Hello,
I am a type 1 diabetic diagnosed in May 2013, after being admitted to the critical care unit in DKA. I had managed to get my A1c down to 6.2 and I was doing great, Then I started having problems getting my insulin refills from my doctor. This has been going on now for the past 18 months. My last A1c was 9.3. It is very discouraging when I cannot get the amount of insulin I need. All his office has to do is fax a request and I would get it. I am now waiting (again) 3 weeks and they still have not faxed the request despite my having called twice and emailed them as well. This causes me to reduce my doses to an amount that does not control the BS because I know I will be completely out of insulin if I don’t. So I run 400-600 BS now and feel rather lousy. I am on Novolog and Levemir. This is just a crazy situation.
Has anyone else had problems getting refills because the physician’s office staff just don’t “get around to doing it?”
I cannot change doctors and I do not have insurance and simply cannot afford to change clinics.
I think that at times we have to take the situation into our own hands. You have nicely asked, but this is your life and being nice isn’t necessary. I would encourage you to be more aggressive. Call his office and ask to speak with the business manager or the person responsible for faxing prescriptions. Tell them that they are not doing their job and harming you and that if they don’t get their act together you will report the doctor to the state licensing authorities. Have them take care of it, they can fill it out and put in the doctors face to scribble his signature. You can go to the pharmacy, tell them you have run out of insulin and ask for their help in getting a refill prescription. Dr’s offices respond better to calls from pharmacies than patients. A pharmacy also has the authority to prescribe you a certain amount of insulin themselves. And since you are self insured you should consider just making yourself safe by walking down to Walmart and getting Regular and NPH so that you can get some sort of blood sugar control. R and NPH at Walmart are only $25/vial.
I was going to day the same thing, but @Brian_BSC, already said it. Assuming you’re in the US, get over to Walmart and get some R and NPH. You’ll have to read up a bit on how to manage BG safely with them, but it’ll be a lot better than running with BGs of 400-600 all the time. And yes, get more aggressive with the doctor’s office - and solicit the pharmacist’s assistance. Waiting for your doctor to “get around to it” could put you back in critical care with DKA!
If possible, I would call the doctor’s office and specifically ask for a few “sample” vials or pens that they likely have in their office. Drug company reps regularly give doctors samples that doctors will pass out to patients who need them. You need that insulin now!
Are you seeing an endo? Do you see a CDE? A CDE could help you to make sure you have tools you need to keep your blood sugars in better control. Sorry you are having these issues. Nancy
It is possible that your physician may not be getting your refill requests because, for any number of possible reasons, office staff are not getting these messages to her/him. I say this because I don’t know of any physician in her/his right mind who would blow off refill requests for insulin (or any medication for that matter) without fear of losing her/his license.
Another thought I have: In my office (and in the offices of most physicians I know) office staff are trained to tell patients who call to request refills to go ahead and call their pharmacy instead to request that their pharmacy fax the physician’s office a refill request directly. This is done for at least two reasons of which I am aware: Patients often have refills remaining that they have forgotten about, so they simply call the physician’s office whenever their supply at hand runs out. If there are actually refills remaining and the doctor has to either fax or call in a whole new prescription, this adds up to a great deal of wasted time and medication flow sheets that do not “balance”. Additionally, it is much more efficient and often results in fewer errors if refill decisions are based on legible faxes received from pharmacies as opposed to hand-written (or even typed) messages from staff who may take down the information incorrectly or who may receive incorrect information from patients (e.g. a patient may request a refill of a medication whose dosage was recently changed.) Are you having the pharmacy where you fill your prescriptions for insulin fax your physician directly? If not, I strongly recommend doing this instead of you calling your doctor’s office when you need a refill.
That is crazy… I can’t fathom an office doing this.
Can you go in person to speak with whoever is responsible for this? I would also ask to have the doctor call you and tell him/her what is going on. Hopefully this will get you your insulin asap.
If all of this doesn’t get results I would make some sort of complaint. If it’s a clinic they must be accountable to someone else.
In addition, I would look into the assistance programs that the insulin manufacturers run, you may be able to get some free insulin from them or reduction of whatever you pay as well as free insulin from your doctor’s office.
Actually, my understanding is that doctors often require patients to visit and pay a co-pay in order to obtain a prescription or refill. If you are uninsured this means that you pay “rack rate” the further visit increasing your costs. Whether this dynamic is playing here, I don’t know. And shouldn’t we change laws so that a prescription can be enduring, I mean exactly how many people stop needing their insulin?
One of the things I like about my doctor is that I can contact her staff and get a prescription (even a new one) and that my pharmacies can easily get a prescription renewed without my intervention with her.
A doctor cannot continue endlessly refilling prescriptions for a patient without seeing them. How often depends on many things, including but not limited to how stable the patient’s condition is, how often documentation of continued need for a medication is required by the “powers that be” (I realize this is a ridiculous and moot point in the case of insulin and diabetes), the necessity of meeting any particular state’s Standards of Care, the type of medication being prescribed (is it a controlled, Schedule II medication?; the chance of it being lethal in an accidental or planned overdose). Where I practice, some Schedule II medications can only be prescribed for a maximum of 90 days before we are legally required to reexamine the patient.
Our bodies and subtleties in our metabolisms change with time, our lives and stress levels change, and countless other factors affect how our medications behave. The human body is not a static environment and neither is the way in which our bodies respond to medications. PWDs likely know this better than a lot of people without serious health issues (or whose health issues do not routinely need constant monitoring and adjusting 24/7). It would be medically irresponsible for a physician to not see a patient at reasonable intervals. And we would not be able to continue providing medical care without followup visits because we would not continue to be licensed.
I don’t live in a medically-underserved area, per se, but I practice a specialty in which there are perpetual shortages of healthcare professionals available to meet the needs of patients requesting our services. I have to turn away at least one patient a day who is desperately seeking medical care because there is a limit to how many hours I can continue working each week (and this limit is making itself more painfully obvious as I approach 60). And there is a nation-wide shortage of primary care physicians (Internists and Family Practitioners), so much so that I find myself providing more and more of my patients’ primary care. The point I’m trying to make is that the last thing physicians need to do is hold our patients’ refills hostage in order to make them come to a followup appointment so we can make money. Every physician I know pushes the limit on following up as often as we need to in order to keep our patients safe simply because there is not enough time in a day and days in a week to do so.
And the state in which I practice (and TBH, I’m not aware of any state in which the following is not true) a physician or someone licensed to prescribe medications (a Physician’s Assistant or Nurse Practitioner) needs to “OK” a prescription refill request. Non-licensed office staff cannot do this, for good reason.
Of course, you know your professional requirements (as does the OP’s doctor). My only comment is that, while true that refills have to be limited without seeing the patient, my experience – as a patient or relative of a patient – has been that when a prescription refill is being withheld due to a need for an office visit, that information is clearly relayed to the patient. My wife perpetually delays getting blood work, due to a fear of seeing the results (needles fon’t worry her like me, and to be honest, much as I don’t want a “bad” result, I’m at the point that I want to know, but to each their own…)… As “incentive,” her rheumatologist has on several occasions withheld a refill until labs are done (or an office visit, whichever is in question). Regardless, the office always informs my wife as to why a refill is being withheld.
I believe that even non-licensed office staff can relay the message that “the doctor wishes/needs to see you before refilling the prescription.” After all, if that is the issue, HOW will the patient know, otherwise?
When I receive a faxed refill request from a pharmacy, I always review the patient’s chart. If I should not approve a refill because I either need to reexamine the patient in order to continue safely prescribing the medication or I need to review lab results in order to continue safely prescribing the medication, I will approve a limited refill of 10 days so they do not abruptly run out of meds, and notify the pharmacy why I am doing this, and have them relay the reason to the patient. Additionally, I have office staff call and tell the patient the reason why I cannot continue refilling their prescription and what action the patient needs to take, e.g. coming in for a visit, having their labs drawn. This is not a control issue, it is a safety issue.
Additionally, in the case of Schedule II medications, refills are simply not an option. I could circle “5” refills on the written prescription but the pharmacy will ignore this and fill only the original amount indicated. As well they should because it is not legally possible to refill a “controlled substance” medication. It has to be a “hard copy” prescription each and every time. That’s the law. Not my law but THE law.
That is exactly the situation I’m in. I’m required to pay $120 office visit fee at the 6 month mark for 5 mins of random small talk, a quick look at my throat & ears (to justify the fee), & a 6 month prescription for my meds. I’m currently on my last refills, which I’m rationing until I can afford to pay the fee, hopefully in October.
It happens more often than most people want to believe. I come from a family of medical providers. I’ve heard legitimate explanations, but I’ve also heard excuses.
Is your copay $120 for an office visit? If so, every 6 months amounts to an average of $20 per month which doesn’t sound very excessive. You are fortunate that you are not required to be seen more frequently than every 6 months. In order to continue prescribing insulin, most endos require that you be seen every 3 to 4 months. I would question my daughter’s endo’s concern regarding the safety and efficacy of her insulin dose if she only wanted to see my daughter every 6 months…
That’s not a copay because I’m uninsured. My first visit every year is $325, then I’m required to return in 6 months. I’m not on insulin. If labs were required I could see the 6 month limit. I only have labs at the beginning of the year.
There’s no reason for the 2nd visit other than bringing in more income for the clinic. It’s the main reason my mother-in-law quit working there. Unfortunately, it’s the only clinic in our area so I’m stuck.
As a rule, I try to remember that I’m not privy to all the details of a forum member’s circumstances, so really don’t have the right to presume or assume anything about their situation. What may be a small bump in the road to me may be an unscalable mountain to them.
Update on my problem getting insulin. I called the office again, and actually was able to talk to a nurse. Usually I have to talk to a receptionist who has no knowledge of insulin, prescriptions or it seems anything medically relevant to answer a medical practice phone. I have never been able to talk to a nurse before. It turns out because they have changed electronic medical records software 4 times in the past couple of months, they have managed to “lose” my medication list and what insulins I am approved to get. So now (crossing fingers and hoping) this will be corrected and I should be getting some insulin in 5-10 days. All I can say is this has been a nightmare, and since I am the type of person who worries when things aren’t right, I have been somewhat of a nervous Nellie. Thank you to all who responded.
No, the original poster (OP) had difficulty getting her physician to renew her prescription and struggles not having insurance. In desperation she started rationing her insulin which I am sure she knows is not good. It is always good to read the original post and the thread to know what has been discussed. That way any response can be relevant and appropriate for the discussion.
DKA can happen at levels of 400 or lower… There is not a single cut-off at which point a high BG becomes a medical emergency. It depends on so many factors.
Where are you getting these numbers?! How is 10 units every three hours conservative? And 15 or 20 units at one time?! My TDD is 55-85 units when I’m not eating a low-carb diet. I’m overweight and am not particularly insulin sensitive (though am not particularly insulin resistant). A 15-20 unit bolus is a massive amount of insulin for me as a Type 1. I can count on two fingers the number of times I’ve done a 20-unit bolus in my lifetime. Seriously, if I didn’t know my correction factor and wanted to be conservative, I’d be starting with 1 or 2 units, not 10-20.
I totally agree. 10 units every three hours would kill me. I rarely do 10 unit boluses. That would be a combination of a correction for a BG of 400 mg/dl and a very high carb meal. Fortunately, I don’t find myself in that unfortunate situation very often.
I have never done a 15 unit bolus.
Medical school actually sounds fascinating to me. But I’ve already paid for two undergraduate degrees and a master’s degree. And I’m sure there would be a huge uphill battle with people freaking out left and right about their negative perceptions of the abilities of a blind doctor. I just don’t have the energy to deal with that kind of stuff again when I’ve already dealt with it while getting into my current career. So, at this point, I don’t have the money nor the desire to make a career change, as interesting as it may be.
But, whether one has or has not gone to medical school is an irrelevent point on this forum, anyway.
The purpose of this forum is not to provide medical diagnosis or treatment. The OP was not asking for any type of medical advice. Nor did my response to you actually go into any detail of medical criteria for diagnosis or treatment. I simply pointed out that blood sugar level alone can’t be arbitrarily divided into “not immediately dangerous” and “medical emergency!” without taking other factors into consideration, and that suggesting someone bolus 10-20 units as a “conservative” correction, even for a very high blood sugar, is not conservative.
