Medical Forum / Diseases and Disorders / Diabetes / October 2005
Test strip Saga
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Julie - 26 Oct 2005 00:11 GMT I picked up my repeat prescription at the chemist last week and she asked if I would answer a questionnaire regarding why and how I use test strips....................she also gave me a leaflet which said that the Health Authority was thinking along the lines that too much is spent on test strips for people with type 2 diabetes and in fact it would be better if they didn't test at all because they worry about their numbers !!!!!! The money would be better spent treating the illnesses associated with diabetes !!!!!!!!!!!!!!!!!!!!!!
It goes from bad to worse it seems :o(
Julie xxx
Delboy - 26 Oct 2005 01:44 GMT Forward a copy of the leaflet to all the strip manufacturers you can think of. Perhaps with the potential loss of all those sales, they will consider dropping their strip prices. LOL; ROFL ;-P)
 Signature Delboy
A common mistake that people made when trying to design something completely foolproof was to underestimate the ingenuity of complete fools.
> I picked up my repeat prescription at the chemist last week and she asked if > I would answer a questionnaire regarding why and how I use test [quoted text clipped - 8 lines] > > Julie xxx vbhol - 26 Oct 2005 11:26 GMT > I picked up my repeat prescription at the chemist last week and she asked if > I would answer a questionnaire regarding why and how I use test [quoted text clipped - 8 lines] > > Julie xxx Hi Julie,
You could try the following - or upload a scan of the leaflet somewhere and let us all have a crack at em ;)
-------------------------------------- Dear Health Authority,
I enclose a copy of your leaflet. This leaflet appears to imply two things:
1) Cure is better than prevention - an interesting reversal of an often used maxim
2) Patients who test their blood glucose levels either do nothing with the results or will panic at the first high reading.
Regarding the second point I recommend that you read the National Service Framework for Diabetes, the Patients' Charter, NICE guidelines for diabetes treatment and all of the other official documents and data sources which strongly support empowering the patient to have more control over their own treatment. All of these bodies stress the importance of allowing those patients who are inclined to take control of managing their chronic condition to do so and give them the tools available.
Since beginning testing before and after meals and other trigger points during the day including exercise periods I have a much better understanding of how my blood glucose levels are affected by my dietary intake and activity. This has allowed me to make better choices in my day to day life and daily management of my condition allowing me to reduce my hba1c from 10.3 to "normal" levels (5.6) over a period of a single year.
This achievement is due to having the testing tools at my disposal. If however you remove the testing tools which allow me to control my condition, against the recommendations of the National Service Framework and National Institute of Clinical Excellence then I am sure that any cost savings on test strips will be more than exceeded by the cost of dialysis, eye treatment and amputation related costs in years to come.
It gives me cause for great concern that you are ignoring the recommendations listed above and putting my health at risk as a cost saving exercise.
I await your response with interest, as I am sure will the Diabetes UK Campaign Network, the local patient user forums, various internet user groups and other assorted publishers.
Yours faithfully A. Diabetic. Diabetes Mellitus Type 2, diagnosed 17th Oct 2003
--------------------------------------
What do you reckon?
VBH. T2/Dx 17Oct03/Met1500/A1c5.7
Yolande Smith - 26 Oct 2005 17:18 GMT ;)
> Dear Health Authority, > [quoted text clipped - 39 lines] > Yours faithfully > A. Diabetic. I think this is brilliant - well-phrased and very much too the point. I have just discovered the leaflet which our local hospital (Addenbrooke's - teaching and medical research) has advocated for distribution to diabetics. The advice to type 2 is that "it is not usually necessary for type 2s to test".
My GP, although sympathetic to my wish to test and prepared to risk the wrath of the practice manager by prescribing some extra strips, did add that I was unusual and warned me that my fingers would get very sore if I persisted in testing frequently. She was impressed by my recent ability to control my BG within 4-6 mmol/l - but again stressed that "run of the mill" non-testing type 2s were the norm. She did also try to convince me that a plasma glucose reading of 9.7 mmol/l at my last HbA1c in September was quite acceptable because it was probably post-prandial.
I should like to foward a copy of your comments to our local hospital's diabetic network group, if I have your permission to do so.
Yolande T2 - diet and exercise alone - free from metformin TID since 20/10/05!
Simon - 26 Oct 2005 18:16 GMT As a type 2 NIDDM I was going along nicely on Metformin, Diet and exercise until this summer when my BG's suddenly shot up to the high teens and even low twenty mmols. If I hadn't been testing it could have been far too late. Try as I might exercising, mowing the lawn, running with the dog, I just couldn't get the BG's down- I started to feel guilty and in some way responsible- what was I doing wrong?
As my doctor, very clued up about diabetes, explained, this is a progressive disease, and in my case the body had suddenly become totally resistant to its own insulin. I'm now reaching the end of my first month of injecting Levemir, the BG's are right back under control, I'm sweating less, drinking less, peeing fewer times at night and now that my muscle groups are getting the carbs they need I find I've got energy levels I thought had gone forever.
It's been said many times on this group, test test test again.
> ;) > > Dear Health Authority, [quoted text clipped - 61 lines] > Yolande > T2 - diet and exercise alone - free from metformin TID since 20/10/05! Peter C - 26 Oct 2005 20:40 GMT "Yolande Smith" <Yolande@ntlworld.com> wrote in message news:x%> T2 - diet and exercise alone - free from metformin TID since 20/10/05!
It's probably a bad idea giving upi the metformin - it has so many other benefits apart form lowering bgs.
Yolande Smith - 27 Oct 2005 12:32 GMT > "Yolande Smith" <Yolande@ntlworld.com> wrote in message news:x%> T2 - diet > and exercise alone - free from metformin TID since 20/10/05! > > It's probably a bad idea giving upi the metformin - it has so many other > benefits apart form lowering bgs. Unfortunately, metformin also gave me a great deal of stomach pain and diarrhoea. I may try to introduce some at a later date.
Yolande
oldal4865 - 27 Oct 2005 13:26 GMT Yolande Smith wrote in message ...
>Unfortunately, metformin also gave me a great deal of stomach pain and >diarrhoea. I may try to introduce some at a later date. > >Yolande Metformin interferes with the digestion of carbohydrate**. That causes fermentation and other unpleasant symptoms.
Some posters assert that they found relief by working to keep the metformin and carb separated within their digestive systems. I don't know how, but they tried.
I would assume one trick would be to eat a zero carb breakfast and take morning metformin, then try to take afternoon/evening metformin between meals, or after zero-carb snacks.
** http://www.fda.gov/cder/foi/label/2000/21202lbl.pdf
". . .Metformin decreases hepatic glucose production, decreases intestinal absorption of glucose, and improves insulin sensitivity by increasing peripheral glucose uptake and utilization."
Metformin works 3 ways to improve glucose tolerance in patients with type 2 diabetes. Unfortunately, by decreasing intestinal absorption of glucose it does cause gastric problems in some people. . ."
Regards Old Al
tog - 27 Oct 2005 13:50 GMT When I started Metformin I too worried for the side effects.. and cut the pill into 4..first day taking just a quarter and worked up slowly over two weeks to a whole one..I reasoned there was no rush..a few extra days wouldn't matter. Taking with little or no carb snacks might also help.
Sue
>> "Yolande Smith" <Yolande@ntlworld.com> wrote in message news:x%> T2 - >> diet and exercise alone - free from metformin TID since 20/10/05! [quoted text clipped - 6 lines] > > Yolande Yolande Smith - 28 Oct 2005 09:51 GMT > When I started Metformin I too worried for the side effects.. and cut the > pill into 4..first day taking just a quarter and worked up slowly over two > weeks to a whole one..I reasoned there was no rush..a few extra days > wouldn't matter. Taking with little or no carb snacks might also help. I have been taking metformin 3 times a day for 3 years - the first 3 months were painful - the next 18 OK. the final last 3 months have been dreadful. To the point where I worried that the bowel sensations might be the precursors of bowel cancer. Since stopping metformin - I have no bowel problems - enough said?
My GP - in her helpful way - simply said "well, this is a problem in some people".
Yolande
> Sue > [quoted text clipped - 8 lines] >> >> Yolande tog - 28 Oct 2005 12:51 GMT More than enough. I hope you find something more suitable soon. Sue.
>> When I started Metformin I too worried for the side effects.. and cut the >> pill into 4..first day taking just a quarter and worked up slowly over [quoted text clipped - 24 lines] >>> >>> Yolande vbhol - 27 Oct 2005 09:56 GMT > ;) > [quoted text clipped - 47 lines] > The advice to type 2 is that "it is not usually necessary for type 2s to > test". Might be a bit over the top, after re-reading with the implied threat in the last para. Then again, there is no point in soft soaping these people when they are screwing with thousands of peoples' health.
However, they almost have a point. Most T2s either do not test or do nothing with the results. Some will panic with the results because they do not know what to do about them so you get the "omg a high reading I am gonna die!" factor because they do not know enough.
Two approaches - teach em more or stop them testing. They are picking the one which does not cost thousands of quid extra, but saves money. Right for the accountants but wrong for the patients.
Having said that I am sure I would not like to be the one tasked with giving advice on testing to numpties who do not want to know or who have trouble grasping the principles. A hard job basically.
But the individuals who do it properly should not have the tools removed even if there are a majority who do it badly.
> My GP, although sympathetic to my wish to test and prepared to risk the > wrath of the practice manager by prescribing some extra strips, did add that [quoted text clipped - 4 lines] > plasma glucose reading of 9.7 mmol/l at my last HbA1c in September was quite > acceptable because it was probably post-prandial. To me at pp: 7.5 = acceptable. 7.9 = infraction. 8+ = cockup.
Having said that I have lapsed in the last few months so there have been too many infractions and cockups. My A1c next month will not be a 5.6 or 5.7 and I have to get back on track.
Sore fingers...hmmm. Depends on what you mean by frequent testing. I have 40 test sites on my fingers - high and low points on the side of each finger at either side, used in a rotation pattern. Takes a lot of testing to get sore. Its never happened to me. I get the odd stinger, but that just depends on what you hit with the stabber.
Sounds as if you have a doc you can work with. Now load yourself up with information on all aspects of DM so that when you are talking to him/her then you can make it obvious in a few seconds on any aspect that you probably know more than them. GPs are not specialists in DM and do not have the chance to learn everything about it. You on the other hand, have only this one condition to learn about, so can become more knowledgable. You'll find it easier to get them to agree to anything once you have demonstrated knowledge.
> I should like to foward a copy of your comments to our local hospital's > diabetic network group, if I have your permission to do so. Feel free. Is that a patient user forum setup by the hospital or independent? Always wondered what they are like.
> Yolande > T2 - diet and exercise alone - free from metformin TID since 20/10/05! TID??
Cheers, VBH.
Patti - 26 Oct 2005 18:54 GMT Well said VBH! The leaflet is scandalous! Patti Penzance, Cornwall On 16u Levemir @ 8pm and 10u Levemir @ 8 am Novorapid as required Perindopril, aspirin, Simvastatin, 300mg Quinine Sulphate & 75msg Thyroxin. A1c 5.7
Alan S - 27 Oct 2005 05:00 GMT >> I picked up my repeat prescription at the chemist last week and she asked if >> I would answer a questionnaire regarding why and how I use test [quoted text clipped - 67 lines] >VBH. >T2/Dx 17Oct03/Met1500/A1c5.7 Very well written. I hope it succeeds - users had better change a word or three or the recipients will quickly twig when duplicates appear.
Cheers, Alan, T2, Australia.
 Signature Everything in Moderation - Except Laughter.
Julie - 29 Oct 2005 12:28 GMT I did actually tell the Chemist that my last hba1c results were 6 and that was because I had been testing. I just hope they send me for this test at least every 3 months rather than just once a year as they do now if they're going to cut down yet again on test strips. Julie
>>> I picked up my repeat prescription at the chemist last week and she >>> asked if [quoted text clipped - 78 lines] > > Cheers, Alan, T2, Australia. Nicky - 29 Oct 2005 17:25 GMT > I did actually tell the Chemist that my last hba1c results were 6 and that > was because I had been testing. I just hope they send me for this test at > least every 3 months rather than just once a year as they do now if > they're going to cut down yet again on test strips. The A1c is totally useless for deciding what to have for supper - or knowing that you need a walk NOW...
Nicky.
 Signature A1c 10.5/5.6/<6 T2 DX 05/2004 1g Metformin, 100ug Thyroxine 95/74/72Kg
fastmoggy - 26 Oct 2005 21:36 GMT > I picked up my repeat prescription at the chemist last week and she asked > if I would answer a questionnaire regarding why and how I use test [quoted text clipped - 8 lines] > > Julie xxx A worrying advancement in our medical care! Ok so the NHS say they need to try and save money but at who's expense? I for one and im sure im not alone here!!??? If it was not for being able to freely??? test ourselves then im sure id be occupying a hospital bed ny now! but as it is i was able to see how my body reacted to certain foods( well we are all different!) and was able to reduce my HbA1c from 12.9 down to 5.2 in a year and it;s staying there thanks to these strips! Ok so they are expensive but what costs more? Of course id like to see the price of these strips come down to a price we could reasonable afford but as it is, we in the UK pay national, insurance for things like this hence the word 'insurance' Personally id rather not want the need to use this particularly service but me like thousands of other T2's need these strips to ensure we stay as healthy as possible and to enjoy life as best we can and not be a burden on our struggling NHS. Well maybe ive said too much but then again that statement is in the health of the beholder/reader LOL
Patti - 26 Oct 2005 22:53 GMT Hi Fastmoggy You are definitely NOT WRONG. I am IDDM which means suicide without test strips... but if you are able and willing to test and use that info why should you be denied?
Why should everyone be at the "lowest common denominator" level of those (far too bl**dy many) T2s who could give a damn? Perhaps some test strips should be prescribed until the doc can decide whether or not the patient is *using* the information in a sensible way.
WOW... let's go even further back... let's have some education for each newly diagnosed diabetic as to *why* they should use test strips and *how* the information gleaned could help to save complications. Rather than Doctors assuming no-one can understand their own condition.
There are some who will *never use the info... stop their scrips... look at another way of looking after them... but for those who *will use the info who are intelligent and enquiring... give them extra education and use them to influence the dummies! Patti Penzance, Cornwall On 16u Levemir @ 8pm and 10u Levemir @ 8 am Novorapid as required Perindopril, aspirin, Simvastatin, 300mg Quinine Sulphate & 75msg Thyroxin. A1c 5.7
fastmoggy - 27 Oct 2005 12:15 GMT > Hi Fastmoggy > You are definitely NOT WRONG. I am IDDM which means suicide without [quoted text clipped - 23 lines] > 300mg Quinine Sulphate & 75msg Thyroxin. > A1c 5.7 Thanks for the words of encouragement Patti. I for one have tested every day(except the few days when i ran out when my meter went berserk and kepted refusing them!) With the results i have kepted, i can now see how my medication,diet and exercise have improved my health. My story is quite straight forward but it took lot of determination and the usual depression and acceptance that i can give this 'thing' a run for it's money. At diagnosis in June last year i was 18St 6Lb never exercised with a HbA1c of 12.9 Today that's now 13St 1Lb, Last recorded Hb1Ac of 5.2 (August) and a Fbgl of 4.8. This is all down to not only the determination i mentioned earlier plus allot more exercise, in my case just riding my bike to work which is about 5 miles aday, but because i had the tools provided( test strips!) to help me make this dramatic change and i for one feel as healthy as i did when i was a teenager! Id hate to imagine someone who is going to be diagnosed in the near future denied this type of self testing because this could be a life saver.
Chris Sunny Nottingham 40Mg Gliclazide per day 1 test a day HbA1c 5.2 Test in 6 weeks..watch this space!
Patti - 27 Oct 2005 20:15 GMT I cannot but agree with everything you say!
Well done on the weight loss and reduced Hba1c! Chris
BTW I went to school in Nottingham.... it was called West Bridgeford Grammar in those ancient days... LOL! Patti Penzance, Cornwall On 16u Levemir @ 8pm and 10u Levemir @ 8 am Novorapid as required Perindopril, aspirin, Simvastatin, 300mg Quinine Sulphate & 75msg Thyroxin. A1c 5.7
JC - 28 Oct 2005 14:25 GMT >I picked up my repeat prescription at the chemist last week and she asked if >I would answer a questionnaire regarding why and how I use test [quoted text clipped - 8 lines] > >Julie xxx The same bureaucratic approach is prevalent in Australia as well. I recently received a letter from the Diabetes Australia processing officer telling me that the Pharmaceutical Benefits Scheme had defined the maximum usage in a 6 month period of reagent strips to be 900 strips - i.e. 18 boxes of 50 strips.
This maximum usage rule equates to 5 tests per day. I test 7 times each day - before a meal, 2 hours after the meal and at bed time. Thus my usage would equate to 26 boxes of 50 strips or 33% over the maximum usage.
Attached was a form to be filled in by my doctor nominating the number of strips that I should use over a 6 month period. My doctor agreed with my testing regime and he filled in the numbers accordingly so I should be safe for 2 years or so.
The annoying thing about this is that they determine the usage by the number of boxes purchased in any 6 month period which doesn't take into account bulk buying. I had purchased 2 lots of 8 and 2 lots of 10 boxes during the previous 6 months. I usually buy another lot when I am down to 2 or 3 boxes. At the time I received the letter I was using 1 box and had 8 boxes in the cupboard waiting to be used.
Aint administrivia wonderful!
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Cheers . . . JC
Alan S - 29 Oct 2005 01:42 GMT >The same bureaucratic approach is prevalent in Australia as well. I recently >received a letter from the Diabetes Australia processing officer telling me that [quoted text clipped - 18 lines] > >Aint administrivia wonderful! Interesting. I haven't had that letter yet. There must be a change in policy; before my 5 month trip away in 2003 I needed a doctor's letter (which I drafted:-) to support the bulk purchase of 30 boxes of 50 strips - but they didn't argue once I supplied the letter. As it turned out, it took me about 8 months to use them all.
These days I can probably handle an average of about 5 daily (I used 100 in the past 23 days) but in the early days of "test, test, test" I used an average of ten daily over a couple of months. To be fair, compared to the US and NHS systems, I'm not complaining. The NDSS is a brilliant system and I'm very grateful to those who set it up. Unfortunately, nothing's perfect, as the recent debacle on Lantus with the PBS shows.
And, for Oz newbies, I could certainly get them well into Jennifer's "test, test, test" with 900 strips in six months - although the majority would be used in the first three.
Cheers, Alan, T2, Australia.
 Signature Everything in Moderation - Except Laughter.
JC - 29 Oct 2005 03:37 GMT >>The same bureaucratic approach is prevalent in Australia as well. I recently >>received a letter from the Diabetes Australia processing officer telling me that [quoted text clipped - 38 lines] >Jennifer's "test, test, test" with 900 strips in six months >- although the majority would be used in the first three. Hi Alan,
It may be a policy change. I have been testing at roughly 7 per day rate since June 2004 so I should have tripped their alarm point around October last year.
I am not complaining about the NDSS - it was the PBS who set the maximum use age rules and told the NDSS to apply them.
I have written to Diabetes Australia and the NDSS asking them to have the maximum usage rules relaxed to allow at least 7 tests per day and to take into account bulk purchasing. I pointed out that buying 10 boxes at a time I could buy up to 30 boxes in any 26 week period. No response as yet.
I wonder which tests they consider should be dropped if the 5 per day rule is to be applied.
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Cheers . . . JC
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