Meter & Test Strip Restriction

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JJay

JJay

Well-Known Member
Relationship to Diabetes
Type 1
I've been somewhat gobsmacked today to receive this from my GP surgery:

"As part of Northamptonshire ICB’s process to improve and review the use of cost effective of blood glucose meters, the decision has been made to recommend the use of the Finetest Lite meter for back up finger prick blood glucose testing in patients using Freestyle Libre 2 flash glucose monitoring system.
In line with this recommendation, we are offering you a new Finetest Lite meter and your prescription has been changed to Finetest Lite blood glucose test strips and Greenlan lancets to be used with this new meter and lancing device."

"Your use of back up finger prick blood glucose tests should be infrequent. The FreeStyle Libre 2 flash glucose monitoring system has a very high level of accuracy. You should only need to carry out a finger prick blood glucose test if your glucose readings don’t match your symptoms, a test isn’t needed when glucose levels are low, falling or changing rapidly. One pot of 50 test strips should last for approximately 3 months."

Now, I've been using a Contour Next meter and strips (and its predecessors) quite happily for more years than I care to remember and this has never been a problem for either this surgery or my previous one in Warwickshire. It has a useful app and integrates with MySugr which I use to keep a comprehensive record of BG and carb intake and for its bolus calculator.

I recognise that the £10 per pot difference in strip costs is significant and would be happy to change if I could use the Finetest meter in the same way. But it's a really basic model - no app, though apparently I can download results to a computer with a USB cable (not something I've had occasion to do for nearly 10 years)!

The Libre has been a life-changer from the point of letting me know what goes on between finger pricks, but I've rarely found it to match BG readings, and sometimes as much as 2-3 mmol out. Although Libre 2 is slightly better than 1 in this respect. As a result I've not been confident to base bolus calculations on Libre readings and still finger prick before meals at home (though not when eating out).

When I first got Libre I was as keen as anyone to cut down the finger pricks and happily based bolus calculations on it. The result after 6 months was a rise in HbA1c from 65 to 68! So I went back to BG tests before meals and the next HbA1c was 53.

And I still test to check (a) am I really hypo? (b) has the hypo treatment worked? (c) the "you cannot be serious" Libre scans (d) before driving again after treating a hypo (thankfully a very rare occurrence) - you know how it goes. And I am supposed to do all this with 50 strips every 3 months?!

Sorry for the long post but I'd be grateful for any ideas as to how I can challenge this.
 
You need to write a strong letter of complaint.
Pointing out the inaccuracies of the Libre for insulin delivery (bolus) if you are a driver then also point out that you can not comply with the law regarding driving.
 
The cost effectiveness calculations for libre are based on reducing use of test strips, so if you’re still testing several times a day then that is quite a cost. You can still input readings into MySugr if you want to do that from the fine test meter.

If libre has made no improvement whatsoever to your a1c and doesn’t match fingerpricks, then can I ask why you bother continuing with it? If it doesn’t work for you and fingerpricking does, then sounds like libre is an expense with no benefit for you at the moment.
 
JJay said:
And I still test to check (a) am I really hypo? (b) has the hypo treatment worked? (c) the "you cannot be serious" Libre scans (d) before driving again after treating a hypo (thankfully a very rare occurrence) - you know how it goes. And I am supposed to do all this with 50 strips every 3 months?!

Sorry for the long post but I'd be grateful for any ideas as to how I can challenge this.
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50 every 3 months seems a bit too low to me. (It's probably about what I use, but I don't drive.)

I'm honestly not sure whether they're being reasonable or not. The NICE guidelines don't seem clear to me in this case (they say that test strips are necessary in some situations but they don't give any indication of how many might reasonably necessary).
 
Are you able to write down what the Libre v. blood test results each time you finger prick? If there is a big (dangerous) difference then you could use this as evidence to ask for more testing strips. Have you spoken to your DSN about this?
 
helli said:
I’m not sure what relevance driving is now DVLA accept CGM readings.
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Do they? I've missed that. Is there a reference please?
 
Proud to be erratic said:
Do they? I've missed that. Is there a reference please?
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This is the first gov.uk reference that came up when I did a Google search for DVLA and CGM: https://www.gov.uk/guidance/diabetes-mellitus-assessing-fitness-to-drive
I notice this is dated 2016 so CGM have been acceptable for Group 1 drivers for the last 5 years.
It lists criteria when finger pricks are needed (so you must carry your kit with you) but these are the same as when I check with finger pricks regardless of driving,
 
helli said:
But that is the same regardless of driving.
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When I'm about to walk home from work I'm willing to trust that I've eaten enough, and (once Libre shows I'm on the way up and over 4) I'll just keep an eye on it as I walk. That would be much less sensible if I was driving (or cycling).
 
My Libre paperwork from the hospital to my GP states 'estimated ongoing requirement for test strips, approx 3 per day' I find the Libre generally very accurate, so I don’t normally use anything like that. But I used three yesterday, because with a combination of hot weather, dehydration, exercise and changing levels, it kept giving me the ‘try again in 10 minutes' just when I hadn't got ten minutes to spare to wait.
 
Robin said:
My Libre paperwork from the hospital to my GP states 'estimated ongoing requirement for test strips, approx 3 per day' I find the Libre generally very accurate, so I don’t normally use anything like that. But I used three yesterday, because with a combination of hot weather, dehydration, exercise and changing levels, it kept giving me the ‘try again in 10 minutes' just when I hadn't got ten minutes to spare to wait.
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I was guesstimating 50 strips a month would be a reasonable number (so about 1 a day but sometimes a couple), but 90 is in that ballpark.
 
Bruce Stephens said:
I was guesstimating 50 strips a month would be a reasonable number (so about 1 a day but sometimes a couple), but 90 is in that ballpark.
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On my repeat, I’m able to order 2 boxes of 50 strips every 28 days, but it’s actually three months since I needed to order any. The only time I'd need a lot is if I had a sensor failure and didn’t have a spare to put on while I was waiting for Abbott to replace it, so it makes sense to have the ability to order a couple of boxes of I need to.
 
Many thanks for all the responses and useful suggestions & links.

I've taken time to reflect, and taken heed of my OH's advice to "choose my battles"! To that extent I will get my free Finetest meter, reduce my pre-meal finger-pricking and see what happens. I'm due my annual review in September and may have something to say then.

Fortunately I still have 100 Contour Next strips left - prescription issued the day before the date on the letter!

@Lucyr I do want to make it clear that I value Libre immensely, as an adjunct to BG tests and for the extra insights it gives me - I wouldn't be without it. It's not all about costs (as the ICB appear to think) but about value, and I would never describe it as being of no benefit!
 
JJay said:
To that extent I will get my free Finetest meter, reduce my pre-meal finger-pricking and see what happens. I'm due my annual review in September and may have something to say then.
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I think that makes sense. I asked on twitter, and (while opinions varied) I think the meter with cheaper test strips didn't get much objection (that's a reasonable request on their part).

I still think 50 test strips every 3 months is too mean, and even if someone wanted a test strip for every meal (to bolus from) and a couple more for verifying odd (or no) values from Libre I think that ought to be accepted. Seeing graphs and patterns (especially overnight) is still potentially valuable enough even if the values aren't accurate enough to bolus on. (I think, anyway.)
 
About 6 months after I became T3c, my GP attempted to restrict me to 4 tests daily. I appealed politely, but robustly and a begrudging increase was given for 7 daily, ie one cassette of 50 weekly. I use the Accu-chek Mobile meter.

Some 2 years on I have existed on that allowance, but I have never accumulated a surplus; in June I was down to my last 5 tests before my prescription renewal was delivered.

There is a presumption that I enjoy finger pricking (and perhaps do it for fun?). Of course I don't; I test actual BG because there is a necessity. I do have problems with the reliability and accuracy of Libre 2 and that, no doubt, means I need to finger prick as much as I do. My wastage (fail) rate is very low with the Accu-chek meter; it was much higher with my original 4Sure meter taking conventional strips; akin to trains and 'leaves on the line' or 'wrong sort of snow in winter' - wrong size blood droplet and trembling hands is appreciably wasteful.
 
JJay said:
Many thanks for all the responses and useful suggestions & links.

I've taken time to reflect, and taken heed of my OH's advice to "choose my battles"! To that extent I will get my free Finetest meter, reduce my pre-meal finger-pricking and see what happens. I'm due my annual review in September and may have something to say then.

Fortunately I still have 100 Contour Next strips left - prescription issued the day before the date on the letter!

@Lucyr I do want to make it clear that I value Libre immensely, as an adjunct to BG tests and for the extra insights it gives me - I wouldn't be without it. It's not all about costs (as the ICB appear to think) but about value, and I would never describe it as being of no benefit!
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For what it’s worth I agree with you. The true benefit of more widespread use of Libre and other varieties of CGM goes far beyond any monies saved in the short term on test strips. The true cost savings will likely not be seen for many years and will be due to many fewer patients developing long-term complications. I read a statistic recently to the effect that 10% of the NHS budget is spent on treating such complications. Hopefully the powers that be will pay attention and take the longer term view.Only time will tell I guess?
 
I have been on Libre sensors for the past 5 years, and agree that they are not always entirely accurate or reliable. For me, the sensors mostly overstate BS levels compared to finger prick levels but previous sensors have been known to record levels which are too low compared to finger prick. My HbA1c levels are nearly always different by about 3 or 4mm/mol as a result and my doctor knows this. However, I do think the benefits of sensors outweigh the cons. I sometimes wonder, though, if other CGM sensors are more accurate.

I obviously still have to finger prick multiple times a day because of the lack of trust of sensor readings (rather defeats the objective) and would agree that the stopping of test strips is hard to understand.

David
 
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