New Guidelines ?

[Jimbo1973]

Had a nice letter from the doctor this morning and now i'm immensley confused. Here's what it says

Dear Mr Oliphant

The latest guidelines for Diabetcs indicates that it is NOT necessary for patients who are diet controlled or are on medication such as metformin alone or with Rosiglitazone or Pioglitazone, to test their blood using a home monitoring kit.

The reason is that the blood test carried out at the surgery gives the doctor all the information needed on how well your blood glucose is being controlled. The test usually done is known as HbA1c and it showsthe long term measurement of glucose in the blood.

Home testing is therefore a painful and pointless exercise for the above type of patient. With this in mind as of the 1st of January 2009 the surgery WILL NOT supply prescriptions for either blood testing sticks, lancets or sharps bins for such patients in the future unless your treatment changes These items will therefore be taken off your repeat.

It is however important for you to attend a diabetic clinic at the surgery regularly where your blood can be checked and a full assessment of your care can be done.

The surgery believes in providing the best medical care and advice for their patients according to the latest available evidence with regard to safety and efficiancy. The doctors would like to to thank you for your co-operation.




Now i've gone and had a good nosey about this morning, and cannot find anything to support this "evidence". The main thing that annoys me is that my Dr advised me to go out and buy a monitor when first diagnosed so that i could keep a very detailed and accurate food diary to record what was causing the really bad high's I was having. I was at the Dr's just before xmas with high BM's and diagnosed with a throat and chest infection, where my Dr also suggested I test daily for the 7 days I was on antibiotics !!

I'm stillwaiting for the Diabetic Care Team to contact me, no sign of contact from the dietician as was promised and now the surgery wants to manage all my Diabetes care instead of the "specialist" team that have so promised to keep in contact with me.

So - where do I go from here, shouldI kick up a fuss and demand these or do I just roll over, give up and let y Dr now take care of all my Diabetic needs ?


Jim

 

[tubolard]

Jim,

There is certainly no evidence to suggest that NICE guidelines have changed since the middle of last year. PCT interpretation of those guidelines may have.

As I understand it, PCTs have chosen to interpret NICE guidelines to mean that those of us on diet only or metformin need only test 2 to 3 times a week, however, testing should be stepped up when ill, changing regime or when feeling hyper.

Regards, Tubs.

 

[sugarless sue]

Check out NICE guidelines Jimbo,

http://www.nice.org.uk/Guidance/CG66/Pu ... oc/English

specifically this section,

Checking your own blood glucose
If you’ve just been diagnosed with type 2 diabetes, monitoring your own blood glucose levels (self-monitoring) should be discussed as part of your structured education programme. The programme will cover how to check your blood glucose and how to interpret and use the results.
Self-monitoring of your blood glucose, with appropriate equipment and information to help you use it effectively, should be recommended if you:
• use insulin therapy
• use certain oral medications that may put you at risk of hypoglycaemia (low blood glucose)
• need to check changes in glucose control caused by changes in medication or lifestyle
• need to monitor changes during an illness
• need to make sure you are safe to carry out your normal activities, including driving.
At least once a year, your doctor or nurse should check the way you are self-monitoring and using the results, and your equipment, so you can carry on getting accurate and helpful results.

No,don't roll over,make a fuss! It is your right to manage and control your own diabetes successfully!

 

[sugarless sue]

I would be far more anxious if I could not test my blood sugar levels when I want to!!Testing certainly does not make me anxious.

 

[hanadr]

It's the same stuff as I get every time I moan about it.
I certainly NEVER received any education and when hunting it up, found it doesn't happen in my PCT. They DO employ 2 diabetes educators though.( and an administrator)
Whether 2 underemployed people on good salaries or some motivated diabetics, who want to test, waste more money, I cannot calculate

 

[sugarless sue]

That is precisely why I test. I know many type 2's who are quite happy not to test and that is their choice.For those of us that wish to test then that is also our choice and we should be allowed and encouraged to do so.

 

[Thirsty]

The attitude at my clinic, (I can't be too far away from Jimbo), seems to be that they'll only prescribe testing strips and lancets if you're at risk of suffering hypos. Gliclazide can (and has) caused my BG levels to fall to dangerously low levels, so my GP is willing, if reluctant, to prescribe limited amounts of test strips. As I understand things, metformin is highly unlikely to have the same effect, so Jimbo may well have have trouble getting his testing gear on prescription.

It would help if the strips weren't so ludicrously expensive. £25 for 50 strips? I smell a big, filthy rat!

 

[fiona35]

Hmm wonder where I stand, I take Metformin, pioglitazone and Byetta but technically this is not insulin but I still have to have needles on prescription so presumably I can keep my sharps bin but not have my test strips which incidentally I had to fight for last time!! I wouldn't mind paying if they were a bit cheaper but I had a shock when I ran out some years ago and the chemist quoted me £21 for the 50 strips - gulp!!

 

[The Governor]

I have to say I find the proposition that you aren't allowed to test intensely annoying.

Having achieved fairly good control now I only test at night before supper and doing so has shown me that my levels can vary between 4 and 6.6.

If I'm 4 I eat, if I'm 6 I have hardly anything.

I do the odd bit of testing during the day every week and half or so and shows me my "normal diet" is controlling my levels well, supper is the only variable meal I have based on what level I am.

It would be difficult/impossible for me to assess this without testing and I'd seriously resent someone taking that freedom from me.

 

[mind_doctor]

if its a case of paying £25 for 50 test strips, i would rather pay myself if my gp stopped prescribing. when i gave up smoking i personally chose to pay for my nrt as it cost far less per month for the lozenges than it cost me over a few days for packets of ciggies.
ok one could argue that smoking was a choice thing and i should pay to stop, whereas diabetes dosn't come through choices.

however my peace of mind does.

there is also a thing called "valid consideration", if we invest personally into somthing then we have a greater chance of looking after what we invest in. its why we therapists rarely offer our services for free, it dosn't work.
£25 would not even cover a week when i smoked, test strips it would be just over a month, no contest really.

i certainly did not choose diabetes, i am not overweight, i am not even over 40, so i guess i am one of the unusual ones. however if i have to pay then so be it. i'm worth it!!! 8)

 

[Thirsty]

mind_doctor, you're already paying for something that the politicians won't allow the quacks to prescribe.

Now, this is old news but, don't you think that some people are rather overpaid?

Have a look around the forum and see how many members are less than happy with the National Health Service.

 

[hoolyuk]

Im in N Ireland and as prescription charges drop to £3 from tomorrow i'd expect the testing strips to come off my repeat prescription before much longer. At the minute 50 strips does me about a month, i suppose if i was paying full whack i'd make them do 2 months.

 

[mind_doctor]

hi thirsty,
i am not quite sure what you mean when you say i am already paying for somthing that politicians don't allow quacks to prescibe.
if you are reffering to my nat ins contributions, well thats for the good of the masses and i'm ok with that anyway. if you were to go into a serious hypo then i'd be ok with the ambulance picking you up and taking you in for treatment.
if you mean prescription charges then i don't pay them anyway. we in wales have no charges for any scripts.
also my gp is prescribing strips and stabby sticks along with my oral meds and there is no indication this will stop either.
i am in no way defending the nhs, i think it is in a diabolical state of affairs. i used to work within the nhs on psychiatric wards and the shifting of funding from mental health to general was absolutely disgusting, however thats a different story.
i do believe that for my own peace of mind i would rather pay for my strips and sticks than not have any at all, also i would rather have to pay for them if it meant someone with a life threatening condition that needs immediate treatment were able to get what they need. its a matter of priority.
i understand there is a cancer treatment on the market that is proven to slow down the effects of terminal cancers, however people cannot get this on the nhs becase its too expensive at £2000 per month. i'd give up my "free" strips and stabbers for those who needed it, wouldn't you?
the arguement of people being paid too much, well one tends to find that those who are paid lots have extremely precarious roles whereby the actions of others can spell ones own downfall. also decisions that have to be made have serious effects on others. i don't begrudge the pay for loaded responsibility.
my original point was just £25 per month for peace of mind is a small price to pay, considering the toxic rubbish a lot of us have put into our systems for many years, 2 and a half pints of beer a week.
respectfully, mind_doctor.

 

[Manogwent]

Hi Jimbo, I would definitely query this as seems to be contradictory in that GP says test and practice says no. seems to more cost cutting than medical reasons. down here i seem to be getting help needed although missing out on dietician as was told practise nurses do this. i would definitely push again, nicely of course, to find out what's going on with your appointments. i was DX in nov 08 and i've managed to get a tester + strips, had eye test and feet looked at so think doing well. go back for more test in Jan . see diabetic nurse and GP in Feb so hope Hba1c has gone down. think all the regulars on here would tell you to push for getting your gear back as they are expensive without scripts. i get free ones as got that magic number ( 60) what a relief!! in the words of catherine tates granny "wharra*******liberty" in taking away your control of your condition, TAKE IT BACK!! and best of luck in doing so.

 

[Jimbo1973]

Thirsty - Your right, im not a million miles away from you, i'm in Bolton.

Ive queried this with the surgery, and the answer from the receptionist, according to the notes made by the Dr, is that he wants to control my Diabetes now rather than the clinic. Ive read the NICE guidelines and CANNOT see anything thee that suggests I should not self test, after all it was my Dr that suggested this in the first place after coming oout of hospital.

I've felt really lethargic for a few days, not sleeping at night and guess what:High BM's again - despite eating sensibly all over xmas, OK i had a small piece of xmas fruitcake, I had a reading of 22.4 yesterday when i felt my worst- this is the reason I self test.

I've had my eye screening and feet test, and am at the PCT clinic next wednesday for my first HBa1C, and a few more tests apparently - i'll discuss this in great detail when I get there


Jimbo

 

[Trinkwasser]

This is obviously complete and utter ****. Expect to see much more of the same in future, after all they have to find some way of paying for all those nice new adverts telling you to stop being fat and lazy eh?

I've NEVER been permitted prescriptions for test strips due to local policy but quite frankly they were essential to my control, especially at first. NOW I don't test much but that's only because I tested a lot at first and now I know what I'm doing.

They DO employ 2 diabetes educators though.( and an administrator)
Whether 2 underemployed people on good salaries or some motivated diabetics, who want to test, waste more money, I cannot calculate

Since even Kaiser Permanente (who are not noted for spending their hard earned profits on healthcare) think testing is cost effective

http://care.diabetesjournals.org/cgi/co ... /29/8/1757

and other papers by Andrew Karter

then it **** well must be, unfortunately the NHS/NICE/PCTs are moving rapidly in the opposite direction