Test strips stopped

[spitfire]

Test strips stopped according to my health team all type 2 diabetics that dont take insulin will have their test strips withdrawn on prescription. received a letter yesterday telling me no more test strips from now on they say according to NICE guidelines we dont have to do it( self test that is) the twice yearly diabetes check will survice anyone else getting this bull**** excuse.

 

[JUSTFOCUS]

I couldn't have put it any better myself spitfire.
They give junkies needles and give alcho's daily payments. It really is a pull out of the hat idea from a goverment that puts people's lives at risk. As most people on this site know the testing is a sure way of getting to know whats your own safe foods and if you have no hypo awareness like myself what chance have we got !! I think every one on this site should get a petition together with there friend and family signing it . Then ask the moderators to personally deliver it to number 10 Obviously with the there red diabetes printed jumpers . Now thats how you catch peoples attention (Free advertising by the 10'oclock news :wink: :wink: :wink: :wink:

 

[viviennem]

I've just been having a trawl through the NICE guideline document (CG66 Type 2 Diabetes: full guideline) which can be found at:

http://www.nice.org.uk/nicemedia/live/1 ... /40803/pdf If this doesn't work as a link, it will be because I followed a link on the NICE website to get to it, but if you go to nice.org.uk and search for CG66 Type 2 Diabetes, or similar, you should find it.

These are some extracts from it (the numbers in brackets eg (50) are for the footnotes in the original) :

6 Lifestyle management/non-pharmacological management
6.1 Dietary advice

6.1.1 Clinical introduction
All people with Type 2 diabetes should be supported to:
_ try to achieve and maintain blood glucose levels and blood pressure in the normal range
or as close to normal as is safely possible

_ maintain a lipid and lipoprotein profile that reduces the risk of vascular disease.

***

it can be argued that limited credence can be given to observational study associations between blood glucose control and self-monitoring as those patients and healthcare professionals who
advocate self-monitoring may be the same people who are motivated to achieve better control.

***

8.1.3 Health economic methodological introduction

A cost analysis of implementing intensive control of blood glucose concentration in England
identified increased frequency of home glucose tests as a main contributor to the total costs of
intensive control.(52) It was estimated that the additional management costs of implementing
intensive control policies would be £132 million per year, of which £42.2 million would be on
home glucose tests. The sensitivity analysis results found that changes in the unit cost of home
blood glucose strips (baseline cost £0.27, range tested £0.16–£0.40) in the proportion of
patients already being managed intensively, and the costs of intensifying management, had the
largest impact on the cost of implementation.

***

The study by Jansen also reported that interventions with SMBG were found to be more
effective in reducing HbA1c than interventions without self-monitoring. The reduction in
HbA1c was statistically significant and it was estimated to be around 0.4%. This effect was
increased when regular feedback was added to the SMBG and was shown in both an insulin treated Type 2 diabetes group, and in a group of Type 2 diabetes patients that included those
being treated with oral agents.

***

Pros of self-monitoring:
_ provides a heightened awareness of, and evidence of, the condition
_ when readings are within advised guidelines and fluctuations are easily interpretable,
patients emphasise the positive role that monitoring has in their diabetes management. Low
readings are a high point giving personal gratification
_ cultivates independence from health services and enhances self-regulation.

Cons of self-monitoring:
_ potentially, self-monitoring can raise anxiety about readings
_ blood glucose parameters were found to be problematic by patients when they felt they
were receiving contradictory information about upper thresholds or no guidance about
ideal parameters
_ lack of awareness as to how to manage hyperglycaemia
_ increased self-responsibility accompanied by increased self-blame and negative emotional
reactions to high glucose readings
_ counter-intuitive readings could be sources of distress and anxiety, in some cases
adversely effecting adherence to diabetic regimens by promoting nihilistic attitudes
_ healthcare professionals were not interested in readings.(50)

***

RECOMMENDATIONS
R22 Offer self-monitoring of plasma glucose to a person newly diagnosed with Type 2 diabetes only as an integral part of his or her self-management education. Discuss its purpose and agree how it should be interpreted and acted upon.
R23 Self-monitoring of plasma glucose should be available:
_ to those on insulin treatment
_ to those on oral glucose lowering medications to provide information on hypoglycaemia
_ to assess changes in glucose control resulting from medications and lifestyle changes
_ to monitor changes during intercurrent illness
_ to ensure safety during activities, including driving.
R24 Assess at least annually and in a structured way:
_ self-monitoring skills
_ the quality and appropriate frequency of testing
_ the use made of the results obtained
_ the impact on quality of life
_ the continued benefit
_ the equipment used.
R25 If self-monitoring is appropriate but blood glucose monitoring is unacceptable to the
individual, discuss the use of urine glucose monitoring.

Obviously I haven't copied all the document, so these are self-selected and may be biased! But I would say, reading the recommendations, that they at least could be argued either way, particularly under R23.

I would also suggest that self-monitoring would help our doctors monitor our condition, as they are now being told to rely on HbA1c results. Lower HbA1c means fewer complications eg CVD, amputations etc, and therefore means lower costs in the future. If self-monitoring keeps us interested, self-motivated and pro-active in managing our condition, and keeps our feet on and ours eyes working properly, it has really got to be beneficial all round!

The things I do on a Sunday afternoon :shock:

Go in and argue with them, Spitfire! I don't think they are managing you 'intensively', by the sound of things! and how much 'education' have they given you? The guidelines advocate an intensive education programme, eg DESMOND and more, in an earlier section.

Viv

 

[JUSTFOCUS]

Viv
superb info the question is how can we exersize it .We need solidaritry which is something we dont seem to have anymore.

 

[TheSparkyPony]

Surely a pack or two of test strips is cheaper than treating the complications that arise from poorly controlled diabetes :|
Personally, I think there should be at least an allowance to have X amount of strips a week, or at least maybe a voucher that pays towards most of the cost of buying them? Anything to make it easier.

It's ridiculous this test strip war, it really is. I used to have (up until last year) really poorly controlled diabetes. You'd be lucky if I'd do 1 BM in 6 months :shock: I used to get berated by my doctor, consultant, pharmacist - you name them, they'd tell me off!
Now, I've turned a corner and my diabetes is pretty much spot on, but I now get criticised by my pharmacist etc for using too MANY strips now, I can't win!

Hope you manage to find a solution, Spitfire.

 

[angieG]

"_ to ensure safety during activities, including driving"

I'm sure there is some way this statement in R23 could be utilised more.

I hold Group 2 licences (Coach and Lorry) and am Type 2 tablet controlled. I have had to sign a declaration for DVLA to say that I WILL test at least twice a day and in connection with periods of driving or else DVLA will revoke my Group 2 category licences.
OK no-one wants a coach or lorry careering off the road due to diabetes but I'm sure nobody including the DVLA wants the same for cars!! If it's a requirement for one surely it should be a requirement for everybody.
If everyone that drives raised concerns with their GP's etc that they have had concerns at times about whether they were safe to drive and quoted the above guideline then maybe some sort of rule could be instigated?
Just a thought.
Angie

 

[viviennem]

Reading between the lines, JF, the guideline seems to say - if your GP's on the ball you won't need to test! BUT in my opinion - if your GP is on the ball s/he is going to want you to test!

I'm sure it might be possible to test unnecessarily. For instance, as I eat from a very definite list of foods and meals - omelette for breakfast, salad for lunch - I don't always test because I know how I react to those. But I want to keep testing first thing in the morning, and last thing at night, and after going out for a meal tomorrow night, and a bit more often 'cos I've got a sore throat and I need to understand what happens to me when I get ill - you know exactly what I mean! And so should the doctor! Other people really do need to test, and shouldn't have to pay for their own strips.

All of the above means I will need a minimum of 60 strips a month - maybe 150 every 2 months - and if that helps me stay on target and avoid long-term costs, I don't see why I shouldn't have them.

We could all email our MPs - email addresses available at parliament.uk - and make our point. Also email the Health Secretary.

If they get snowed under, something may happen. Look at the reaction to the Forestry sell-off.

Viv

 

[JUSTFOCUS]

Viv
AS sparky said it's got to be safer than not testing i done a posting about letting people know that if they drive and are over the correct bg there insurance is void similar to drink driving. I mentioned in my post about testing and documenting your results and carrying them with you because the first thing that would be asked had you happen to have crash is (your diabetic it must be your fault)
strangely enough that would be your insurance companies point of view. And also the prosctnr < can't spell at the mo :lol:
Surely this needs implementing as law therefore we should have access to free test strips :idea: OK why don't we e-mail top gear and let them do the pushing :idea: :idea: :idea:
Its all about money they give the meters for free then hammer the living daylight out of the strips ?
could be an opening there!!!!!!!!!!!!!!

 

[Sid Bonkers]

Seems to me that there have always been GP's and trusts that have refused T2's test strips and it will only get worse whilst the country is trying to dig itself out of debt. Thats just the way it is I'm afraid.

But it does upset me when I read newly diagnosed T2's that are diet only saying that they will not bother testing due to the cost. Whilst I appreciate that test strips are not cheap they are essential IMHO to controlling blood glucose levels. But once you have a good understanding of what different foods do to your levels you won't need to test so often, I probably only test 2 or 4 times a week now unless I am under the weather, but I am fairly well controlled at present, obviously if that changes I will test more often but what I am trying to say is that you wont have to test 8 times a day forever, just until you get a handle on things.

Now obviously if you are on insulin or Byreta or some other insulin inducing med you will have to test regularly just to assure you are not going hypo and therefore should not have a problem getting test strips on script but for the diet only and Met takers amongst us you should only have to fund multiple strips for a few months.

It's your health and testing is the only way to gain and maintain blood glucose control despite what some GP's will tell you. Even if you can only afford 1 tub of strips a month it is very important that every newly diagnosed diabetic gets a good understanding of what different carbs do to their bg levels. So please, please if you cant get strips on script buy your own, off ebay if necessary and get those levels down, you might just extend your health and what is more important than that?

 

[bowell]

Dont wish to Pee on anyones Fire But
Gp and PCTs still dont prescribe freely

We have even deeper cuts coming

see below:
Not much has changed


petition the Prime Minister 03 June 2010
http://www.hmg.gov.uk/epetition-responses/petition-view.aspx?epref=Diabetes-Advice


4 May 2007 – A petition sent to No 10 Downing Street.
understand that a government policy is about to be passed limiting Type 2 diabetics to 100 test strips per year.

The Government’s response to the Petition

http://www.hmg.gov.uk/epetition-respons ... tes-Advice

The situation regarding blood glucose testing strips has arisen following the issue of guidelines from the National Institute for Health and Clinical Excellence (NICE) on the management of blood glucose in Type 2 diabetes. NICE advised that in Type 2 diabetes, self-monitoring of blood glucose has not been shown to have a significant impact on long term blood glucose control (HbA1c levels), decreased body weight, reduced incidence of hypoglycaemia or improved health-related quality of life. Some PCTs have taken this to mean that home blood glucose monitoring is not indicated, and have discouraged the prescription of the blood testing strips used in monitors.

However, the NICE guidelines go on to stress that there are benefits from self-monitoring programmes, particularly as part of an integrated self-help package and this is central to the National Service Framework for Diabetes. The ideal, exemplified in the Framework, is that people with diabetes have sufficient knowledge to take decisions in partnership with their healthcare professional about the best regime to manage their condition, including the benefits of home blood glucose monitoring. On the basis of this, Sue Roberts, the National Clinical Director for Diabetes, produced a factsheet for Strategic Health Authorities on home blood glucose monitoring. The factsheet reiterates the NICE advice, and suggests that PCTs may wish to link their strategy on self-monitoring to that on patient education.

A message reinforcing this advice was circulated through the Medical Directors, Chief Nursing Officers and GP Bulletins in February 2005.

Any PCT which is automatically discouraging the prescription of blood glucose testing strips is not acting in accordance with NICE’s advice that self-monitoring may prove useful to people in their overall approach to self-care.

If you have concerns about your own treatment, you should speak to your GP. You can also contact the Patient Advice and Liaison Service (PALS) at your local PCT. This can provide information and advice about NHS services, including information on how to make a complaint.

 

[angieG]

Just been reading an interesting American(?) fact sheet about Metformin

http://www.drugs.com/pro/metformin.html ... 3881c930b5
(Hope posting this link doesn't contrevene forum rules, if so Mods feel free to remove)

in amongst all the informantion it says..

"Information for Patients
Patients should be informed of the potential risks and benefits of Metformin hydrochloride tablets and of alternative modes of therapy. They should also be informed about the importance of adherence to dietary instructions, of a regular exercise program, and of regular testing of blood glucose, glycosylated hemoglobin, renal function, and hematologic parameters."

This seems to be at odds with the 3 or 6 months tests if we don't have strips.

Angie

 

[viviennem]

Bowell, the government response to the petition seems to support the case for SMBG, provided each person is willing to argue his/her case. 'Every diabetic is individual' - how often do we say that on here?

'No blanket policy by PCTs' is a useful comment in the response. That seems to be on our side, too. If you can argue your case that you should get them (strips), they should be made available. After all, no one should be testing just for the sake of it. We should all know why we test and what we hope to achieve by it - and that's what our HCPs are supposed to be 'educating' us to do.

I'm not having problems getting them at the moment - but I have had a comment to the effect of 'test as little as possible, they are expensive'. So I'm marshalling my arguments.

For instance, just tested 2 hours after chicken/leek/mushroom in a cream sauce, and a cheese sandwich with one slice of wholemeal multi-grain bread. 7.1 - higher than I like, though within target range. Doc would say it's fine! I still have this sore throat hanging around - so I think I should be testing regularly at the moment, to find out what an infection does to me!

A lot depends on building a good relationship with your GP. I always try to see the same one, but I think I'm very lucky with all three of our practice doctors. At least they listen, to a greater or lesser degree!

Viv

 

[bowell]

Hi viv

Im lucky or unlucky depends how you look at it
My own heath position has changed from Feb 2010 not related to diabetes
A new Gp gave me 50 stips a month
however due to other drugs and interactions , I now get all the test strips i can eat.

Before that i had to get all mine from ebay just got fed up with fighting them :twisted:


Pain Consultant that prescribed them for me ,Sent letter to surgery and DSN
right out of the blue

 

[viviennem]

Have a look at the thread called 'Thank Goodness for Being Informed'. Phoenix has put a link on there about the results of some American studies that say something to the effect of 'a patient . . taking aggressive control can really reduce the incidence of complications including kidney disease . . .'

I meant to write the link down, so I'm going to do that no.

Viv

 

[cugila]

Anybody having trouble getting test strips or having them stopped should read the thread in Greetings and Introductions that Sue and I put together........'TIPS FOR STRIPS'. Plenty of ammunition to throw at your HCP's.......petitions and protests are all very well but most people have to deal with this on an individual basis, so the more you can argue the case the better, politely of course ...... :twisted:

See here :

viewtopic.php?f=20&t=19002#p173253

 

[spitfire]

Thank you all very much for your informative replies they are very helpful im off back to the docs now to argue a few little points will let you know how it goes thank you all once again.

 

[noblehead]

Thank you all very much for your informative replies they are very helpful im off back to the docs now to argue a few little points will let you know how it goes thank you all once again.

Good luck spitfire!

Nigel

 

[Harbottle]

Spitfire, I see there is no follow up on how you got on.

I ask because I have asked for test strips today and have been denied them. I have been funding them myself for the last two years and although I'm not on medication my Hba1c has just risen and I feel I need to keep tighter control.

 

[kareng236]

I was diagnosed as Type 2 at the turn of the year and prescribed Metformin. I have been border-line for two years. Both my parents were diabetic so I have some prior experience of the condition. Surprised that the doctor kept pooh-poohing the idea of blood or urine testing. The same old chestnut that you are all hearing - that Metformin does not cause hypos - so no need to test. I have pointed out on several occasions that I am not even considering hypos - I am more concerned about high readings. I have had two good HBA1C results - so my Doctor will have even less reason to feel inclined to have me do blood tests. I am getting good results because I am terrified of eating anything containing carbohydrates - which is almost everything. I realise we need carbohydrates in our diet - but without being able to experiment with foods and take blood tests - how are you meant to know? I asked one of the nurses at the practice and it transpires that it is indeed a cost cutting exercise.

 

[JUSTFOCUS]

Hi again
my DN told me that if i was refused test strips i should get in touch with her ,The reason being that i have really changed my life style and done 99% of things to help my own health .This was a good boost of confidance .I am allways honest with her and the more i'm doing the more she's backing me ,it really makes it worth it getting good feedback. Try telling your gp that as you drive with children in your car would they be happy to do that with there children without testing ??
Put it in writing and post it recorded . Hope this helps as it's important.
Good luck and please post back how you got on .