Testing guidelines

Am I the only one concerned with the current testing "guidelines"?
This is what I'm being told.
Those on diabetes medication get one test strip per day some are only given one per week.
Those taking insulin should test 3x per day.
Yet, when you read booklets and are being "coached" by your diabetes nurse or educator and even the commercials, they are all saying to test often.
I am a type 1 on insulin for 17 years and now on the pump. I was told to test before and after meals. That's 6.
Then they want a fasting and a bedtime blood sugar. That's 2.
Sometimes they want me to test at 3 am because we think I'm dropping or spiking in the middle of the night. That's 1.
When you're sick you are told to test sometimes as often as every hour.
You are supposed to test before, during and after exercise. That's 3. You are supposed to test before you drive.
You are also supposed to test during strenuous activity. Such as gardening, yard work, bike riding, house cleaning.
Also when you're out in the hot weather.
I for one don't feel low blood sugars when I'm out in the heat or when doing strenuous activities until I'm in the danger zone.
I'm tired of having to "fight" for my test strips. Why does the ADA and Medicare only say or cover 3 test strips per day?
My insurance will not cover a CGM. I would love a CGM. It would certainly make my life a lot easier and a lot less stressful.

Jewels this is an awful policy. i posted parts of this this morning on the discussion "free stuff" and I will just reprint it here

"Actually once per day is the medicare standard for type 2 Diabetics. There is some reason for that standard, and most of us likely agree the reason is pretty good one. It was found that a good deal of Medicare excess diabetic supplies were ending up on Ebay and Craigs list for sale. These listings on the black market are abhorrent to me but if you look at Ebay in particular for any type of strip you get a large listing of Gray market providers, most first purchased using private insurance or Medicare dollars.

So to cut that abuse Medicare instituted these very tough and in my judgement for any diabetic who cares about their health counter productive guidelines. By the way it is 3 times per day for a type 1 or LADA patient (I believe). Both are completely out of the realm of feasibility. Many of us are trying to change to that along with support for making CGM's an eligible medicare expense. We have made absolutely zero progress so far.

With the test strip issue, if you are using medicare to purchase test strips the doctor can write a script for supply of more testing strips per day. Of course there is a down side if you use more than the specified amount you must turn a 30 day log of testing in every six months to your doctor, who can and often is being audited for medicare violations, including excess test strip usage.

Most doctors will not accept these logs, as they generate so much paper in a paperless world. Unfortunately, in those cases, the patient has to maintain the paper at home in case it is called for and you never know when that might be."

"Now not to scare folks if your secondary insurance is paying for the test strips medicare does not care how many use. This only applies to Part B purchases, which for good and valid reasons, some years ago, became free for most medicare patients. In this case free (we diabetics and our families cost ourselves using and selling on the gray market) is a very costly proposition."

The theory of the 3 a day comes from only testing before breakfast, lunch and dinner and ignoring everything else. Ok fine, but that as we all know is just daft, but that's where they dreamed up with this figure. I can easily do 8-10 a day, sometimes a lot more, but it all depends on the day. I get it in the neck every time I order more but I just rant enough it's easier for them to sign them over than to have me rattling on all day at them :P

I'm pretty sure the 3 a day limit came from ADA recommendations of testing 3-6 times per day. I read somewhere on the ADA site recently(for the life of me I can find it again) that they were amending this guideline to a broader, "as needed". Since the ADA mistakenly gave and number range in the past, insurance providers jumped on the low end as THE standard. BTW Medicare is not the only insurance that has this limit currently.

i have been tracking my testing and I test routinely 9-12 times a day. It is just such a dumb rule. I mean lets face it, i can easily go thru 18 times a day if I am low or high and worried about it. Maybe that is obsessive, but if I am in the 30's and trying to to recover, I am testing more, if I am over 300 and loading insulin like a man possessed, i am testing more.

If we are in the US please write your congress person in particular and senator and ask that they broaden the scope of testing to up to 10 times daily on a doctors order. Also please ask that they force medicare to to accept payment for CGM's. We need to make a big enough fuss about this that medicare changes their rules. Most people do not realize that if the medicare rules stand, it will eventually serve to give a reason for all carriers to significantly limit test strips in many areas of our lives.

This is not a political statement, but unless we get this moved through the house we do not stand a chance in getting it changed. Last I looked the bill to force medicare to accept CGM's does not have a single republican sponsor. Without a republican sponsor it will not go anywhere. My congress person is a republican and a member of the house diabetes caucus. I plan to ask her or the republican nominee (she is opposed in the primary) if they will or will not support the expansion of medicare to allow payment for CGM's. This is big big issue. We need republican support for the concept in order to move it forward. It is a fact of life that Republicans control the house, the bill is in the house for consideration. This is not a partisan issue. This is an issue that is putting many insulin dependent diabetics at great risk.

Thanks in advance for you concern on this issue.




its the same thing here in spain on the socialized medicine/seguridad social. i get three strips a day. a months supply costs me like 3 euros, but i cant get anymore unless i buy them out of pocket. when i go back to the states, i head straight to walmart and buy about 2000 walmart strips for the year. i dont know what i would do if i didnt get back to the states because 100 of my strips here without the scrip is like 84 euros.
it really IS the stupidest thing. i test about 6-8 times a day as i do exercise through the day. the only way to live on three is to eat and then just not move.

Thanks for all the great comments and support. What I meant by medicaid/medicare is that insurance companies are following the medicare/medicaid guidelines. Which is daft.

Shoshana27, oh it's even worse if you're a type 2. They only allocate 1 strip per day. Even if you're on meds.
they lecture us on testing, test often blah blah blah but then they won't cover the supplies.
Doctors now are giving up with fighting the insurance companies. I have to fight my own endo to get him to help me get the supplies I need.