GP's Surgery are being idiots - can I have a rant on here please?!

[Babysaurus]

I got a call from my GP surgery yesterday re the amount of strips and insulin I am asking for.
I explained I was a Type 1 and also six and a half months pregnant, along with recently having gone on the pump, so was doing a lot of tests - between 12 and 20 a day. I was immediately told, in a nice but firm way (if that makes sense, she wasn't overtly rude but was very much 'telling' me) that 'that is way too much, we recommend four tests a day. More than that is unneccessary.'

So, I then explained that I have been advised to test before meals, after meals, and also need to test before and during exercise, before bed, when I get up, and often before and after snacks etc as I needed to be extra tight with maintaining the control I have etc etc (as you guys all know.) I also said that I was developing insulin resistance, which is common with Type 1's in later pregnancy, and this too needed to be kept on top of which is done by more testing. The GP said again that four times a day was fine, and my current rates of testing were 'ridiculous'. It was like talking to the wall.

Then, she asked why I wanted 'more than one vial a month' of insulin (most patients only need one allegedly.) Again, I explained that I was becoming resistant so the 300 units I was getting through every two days meant I needed more than one vial a month. Again, this is apparently 'way too much' so she said they won't give me more than two vials a month and if I needed more I needed to make an appointment to come in and discuss it when them.

Grrrr!! What on earth does she think I am doing with all this stuff? Selling it?!

I think I am especially annoyed that this GP clearly knows a limited amount about diabetes but is still giving 'advice' on how to manage it, something especially risky during pregnancy. Imagine if I didn't know better?! I had explained exactly why I was testing in the patterns I was, and this explanation was close to brushed off as if I was simply neurotic. I also said that I understood it was expensive but it was unfortunately part and parcel of the way things are at the moment - I wasn't living like a science project for fun, after all! I also said I didn't want to be down to my last couple of strips before I could get more, this is especially irritating if I was away for a few days, and it's not like they go off is it? I can always not order some for a bit if I have too many (unlikely at the moment but still...) They have agreed to give me six tubs (negotiated up from 4) of strips a month and said I will have to buy any others. 😡

I have left a message with my DSN who's fab and hopefully she can make them see sense.

Rant over.

 

[allana]

I don't blame you for ranting! I had a similar conversation re the amount of strips I had requested. It drives me crazy when gp,s question every repeat prescription request.

I hope your dsn will talk some sense into your gp Hun

Xxx

 

[PhoebeC]

Rant away.

I wish i was shcoked by this but im not just annoyed for you.

Because when i had Jemima i was early and unexpected only had one box left, thats 50 stripes, so like you say testing on my own monitor during labour testing every 2 hours i soon run out and the hospital couldnt give me a prescription, even though they are a hospital they couldnt get me anymore.

Ive never heard of anything so silly, I d ran out because of their testing all the time and they wouldnt do anything to help me out, i had to get my father in law to drive 10 miles to pick the stuff up from the chemist so i had them to use in the hospital.

Really you need a few spares of everything because your pregnant.

Id phone your team at the hospital or your dsn and tell them the score.

Hope you get it sorted,

xx

 

[sugarfreerach]

Are you on a pump did I see mentioned previously? If so contact your pump nurse and ask her to write a letter to your GP. Mine did and it was sorted. I wasn't allowed the extra strips or insulin after pregnancy though,which was fine as my insulin went down dramatically and I don't have time to test half as much.

 

[Robster65]

DiabetesUK should have a service to contact GPs who need a bit of an update. It's a common problem and one that needs addressing but time and again, we have to run round getting A to tell B and nothing moves forward.

Imagine if you weren't so clued up or more timid. What damage would be done by following the GP's advice. But I'm sure it wouldn't show up statistically. It would go down as poor self-management.

I hope you manage to get things sorted.🙂

Rob

 

[Northerner]

I find this utterly outrageous and ridiculous 😡 As you say, clearly this GP knows next to nothing about Type1 diabetes - let alone the very specialist knowledge about insulin pumps and diabetic pregnancy! To dismiss your explanations is highly insulting, and just shows her ignorance even more. You should not have to deal with this at a time when you have rather more pressing concerns. In a way, it doesn't surprise me that much, as I read a while back in a book intended for GPs that 'Type 1 diabetics may need to do two, or as much as four tests a day' 🙄

I hope your DSN puts a rocket up her pants so that she apologises and is shamed by her attitude.

 

[trophywench]

I'm seething on your behalf!

There's little point in my asking these questions, I realise BUT

How many T1 patients have they got?
How many of them are pumpers?
How many of them - pumping or not - are at ANY stage of pregnancy?

My GP clinic is pretty big - suburbs of Coventry - at least 6 doctors and usually one locum as well.

One 'diabetes specialist GP'.

Dunno how many diabetics, or how many T1's out of that.

How many pumpers? - ME.

 

[Babysaurus]

Thanks everyone for your replies. Its good to be able to vent my frustrations onto people who understand!

Phoebe I am even more aghast at your story! That is truly bonkers! I could understand it if we were all demanding something like valium or methodone, but blood testing strips, I suspect, don't have quite the same 'street appeal' do they?

Yes, clearly the GP does not have a clue about Type 1 diabetes, which is why I was trying to explain to her the ins and outs of why I was requesting the amounts I was requesting. I also added that while I realised it is expensive, it is probably far less expensive that diabetic retinopthy etc which could be (another) nasty consequence of bad control or any of the other nasties I could easily develop as a consequence of not keeping on top of things. While I say she was polite about it, she was, she clearly saw herself as the one who knew better and my explanations didn't seem to make any difference.

Normally I like to have a small stock of strips and insulin too, beats going to the chemist once a week like I am having to at the moment, but I think there is fat chance of that at the moment!

My DSN will hopefully make them be able to see sense. In the meantime, I am justifiably angry at being given pointless advice by someone making out that she knows what she is talking about!

Trophy - I think your questions are good one's to ask. I will steal them and use them when the need next comes up. (While I wish the need wouldn't, I have a horrid suspicion it will...)

Thanks again everyone x

 

[Babysaurus]

GP's advising like this make me realise quite why the ante-natal clinics are full of diabetic women with mahoooosive bellies!

 

[Twitchy]

GP's advising like this make me realise quite why the ante-natal clinics are full of diabetic women with mahoooosive bellies!

Easy tiger - mahoosive belly does not equal poor control - i had massive amounts of excess fluid first time round with an HbA1c of 5.8%. 😉


Babysaurus - I think it might be time for the magic phrase : "if anything goes wrong with this pregnancy due to the restrictions you are imposing on me Dr X, I WILL SUE YOU. Not the practice, YOU. If you don't support me i will also be going go DUK, my MP & the press.". (as the medics seem to assume we are looking for any excuse to sue, maybe we ought to use that to do what we need to in order to keep baby safe?!) Really frustrating to hear you hVe this stress on top of the already stressful nature of a diabetic pregnancy, don't let the expletives get you down!! Let off steam here & know that we're rooting for you! Xx

 

[margie]

Thanks everyone for your replies. Its good to be able to vent my frustrations onto people who understand!

Do you drive ? As that is another thing that can increase the number of strips you need.

I hope that your DSN can speak with the GP and maybe explain how pregnancy can affect your diabetic control and why it is important to be able to do all these tests.

Good Luck.

 

[Abi]

By refusing to prescribe sufficient insulin they are putting you at risk of DKA. Maternal DKA carries a very high risk of foetal mortaility. I think this warrants a formal complaint

 

[trophywench]

If you just have ONE hypo, that's at least 2 extra strips you'll use - one cos you think you are low, the next to see if your treatment worked.

Does she even realise what the BG parameters ARE in pregnancy? - 3.5 to 5 before meals, no more than 7.8 one hour later, is it? - and if not adjust either insulin or food to suit, and keep on testing at those intervals EVERY SINGLE time food passes your lips for 9 months?

 

[Robster65]

...and then ask her to run through how you can maintain those figures on 4 tests a day. And what happens when you've used your 'quota' of insulin and find yourself at 15mmol/l after one of your 4 tests.

Should get her thinking creatively. 🙂

Rob

 

[Ellie Jones]

Don't dismiss that insulin isn't saleable it is and like test strips it is illegally sold on the black market and places like ebay😱

I'm not siding with your GP, but in part she didn't act totally out of order... She acted responsibly to a certain extent.

Large increases in the need of prescription medication could indicate that something isn't right, it could be illegal intentions, suicidal tendency or even that the patients medical condition needs an urgent review... So investigation does need to be done to find out what's going on.

Which yep your GP was totally right in phoning to ask, where she went wrong is her response to your reasons..

You've contact your DSN who is more than likely contact your GP to put her straight etc.

But why don't you book an appointment to see your GP, print off your data from your pump and your meter... Then she can see that you are using what you say you are, and you can explain why you need to use this...


Mind you how on earth do you go through 20 test strips in a day, I don't do this even when I'm basal testing for pump adjustments, my average 8-12 per day..

 

[Babysaurus]

Ellie, I can use up to 20 a day as I am testing before and after meals, do a hell of a lot of exercise which makes levels fluctuate, am also testing more when I get a higher or lower reading than I need. It is very easy to get up to 20 a day, or just under. I also have been on a pump for just over a month. Normally people are given a 6 month period to be expected to get used to it, being pregnant I don't have this luxury so am in at the deep end. This too results in a lot of testing to make sure the insulin sensitivity settings are right, and these too can change every few weeks due to insulin resistance which you can't know about if you aren't testing. As I said to the GP, I am not just doing all this for fun! Maybe she was right to ask (although I still think this sounds as if it is more cost related than anything else) but she certainly was not right in her responses.

Also, I don't want to book an appointment with the GP. I have enough on without booking appointments with someone to explain why I am asking for what I am asking for, I tried to do this over the phone to no avail anyway.

Twitchy - ooops! I cocked up there didn't I?! Sorry, I realise it's not purely due to bad control, there are other factors which can make you huge too. Not sure if I fancy the threatening to sue route, tbh. Hopefully they'll see sense soon instead!

Trophy - that's a very good point. One hypo does indeed use up two strips, or sometimes even three. I suspect she doesn't know the parameters in pregnancy, no. (Are they different from Type 2? Maybe that's where the confusion comes from.) This in itself is fine, she is a GP not an endocrinologist after all, so nobody is expecting her to know. However, as this is clearly the case its surely not a good idea to start telling people how to look after their diabetes or how much medication they need.

 

[RuthieG]

Ellie

I have to agree with Babysaurus here on two points
1) The GP should see enough of her history (pump, pregnancy) to ask reasonable questions about her current situation and there seems no evidence that she was considering her welfare, suicidal thoughts etc
2) I have definitely had days as a new pumper and pregnant where i can use 15 or so strips. For exampe today when my after meal reading was 9.1 (it should be 7.8 or under). I corrected and tested again an hour later and it was still high so corrcted again. Then 45 minutes tested again and it was finally coming down. Then tonight I will test after my meal (prob not befor as it is nearly meal time, before and after exercise and before bed. So that is waking, after brekkie, mid morning x3 post meal (inc corrections), before lunch, after lunch (x2 - one correction) and then at least another 4 tonight. That is just an average day so I would say the odd day it could be a few more.

I don't have a downer on GPs because I personally have had a good experience with them all but that doesn't mean I would understand how this GP acted becaus it seems unreasonable.

 

[RuthieG]

Insulin per month

Also Babysaurus for inf my pump DSN said she usually says that a pumper will need three insulin vials a month. That seems about right to me, althoug it is early days so still experimenting a bit with basal

 

[Smit]

Lol I came on tonight to post the exact same thing. I am the opposite, insulin levels not going up and having loads of hypos. My doctors have said im only allowed 100 test strips a day. Then when I questioned it was allowed 10 a day. Still not enough. i spoke to my consultant at the hospital yesterday and he has written an email to GP, hoping it will sort things out. Xxx

 

[Babysaurus]

Smit, I hope it sorts things for you too. As I have said, its not that I don't understand why they are questioning things as strips etc are very expensive so they obviously don't want to be paying for things unneccessarily, but its not like we have a lot of choice but to make sure things are okay at the moment is it?

Ruthie, your HBA1C's are almost identical to mine! I am glad you too find it is easy to use far more strips when trying to get your BG down to target level. Normally I would not worry about being, say, 9.0 an hour after eating but at the moment its very important to be within target range and also not risk it going any higher. Generally, I have been able to keep within target, but occassionally it has shot up and has taken longer than expected to come down. Likewise, I have tested more than usual if a bit low as I don't want to risk over as well as under-treating.

Its a joy being diabetic and pregnant isn't it!!