Doctor refusing my prescription !

[Nayshiftin]

What a shame. And what a load of "following the herd" responses.
Monitoring your blood sugars, learning what effects you via testing and how it effects you, is immensely useful in your overall management. It gives you control and insight.
The idea that a type 2 can suffer along with three monthly blood tests, cos you " don't need to know" is a very narrow minded thought process. A motivated type 2 can change their management right around with the knowledge that monitoring can provide, and in a very timely manner.

100% agree. Nothing changes you but knowing your going in the wrong direction. If i did not test Id have a very high HbA1c

 

[Martin.A]

A motivated type 2 can change their management right around with the knowledge that monitoring can provide, and in a very timely manner.

Agree 100%, but not if only testing 2-3 times a week, and even then only if they feel a bit iffy, which is the case here.

 

[Clare153]

100% agree. Nothing changes you but knowing your going in the wrong direction. If i did not test Id have a very high HbA1c

I started off with a ridiculously high hba1c just under two months ago and by using my self funded dexcom and the knowledge and confidence it gives me, I have been 96% in range (4 - 10) for the last two days and 100% for the three days prior - can't wait to see my next hba1c results! Knowledge is very much power.

 

[Clare153]

Agree 100%, but not if only testing 2-3 times a week, and even then only if they feel a bit iffy, which is the case here.

Absolutely why I support the idea of all motivated type 2 being supplied with continuous monitors.

 

[Nayshiftin]

Absolutely why I support the idea of all motivated type 2 being supplied with continuous monitors.

I could not keep a continuous monitor on but I bought the test strips and was delighted on Amazon the ones I got were reduced and that meant I got them cheaper. It depends Martin if you eat the same things then if you do feel unwell infection does change blood sugars. I know if I get a UTI I can see a change and the reading would get me to test my temperature etc. I get hot flushes so temps are often undetected but the blood sugar I now know is another marker for infection. I can go days without testing. Then I go on a get my blood sugars down. Like now changed my medication to none so a low-carb diet is working well for me. So I am testing more. Once I go on the Oviva diet I will use more. I have self-funded which I do not grudge. Thinking about buying a water filter as don't like our water and my hubby complains about plastic bottled water. Has anyone tried Phox water filters?

 

[42istheanswer]

@Nayshiftin my sister used to have Phox water filters (maybe still does, haven't discussed it with her recently) and really rated them

 

[everydayupsanddowns]

all blindly following the NICE Guidance Notes. They are Guidance Notes but have to be blindly obeyed.

Just to balance this a little (NICE do get a lot of flak, and sometimes bring it on themselves).

NICE isn’t about bureaucracy for its own sake. It is an independent body charged with sifting all available published research evidence, alongside health economic data to establish whether an intervention works, is safe, and offers value for money.

So the more expensive something is, the more positive impact it must have on a person’s quality of life and health outcomes (including long-term health and diabetes-complications-avoidance).

The difficulty is that the last time T2 guidance was reviewed, there simply wasn’t the balance of evidence that “test strips for all T2s” was cost effective. There were a couple of big studies by Farmer et al that tried to see if people with T2 on non-hypo inducing meds got benefit from testing, but alas (partly because of the study protocol) they found that the majority didn’t like testing, got no clinical benefit, and actually found the numbers confusing/depressing when they stuck to the diet they had been given.

Of course, that’s a different approach to many on the forum who use structured BG checks before and after meals in order to change their diet to one that suits their body better.

But NICE’s job was to review the evidence, and make recommendations based on what it said (even if the clinicians were expecting or wanted something else).

CGM in T1 had exactly the same hurdle to get over. For years there wasn’t enough quality evidence that CGM worked well enough to excuse the cost (despite many people’s lived experience of how useful it was). That’s why I had to self fund (at £50 per sensor) until this year.

BG monitoring for T2s to fine tune diet needs more good quality evidence to tip the balance, unfortunately.

 

[Martin.A]

BG monitoring for T2s to fine tune diet needs more good quality evidence to tip the balance, unfortunately.

Having completed the fine-tuning of my diet a while ago, my sole purpose in testing these days is to look out for any upward trend in my levels that would suggest things are going awry.

 

[42istheanswer]

My GP surgery initially just prescribed me with strips blanket available each month, I didn't always request them (since when I was diet controlled I wasn't entitled to free prescriptions and could often find them cheaper on eBay - though tbh I did suspect some of those were people getting prescribed ones and selling them rather than using themselves) but I noticed last year that they had switched it on my repeat sheets to "type 2 max 4 per year". I ordered some in consecutive months when I had a 3 month pre-paid certificate (due to needing some other meds, which with my 3 monthly asthma preventer inhaler meant it was more worth it) but still only ordered 4 in 2023 so didn't see if they would have refused further ones. I have ordered 2 this year so far I think since I have been on metformin (still using some purchased previously too, checking date to use in order). I shall look into whether they continue to give me prescriptions without having to get the diabetes clinic to intervene once I run out and need more from them. (And only 50 per month means that I can do fasting daily but only occasional pre & post meal testing anyway so I may need clinic to specifically request more if they want me testing more frequently if I conceive and get transferred from pre-pregnancy clinic to pregnancy clinic)

 

[Nayshiftin]

Just to balance this a little (NICE do get a lot of flak, and sometimes bring it on themselves).

NICE isn’t about bureaucracy for its own sake. It is an independent body charged with sifting all available published research evidence, alongside health economic data to establish whether an intervention works, is safe, and offers value for money.

So the more expensive something is, the more positive impact it must have on a person’s quality of life and health outcomes (including long-term health and diabetes-complications-avoidance).

The difficulty is that the last time T2 guidance was reviewed, there simply wasn’t the balance of evidence that “test strips for all T2s” was cost effective. There were a couple of big studies by Farmer et al that tried to see if people with T2 on non-hypo inducing meds got benefit from testing, but alas (partly because of the study protocol) they found that the majority didn’t like testing, got no clinical benefit, and actually found the numbers confusing/depressing when they stuck to the diet they had been given.

Of course, that’s a different approach to many on the forum who use structured BG checks before and after meals in order to change their diet to one that suits their body better.

But NICE’s job was to review the evidence, and make recommendations based on what it said (even if the clinicians were expecting or wanted something else).

CGM in T1 had exactly the same hurdle to get over. For years there wasn’t enough quality evidence that CGM worked well enough to excuse the cost (despite many people’s lived experience of how useful it was). That’s why I had to self fund (at £50 per sensor) until this year.

BG monitoring for T2s to fine tune diet needs more good quality evidence to tip the balance, unfortunately.

For me Id much prefer type 1 who need it for life saving have it.
I do not mind self funding . I guess though it depends on circumstances.
I resent more them saying it’s all Type 2’s fault due to obesity.
To be fair I am not a glutton , I am really not so I resent that everyone skinny eats nothing and is therfore good.
lets hope my diet this time works and i can realise that i can get things under control.

 

[everydayupsanddowns]

For me Id much prefer type 1 who need it for life saving have it.
I do not mind self funding .

Well it’s interesting isn’t it… Another member has just completed a short term experiment following advice given to them by a dietician, and was able to see (through self-funded strips) that the advice didn’t suit them personally. But if no strips - how would they have known??

My experiment with carbs is now over.

My dietition advised that I ate 100 to 200g of carbs a day. two weetabix and a slice of wholemeal toast sent me to 17.6 on my meter. That’s somewhere i have never knowingly been before! Now I have purchased a carb counter book so i am going for 1 to 90g a day from now on! Fruits are ok but...

forum.diabetes.org.uk

 

[Proud to be erratic]

Just to balance this a little (NICE do get a lot of flak, and sometimes bring it on themselves).

I have no particular criticism here with NICE. My point was rather more that the NICE Note is Guidance and sometimes it feels that the Guidance "must be obeyed" irrespective of medical judgement. In general if the NICE Guidance is there, then that does provide a route for a medical practicioner to follow. But sometimes (and I accept that such times may not be often) a medical practioner with the background and training that a GP has could and in my view should use some judgement.

This forum does reveal the occasional contradiction where it seems (reads) that a member is being denied something just because there is bureaucracy enveloped in stupidity (or perhaps the other way round) and a GP who allows financial accountability to influence their judgement is on a slippery slope. If, of course, the higher level CCG or these days ICB has firmly prevented a GP from an action then that is different and difficult. But usually the Guidance Notes leave manoeuvre room.

I'm not remotely privy to the daily work pressures that GP's have to manage, without administrative bureaucracy also bearing down. So I acknowledge my argument is one-sided. But when my GP decided my test strips should be rationed (even though my Hospital discharge paperwork declared me as T1 and so the Guidance should have been clear that I could test more than 4 times daily) I had to make both the business and medical explanation to my GP that this was a poor decision. All unnecessarily stressful.