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Blood testing strips, type 1's and the NHS

My doctor has changed all my prescriptions to cheaper alternatives, like levemir to abasaglar, and b-microfine to braun, however, I asked to keep my 150 strips per month because I test often to make loads of corrections so I can be as non diabetic as possible I said take away my strips I will not have great control, she said ok I will keep you on 3 boxes, I wouldn't mind I reduced my needles to 2 boxes instead of 3 for them and agreed to cheaper alternatives, the aviva nano strips I have can be sourced for £11 a box online dont see a problem, could just die might be cheaper for them

They wouldnt say boo to a vulnerable drug taker who is getting better but not really, but a type 1 diabetic whos fault it is not to be diabetic they will.... pfft
 
Dixon1995 said:
My doctor has changed all my prescriptions to cheaper alternatives, like levemir to abasaglar
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You might want to have a conversation about that. Abasaglar is Glargine and is proven to be more variable and increase severe hypo risk versus both Levemir and Tresiba. In your position I would be saying no to that. If you want some links I can provide them to you.

I also think you should change GP with the attitude yours seems to have.
 

I knew Levemir was a Detemir and Abasaglar was Glargine, it made me laugh when my GP said its the same thing. I did query it but she was very evasive about the whole thing, and her excuse was that Levemir is the most costly and that there is an increased demand for it. To be honest with you, I am happy on the Glargine as I have been on it before I know how to control it, but god imagine someone who started on Levemir to be told its the same as Abasaglar, it could lead to serious issues as you said with hypos!

I agree my GP is pathetic, but they all have the same attitude in my local, she also moved me from the care of GP surgery to the care of the Diabetic centre on hospital, so at least I will be seeing a Endo Doctor

I have since sent a suggestion into that surgery to be looked at
 
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It is very concerning that a health care professional thinks they can swap basal insulins like this. For some people the difference between glargine and levemir may be the difference between good control and no control, all for a relatively small difference in cost. Can you notify the consultant at the hospital clinic, or take this up with diabetes UK?
 
Dixon1995 said:
she also moved me from the care of GP surgery to the care of the Diabetic centre on hospital, so at least I will be seeing a Endo Doctor
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I think this is very good.
If there is a problem with the insulin (or test strips) your GP has prescribed, you should have the support on the endo doctor to overturn this. The Endo should know how to manage diabetes much much better than a General Practitioner.
Hopefully, you get an appointment with the Endo soon.
 

You're correct an Endo is much better at managing diabetes than a General Practitioner, the GP was more bothered about managing money. Surely they should know from the Notes on screen, knowledge and 20 years worth of learning and experience that Detemir and Glargine are 2 different medicines and could have different effects, or that 2 different insulins are different, I mean she had an insulin chart on the wall. To me it came across as if the GP has seen the word BASAL and just assumes that is it
 
very recently I managed to get my GP to up my repeat to 250 strips a month. my improved hba1c and obsessive paper charting helped the argument.
 

Hi, i expect you are in London, the situation there is not yet so fraught, most of the changes are coming in to other areas, i have been told that the doctors here no longer have the final say on prescribing, it is the pharmacist, who works with the CCG and one who works with the practice and/or the CCG, stuff can just go from your prescription, type 2s are faring the worst here, and type ones who are not in hospital, but soon whatever hospital letters you have will be redundant unless renewned within the last year - this is going to drive hospitals mad, i imagine, and in this area, from a council meeting, i can see that soon hospitals will have to speed discharges back to GP, all areas were being talked about. in some depts there is such a rush to discharge that there is not even one follow up to see how the patient is managing.
 

Hi @ann34+, whilst that may be the case, we're facing the same CCG idiocy about not understanding the health economics here. Every time that someone using Glargine ends up in hospital or calling out an ambulance, the cost of the cheaper insulin is overridden multiple times by the cost of simply an ambulance call out.

As an example:

An annual supply of Glargine for a type 1 using 30u a day (a not unreasonable average) costs £113.31. The tresiba equivalent is £139.8. (I'm using Tresiba because I don't have the data for increased hypos of Lantus compared to Levemir, but do for Tresiba).

Tresiba is therefore 23% more expensive.

However, as the SWITCH1 trial showed, when you are using Lantus you are one third more likely to have a severe hypo that will need an ambulance call out and may result in hospitalisation than Tresiba.

In real terms that's one severe hypo annually. Or in other words, it costs an additional £240 per year to call an ambulance to deal with that hypo.

On the Tresiba, it's likely to happen once every 18 months, or in other words, it costs £160 per year.

The cost saving of using Lantus over Tresiba at a prescription level is £26.49 per year, so the increased ambulance call out cost (£240 vs £160) means that Lantus really costs at least £53.51 per year more than Tresiba. And that excludes any hospitalisation as a result of the ambulance call out.

My point? It's worth delving into the health economics of any decision that a CCG makes and digging through the data, as it's very easy to make it clear to them that their policy not only costs more, but is demonstrably negligent in its outcomes, and CCGs don't like either of those things.

Feel free to use this analysis with your healthcare team to make your point.
 
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Good point well made. Probably a rhetorical question, but is the same person responsible for both budgets?
 

Hi, Tim, yes, very good point, i ticked agree under your response a while back but i have a number of non diabetic health probs at moment, i am sorry i have not got back sooner.
When issues are clear cut, as in your example above, i imagine the CCG might respond to the logic. But when issues involve factors like quality of life, what other health problems people may have, etc - which used to be regarded as importent - i am not so sure. There seems not much interest in a population's overall feelings of health and wellbeing , even if, in the long term , this has/will have an important bearing on CCG costs.
Regarding Sheba's important point, i do not know, but, from my own experience, i am pretty sure an ambulance call-out does not affect the surgery budget, and i am unsure regarding the CCG budget. Why do i say this? My surgery seemed unconcerned re my ambulance callouts, often never even discussing them.. No one phones me next day etc, as used to be the case, and a number of times the surgery does not even know of them. There does not apppear to be time to collate information in the surgery - i have learnt that the patient must do extensive work.
i would now advise anyone, especially if they are over 65, who is feeling very ill, and whose surgery is reluctant to refer for what could be a serious issue, to call an ambulance . This may not work in every case - i went through hell when i was not diagnosed with a bone break due to , probably, strict rules regarding when MRI can be used in A and E, but at least one gets a basic blood test done so potentially serious electrolyte and blood problems can be picked up.
 
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I have just been diagnosed with Type 1. I am testing at least 10 times a day in order to understand my condition and my body. I am negotiating with my local NHS trust about the cost v benefit of the Freestyle Libre v strips. I must say the NHS have been amazing over the last couple of weeks from my original ketone problem, my 111 HbA1c and now 7.8 average in my 2nd week. without regular testing this would not have been possible. As its an auto immune problem and not lifestyle caused I believe we all deserve as many strips as we believe necessary to manage the condition or access to at least a trial of the Freestyle Libre system.
 
I used to barely test to be honest. It was bad of me but I wasn't off the rails or whatever, just used to sit around 7-9 all day every day so just stopped checking it as I could always feel when I hypo'ed anyway. Now, I test frequently 6 times a day roughly. . Had a little scare I guess a few days ago where I was in the 2s on consecutive days and didn't even feel it both times though and that accompanied by the fact I have about 5 or 6 hypo's a week these days has made me test even more the last couple days. I tested 15 times yesterday for god sake out of worry that I'm going to hypo and not feel it. Could worry that the doctors will moan at me for the rate I'm going through these testing strips but screw it, It's my health, and I don't care if I'm costing them a little bit of money going through a box of 50 a week, I saved them money when I used to only go through a box a month when I wasn't testing very frequently.
 

This is how things should be, you are using what you need, numbers which may not be the same every day, to keep yourself well. None of us tests for the sake of it. But some areas are setting limits across the board, and then individuals who use more than these miniscule numbers are 'flagged up' - that was the word used to me - strip numbers i have been using for literally decades, which have kept me diabetically well are now being questioned yet again (i have been through this at least 3 times before, but this time seems more unpleasant, especially as i now have several other autoimmune problems).
 
I am in Scotland and the pharmacist I go was asking do I need blood strips so often,I said it depends on my blood sugar levels. Pharmacy even asked if one lantus pen could do me a month
 

I agree with most of what you say but even if it was caused by 'lifestyle' surely any tool that will help you combat it should be given to you albeit not excessively as there are costs? A type 2 for example deserves help to improve their health, you cannot say 'no, you caused it yourself', firstly because that is not true as there are many reasons, and secondly how unethical that would be, do we stop treating smokers/drugs users/non exercisers/fat people in general/drinkers and so on?
 
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