I am writing on behalf of a friend who is very interested in taking more control over her T2 - and is very capable of doing so (retired RN). I have it easier since I have T1 and have my Rx for 10-15 fingersticks a day. Her HCP is a PCP who (in my opinion) seems to think he is doing her a favor by only having an Rx for once a day bg checks. She is interested in learning how her body reacts to foods and how her body reacts to her exercise sessions/classes.
Her A1C is acceptable to her HCP - 7. Of course that’s just an A1C - an average. So is her A1C the result of 7, 7, and 7? Or is it the result of 0, 7, 14? She wants to know. I am thinking that at the very least,m she should have an Rx for 4 times a day, morning, night and at least before and after a meal. Let’s throw inexercise sessions, and that would go to 6 times a day. If I could be without my CGM for a few days, I would loan it to her, but I really don’;t want to go there - much as I cherish our friendship.
For those of you who have been successful in getting an Rx for more test strips - what argument won the HCP to see things your way. I did suggest she buy a Relion meter and strips and so some frequent checking to show the value of a larger quantity Rx.
Good luck to you and your friend. I have no suggestions, but I think the root of this issue (here in BC, Canada people who don’t use insulin only get 200 strips a year!) are the studies showing that there is “no benefit” to daily testing for people who don’t use insulin. Someone really needs to do a study that includes educating the participants about how to utilize the results of their tests and give them six tests per day, and I’m betting that would show a benefit.
True metrix strips on amazon $42 for 300 strips. I have good insurance and I chose to buy my own just to avoid the bs.
There is no more effective way to empower a person than to let them realize hey can afford the tools to their own success instead of begging for them
I’m on insulin, but I had to do a small battle with my doctor to get what I have now (6 / day). He’s my GP, not an endo. The upside is that since he’s admittedly not an expert on prescribing insulin, he’s willing to give me some latitude. I walked out of the hospital with a prescription for 10/day, as well as a for bolus. When my GP took away the bolus (a good decision), he reduced the strip scrip to 2 / day.
I had taken the initiative and called my insurance company to see what they would pay for, and they said they would cover whatever was prescribed. I then called the office and asked for an increase in strips. He at first said no because he didn’t think insurance would cover it. When I got that message, I called back and advised the nurse that my insurance would pay, and asked again. I got a call the next day, and was given a 2nd hand “lecture” along with my increased scrip. I smiled, told the nurse I would accept the lecture (she laughed), and accepted my prescription.
This was in May. When I went in for my checkup in August, my A1C was down to 5.7 (it had been over 14 in the hospital the first of May). Doc was thrilled, so he has yet to question me on that again. For me, the key seems to have been to make my case that I wanted to know how the meals affected me and the willingness to contact my insurance company to make sure it would be covered. Following up with results helped justify it after the fact.
If the patient is willing to look at the test results and apply that knowledge by improving food choices and making medication changes then that should help persuade reluctant doctors to order more strips. Dropping your A1c down to below 6% certainly didn’t hurt, either. Good job!
I would agree Relion or True Metrix would be good/affordable options. My mom is T2, and typically does fasting BG only, but more when her A1C has gone up.
Unless your friend is using insulin, I think it would be most beneficial to test in pairs, meaning before/after meals or exercise activity. Could be different meal/activity each day, and use 3-5 strips per day, so RX for 4/day would work well if dr agrees. Maybe more in the beginning as she learns how much her BG rises after certain meals, and may make different choices and compare differences. Logging is essential, and counting carbs to know how equivalent one meal is compared to another. Having a plan such as that to share with the dr would be helpful.
An A1C of 7 equates to average BG of about 154. If she has fasting BG consistently in 80-100 range, then could focus more on before/after meals. Most likely she has post-meal BG’s 180+, that average out with 80-120 overnight and pre-meal numbers. This was the pattern my mom found when her A1C reached 7, and she made diet changes so that now it is back in 6s. The other time my mom tested was when she felt symptoms of being low, which were infrequent, but usually after activity/exercise.
I just found this article. My problem is it fits my intuitive mindset. The other problem is it discusses a study of teens with type 1 rather than adults with type 2, but it’s evidence against what many type 2s are told: there’s no proven benefit for people with type 2 from frequent testing.
Doctors tend to think they’re doing us a favor, I think, by not asking us to poke our fingers 5-10 times a day. Sometimes the key is just telling them that you want to and refusing is not doing us any favors.
I’m not on insulin therapy, so I fit the profile of your friend in some ways. And here’s what I did with my PCP:
Me: “I’m not OK with an a1c of 7.0, and I would like tighter control. Testing is one of the only tools I have to achieve that, and I would like a prescription for a minimum of three tests a day.”
PCP: “Well, studies show…”
Me: “I understand you’ve heard differently, but I want tighter control than that and want to test three times a day minimum.”
PCP: “Studies show that testing too frequently…”
Me: “OK, it’s time for me to get a new doctor. Thank you, and goodbye.”
New PCP (also PCP for my wife and son): “You seem to know as much about this as I do, are you sure you want three strips a day? I’ll write you a scrip for 5 or 10 strips a day if you think it will help with your management.”
Me: “Fantastic! Let’s settle on 120 strips a month, thank you!”
Jen
I am sure somebody in the pharmaceutical industry greased the palms of some of our MLAs in order to get the new legislation restricting test strips for those not on medications or insulin. That someone would be the pharmaceutical companies that benefit from people giving up managing without meds or insulin. As you probably know BC is the only province in Canada where a sitting MLA went to prison for taking bribes (A Socred forestry minister in the 50s who took bribes to allocate large swathes of public(crown) forests to a private timber company.) Old habits die hard. Then you have the recent scandals with the researchers in Victoria who were fired for alleged corruption but later cleared though it did not help the one who committed suicide, when he lost his job. And it turned out the allegations were all trumped up because they were doing research that the drug companies did not like. Yes, it is a fact of life that we live in a Canadian province run by a government (the so-called BC Liberals, lately more often known as the BC Fiberals) that has a long history of dishonesty, corruption and bribery going back to their Socred origins, and penalties against those who dare to manage their diabetes without an RX is but the latest example. There is an election next year but don’t hold your breath, progressive people in this province are known to be too lazy to vote and they leave it to the conservative, stinking filthy rich as well as newer Asian immigrants (who hate all taxes) to run the show,
I find the issue of test strips strangely confusing. Why would a doctor not want a patient to test more and attain better control? Then I realized that many GPs have a fundamental misunderstanding of diabetes, particularly T2 diabetes treated with oral medications. They think that the only purpose of testing is to provide information to the GP so that they can adjust medications up or down as needed. They don’t see testing as having any actionable element for the patient. They don’t expect a patient to figure out what meals cause their blood sugar to soar and they certainly don’t expect patients to reduce or avoid those meals.
So to me, the key to dealing with a GP like this is to “lecture” them. Let them know that every person with diabetes treats their condition with many, many decisions every day. And all these decisions need to be informed and a vital part of that information is blood sugar testing. If your GP doesn’t want you to take care of yourself then they should just say that instead of doing some power play with the test strips.
It really riles me to read this story. I have a lot of respect for many medical professionals. But I don’t expect my doctor to tell me what to do - I need him/her to give me all the data, and let me make the choices. Particularly for diabetes, when the patient becomes the expert in his/her diabetes, the doctor should not make this kind of judgment. It riles me that you have to fight for something that I consider simply necessary. I am really sorry that you have to go through this. Many people may not able to be as assertive as you are with their doctor, and would pay the price with their health.
@artwoman, there are many sources of cheap strips and meters. The cheapest I know, I think, is Walmart, for about $9 /100 (suited for their proprietary meter, rated “very good” by Consumer Report).
So, if she needs to, she could buy plenty for herself without a prescription (if she lives in the US).
But, really, there is NO REASON AT ALL for her doctor to limit her. She needs to be able to make these decisions herself, and, if her doctor is not willing to support her when she asks, she should walk and take another one. This is not the 19th century. Have you ever heard this doctor’s joke:
2 guys are waiting in a long line to enter Paradise
while they wait, a big man (woman?) walks briskly by them, with a big beard, a white lab coat and a stethoscope hanging around his neck.
one of the guys asks: “who is he?”
the other answers: “God. He thinks he is a doctor.”
This describes well, I think, the state of mind of some GPs who feel that it is still appropriate to make decisions for their patients…
OH wow, never thought about it that way! My last visit to my GP before I got a new doctor he was reviewing my quarterly bloodwork, and demanded that I do three things: stop testing (unless I felt “funny,” and no more than twice per week); stop exercising (because I have moderate lows); and relax my diet so that my A1c would rise back to “appropriate levels for a diabetic” (in the 6.0-6.5 range according to him).
Makes perfect sense: since he had my A1c, there was no reason for me to keep testing, because he had the information he needed to give me terrible advice, in the form of eating more carbs and exercising less.
WestofPecos you summed it up so well: as PWD’s we have to be the PCP. It is even more so for T1’s - like me. I make insulin dosing decisions 24/7 - not only does one size not fit all, one size doesn’t fit me all the time. I’ve battled with HCP’s about my having my foot on the accelerator. One (thank goodness he’s retired - about time!) wanted my A1c at 7.5 - cuz I am an “older woman” (don’t know which word to be the most angry about - “older” or “woman”. He refused to believe that I could do so well -after all I’m “…just a…” - I didn’t let him finish the sentence. Whipping out the print outs from my CGM that showed I was range (as defined by me) close to 90% of the time shut him up. I then asked if he was of the school of thought that once a person is Dx’d with any kind D, they MUST also be Dx’d wwh two co-=morbidities:L stupid and lazy.
Like you I have respect for a lot of HCP’s, but they have to respect me as well. 40 years of experience (with D) has to count for something, With D as disease that has no cure,does not go away, we has PWD’s have to cope with it. No wait for a quarterly or semi=-annually apt to make changes. Since so much of our care - all PWD’s - involves our actions and decisions - we have to be able to handle the decisions and changes that come with that. My first Endo was a dream-Endo. His job, as he saw it, was to train me to be my own PCP. The only reason I am not seeing him is that I moved 1000+ miles away.
Indeed, it does. For forty years, over 350,000 hours, you have made treatment decisions as well as lived with the consequences of those decisions. Skin-in-the game tends to finely focus learning. I’ve heard it takes 10,000 hours to master a skill; you’ve done that 35 times! That experience deserves as much respect as the doctor.
I appreciate that, but he has admitted he’s not an expert, so I’m sure he’s going off of old information and referring to studies that show that there’s no benefit for people to test often. He told me right out of the hospital that if we needed to, he’d be happy to refer me to an endocrinologist since his experience with insulin is limited. I respect him a lot for that, and this attitude is working well for us.
And it really helped that I came in to my August and November appointments with A1Cs below 6. He’s not said a negative word since about my testing strip prescription. I’m willing to deal with a doctor who is trying and willing to learn with me. In many ways, it puts me in the driver’s seat.
@artwoman, I loved your post: sharp, feisty and funny! It defines so perfectly the situation of a PWD that I cut and pasted your whole post into my notes to be able to refer to and quote it in the future.
You must be a really fun person to know! Happy new year - Michel
I had to like your post! Thank you! I do have a mouth on me, and I’m not afraid to use it . So does West of Pecos mean you are in Texas? I’ve lived in Portland Oregon for 5 years now and have yet to meet T1’s with my attitude and drive.
