."

[RobiJo]

Sometimes I feel like a doctor. Then I remember that I am much to smart to be one!

As much as you like your doc, if they won't write you a script for more tests per day... find one that will.

I really despise docs that don't allow proactive patients. They should wish more were like you!

[lgvincent]

I have the same problem. I test 10 or more times a day and I was told that I only needed to test three times a day even though I've had type 1 diabetes for 40 years and go into insulin shock without knowing it. After a lot of arguing with the guy, I finally got him to write a prescription for 5 a day. The others I have to buy on ebay since I can't afford to pay full price for them.

[Scrabblechick]

If you have access to a fax machine, Hammer, write out exactly what you've written out here and fax it to your doctor. Or hand deliver it to his office. Also write a letter to the insurance company, explaining why you need to test more often.

However, tell your doctor you are very disappointed that he's not supporting you in your quest to be more proactive about your health and that you really wish he would go to bat with the insurance company for you. That should wake him up. Be polite, though.

I hope you can get this straightened out and get all the strips you need for your best health!

[Hammer]

I thought about telling my doctor to write me a prescription for more test strips, but the problem is, the insurance companies expect him to adhere to their guidelines of three tests a day. If he wants me to test more often than that, he has to explain to them why I need to test more often. Most doctors don't have the time or want to be bothered explaining to the insurance companies why they have to do something....especially when he thinks that three times a day is okay.

I ran into a similar problem with the insurance company before, only then it was over a prescription the doctor wrote for me. Up till then, I was having trouble getting this medication, since it had become popular and most pharmacies had trouble keeping it in stock. I had my prescription transferred to Wal-Mart since they had it in stock. The doctor increased the dosage after a month because the dosage I was taking wasn't doing the job. The pharmacist told me that the insurance company might balk at this higher dosage. They did, but he did something and the insurance company okayed it. After another month, my doctor increased the dosage again, and the Wal-Mart pharmacist shook his head and told me that he knew the insurance company wouldn't okay this new dosage.

When he tried to run it through the insurance, they wouldn't accept it, so he called them and they told him they wouldn't accept it. While he was on the phone with the insurance company, he looked at me and shook his head. I told him to give me the phone. When I got the phone, the first thing I did was ask what the problem was. The moron on the other end told me that the dosage my doctor prescribed was more than what was recommended by the drug's manufacturer, and that they thought it was too high.

Okay, that was all I needed to go ballistic. The first thing I said was, "Are you a doctor?"...to which they said no, but there was a doctor there, so they connected me to this doctor. I asked this doctor, "Are you my physician?".....to which she said no. I said, "If you refuse to give me this medication, and I get sick, can I sue you for malpractice?"....they didn't say anything. I said, "My doctor knows exactly what he's doing and I need this quantity of medication, and he discussed it with me before prescribing it. You don't know anything about what my medical situation is, so who are you to tell me what is too much medication? I'm paying you to pay for my prescriptions, not to offer me advice that I don't want! Do you understand that!"....they just said yes. I said "Good, now just pay the d*mn prescription, and shut up! I'm not interested in your opinions, do you understand?"....they said they did.

I handed the phone back to the pharmacist. It's funny, but as I was yelling on the phone, I noticed that the other pharmacists there (there were 4 of them) were all smiling and clapping for me as I was yelling at the insurance company....as if to say, finally, someone is telling them off. Insurance companies....they make sure they get their premiums on time, but they don't want to pay out any more than they have to and they'll fight you for every penny.

[Scrabblechick]

I still think the reason insurance companies won't pay out for supplies and meds for diabetics is because they WANT us to die young and decrease the surplus population. It's cheaper for them to put us on dialysis for 6 months rather than pay out a lifetime's worth of supplies and meds.

[pokie]

Insurance companies can be infuriating. But, it's not all their fault. Drug companies have a huge part to play. I still can't wrap my brain around why a box of strips costs over $100. patients and insurance companies are being soaked. I'd be willing to bet if the drug companies were to lower their prices a bit, insurance companies might not balk so much at giving us what we need. That said, I still think that insurance companies should have to adhere to doctor's prescriptions and not try to second guess them. One of my biggest fears is somehow losing my insurance (fortunately it is not linked to employment) because I would never be able to afford all my meds and still keep my home.

[hermit104]

Hammer, in the UK the vehicle licensing people strongly recommend for safety reasons that anyone on insulin test before driving then every two hours and I understand that this can be a useful lever to get more test strips.

If you drive, is there a similar rule where you live that might assist you?

Regards.

Rona

(Phew, first post done!)

[Hammer]

Pokie, my FreeStyle Flash test strips sell for $100 for a box of 100 in the local stores, but I found them on-line for $60 for 100 strips.(not through E-Bay....I've never cared for E-Bay, so I've never used them.) Apparently the drug companies who sell strips package them in different packages. It's all the same stuff, only in a different box and at different prices.

Rona (Hermit104), welcome to the forums. I think you'll find that this is a very friendly place, and you'll find a ton of good information here. As for using insulin and driving, I don't know if that law exists here, but even if it did, it probably wouldn't apply to anyone using Lantus insulin. Lantus is used to maintain your fasting blood glucose level. That means that you take it once a day, and it keeps your blood glucose (BG) at a certain level. If you eat something, it doesn't prevent the spike that will come from the food you ate, so you need to take something else to keep the spikes down.(I take Byetta)

If you test after you've fasted for a while, like in the morning when you first get up, or before bed if it's been 4 or 5 hours since you've eaten, then that reading will tell you how low the Lantus is maintaining your BG levels. The Lantus won't lower that level any more than that, so testing any more than once won't show you anything.

Taking the Byetta will only lower the spikes after a meal, so unless you took the Byetta and didn't eat anything, your BG levels shouldn't go below what your fasting level was. (I take the Byetta before breakfast and before dinner). Since these two drugs affect your BG levels in this manner, the insurance companies feel that 3 tests per day is sufficient. What they don't take into account is that you need to test before and after each meal to see what the food you ate is doing to your BG so that you can arrange your diet to exclude foods that cause a big rise in your BG levels. All the insurance companies care about is what the drugs are doing to your BG levels, and they want you to test before breakfast, before dinner, and before bed.....all of these are fasting BG readings, so you don't know how high your spikes are. If your going to ignore your spikes, you might as well not test at all since the spikes are what seems to cause the most damage to your body.

[Emm]

Wow Hammer look how far you've come since you joined!

Originally Posted by Hammer

I like your suggestion though....get the A1C reading now, which should be low, then eat the wrong things to make sure the next reading is high.

As tempting as that might be, your health has to come first - I hope you find another way! The comments about driving might help - or maybe you can use my excuse, that menopause has interfered and I need to test more... lol.... they might have trouble believing you, what do you reckon?!

I answered her with, "No, is the doctor a diabetic? Has he lived with diabetes for years like these people have? Has he suffered from the complications that these people have? These people live with diabetes every day of their life, and they know what things affect them and how they affect them. Does the doctor know this? No, he reads it out of a book, right? While I have the utmost respect for the doctor, I'm going with the information from those who are living with diabetes since it's from real life experiences."

FANTASTIC!! Well said I so wish I had you with me when I was dealing with the same problem with my chemist & doctor!

Originally Posted by Scrabblechick

I still think the reason insurance companies won't pay out for supplies and meds for diabetics is because they WANT us to die young and decrease the surplus population. It's cheaper for them to put us on dialysis for 6 months rather than pay out a lifetime's worth of supplies and meds.

Actually I heard it's the opposite (in this country anyway). It costs many many thousands to fix up a diabetic complication. Not to mention the money they aren't earning in lost work time etc, and possibly taking in a sickness benefit. Regardless of the cash, I know what I'd prefer... day to day good health!

Originally Posted by hermit104

(Phew, first post done!)

Welcome to DF, Rona!

[fgummett]

Originally Posted by Hammer

Lantus is used to maintain your fasting blood glucose level. That means that you take it once a day, and it keeps your blood glucose (BG) at a certain level. If you eat something, it doesn't prevent the spike that will come from the food you ate, so you need to take something else to keep the spikes down.(I take Byetta)
If you test after you've fasted for a while, like in the morning when you first get up, or before bed if it's been 4 or 5 hours since you've eaten, then that reading will tell you how low the Lantus is maintaining your BG levels. The Lantus won't lower that level any more than that, so testing any more than once won't show you anything.

I know that in theory Lantus has a flat curve but is it really that 100% reliable... no variability in absorption or release..? Even if it is flat is there no variation in your need for basal insulin through the day... for example I use three different basal rates through the day with my pump.
I think that law or no, in order to safeguard your driving license, if you are taking insulin you should be able to test before a trip.
Are you sure it is your doctor that is limiting you or is it just a policy in his office... have you discussed it face to face with him?
BTW Kudos on the way you dealt with the insurance company

[Razo681]

My Doc didn't prescribe an amount for test strips, just a prescription. Then the Pharmacist just asked how many times I tested. I told her (a ton ) actually I said 7-10 times a day. She said "that sounds right", and I haven't had a problem. I would have to say that the test strip thing is the most frustrating about the whole maintenance of this problem. If you have to go out and buy these things, they are outrageous, and if you're like a lot of diabetics you take your meds, whether its insulin or pills, based on the readings.. GRRR....

[Hammer]

Originally Posted by Emm

As tempting as that might be, your health has to come first - I hope you find another way! The comments about driving might help - or maybe you can use my excuse, that menopause has interfered and I need to test more... lol.... they might have trouble believing you, what do you reckon?!

I'd never do that...eat lots of sweets every day then get an A1C test. First off, I don't care for sweets, especially candy and chocolate. I never eat dessert, never eat cakes or pies. Heck, the one time my blood sugar went too low and I got the shakes, I knew I needed to get some carbs into me to stop the shakes. I had to resort to mixing sugar in a glass of water because there wasn't anything in my house that was sweet.(I had no fruit here either).

I wondered if there is such a thing as male menopause. From time to time I'll get these hot flashes, for no apparent reason. I'll be sitting in a chair reading or watching TV when all of a sudden, I'll start to get hot. I'll get so hot that sweat will start running down my face. It feels like the heat was suddenly turned up, but it wasn't. It'll last for maybe ten minutes or less, then it will go away.(No, I don't get mood swings. )

Originally Posted by fgummett

I know that in theory Lantus has a flat curve but is it really that 100% reliable... no variability in absorption or release..? Even if it is flat is there no variation in your need for basal insulin through the day... for example I use three different basal rates through the day with my pump.

I wondered about this also, so I've compared my morning reading (which has a little Dawn Phenomenon in it) and my before bed reading (which is after 6-8 hours of fasting), and the before dinner reading which was after 5 hours of fasting, and they are all similar....maybe 2 or 3 numbers different. There are many times when I'll go 4 hours between meals, and my before readings are always within a few points of my bedtime or first morning numbers. I took that to mean that the Lantus was keeping things at a constant level.

Originally Posted by fgummett

Are you sure it is your doctor that is limiting you or is it just a policy in his office... have you discussed it face to face with him?

No, actually I haven't. When I call his office, I talk to his nurse. She said, " Dr. XXXX recommends that you only test 3 times a day, since you're on Lantus." From that, I got the impression that she was acting on the doctor's instructions. I'll bring it up on my next visit.

Originally Posted by Razo681

If you have to go out and buy these things, they are outrageous, and if you're like a lot of diabetics you take your meds, whether its insulin or pills, based on the readings.. GRRR....

Yes, I know and I've found that weird things can affect your BG readings....things you'd never think would be a problem. The other day, I felt my throat getting sore. Never knowing if this is the onset of a cold, I sucked on a zinc tablet. They taste terrible (like an aspirin) but sucking on a zinc tablet helps to prevent a cold, if you do this at the first sign of a cold. It takes a long time for a zinc tablet to completely dissolve on your tongue, which is good since you want to keep swallowing the zinc. Hours later when I took my last reading of the night (my 6-8 hour fasting reading), instead of the usual 120 I expected, it was 199. My after dinner reading was in the 140's, which is typical, so the only thing I consumed after that reading was the zinc tablet, so it must have been the zinc that raised my numbers.(these tablets are like an aspirin....they contain no sugar, and you're not supposed to suck on them, you're supposed to swallow them whole like aspirin). If I wasn't able to test then, I'd never know that zinc did that.