Balance - 250th issue

[Northerner]

Well, from reading my copy of Balance today it seems that in some areas strip restriction for type one's is still a problem, And one long term type one wrote in stating that his/ her DSN was trying to cut him/ her from 3 tests per day to only one!
Suspect this is a practice nurse who has studied the 1980 edition of Noddy's Guide to diabetes
Scary stuff as it seems that in some areas type one's are being denied referral to secondary care
At least my local health board has a diabetes care pathway with monitoring guidelines advising that insulin users on basal bolus may need up to 200 strips per month.

It's quite shocking to think that some HCPs are so lacking in knowledge when others know perfectly well what is required. Things seem to be pretty good in my area. At a recent GP meeting where I was a patient rep I brought up this issue of strip restriction and was assured there is no such policy in my PCT.

 

[trophywench]

There isn't in ours either Alan but OTOH they are restricted to prescribing more than 100 a month without entering a 'reason' every time you request a repeat. It's only a code they have to enter for whatever the reason is, but how tedious for them to have to do that with every T1 At Least.

 

[mcdonagh47]

Another thing that's interesting is to see the pace of change (or lack of).

For instance, the August 1977 cover has a report on an 'artificial pancreas', which I'm assuming is what we'd now call an insulin pump.

I love the very retro-future quote that sounds more like it's from the Onion: "Professor Alberti predicted that in the long term the pancreas will drop from its present filing-cabinet dimensions to the size of a pocket calculator".

But also, isn't it just fundamentally depressing that 35 years after this all happened, pumps still aren't a regular treatment method in the UK despite their widespread adoption in other comparable countries?

one reason why the UK is behind with pumps is that when they became really viable in the mid nineties with the advent of rapid acting analogues, the older diabetic community basically rejected the idea. Injections were well established and they weren't prepared to try something different. So Britain has lagged behind and the lower numbers on pumps means that economies of scale can't be fully achieved and pumps remain comparatively expensive , so it becomes a vicious circle. In the USA for example the insurance companies that dominate diabetes care were early convinced that pumps would save money in the long run.

 

[Phil65]

.....loved Arthur Smith's and Mari Wilson's column on page 66.

 

[trophywench]

Not sure they did reject them Vic, which of them was ever asked if they'd like one? Nobody in either Worcs or Warks certainly.

 

[JoeFreeman]

Well, from reading my copy of Balance today it seems that in some areas strip restriction for type one's is still a problem, And one long term type one wrote in stating that his/ her DSN was trying to cut him/ her from 3 tests per day to only one!

We're doing a lot of work on this test strips issue at the moment. We have a position statement for people with Type 1 (and Type 2's on insulin) and are putting the finishing touches to our Type 2 statement as I write...

There was a diabetes debate in parliament last week and - rather pleasingly - Anna Soubry (Parliamentary Under Secretary of State at the Department of Health) had the following to say about restrictions on test strips:

"Frankly, this is bonkers; people with diabetes who use strips need to use them and often need to use many in a day. I am not happy if there is any form of rationing of those strips."

You can see the full transcript here (it's loooooong. Search for the term "bonkers" and you'll get to the good bit!)

We see this as a really positive step. There'll be more of a push around this issue in coming months which I can keep you all update on!

 

[Northerner]

We're doing a lot of work on this test strips issue at the moment. We have a position statement for people with Type 1 (and Type 2's on insulin) and are putting the finishing touches to our Type 2 statement as I write...

There was a diabetes debate in parliament last week and - rather pleasingly - Anna Soubry (Parliamentary Under Secretary of State at the Department of Health) had the following to say about restrictions on test strips:

"Frankly, this is bonkers; people with diabetes who use strips need to use them and often need to use many in a day. I am not happy if there is any form of rationing of those strips."

You can see the full transcript here (it's loooooong. Search for the term "bonkers" and you'll get to the good bit!)

We see this as a really positive step. There'll be more of a push around this issue in coming months which I can keep you all update on!

Good to hear Joe. I suspect a lot of the rationale behind strip restriction stems from the lack of knowledge of those proposing it. Even many well-informed HCPs seem to need a reality check as to how many strips per day is a reasonable minimum and what might constitute obsession, and I think those less well-informed fail to distinguish between insulin users (and hypoglycaemic agents) and non-insulin users.

 

[DeusXM]

one reason why the UK is behind with pumps is that when they became really viable in the mid nineties with the advent of rapid acting analogues, the older diabetic community basically rejected the idea.

I've always looked on it more as an NHS issue rather than a 'diabetic community' one - particularly as the majority of people who'd benefit from pumps would usually be T1s and therefore most 'new' T1s in the 1990s (such as myself) would have been of a younger age. Even if we couldn't have shifted those who'd had T1 for 30 years onto pumps, surely the newly dxed could have been put on them?

No, I think the blame is much more on the NHS's slack diabetes targets, which consider an A1c of 7.5% to be 'good' whereas anything under 6.5% is 'bad'. Most pump users I've spoken to have A1cs in the 5.5-6.5 range. No wonder the NHS hasn't kept pace. They obviously cost more than injections and according to their own guidelines offer 'worse' control. 🙄

 

[trophywench]

You could have most certainly shifted the '20 year diabetics' though Deus; of which I was one.

I was 40 in 1990, it was a superb time of life for me - except of course for the (sodding) D. Which, the same as always, didn't behave itself very well. And 10 years later it still didn't. And Ditto 15 years.

When I'd had D for 39 years and 7 months - ie 2012 - only THEN was I offered a pump. It had been mentioned to me 3 years previously to be fair, but since I was actually having a complete mental breakdown at the time, I didn't really think I could cope with any more stress. So I actually said, a pump would just be on straw too many at the moment, since this camel's back was already broken.

So I was 62 when I got my pump. Consultant said 'I wonder if ...?' and I bit his hand off there and then without going away and thinking about it. Yay! But exactly the same as I would have in 1990 ......

Furthermore I met another retired T1 lady at the 'Big Event' last summer. She was fairly recently diagmosed. She was intrigued by wares on display on the pump stands and we discussed it over lunch. She said she was very interested in one, but she expected she would be too old to be considered. I said - don't be ridiculous! Asked who she was under, as it happened I knew her hospital are very pro pump. And told her that. (BERTIE's 'dad' is her consultant)

And guess what? - she got hers last week !

With regard to the Parliamentary debate, a very good debate, except of course debates usually have two sides don't they - so you could hardly call it a debate at all really - since everyone was speaking FOR the motion. LOL

But there are a couple of things missing from it, points that weren't made and both of VERY great importance.

1. Sugar has been singled out yet again. It is the obvious one I agree. But it's the TOTAL carb content that needs to be considered, not just the sugar.

2. There seems to be a misconception amongst even diabetics that doctors treat people's diabetes. In fact it's immensely popular with doctors themselves and indeed, the whole of the NHS.

But it's gobsmackingly incorrect.

And don't we know it?

 

[PattiEvans]

But there are a couple of things missing from it, points that weren't made and both of VERY great importance.

1. Sugar has been singled out yet again. It is the obvious one I agree. But it's the TOTAL carb content that needs to be considered, not just the sugar.

2. There seems to be a misconception amongst even diabetics that doctors treat people's diabetes. In fact it's immensely popular with doctors themselves and indeed, the whole of the NHS.

But it's gobsmackingly incorrect.

And don't we know it?

Absolutely, they are very important points. I read the full debate and whilst reading it I noted that a great deal of emphasis was put upon podiatry services in order to avoid amputation and throughout I was thinking "the first defence against amputations is good control". In order to gain good control we must have good education. I have always maintained that all Drs should give newly diagnosed T2s a copy of Jennifer's advice and a supply of test strips. It would at the very least jolt the complacent out of their complacency and at best enable the motivated ones to take control which would be far far better than the current regime of bad diet advice and keeping people in the dark.

I'm also much annoyed about the fact that T1s are not all automatically given the tools for good control, if we can't all have pumps at least give us all carb counting education, it's so simple and so low cost set against future complications.

Pointing this at Joe... it's all very well Diabetes UK campaigning for T1s and T2s on insulin having strips, but what about T2s not on insulin? I have seen so many do so well given the basics of an education and a few strips!

 

[rhall92380]

Pointing this at Joe... it's all very well Diabetes UK campaigning for T1s and T2s on insulin having strips, but what about T2s not on insulin? I have seen so many do so well given the basics of an education and a few strips![/QUOTE]

I was fortunate enough shortly after diagnosis to get some education also a free test meter from a rep and the GP Practice prescribed test strips.

Having lost 4 stones and got my blood sugars under tight control - via diet and exercise - the GP decided to stop the test strips!

Richard

 

[JoeFreeman]

Pointing this at Joe... it's all very well Diabetes UK campaigning for T1s and T2s on insulin having strips, but what about T2s not on insulin? I have seen so many do so well given the basics of an education and a few strips!

It says in my post that we are "putting the finishing touches to our Type 2 statement as I write..." so it's on the way! This will cover those not on insulin, who manage their diabetes by diet/exercise and/or tablets. Apologies if that wasn't clear...

 

[PattiEvans]

Thank you Joe, I look forward to seeing the statement.

Richard - the strips made a difference to start with didn't they? Pity the GP saw fit to stop them.

 

[Northerner]

Thank you Joe, I look forward to seeing the statement.

Richard - the strips made a difference to start with didn't they? Pity the GP saw fit to stop them.

Indeed, 'Ah, that worked for you, let's put a stop to it then!' 🙄 The better course of action would be to encourage less frequent testing, but enable it for unusual or new meals/circumstances and spot checks to ensure things are on track. But they probably think the HbA1c is the only thing necessary once things are under control.

 

[rhall92380]

Richard - the strips made a difference to start with didn't they? Pity the GP saw fit to stop them.[/QUOTE]

Indeed, 'Ah, that worked for you, let's put a stop to it then!' 🙄 The better course of action would be to encourage less frequent testing, but enable it for unusual or new meals/circumstances and spot checks to ensure things are on track. But they probably think the HbA1c is the only thing necessary once things are under control.

Yes Patidevans the strips did help me get my BS under control.

Alan I agree that to encourage less frequent testing, but enable it for unusual or new meals/circumstances and spot checks to ensure things are on track is a better course of action - it's what I was doing anyway by that point. To add insult the Doctor said that it would cause me to worry unnecessarily if I got high results from self testing!

Richard

 

[Northerner]

...To add insult the Doctor said that it would cause me to worry unnecessarily if I got high results from self testing!

Richard

From the 'ostrich' school of medicine, eh? Just bury your head in the sand - if you don't know what the numbers are they can't hurt you? 🙄