I’ve been self-managing my diabetes for 24 years, with prescriptions from a barely-aware doctor. He had never suggested an insulin pump, never suggested a CGM, never suggested ways to calculate insulin needs. Just “Hey, how are you, here are your numbers, what prescriptions do you need”.
Recently a new Endo showed up in the area, and he’s great. Goes over my pump readings, my CGM readings, trends, new therapies, all of the stuff I’ve been missing since DX. I’ve been seeing this doc since June.
Unfortunately, all of my prescriptions from the previous doc have now expired, and the new doc is sending in scripts for “best case”. I use between 50 and 80 units of insulin per day, it varies quite a bit. This new doc called in a script for only 60units/day. That’s PROBABLY close to the average, but it’s winter, my weight is going up, my activity is going down, and that can only mean higher average insulin needs. (on a completely unrelated topic, I have a weak spot for Christmas cookies) I can’t believe that best practice for scripts is to go by average and not recommended or worst case. If I use 75 units on Monday because I had to work 16 hours in the computer lab straight and only could eat from the vending machines, is he suggesting that I then can only use 45 the next day?
Similar issue with testing. I test, on average, 4 times per day. I have the CGM, so at least twice is for calibration, and I WANT to do meal time calcs too with every meal. He called in a script for only 3/day. I would have thought he’d send a script in for what I should be doing, not what I am doing, let alone LESS than that.
Ugh. Frustration out. Thanks for letting me vent. Waiting on the Endo’s nurse to call me back to either agree or justify why.
Can you ask him to write “use as directed” instead? So that maybe you can get refills earlier and as you need them? That is so stressful when they do that!
Will your endo or CDE take over.diabeties prescriptions? I used to use a vial and a half of insulin a month and the way my GP wrote the script I was picking up one vial at a time - complained to my CDE and she arraigned to take over the scripts - problem solved. Went over to ordering generic test strips from Amazon and submitting to my flex account for reimbursement - I use a lot of strips and the cost of generics is a fraction of name brand.
If you pick up your prescriptions locally you can make it someone elses problem. Go to your pharmacy and tell them you have run out of insulin and you need more. Tell them to contact your doctor to renew the prescription for the amount of insulin you need. Generally the pharmacist can negotiate out this transaction for you.
The other thing to remember is that you can often refill a prescription early. My insurance allows refilling a 30 day prescription 7 days early and a 90 day prescription 14 days early. If you refill your 30 dat prescription 7 days early that would mean that 30 day prescription for 60 units a day could be squeezed out to essentially 80 units a day.
What the doc writes as instruction to the patient means nothing to the pharmacist. All the pharmacist cares about is the “Disp:” part – i.e. how many vials, pens, units, etc, to provide to the patient. How much total insulin did your MD order to be dispensed to you?
Sorry to hear that your new doctor doesn’t get it. And you need to make him understand that one number doesn’t work everyday. Total daily units is a huge pet peeve for me because it changes everyday. I mean I can go one day without eating anything and just have basal insulin going or I can have a huge burger with fries and need a huge bolus. So my insulin prescription always reads for much more than I “usually” use on a daily basis. As a PWD, you always want to have more than you need not less. Never know when that emergency might happen. Keep pushing and fighting. Any Edno should know how much this disease varies day to day. Hang in there and sorry you have to fight to stay healthy but we all seem to have to do it. Sad statement isn’t it?!
Hi miketosh,
I don’t know if you are locked into your Endo situation, with insurance or whatever, but from what you described, man I would be doing some Endo shopping immediately! Is it possible to find one that is more in-touch with the disease? My ideal Endo would be a diabetic, or the parent of a diabetic! Just sayin’
On a completely unrelated topic, I’m new here so I found your post from many many years ago. https://forum.tudiabetes.org/t/diabetes-and-heart-rate-while-running/
I don’t know if you are still working on this, but I have heard of studies that have reported that higher level of insulin use prior to exercise can lower your lactate threshold. Basically you hit LT sooner if you have used a lot of insulin recently. That’s why on the day before a race, you are supposed to cut both carbs and insulin use (you gotta carb up several days before). Can’t find a google reference to it right now, I’ll keep looking. Anyway, could that be part of the reason why you reported seeing a higher HR, maybe?
Not too many choices without driving an hour to Philly, so I’d like to give this guy a shot. He’s new here, and young in general, so he may just not know yet.
After years of training, my resting hr is down in the 40s now. I usually top out around 185/190 during anaerobic running workouts. My normal run hr is 170 now, but that’s a neat topic to look into. I’ll have to try some tests myself to see how day before insulin affects my races!
You know, Gary Scheiner is in Wynnewood, PA. He is the 2014 AADE educator of the year, has T1 himself, specializes in sports and has staff that can prescribe insulin for you. He also works remotely with patients. There are a few videos here at TUDiabetes with Gary.
Double check the script and calculate for the maximum potential use before leaving doctor’s office and complain if not a 30 day supply. Not like you are wanting more narcotics than you need. Refusal to work with you should be an indication to search for another provider.
Three of four scripts shipped but today I got a call that they don’t send scripts for dexcom scripts to the pharmacy. What??? I didn’t expect issues so I didn’t ask for the written scripts. I had assumed they would be able to send scripts to the pharmacy. They said I should contact dexcom directly to get a script for sensors.
The end result for test strips is that he only wrote it for 3 per day. I’ll deal with that for now. Next time I’ll ask for written scripts and make sure they are right
I can ONLY get my Dexcom supplies from a pharmacy (mail order in my case). It’s not the doctor’s decision who can/should get the script – that is in the hands of the insurance company!
Even with my Dexcom CGM (for 8 yerars now - love and I am willing to pay out of pocket for it) I still do 10-15 fingersticks a day. I had to prepare a schedule for the Endo (who I didn’t like anyway - he can’t find it within himself to respect patients as smart people). Anyway aside from the usual times - upon waking, before and after meals, before workouts or dance classes, and before going to bed, I also test if there are several hours between meals and every time I get behind the wheel of a car. When challenged on whether I truly check every time I drive I had a question for the Endo. I asked how many times during his Emergency Med rotation he was on scene with EMS when responding to an accident - especially ones where a driver (or two) did something stupid while/before driving). He said “none” I said I’ve lost count (as a dancer my day job was with the Police Dept and with the Fire-Rescue Dept). That shut him up and I got my Rx.
I found that preparing a schedule of the times I check very helpful because they all made sense. I am amazed that some HCP’s think they are dong a patient a favor by suggesting And Rx’ing) a minimum number of bg checks. It is especially hard for T2’s. How the hell are they supposed to learn how certain foods or activity affects their bg? As someone once said - we are our own PCP and science fair project (it’s just that the science fair lasts all year)
