Access to test strips - can you logically answer 'no' to these questions?

[Dillinger]

Hi,

As a Type 1 I don't have issues in getting test strips for which I'm very grateful. I know a number of Type 2 diabetics are told that they shouldn't test. As far as I can see that must be a combination of short term costs and the generally very poor results that diabetics get following traditional nutritional advice (so that the HCPs essentially give up).

I thought I'd write out some questions/statements for your HCP so that if they were to answer 'yes' to each of them would logically result in only 1 outcome; the provision of test strips.

Can anyone find a way to say 'no' to any of these? I think it would be pretty hard to do; what do you think?

We might be able together to come up with response to the 'we don't prescribe test strips/they don't help' school of thought?

The HCP challenge - do you agree or disagree with these statements:

1. The HbA1c test shows what our blood sugars are like on average.

2. The lower our HbA1c levels are the lower our risk from complications are.

3. In order to lower our HbA1c levels we need to reduce our blood sugars over time.

4. An HbA1c result does not give information on individual spikes in our blood sugar levels.

5. Food is the major contributing factor to raised blood sugar levels.

6. Some foods have different effects on our blood sugar than others.

7. We cannot accurately tell what our blood sugars are at any given time.

8. In order to monitor what the effects of different foods are we need to test our blood sugars.

Given the above we need to be able to test before and after meals.

Best

Dillinger

 

[satindoll]

I think you left off an important question 8. Do you want to reduce overall diabetic costs and costly complications.
I'm a lucky t2 I get my strips on script.

 

[sanguine]

Nice one @Dillinger

3a (or maybe an alternative to 6) - HbA1c tests do not help in determining short-term variation, especially high amplitude spikes. The mitigation of these spikes is also essential to good control.

 

[satindoll]

Nice one @Dillinger

3a (or maybe an alternative to 6) - HbA1c tests do not help in determining short-term variation, especially high amplitude spikes. The mitigation of these spikes is also essential to good control.

OOOOOO get you with the long words, er what

 

[sanguine]

OOOOOO get you with the long words, er what

'Complications' is longer than any of mine lol

 

[Loobles]

I do hope somebody tries this out and lets everyone know if it worked

I've no chance of getting them being pre-diabetic yet, ironically, my GP thinks it's a really good idea to test....you know, since I'm paying for it.

 

[satindoll]

'Complications' is longer than any of mine lol

Yeah but only just and I had to get the dictonary out to spel it

 

[phoenix]

Devils advocate
1) Doctors often (so we are told) suggest that there is nothing that people with T2 can do about the levels so therefore is no point in testing. They may even say this makes people depressed and they can point to the evidence to this (Farmer et al)
( I also suspect that many doctors can attest to the uselessness and waste of resources involved in merely of testing and writing the answers down

I think that you should pre-empt this by saying what could be done ie lowering portion size, changing/eliminating foods, introducing or varying types or timing of exercise etc

There is some evidence that structured testing aimed at addressing these issues is effective (unfortunately but not surprisingly by Roche).

Polonsky WH, et al. Structured self-monitoring of blood glucose significantly reduces A1C levels in poorly controlled, noninsulin-treated type 2 diabetes: results from the Structured Testing Program study.
Diabetes Care. 2011;34(2):262-267
Review of structured testing
Self-Monitoring of Blood Glucose: One STeP Forward?
Wendelin Schramm, M.D., Ph.D
Diabetes Sci Technol Vol 6, Issue 4, July 2012

@sanguine:
Not sure that pointing out eliminating short term spikes is particularly useful (it is extended periods at higher levels that have a big effect on HbA1c).
Whether this it is beneficial to focus on them is undecided and very controversial with many paper and debates on the issue.
Case for and against a relationship between postprandial hyperglycemic variability and complication risk
http://care.diabetesjournals.org/content/36/Supplement_2/S272.full

 

[satindoll]

Devils advocate
1) Doctors often (so we are told) suggest that there is nothing that people with T2 can do about the levels so therefore is no point in testing. They may even say this makes people depressed and they can point to the evidence to this (Farmer et al)
( I also suspect that many doctors can attest to the uselessness and waste of resources involved in merely of testing and writing the answers down

I think that you should pre-empt this by saying what could be done ie lowering portion size, changing/eliminating foods, introducing or varying types or timing of exercise etc

There is some evidence that structured testing aimed at addressing these issues is effective (unfortunately but not surprisingly by Roche).

Polonsky WH, et al. Structured self-monitoring of blood glucose significantly reduces A1C levels in poorly controlled, noninsulin-treated type 2 diabetes: results from the Structured Testing Program study.
Diabetes Care. 2011;34(2):262-267
Review of structured testing
Self-Monitoring of Blood Glucose: One STeP Forward?
Wendelin Schramm, M.D., Ph.D
Diabetes Sci Technol Vol 6, Issue 4, July 2012

@sanguine:
Not sure that pointing out eliminating short term spikes is particularly useful (it is extended periods at higher levels that have a big effect on HbA1c).
Whether this it is beneficial to focus on them is undecided and very controversial with many paper and debates on the issue.
Case for and against a relationship between postprandial hyperglycemic variability and complication risk
http://care.diabetesjournals.org/content/36/Supplement_2/S272.full

Don't know what all this means but I do know that some commissioning groups are holding back on funding for us t2's, my daughter has been trying to persuade the group she manages to approve funding for more t2's to help them get their lives on track, costs less in the long run she could quote the numbers blindfolded, but was so fed up with their attitude she has now moved to another more open minded group where she can hopefully help improve the lives of many more diabetics of all types.

 

[sanguine]

@sanguine:
Not sure that pointing out eliminating short term spikes is particularly useful (it is extended periods at higher levels that have a big effect on HbA1c).

Yes but we're talking about the benefits of having test meters and strips provided, and eliminating big spikes is one of them. According to Jenny Ruhl the kidneys are impacted by wild fluctuations worse than by steady levels. If we only had HbA1c you would never get to see or manage that detail.

 

[satindoll]

Yes but we're talking about the benefits of having test meters and strips provided, and eliminating big spikes is one of them. According to Jenny Ruhl the kidneys are impacted by wild fluctuations worse than by steady levels. If we only had HbA1c you would never get to see or manage that detail.

Nearly posted GO GIRL, der, YO MAN

 

[JohnD54]

Another view put to me by a pharmacist that I know, when I told him about having been diagnosed with Type2 and asked his opinion, he advised that I go away ( very nicely) and do some research.

This I did and ended up here after a couple of weeks, decided on a sort of LCHF and extra exercise regime.

Met up with same pharmacist a couple of weeks ago and he asked me how I was going on, apart from the obvious fact that I had already lost approx 1.5 stone he said. Told him about my new regime and that I expected to be able to live this way for life.

We then had a quite lengthy discussion about diabetic people that go to his Shop to have their scripts filled, and he advised me practically no one EVER asked any questions, just pick up script and leaves, he see's people's intake of drugs for diabetes just continue to elevate until most end up on insulin and we all know what happens from there.

Regrettably to say I feel a majority of people don't look for an alternative way of dealing with this problem, and just continue taking the drugs that are given to them. The answer should be to properly educate people, but this is the same for all things
Education and awareness, it's easy to blame the establishment, but quite often it's for us to take responsibility for ourselves.

Thanks heaven we appear to have the later type of people on this Forum.

Excuse the verbal diarrhoea.


Sent from the Diabetes Forum App

 

[Dillinger]

Devils advocate...

How about being a diabetics advocate?

I think everyone on here would agree that test strips are essential. Yet time and again we hear of people being refused them or dissuaded from using them.

Uninterested diabetics won't do anything about the information they provide, but by definition almost if you are on here asking questions you are interested.

It's easy to be intimidated by the arguments from authority that are presented by some HCPs but that doesn't mean that those arguments are any good.

We're just trying to provide some ammunition for people to use.

Best

Dillinger

 

[eddie1968]

As a Type 2 on insulin I get my meters and strips free of charge from my Diabetes Clinic. I don't really care for both sides of the argument because it all boils down to the cost of prescribing such equipment to type 2's on oral meds or diet alone. The NHS could not shoulder such a cost and this is why GPs are reluctant to go down this road and solely rely on HbA1 tests. I wish the health care system in the UK was an Utopia but it is not. Type 2's will always get the raw deal and people will go out of pocket buying equipment and expensive strips.

 

[phoenix]

@Dillinger:
Haven't you heard what people report back when they talk to the doctor?
I've even heard people make the quote about getting depressed. They don't realise that comes straight from the Farmer trial and also from the conclusions of the NHS review.
The only let out clause in that NHS technology review on SMBG which is very much a cost benefit analysis is in the context of education and doing something with the strips .So I would demonstrate how one can make use of them in the most cost effective manner
( as was successfully done in the accu check trial)
It was not intended to be negative criticism .

 

[minidvr]

I purchased my own machine and strips, because it was patently obvious that my doctor and DN are anti-testing for type 2.

I can afford to do this. How many T2 are not able afford to do this?

 

[eddie1968]

Minidvr, I did it for years, must have cost a lot of money. Yes you and me are spot on, GPs and Practice nurses and some DSNs are "anti-testing".

 

[minidvr]

My GP was adamant that I didn't need to test. The DN said it was unnecessary toeing the practice party line I think. When I told her that I'd bought a test kit, she at least showed me the correct way of using it, but still muttered about it being unnecessary.

 

[satindoll]

I am t2 Insulin dependant, luckily my Dr was enlightened enough to give me a meter and strips on diagnosis before I even went to the hospital as he said if I didn't know what was happening when it happened or why from the start how the hell was I supposed to understand later, in fact the hospital dr said it made their life easier as they had an idea of what they needed to do to help me. and of course by then I'd got an idea of what foods upset my numbers so tweaking my diet was made a lot easier.
I feel sure if all newly diagnosed patients were given a meter and strips and diary and had it explained to them to do the before and x hours after tests they would benefit from it, a simple hymn sheet with instructions would suffice and at least give them reassurance that they are not looked on as twerps and a good start to the life changes they will have to make either on or off the jabs.
Even if it turns out they need only oral meds, keeping a tight reign on those numbers from the start can mean the difference between a long and productive life or a living an on the edge existence. and less excuse to whinge especially when they know they are not doing the right thing.

 

[minidvr]

I think that my Doctor was quite patronizing towards me. He seemed to think that T2 was due to a lifestyle choice as I was a bit overweight. When I mentioned family history, Father died from diabetes complications, both siblings type 1 for last 15 years or more, he said, Oh, there might be a genetic link?? Well of course there is. Diabetes is known to run in families. The fact that I'd avoided it so far too age 64 was probably due to a very active life until I retired.

Medical staff tend to think that they know best, and in some cases they do, but I see a bit of a them making an assumption about us, sometimes without any justification whatsoever. And as for compassion, that was left at the bed of the first patient who vomited on them.