I went to the doctor today and after a two hour appointment I was told that I was not going to be given a prescription for Insulin. Yikes. It was because I was Type 1. "We don't treat that. You need a consult to an Endo. How about Septemeber?" Run for the door.
Holy moley! And how are you supposed to manage in the meantime?
You
have
got
to
be
kidding!
BTW, nice to see you so active, Ellen! Haven’t seen you around much lately…
She gave me some vials of Lantus after that, but I could not talk her into the Novolog. I have enough left to last but no Novolog short acting pens for now. I asked her how I was supposed to eat. I was horrified. She would not prescribe it without an A1C... but she did order that. She is new for me. My first appointment. Still... thanks Dave.
You do not need a prescription to buy insulin. I went 8 years without insurance and just bought my insulin over the counter at Walmart pharmacy. I don't know if all types of insulin don't need a prescription but I know Novolin N and Novolin R and Novolin 70/30 do not need a prescription. They are old school but got me through 8 hard years. And you pay full price which is $25 - $30 per vial. At least that's the way it is here where I live in California.
That's scary. So was the doctor afraid your diabetes might rub off on him?
I could not believe it. I did say that I guess I wouldn't eat a couple of weeks. Then she got the idea to ask me how long I had it. I said twenty-five years and I was Type 1 LADA. She said, "What is that?" Oh, I felt so depressed.
I didn't know what to do. I was new to this VA office. I have an appointment on the 29th with the doctor. She said they were short because of cutbacks.
I remember being just as frustrated when I left my home state to head out to grad school. Got a recommendation, for a highly rated endo at the new location get an appointment three months out. Wow, 3 months is a long time to go without having any prescriptions, but I pay for insulin and test strips out of pocket and I carefully optimize my bg control so that I will have great labs and look like the world's best controlled diabetic when it finally is time for the appointment. First time there, I go to get some lab tests but don't get to see the endo. A week later, right before I'm supposed to go in and see the endo, I get a phone call - they don't want me as a patient, since my A1C was 5.7% which is at worst pre-diabetic so I'm not eligible to see the endo. I am eligible to see the nurse practioner who cannot prescribe insulin but is glad to tell me how my "pre-diabetic" numbers mean that I have to watch what I eat or else (OMINOUS MUSIC DUH-DUH-DUH) I might end up needing insulin! Eventually after some arguments and a requirement that I had to have glucose tolerance tests (what, am I supposed to "flunk out" by not taking insulin and end up with stratospheric bg's, or take insulin with the glucose tolerance test and end up still not eligible for insulin?) I just gave up in disgust.
oh my that is scary. I think the NP thought I was a type 2 which is frightening to think about that they would let anyone with a 169 bg which is what I had on a blood test go with no medication. At least they scheduled me to see a Doctor in the clinic on the 29th. I have enough insulin left to make it but she did not prescribe it and I am running out soon. If I have to buy it I will and thankfully I have enough test strips to last a while. My last doctor prescribed too little Novolog because I use it for corrections with meals too and he didn't add that in. I think it is common around here to avoid Type 1s and send them to an Endo. My last PC said that he would not treat a Type 1 either. I want to go to an Endo and have for a long time but I have been distracted by other issues with my health that are making the diabetes move down on the list of priorities. I am scared because of this. I know diabetes is first.
Some doctors are such buffoons. I hate it when that happens!!!
My understanding is that Insulin Analogs like Humalog, Lantus, Novolog and Apidra, require an Rx in all 50 states.
Hopefully you can get an endo, because endos can deal with type 1's seemingly better than just any other type of doctor. It sucks when the only endo you can get is months away. I had the same deal when I first got my endo though I wasn't on insulin at the time (I was just diagnosed and the previous doctor was stupid and refused to believe I was a type 1) . It's just really crappy that they don't understand that you're a type 1 and you NEED your novolog. It's not optional, you're not a type 2 that is just using insulin in a different way, you're a type 1 that needs it and you've had diabetes for 25 years where you have a reason for tight control. Tight control after years of diabetes is the best way to prevent complications. How do doctors not get this at all?
I REALLY wish I could help you as I have 2 novolog vials I don't really plan to use (I use the pens, this was left over from when I attempted to use the pump) but I can't due to the fact I can't send you an rx product and it's really hot out where I'm not sure if it'd survive if I even could send it.
Do you know the logic behind this? I mean regular can kill as effectively. With medical devices it gets even stranger. What is the logic to need an Rx to buy a Dexcom device out of pocket?
Things are not driven by logic they are driven by history and power. Regular is human insulin, exactly the same as natural insulin so it cannot be patented. And while you can still patent processes to produce it, I believe the protection from recombinant DNA process patent in 1978 has expired. A good description of the contorted history is found here:
A U.S. government report discussing insulin’s status stated that it is a prescription product in Australia, Italy, the Netherlands, and the United Kingdom.3 Why is it available on a nonprescription basis in the United States? When the prescription legend was codified by the 1951 Durham-Humphrey Amendment to the 1938 Food, Drug, and Cosmetic Act, medications that required administration by injection, or were of such toxicity that a patient could not self-treat, were made prescription only.4 Inexplicably, insulin was exempted from these laws in the U.S. despite its clearly meeting both of those criteria.4 Perhaps the legislators wished to ensure that patients requiring insulin on an emergency basis would not be denied this life-saving medication. However, this thinking is fundamentally flawed, as public health advocates could make an argument to add medications such as epinephrine pens, asthma rescue inhalers, and a host of others to the ranks of nonprescription products. One writer suggested that insulin was continued on as a nonprescription product because patients with diabetes “generally carry the diagnosis for life.”5 For obvious reasons, this explanation is equally unsatisfactory and could apply to such diagnoses as hypertension and terminal cancer.
Nevertheless, the fact remains that nonprescription insulins have been available only from pharmacies since their introduction in the 1920s. Wholesalers and other suppliers will not sell them to nonpharmacy outlets. Thus, they have been a valid third class of medications within the U.S. for decades.
The current situation is that the federal government does not require a prescription for human insulin (R or NPH) and further restriction is left up to the control of the states. For the most part, Human rDNA insulin is available Over the Counter (OTC) without prescription in every state in the US (with some issues). Personally I have found that buying insulin at Walmart in Virginia is easier than getting OTC syringes.
ps. The FDA still has authority to approve insulin production and purity/safety and has had that authority since 1941, so you can't just make the stuff and sell it out of your garage.
pps. In the US a CGMS requires a prescription (although not in the UK). I'm not sure of the reasons, the most common reason I see is to protect against "sharing." Heck, stupid stuff requires a prescription, like Metanx which is just a bunch of vitamins also available OTC.
It is really sad this situation. I really don't know what to do other than just wait and see what happens with the doctor. Thank you for offering to help Sensorium but I know that you can't. The problem is that I was prescribed only 17 units of Lantus and I now take thirty. The NP said she could only write for the old prescription. This doesn't make sense because people's insulin requirements change. She didn't ask about syringes either though I have some from prescriptions in the past. I can buy regular but I will really have a hard time adjusting to this. I knew this was coming when I changed my insurance.
I would hate to be a person without insurance at all having this much trouble as it is. I believe that I need tight control yes, but after 25 years with Type 1 it is difficult. I also have other health issues that are even more of a concern. I think that stress is a major issue here and depression. It is a dire state we are in as far as I am concerned with health care in the US.
Did you get a prescription for the 17 units/day? I might have even pressed for a compromise and asked for 20 or even 25 units/day. And we have to understand, a NP has very limited prescriptive authority which probably is why she went all hinky on you. One tactic I use is to enlist a pharmacist into the equation. Go to the pharmacist and tell them that you have diabetes, you absolutely need your ^&&^%^& insulin and syringes and really, really need their help in getting a renewal approved. Often a regular pharmacist will have records on you and have an inside line to the doctors office and can get it done. Heck, they might even be able to call up an old doctor you don't even see anymore and get a prescription renewed.
ps. And personally, I consider it an insult to have diabetes, a life long condition and be required to submit myself regularly to be approved time and time again for insulin. Exactly how many diabetics walk through the door, suddenly cured and need to be removed from the roles of those granted access to insulin.
pps. And if a doctor ever refuses my prescription for insulin I would not hesitate to ask them to sign a note that they have decided that it is medically appropriate for me to stop insulin therapy (this is the nuclear option).
With a prescription for 17 units of Lantus a day, but with a bottle of Lantus being only good for 28 days according to the manufacturer, wouldn't you have a good point with the pharmacist that you should be able to get a bottle (of 1000 units) every month? I've had the pharmacist step in with data like this for me in the past.
WOW! That is beyond ridiculous. I haven't had time to research you but did you just get diagnosed or do you have a past endo? I know that while I was searching for an "Adult" endo (it's a tough decision to make)..I would call my old endo and she would call in the prescriptions for me. You cannot be without insulin...Another thing that I did hear is that you can go to the ER? They may help. I am not 100% sure though.
Thanks for all the ideas. I have had this disease and many chronic illnesses for many years. Things are getting quite confusing for me. Along the way, understandably, I have gotten “gun shy” of doctors especially in the area that I live. I know that it is my responsibility to keep my blood glucose stable. I woke up with a BG of 122 this morning which is with the 3o units of Lantus. The NP was just getting my records ready for the real doctor. I know she does not know that much about diabetes and that she is just filling in during the shortage at the VA. I am lucky that she saw me at all. I do feel a lot of anxiety about running short. I think that I will be okay. I need to count everything. I hope that I don’t run out of Novolog and since I have pens now I have to worry about supplies. This is why I have never tried a pump. I think that I am not the only one who has had to deal with this situation. The doctors do not seem to have EHR that they can access. I asked why and was told there were too many different computer programs. She couldn’t see or understand that my dosage is flexible depending on what is going on I have to change or increase the dose. I can’t understand why she didn’t know that fact.