MDI is freedom from physician and insurance oversight and manipulation


#22

Stockpiling insulin just means at some future time you can skip a purchase. Lets say you get 12 months of insulin in 10. What do you have? Maybe you buy 11 months and skip one. Maybe next year you skip 2. It is not what you get, rather do you have enough to accommodate emergencies etc. It is not a morality issue, it is one of flexibility.


#23

Again an easy problem to solve by asking your doctor to prescribe exactly the amount of units in the box for a 90 day supply.

Eg 1500 (units in a box) / 90 = “doctor please prescribe me 16 units per day so that I can get a whole box every 90 days and have a reasonable backup supply for emergencies or travel or whatever”


#24

a worthy strategy that I employ on every drs visit. :sunglasses:


#25

I guess I do feel as though morality is a component of this issue. It saddens me that I am the one who feels compelled to apply morality but our healthcare system, physician, pharmacy, insurance company, pharmaceutical company, feels no such compulsion.


#26

My endo appt is the end of April. I like to sit back and give people a chance. I sure hope she does the right thing without being prompted. I’m sure she will “plump up” the rx, but I don’t feel confident that she will go as far as necessary. It’s scary to find another doctor you can trust. This last three months of battles with insurance and pharmacy has worn me down.


#27

There is no need to wait that long just give her office a call and ask her to increase your rx amount, it’s not a big deal.


#28

They set the rules, you play the game. As long as you are using the insulin for yourself and only yourself, morality should not come into play, especially since you have no way of 100% correctly determining your exact insulin needs for the next 90 days. If you were to share your insulin, or sell it that would be a whole other issue. That is the problem that happened with test strips. Many individuals get their strips over prescribed specifically with the intent of selling their excess strips on eBay or other marketplaces. That is both immoral and illegal.

You need sufficient insulin for your daily care + emergencies. That is a mortality issue, no morality component involved.


#29

With all the roadblocks I’ve encountered this last three months it feels like a big deal to me. Asking my endo to increase my daily dose from 6 units/day to 16. I am going to give it a try though. Every phone call, every mychart message, etc is entered in medical records. All of this is subject to review. I’m worried that my endo is protecting herself… we’ll see how this pans out.


#30

You have not brought up the option of possibly interviewing other endos. You may find it more comfortable for both yourself and your current endo to make a switch. At least talking to 1 or 2 others you would get a good feel for what is fair play for both yourself and for the industry. You need to be totally at peace with yourself as well as your medical team. Stress is supposed to be avoided, especially for diabetics.


#31

Well, I am a licensed spiritual director, and I say do what you need to do to have enough insulin and never feel guilty about it.


#32

This has been a thought in my mind. My endo is someone I know through my work who is very smart and a respected researcher. She is the person I went to when my primary told me I had Type 2 diabetes and come back in a year. She did everything right, immediately. I was very fortunate that she “accepted” me as a new patient (she was not accepting new patients). If things don’t pan out well with the long-acting insulin script I need to consider options. The drive to her clinic is 80 miles each way.

It’s been such a tough three months dealing with insurance and pharmacies that I’ve grown cynical, paranoid and skeptical. I need to give this woman a chance. It’s been 8 months or so since I’ve seen her and I hope she is the endo that you folks here on TUdiabetes find the norm.


#33

Thank you!!! That makes me feel sooo much better!


#34

@Lauri integrity aside, you are morally obligated to survive. Asking for more is not morally wrong. It might be an integrity issue, but survival is not morally wrong.


#35

I’m a licensed ventriloquist


#36

oh gawd…


#37

Also just a thought, if this doctor who doesn’t accept new patients and you know through research doesn’t seem to be fitting the bill for the type of ongoing support that a practicing endo generally needs to, then that kinda makes sense… might be a better fit to work with one who considers it their job to help manage their patients prescriptions instead of publishing journal articles… just a thought


#38

Follow @Sam19 advice. It’s the best and easiest way to get what you need.


#39

IMHO this is not a morality question.

There is no indication anywhere in the thread of any of these products being used by anybody other than the intended person. Likewise there is no indication of any of these products being sold on the black market.

IMHO this is simply common sense.

Exactly. 100% Agree.

If we need something, I don’t even bother with the phone. Just send a quick message via the Doc’s online portal. Takes me about 30 seconds. If not urgent, the Doc would generally have a turn-around (with proper action) within one business day. If it was urgent, I would call on the phone and ask for something right away.

The Doc works for me. I don’t work for them. We can have a good relationship as long as they don’t forget who works for who.

Exactly. Our Ped Endo knows exactly what the typical range of insulin on a typical day is. As well as being able to look and see what sort of variation and see that on some days, the insulin use is significantly higher. If middle of July one of those Starbucks crapachino whatever 150 carbs drinks is wanted - then obviously that is going to be a high insulin day. Get the flu? That is high insulin for about two weeks probably.

Our Ped Endo has full access and knows what insulin is actually used.

As well, our Ped Endo is practical and knows that insulin waste occurs with pump changes. Fill the tube. Leftover insulin in the cartridge. Bad site. Whatever.

Our Ped Endo would be horrified if we ran out of insulin and would probably (and properly) give us a lesson on supply management.

At the end of the day, our Ped Endo is knowingly writing the script TO THE PHARMACIST for approximately three times our average daily use. This HAS NOTHING to do with instructions for our use or what the Endo think we use. This is STRICTLY for the PHARMACIST.

We have slowly built up about a 2 month extra supply and now maintain that. The insulin is not on auto-refill. When the last vial is opened, I request the script to be refilled.

Different people consider their circumstances and can decide for themselves what size of an emergency supply is appropriate. For us, 2 months seems a good and reasonable amount.


#40

That’s easy - a month before you see your endo, put yourself on MDI, unplug your pump, and just fill your pump with water. Bolus the hell out of it at every meal. You can get a script for whatever amount of insulin you need.
:grinning:


#41

I don’t think all endos/offices handle this identically. Some are very small outfits without much autonomy by the office staff and others are larger and the doc will never get to the nitty gritty of prescriptions, those details are always worked out by the office staff. (Of course the prescription is ultimately signed by the doc.)

My current (rather large and well staffed) endo’s office staff handles all the prescription details and often does it well and when they don’t do it right I can work with them to get it right. I’m 100% sure if you called the office staff saying “I’m running out of insulin soon could you up my prescription” they would get you hooked up with a more appropriately prescription from the doc and you do not have to wait for your next appointment.

BTW, I’ve been T1 for nearly 40 years many of them “going it alone” and it is a very recently learned skill of mine, to call up the docs office go through the phone menus and ask for what I need and stay on the phone until they understand and we (together) get it done. I normally don’t have that kind of patience to sit on the phone. This has been a very hard skill for me to develop.

Sitting on the phone during the business day for most of an hour is something my current job lets me do but certainly not everyone is so lucky.

Some other specialists I see do pretty well with “electronic portals” for a lot of messaging (especially lab results, but also “straightforward” prescription renewals) but for something complicated like revising or tweaking a prescription it is seems to ALWAYS be necessary to make the phone call.