Fighting for test strips

Type 1 and LADA
1

My son, diagnosed just a few short years ago, went off out of state to college. With a move to a new Endocrinologist Center his new Type 1 Practitioner had no problem with writing him a prior authorization for four more strips per day. She recently moved out of the practice and his new assigned practitioner said that she would not work with him because she thinks that the Dexcom is reliable enough and only gives 10 test strips a day to pregnant women.

The general amount is about 6 and that is just about what he uses unless he is more active (avid skier) or the few extra days it takes for the Dexcom to chime in when the sensor is changed or when sick. You just don’t know, so I did not think it was much to much to ask for four more per day.

He is moving to another practitioner within the office and we will see if they will provide the extra.

Is this just too much to ask? We never had a problem or were questioned about this in the past with any doctor/practice that he had.

And this was all done in an email portal. Not even a discussion with me or my son in person. Just can’t believe it. My son never should have to feel nervous or guilty about having Type 1. At age 19 and a Freshman in college he is learning every day to better balance his blood sugars and when the time is right, I am sure he will be testing less.

What a Dear Abby Moment.

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I couldn’t agree with you more. Time for a new Dr.

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Definitely time for a new doctor. The current doctor should be glad that he is vigilant in monitoring his diabetes. She should also realize a new area and new to college are stressors. I have never understood why doctors think they are “strip police”. I hope you get this solved to your and your son’s satisfaction. He does not need the aggravation and you don’t need the worry.

4

What I don’t think people understood is that while the Dexcom has been approved for insulin dosing that does not mean that only two strips a day are required. My experience is that a sensor is unreliable on the first day (perhaps even longer). So it is not prudent to do mealtime dosing based on the Dexcom the first day. I also consider it dangerous to treat highs based on the Dexcom as an error is such a serious thing. And I often get false lows with the Dexcom so I also think it is unwise to treat lows based on the Dexcom. I still confirm with my meter. This is about being safe.

A doctor that won’t keep their patients safe and put them in a position of not having enough strips is not a doctor I want near me.

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5

Exactly. Whenever I make significant corrections, whether adding insulin or carbs, I like to confirm with a fingerstick. If I’m just nudging my BG with a micro-carb or micro-insulin correction and I’m confident in the accuracy of the CGM, then I will dose on the CGM alone. I’ll also dose for meals if I’m confident in the CGM performance.

The Dexcom G5 User’s Guide makes this statement.

Diabetes Treatment Decisions

If your Dexcom G5 does not display a sensor glucose reading and an arrow or if you are getting inaccurate or inconsistent readings, use a fingerstick blood glucose value from your blood glucose meter to make diabetes treatment decisions.

Under a section entitled, Using CGM for Treatment Decisions, the guide adds this advice.

If you have symptoms of low or high glucose, but your CGM is not showing low or high glucose sensor readings, take a fingerstick blood glucose measurement with your BG meter. If you are a caregiver of someone using the Dexcom G5, watch how they act. If their symptoms don’t match the CGM, take a fingerstick BG measurement.

Your BG meter is your backup when/if your CGM is not showing a sensor glucose reading or your symptoms do not match your sensor readings. Remember to wash your hands before taking a fingerstick.

While your son’s doctor seems to be paying attention to the FDA decision granting the Dexcom G5 the ability to be used for dosing decisions, she may not have read any of the fine print or really thought it through what this means in the real world. She might look at it differently if she had a son or daughter using insulin. It seems her professional opinion was formed short of due diligence.

I’m a long term T1D who used up to 14 strips per day, even when I wore earlier CGMs. I’ve now cut back to six per day but I think I could make a case for at least ten per day if I felt I needed them. But I’m not 19 with all the odd hours, social eating, and other stressors of being a young adult.

If your son likes this doctor otherwise, he might attempt to negotiate/inform her of his real need for more strips. If he doesn’t like her for other reasons then changing docs makes sense. Learning how to deal with doctors and getting what you want is a critical skill for living with diabetes. Good luck!

6

And he might want to remind the doctor that occasionally the strips are bad…meaning they cause an error when the meter tries to read them. I’m using one touch, and I get at least one bad strip in every container, and sometimes five or more in one container. We need to have extra strips to cover ALL contingencies!

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Before I got approved for more strips we used the meter and strips from walmart they were cheap (9 cents a strip) and pretty accurate when compared to my other meter…it’s not a perfect solution but it gave me the freedom to test as often as I wanted

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I personally got tired of fighting about the strips. I check as often as I need to in order to feel safe. That number varies according to how the day is panning out. Amazon Prime is my answer-----just as cheap as the ReliOn ones and these strips bluetooths to my pump. I now will answer to the question, “How many strips do you use a day?” with " “As many as I need to”.

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Absolutely Agree!

My son had a new appointment with another practitioner within that office two days ago. Smooth sailing for this visit and an acceptance for 10 strips. We shall see what the next visit holds. I talked to many people in that office and shouted out my dismay of the prior visit. I hope that word got around.

Thank you

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I like that outcome. Getting what you want from our medical system is a skill we all need to use. Glad it worked out for him.

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I have never encountered a doctor behaving this way. For me it’s the Rx insurance that decided to be the strip police. They wouldn’t give me more than 4 per day without BOTH a prior authorization AND almost tripling my copay. My answer is Wal-Mart online.

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Hi Ruth4,
I’m in agreement that there are a number of reasons for using more strips. But I’m puzzled by your statement that each vial of One Touch has at least one bad strip and sometimes up to five. My own experience with One Touch strips has been quite good. So, I’m wondering what your definition of “bad” is and how you know that’s the case. When I’ve done comparison testing across multiple meters, I find they track pretty well. And when I do multiple tests with a single meter using a single large drop of blood, the results are quite repeatable.

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When it’s a “bad” strip, I get an error message before even putting the blood onto the strip. Usually, the “25” (code, which is now always 25 with One Touch UltraLink) doesn’t even come up before I get the error message.

I don’t mean to imply that the One Touch experience isn’t good…If I’m getting one bad strip out of 50, and over the years I’ve actually gotten many containers with no bad strips, the defective rate is pretty darned low. I only pointed this out because if insurance companies are being very tight with the strip allowance, one could actually run out of strips before being able to re-order. I’m lucky in that my doctor will back up any amount I want to use, even if it means getting special authorization, but some doctors do not want to bother with that. Many insulin-dependent diabetics have posted in the past that they can only get 3 strips a day, which isn’t sufficient EVEN if there are no defective strips!

Ruth

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Wow! I’m wondering how our respective experiences could be SO different. I’ve been using One Touch since way before they were able to standardize the code at 25 and I don’t recall an instance where the code didn’t come up. I think I can recall a couple of times when I tried to put the blood on the strip before the little drop symbol came up, but that’s about it. I use about 200 of these strips each month, so obviously we’re having totally different experiences.

If you take the defective strip out and reinsert it, do you still get the error code? What is the error message or code? One failure in one hundred or even in several hundred is NOT what I would call good quality control. Imagine that 1 in every several hundred pills you purchased was the wrong strength or had no active ingredient. The fact that One Touch has been able to standardize their code at 25 tells me that someone there is doing quality control at a much higher level.

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I have the world’s worst memory, and I don’t remember what the error code is…but I will write it down next time it happens and post it to this thread (and look it up in the book). In the past, I did try removing and re-inserting the strip, but that didn’t work, so I don’t even bother trying now.

As for the comparison to medications…well, I don’t think you can compare, at least not when the rule of thumb (whoever set up this standard) is that meters are only required to be accurate to within 20%. Using that criteria, I don’t think the amount of bad strips I’m getting is so terrible.

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After typing the above, it occurred to me to find out who sets the rules for BGM’s, and it turns out it’s the FDA. Apparently they’ve come up with some “new and tighter” standards, as of 2014, as follows:

patient and industry comments.

"For glucose meters used by people with diabetes at home (“over-the-counter”), the FDA guidance specifies the following accuracy standards:

95% of all measured blood glucose meter values must be within 15% of the true value (a lab measurement); and

99% of meter values must be within 20% of the true value."

Of course this doesn’t answer the question of why I’m getting as many defective strips from One Touch as I have been, but I’m going to start collecting them and sending them back to One Touch.

17

I have a couple of One Touch meters I use for emergency backup, but I mostly use a ContourNext+ because it links to my pump. I probably hit a bad strip about once every two vials, so one in fifty or 2%. Similar to what you’re describing, the error message appears before testing, usually proclaiming it to be a “used strip” even though it isn’t, though recently I’ve seen an error saying the strip was inserted wrong-side up, even though it wasn’t.

Question: do you keep your strips in the vial until you use them? I sometimes carry 3-6 strips loose in the zipper compartment of my tester case because the vial doesn’t fit very well. As long as I keep the case closed they are fine for at least a day, but when I tried carrying a couple days’ worth I got a lot of those “used strip” errors, so I keep it to what I think I’m going to use over the next few hours.

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Nope…my strips are always in the vial. Being female and having a purse, I just carry the case with me, strips, lancets, cotton balls and all.

I got one of the Contours with my last pump, but I didn’t like it as much as the One Touch. Plus, I had a ton of strips left. Then I loaned the Contour to a relative who’s also diabetic and has lost his bgm, and I never got it back. So now, even if I wanted to switch, I’m stuck with the One Touch. But since I still like it and am used to it, not a problem.

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I think we’re in agreement about most of this discussion: people who need more strips and can use them to improve their health should be able to get them. And that should allow for any supplies that are defective.

My point was sort of a side issue having to do with quality control. Most products have a range of acceptable variability. Sometimes that range is set by government regulations or company standards or both. Sometimes that range is pretty loose, either because further precision isn’t needed for a satisfactory outcome or because the technology won’t support tighter limits. As you note, the tighter FDA regulations on new meters is an example of tightening this range of acceptability.

But what you’re talking about is product that doesn’t meet the acceptability criteria (ie. is not functional.) When one in every several hundred strips is failed, that is terrible quality control. Some years back, a number of companies jumped on the “Six Sigma” program that requires that 99.999% of product coming off the line be acceptable. Of course, not all products require that degree of success, but few quality control experts would be bragging about a failure rate of one in several hundred. By definition, a failed strip is outside the new 20% limit. So, one failed strip in 100 would already put you at the 99% limit.

If I ever experienced a failed strip in every several vials, I would be on the phone to One Touch in the morning. They would REALLY like to know this. And unless they could quickly identify the problem, I think there would be some top level meetings and possible shutdown of the manufacturing process until this could be sorted out.

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It’s my understanding that the strip vials contain a desiccant to keep the strips dry. If the strips are moisture sensitive, I suspect that you are getting more errors than you think. You may not get an error message after only a few hours external storage, but it’s possible that the accuracy of those that are still working is compromised.