I've Just Got A Letter ?

[pinky]

Hi there it's PINKY here again
I've just got a letter back from my senior practice nurse and I quote--



I was given your letter to respond to in regarding the provision of lancets and strips for your monitor. the PCT have advised us that we should not provide strips for patients who are not on insulin or about to go onto insulin, as taking tablets for diabetes dose not allow you to change what you take as they last for the 12-24 hours. The METFORMIN in particular do not cause hypo's (very low sugars) We do monitor you regularly your blood test are done at least twice yearly and advice given regarding the results. We can how ever provide you with urine testing strips which will show if you have an excess of sugar in your urine 2 hours after eating and give you a fairly good guide as to your control in between your appointments.
your last HBa1 was 7.4% which is steadily going down to 7% needed for good control..



this was most of the letter that was sent to me first since my first blood test I have had 4 and it was on the last test that she put my tabs up to 3.... I'm due to make another appointment mid July for two sets one for diabetes and one for liver and kidney functions so from the start she has got it wrong....! what I'm confused about is this NICE guild lines dose it have any balls or not if nobody is going to take any notice then why write it I've got a meeting with the DESMOND group to talk about it on this coming Wednesday so I will be asking lots and lots of question....!!!!! and I've just found out that one of my local Councillor is on a medical comity so I will be sending her a few Emails very soon please do keep your help coming in and may be in the coming weeks I may have some good news and not the answer NO ! thanks alot PINKY...

 

[Northerner]

...the PCT have advised us that we should not provide strips for patients who are not on insulin or about to go onto insulin, as taking tablets for diabetes dose not allow you to change what you take as they last for the 12-24 hours. The METFORMIN in particular do not cause hypo's (very low sugars) ...

Well, I'm sorry but this is nonsense. You may not be able to fine tune your levels by using insulin, or adjust your metformin to improve things, but you CAN monitor the effects of different foodstuffs on your levels and make appropriate adjustments to that! Having blood tests twice a year won't tell you which food you need to reduce or cut out of your diet and what is OK. That's the whole point about testing in the early stages after diagnosis, so that you learn how to tailor your diet to your own body's particular tolerances whilst at the same time retaining flexibility in your diet. Urine glucose strips, to my knowledge, will only give you an indication of high levels when your blood sugar is above 10 mmol/l, which can be of some use, but is saving pennies really in the scheme of things.

Keep at 'em! 🙂

 

[trophywench]

Pardon me for mentioning this in response to what an exalted and knowledgeable HCP has stated, but I simply feel the need because I wouldn't want you or anyone else believing what she said !


To test the glucose in your blood 2 hours after a meal, you need to test Urine 4 hours after the meal because it's only an indication of what glucose might have been in your blood 2 hours ago, though that timing of that could of course easily vary up or down, just depending on whether you had a high or low renal threshhold instead of a normal one!


I can tell that Somebody doesn't seem to know what the hell they are talking about, do they? Doesn't even know how Urine testing strips work. Parlous. Still - to be fair, they've only been around for over 40 years so I spose she hasn't had time to learn yet .....

Unless of course they have re-invented them?

 

[slipper]

My relationship deteriorated rapidly when I told my nurse I wasn't happy testing just twice a week. She actually told me off and made me feel unreasonable, strips were not for peeps like me who can control their BG, type of comment!!!!! How does she think I am controlling it?

Spoke to my GP, who ok some more strips, but I just know there may be trouble ahead with boss GP and the nurse.

 

[jalapino]

This sounds to be a pretty common thing im hearing a lot, im down to just one tablet a day now metoforim after i told my nurse i stopped taking them as diet seems to be working for me so i was given the bg monitor, this was her idea and has asked me to keep using it until i see her next apx 3 weeks and it really helps for example yesterday pre breki was 6.6 two hours after breki 9.9 before bed last night was 12.8 which was odd because i had not eaten for 4 hours, but at least i can monitor my blood, as northerner says it's about the pennys

 

[Katieb]

...and isn't it wrong to say that those on Metformin don't have hypos??? I thought they could, or have I got that bit incorrect?? Katie

 

[Northerner]

...and isn't it wrong to say that those on Metformin don't have hypos??? I thought they could, or have I got that bit incorrect?? Katie

I think it is highly unlikely, but not impossible to have a hypo whilst on metformin, but not due to the metformin lowering levels too low - rather it would be dependent on other things such as physical exhaustion or 'special' physical reactions such as those experienced by Lucy123.

 

[trophywench]

They are not SUPPOSED to give hypos. Anything you read tells you they don't.

They are not on the DVLA list of hypo-inducing agents.

Of course, we hear that quite a few peeps do have em and that's all they are taking - but I have to say - only usually when they have their D & E sorted and aren't getting high BGs most of the time.

Plus from what I understand, these are usually above 3.5. Still feels like Bleurrgghh of course and the treatment is the same. As do 'false hypos' when you are far above 4 but your BG has been pants for so long all your bodily warning things get confused. Plus my understanding is that Metformin also interferes with the mechanism that makes your liver dump glucose (well, Glucogen, or is it Glycagen? - always forget) into your bloodstream to bring your BG back up. So you can't rely on that helping you out.

But would it class as hypo if you had a car accident - do the DVLA rules that apply to peeps on hypo-inducers, still apply when you aren't?

I suppose - to get classed as a hypo-inducer, you'd have to have evidence that you went under 3.3 because of taking it - cos that's the level at which the European Committee stated that 'impaired neurological function' kicks in. So even if you think you are OK, you ain't.

My beef about that is, it seems DVLA's medical officers have decided that as meters have a tolerance of up to 20% they'd set the level at 3.3 plus 20%, and rounded it to 4. Other countries say 3.7 so their effort to bring everyone onto the same line has failed and some poor innocent French diabetic bloke could come here, have an accident and get into a right mess. At which point he would no doubt be told that ignorance of the Law is no defence ......

 

[tomtat]

{ We can how ever provide you with urine testing strips which will show if you have an excess of sugar in your urine 2 hours after eating and give you a fairly good guide as to your control in between your appointments.}


My doctor informed me the other day that some people (me inc.) have kidneys that have a high glucose tolerance so the urine strips are of no use to them.
I'd queried why my diabetes had only recently been picked up (after blood test) when I'd had urine tests which all said negative. She thinks I've been diabetic for a long while.

Confusion reigns!!

 

[Ellie Jones]

Everybody can suffer an hypo even non-diabetics! But in concerns of medically it's defined by whether or not, a hypo could cause death if not treated, and it's only when either insulin is injected or medication that increases the body's own insulin production, so can lead to an over-dose of insulin which they body doesn't have enough glycogen (glucogen is the hormone that signals the liver to dump it's glycogen store) to return blood glucose levels to normal etc..

Metformin doesn't prevent the body from doing this, so hence not medically classed as hypo inducing medication!

Interestingly enough if a non-diabetic was involved in a car accident and their blood glucose where found to be in the hypo region, and it was found that they hadn't eaten for a lengthy time before driving, they could be prosecuted for driving without due care and attention!


Going back to the letter, personally I feel that the nurse is way off her mark, concerning the 'why' behind the not prescribing test strips, and surely because the PCT is making it's own mind up to which parts of the NICE guidelines it's choosing to implement than isn't the PCT acting illegally!

As they can't decide what parts of the criteria they will or won't meet, but the patient has the right to test strips within the criteria, all the PCT can really do, is ensure that if Test Strips are being prescribed then they are being used effectively i.e the patients using the information to improve blood glucose control!

 

[Kwaka1]

Hi Ellie, can you reference your point of driving without due care and attention to any point of law? I ask this due to being an ex police officer I've never heard of this.

 

[trophywench]

NICE Guidelines aren't Law EJ. They are just guidelines; in other words they can be ignored.

You know as well as the rest of us that if it's gonna cost em dosh they'll fight it tooth and nail.

And the more people allowed to employ mega-flawed research methods that erroneously conclude that testing makes T2s feel depressed or similar, the worse it will get.



Well - reading threads like this time after time (cos it is getting worse year by year) makes me depressed; perhaps we should be like the PCTs and ban them?

 

[alisonz]

I'm in the same boat as Pinky. My GP won't let me have strips for my meter either. Only difference is they won't give me urine sticks and tell me I only need HbA1c done yearly. What good this does beats me.
I've given up with arguing it and just get on with it now.

 

[mrpistachio]

Alisonz - pretty much same thing happens to me. I've been moved from one meter to another solely because of "cheap" test strips about 3 times in the last 2 years... plus there is so much difference between meters god only knows what my actual real BGL is!