I am posting about my experience at my GPs office yesterday because if possible I want to spare other people on Medicare the tongue lashing I received. Most of us realize that the 'new health care laws' are not favorable for Diabetics.
The following is what was said to me yesterday:
You are obsessive/compulsive for testing your blood sugar more than 3 times a day.
Your A1C of 5.7 means that you are having too many lows, so you should lower your basal so your A1C is 7 or above.
You can't possibly be Type 1 because you are taking Metformin. Metformin is only for Type 2, so therefore you are Type 2.
You are not Type 1 because you were old already when diagnosed.
When I told him the Endocrinologist had done a c-peptide test that came back at 0.2, he still insisted I was Type 2.
He is not my regular GP, but someone who is filling in for my Doctor. However he refused to write a script for more than 3 strips a day which Medicare allows. Because I pay for a Dexcom Gen4 out of pocket, he also said I can rely upon that for knowing what my blood sugar is doing.
I don't have an Endocrinologist but I am actively seeking to find one. That is the last thing this GP said to me "no other doctor will have you for a patient because you are non-compliant". I have refused statin drugs because of adverse side effects. His nurse also told me I make their practice look bad because of my non-compliance.
Seniors - watch your back. The new laws are not doing us any favors. Get yourself a kind doctor and maintain a good dialogue with him or her - even if you have to drive a ways to find one. Now there are no Endos in my town, so I am out of luck.
This doc suffers from a stunning case of ignorance. I am not seeing how the new health care laws factor in, though. I wonder if it would feel good to write a letter refuting each of his incorrect statements (and send a copy to your state's medical board)?
This GP told me that Medicare will only allow a total of 3 strips per day for a Type 1 person with diabetes. It is this GPs position that because I also use Metformin, that I can't possibly be Type 1, but instead I am Type 2. Never mind that my Endo at the time of diagnosis said I as Type 1. I am overweight so I guess he looked at me and assumed I am Type 2.
You can't change the way the doctor thinks, and it won't help to tell him he's just wrong. Luckily strips can be purchased without an RX, and there are good inexpensive options today for getting more until you find a doc who will prescribe what you need.
Here are the FACTS about what Medicare will allow:
of course not! Where did that come from? I am in complete agreement with what Don said, and would write a letter myself, and I'd include the Medicare rule. The doc is ignorant, rude, and wrong! Who knows what other bad advice he spits out ?!?
That doctor was not only a jerk but ignorant as well.
What I would do is write him a letter (an old-fashioned hard-copy snail-mail version) and copy your regular doctor. In that letter I would dispassionately refute each ignorant conclusion that that doctor has drawn. Stick with the facts. Cite your c-peptide test at diagnosis. Did you have any antibody tests? If this doctor knew anything about diabetes, he would understand that T1s can become insulin resistant, too. I know this from first-hand experience.
You can cite this recent study with 20,000 T1 participants found that "In all age groups in the study, testing more frequently was linked to safer blood sugar levels, according to the study published in Diabetes Care." Here's a link to a Reuters story about it:
No one (including this ignorant oaf) likes to receive criticism in front of his peers. Doctors are responsible for taking care of whole human beings, including their emotional side. The first rule of medicine is: do no harm. He may have thought he was giving you "tough love" but to do that one has to well informed as to the facts.
I would close this letter by telling your regular doctor that you refuse to see this associate again.
The beauty and strength of a well-crafted letter is that it gives you time to hand-pick each word and phrase. Your doctor and his insensitive fill-in will read your letter to the end. If you tried to deliver these thoughts in person, it's likely that their attention would not last for the entire length of your statement. Words on paper persist and form a permanent record. The offending doctor will be forced to face his unprofessional behavior and may cause him to see your side of the experience.
I would request an apology but would not hold my breath waiting for it.
Here’s the link to the American Diabetes Association’s journal, Diabetes Care, article on frequent BG testing and better A1c’s. This is only an abstract. They hide the full version behind a pay wall:
Let's face it. The so-called "Affordable" Care Act is anything but and is already proving to be an enormous boondoggle. It's all about profit for the insurance companies. In this equation is huge cuts to Medicare. Doctors will be receiving less from Medicare, therefore they are not too thrilled to accept seniors as patients. Certainly take your own advice and get a kind doctor that will write the prescriptions you need to manage your diabetes. You seem to know what you're doing and don't need advice from a doctor. That being said, the treatment you received from fill-in GP was outrageous. You should write up a formal complaint to the state medical board. Also, you should get the non-compliant label removed from your records.
I think I would check that doctor's license. Did he get it by sending in a dollar and two box tops from Post Toasties?
I think most diabetics, with an A1-c of 5.7,would be considered by most rational doctors as well controlled.
Metformin is one of those drugs that really doesn't do too much, but it doesn't hurt, either. My endo has me taking the drug, and says he encourages it with most of his adult type 1 diabetics, because it helps the body use the insulin that it has, making no distinction between injected and naturally produced. He claims it delays insulin resistance. I am all for that.
does that doctor want you to lower your basil so that you are sick all the time? Being high all the time, at least to me, means being sick, or run down, or thirsty, or something almost all the time. That isn't a great way for a diabetic to live. Just my opinion, but had this happened to me, I would be looking for a different physician and reporting this clown to the state licensing board.
this has nothing to do with new laws, medicare has always had a test strip limit, I believe. You said you don't see an Endo. Thus, were you ever confirmed diagnosis of type 1, i.e, cpeptide fasting and antibodies tests? many insurance companies have a protocol or limits to how many test strips they'll supply. however, if a doctor does a pre-autho, they'll override it. mine did and I get 400/month, i am a type 1.
I believe too you'll have to provide data, i.e., cpeptide - fasting and antibodies tests to confirm your type 1 diagnosis to medicare. an endo doesn't just 'say' you're a type 1 or type 2, they test for the different factors, type 2's typically have metabolic syndromes, etc..
thank you for bringing up "ACO's". Dead on target. I tried to bring this up on tudiabetics and got no response. This is what medicare wants to do and set up these huge monolithic care groups with hospitals, doctors and specialists all crammed in. Medicare will make one check for your care and all the provider's of the ACO get to fight for their share. This is an incredible nightmare for us all. Based on your primary providor, you can be assigned to an aco without your permission or advanced notification of intent to do so.
As for that Doctor, I would not waste my time and simply put effort in to find a Doctor you are compatible and can agree with. Your health needs that. You do not need him putting you down as a crank/difficult unattentive case.
When I applied for a pump in 2010 just before I went on Medicare, my Endo had to fill out a ton of paperwork including the c-peptide test result. Apparently it was approved because I was approved for a pump and the paper work that came back said Type 1. This Doctor yesterday had his own "agenda" and it wasn't to help me stay healthy. I got the impression that his attitude was "I'm right (the doctor) and you're wrong (the patient). He didn't really hear anything I had to say in my own defense.
Plus he had a female med student following him and both of them were talking at me at the same time trying to convince me I am obsessive/compulsive because I test more than 3 times a day. I don't know how you younger people do with two people talking at you, but I don't do well at all. I am deaf in one ear and I wear a hearing aid in the other ear. I realize now that no doctor probably really wants me for a patient, but why can't they just say "we can't treat you in this office". I would much rather hear the truth than for someone to lecture me like I was 5 years old. And then they wondered why my BP was so high??
well, i'd go back to your endo who gave you the pump and Dx'd you as type 1 or see a new one. no endo would deny a type 1 diabetic on a pump more then 3 tests strips per day. Your pump company, not sure if it's MM, can send you test strips, just have them complete paperwork, send to endo who Rx'd your pump and confirmed Type 1 diagnosis, no?
Yes, I've had the c-peptide test and it came back 0.2 one time and 0.1 the second time. No antibodies test was ever done because by the time I was able to see the Endo it had already been almost 3 years since the first GP I saw diagnosed me based on one fasting blood glucose test and nothing else. I requested a referral to an Endo but was refused. That GP told me that Endos were useless and that they would not tell me anything different than the GP told me. Like a fool, I believed him. The same GP also refused my request for an insulin pen. He told me a syringe and vial were good enough for me. Same GP also refused me a referral to get a pump too, so I went in search of a different doctor.
