Refused Testing Strips by GP

[everydayupsanddowns]

Part of the challenge for motivated T2s who can and do successfully use self monitoring of blood glucose (SMBG) to improve their blood glucose management through adjusting their diet and exercise patterns (ie most members here who choose to self monitor) is that they need to be seen as the exception, rather than the rule of the T2 population.

There are significant studies into SMBG in T2 which are interpreted to show that 'It Does Not Work' (Farmer et al etc) and the NICE guidance is clear that self monitoring should not be routinely offered in T2 unless you are taking something more likely to cause hypos than Metformin.

1.6.13 Do not routinely offer self-monitoring of blood glucose levels for adults with type 2 diabetes unless:

• the person is on insulin or
  
  
• there is evidence of hypoglycaemic episodes or
  
  
• the person is on oral medication that may increase their risk of hypoglycaemia while driving or operating machinery or
  
  
• the person is pregnant, or is planning to become pregnant. For more information, see the NICE guideline on diabetes in pregnancy. [new 2015]

https://www.nice.org.uk/guidance/ng28/chapter/1-Recommendations#blood-glucose-management-2

The old Farmer study (and a subsequent follow-up) conclude that self monitoring has no positive effect and actually causes people distress. It costs money, and it not only doesn't help - it actually makes people feel worse. And this I am sure we find very confusing. But it is evidence of these and similar studies that form the basis of the NICE guidance not to offer strips to T2s.

Of course, if some of our T2s look at the way that study was conducted, they will immediately see that of course it wasn't going to work if that was what they were doing! Because if I remember right, part of the initial study setup was to ensure that they kept eating what had initially been agreed and did not deviate. Rather than using their individual results to adjust their diet for better BG outcomes.

I find this paper from Australia really interesting in that regard - https://www.mja.com.au/journal/2015...sely-when-it-comes-monitoring-type-2-diabetes

Because it again demonstrates that you can't necessarily improve T2 outcomes just by spraying test strips around to people who really aren't interested in them (or people who have been given inappropriate advice on how to use the results). Again it shows that just testing alone is unlikely to confer benefit, and may cause problems. What really works is the test-review-adjust style approach that T2s here advocate.

For SMBG to be effective in people on D&E/metformin the people involved need to learn, or be shown what to DO with the information, how to adjust their diet and exercise in response to the results they see 1 and 2 hours after eating vs before the meal. How long they need to commit to the tiresome business of intensive self-monitoring while building up their understanding of how different foods affect them as an individual, before they can drop back to a more relaxed, occasional 'maintenance level' and give their fingers a rest. All this takes effort, and commitment. And it is not necessarily an approach that everyone will want to take.

My opinion is that people who are motivated to use self-monitoring to improve their BG outcomes need to convince their clinic/GP that they are unusual. That they are the exceptions to the rule. That they understand that SMBG doesn;t generally work for people in their position, but how it will work for them, and improve their long-term health/reduce complication risk.

My guess is that many Drs and Practice nurses are not purely doing this to save money (though I am sure some are). They are doing it because there is substantial scientific evidence that it doesn't 'work'.

You need to demonstrate that you are one of the cases in which self monitoring offers real benefit.

 

[Radders]

Part of the challenge for motivated T2s who can and do successfully use self monitoring of blood glucose (SMBG) to improve their blood glucose management through adjusting their diet and exercise patterns (ie most members here who choose to self monitor) is that they need to be seen as the exception, rather than the rule of the T2 population.

There are significant studies into SMBG in T2 which are interpreted to show that 'It Does Not Work' (Farmer et al etc) and the NICE guidance is clear that self monitoring should not be routinely offered in T2 unless you are taking something more likely to cause hypos than Metformin.


https://www.nice.org.uk/guidance/ng28/chapter/1-Recommendations#blood-glucose-management-2

The old Farmer study (and a subsequent follow-up) conclude that self monitoring has no positive effect and actually causes people distress. It costs money, and it not only doesn't help - it actually makes people feel worse. And this I am sure we find very confusing. But it is evidence of these and similar studies that form the basis of the NICE guidance not to offer strips to T2s.

Of course, if some of our T2s look at the way that study was conducted, they will immediately see that of course it wasn't going to work if that was what they were doing! Because if I remember right, part of the initial study setup was to ensure that they kept eating what had initially been agreed and did not deviate. Rather than using their individual results to adjust their diet for better BG outcomes.

I find this paper from Australia really interesting in that regard - https://www.mja.com.au/journal/2015...sely-when-it-comes-monitoring-type-2-diabetes

Because it again demonstrates that you can't necessarily improve T2 outcomes just by spraying test strips around to people who really aren't interested in them (or people who have been given inappropriate advice on how to use the results). Again it shows that just testing alone is unlikely to confer benefit, and may cause problems. What really works is the test-review-adjust style approach that T2s here advocate.

For SMBG to be effective in people on D&E/metformin the people involved need to learn, or be shown what to DO with the information, how to adjust their diet and exercise in response to the results they see 1 and 2 hours after eating vs before the meal. How long they need to commit to the tiresome business of intensive self-monitoring while building up their understanding of how different foods affect them as an individual, before they can drop back to a more relaxed, occasional 'maintenance level' and give their fingers a rest. All this takes effort, and commitment. And it is not necessarily an approach that everyone will want to take.

My opinion is that people who are motivated to use self-monitoring to improve their BG outcomes need to convince their clinic/GP that they are unusual. That they are the exceptions to the rule. That they understand that SMBG doesn;t generally work for people in their position, but how it will work for them, and improve their long-term health/reduce complication risk.

My guess is that many Drs and Practice nurses are not purely doing this to save money (though I am sure some are). They are doing it because there is substantial scientific evidence that it doesn't 'work'.

You need to demonstrate that you are one of the cases in which self monitoring offers real benefit.

Brilliant explanation, I love this!

 

[Bill Stewardson]

Part of the challenge for motivated T2s who can and do successfully use self monitoring of blood glucose (SMBG) to improve their blood glucose management through adjusting their diet and exercise patterns (ie most members here who choose to self monitor) is that they need to be seen as the exception, rather than the rule of the T2 population.

There are significant studies into SMBG in T2 which are interpreted to show that 'It Does Not Work' (Farmer et al etc) and the NICE guidance is clear that self monitoring should not be routinely offered in T2 unless you are taking something more likely to cause hypos than Metformin.


https://www.nice.org.uk/guidance/ng28/chapter/1-Recommendations#blood-glucose-management-2

The old Farmer study (and a subsequent follow-up) conclude that self monitoring has no positive effect and actually causes people distress. It costs money, and it not only doesn't help - it actually makes people feel worse. And this I am sure we find very confusing. But it is evidence of these and similar studies that for the basis of the NICE guidance not to offer strips to T2s.

Of course, if some of our T2s look at the way that study was conducted, they will immediately see that of course it wasn't going to work if that was what they were doing! Because if I remember right, part of the initial study setup was to ensure that they kept eating what had initially been agreed and did not deviate. Rather than using their individual results to adjust their diet.

I find this paper from Australia really interesting in that regard - https://www.mja.com.au/journal/2015...sely-when-it-comes-monitoring-type-2-diabetes

Because it again demonstrates that you can't necessarily improve T2 outcomes just by spraying test strips around to people who really aren't interested in them (or people who have been given inappropriate advice on how to use the results). Again it shows that just testing alone is unlikely to confer benefit, and may cause problems. What really works is the test-review-adjust style approach that T2s here advocate.

For SMBG to be effective in people on D&E/metformin the people involved need to learn, or be shown what to DO with the information, how to adjust their diet and exercise in response to the results they see 1 and 2 hours after eating vs before the meal. How long they need to commit to the tiresome business of intensive self-monitoring while building up their understanding of how different foods affect them as an individual, before they can drop back to a more relaxed, occasional 'maintenance level' and give their fingers a rest. All this takes effort, and commitment. And it is not necessarily an approach that everyone will want to take.

My opinion is that people who are motivated to use self-monitoring to improve their BG outcomes need to convince their clinic/GP that they are unusual. That they are the exceptions to the rule. That they understand that SMBG doesn;t generally work for people in their position, but how it will work for them, and improve their long-term health/reduce complication risk.

My guess is that many Drs and Practice nurses are not purely doing this to save money (though I am sure some are). They are doing it because there is substantial scientific evidence that it doesn't 'work'.

You need to demonstrate that you are one of the cases in which self monitoring offers real benefit.

Absolutely spot on. Therefore, any patient who puts their hand up and requests the necessary equipment to self test has already shown that they are motivated enough to WANT to assist the clinicians by working towards the correct food intake. Your/my healthy food plate may not be same as the next persons.
No one is/should be under the impression that testing cures anything by itself, however there is a very good chance that it will assist the staving off of all kinds of future problems and definitely improve the patients quality of life on an ongoing basis, if only by improving confidence, and we all know the amplified effect stress has on blood sugars.
Financial considerations do have to be considered, again, I see that "prevention is better than cure" being an extension of the above.
A blanket refusal across the country is not acceptable, never mind the underhanded way it is currently being operated.
Me or you buying strips at the chemist are very likely paying a lot more per strip than the NHS would be, I would assume the same applies to meters.
Are unwaged people currently being refused ??
Does DUK support the pro or anti position ??

Then ofcourse there is the possibility that It is pointless, personally I doubt that.

 

[Stefan Diabetes UK]

Hi, I am a "Newbie" on here and I have just received a letter from my GP stating that my Prescription for my Diabetic Testing Strips has been Cancelled, as they don't think I need them ? I am absolutely Astounded by this..... I have been a Type 2 Diabetic for around Fifteen Years, and my GP and Nurses have Congratulated me Constantly on how well I have managed my Blood Glucose Levels and my GP has commented that if he didn't know better he would think that I didn't have Diabetes. I will now be unable to Control my Diabetes as well as I had previously and I feel that I will be in Danger of Having Hypo episodes.... I really don't know what to do ? I Don't think that Speaking to my GP will help , because I have had Disagreements with her before about my Diabetes........ Chris

Hi @CHRISJK sorry to hear about the problems you've been having getting the test strips you need. You might find the Diabetes UK Testing Times campaign tools useful here. There's a free advocacy pack which sets out the current rules around test strips and gives you tips on how to make the case that test strips help you manage your diabetes.

We also have a tool to help you write to your local health care authority to challenge the decision, if you don't get anywhere with your GP. It gives you a template letter which you can then add the details of your own experience too.

Our research showed that 1 in 4 people living with diabetes had faced some sort of restrictions, so we started the Testing Times campaign on this issue earlier this year. There's more details on our website.

As you'll have seen quite a few people on the forum have faced similar issues and I'm sure will also be able to offer very helpful advice.

 

[Bill Stewardson]

Hi @CHRISJK sorry to hear about the problems you've been having getting the test strips you need. You might find the Diabetes UK Testing Times campaign tools useful here. There's a free advocacy pack which sets out the current rules around test strips and gives you tips on how to make the case that test strips help you manage your diabetes.

We also have a tool to help you write to your local health care authority to challenge the decision, if you don't get anywhere with your GP. It gives you a template letter which you can then add the details of your own experience too.

Our research showed that 1 in 4 people living with diabetes had faced some sort of restrictions, so we started the Testing Times campaign on this issue earlier this year. There's more details on our website.

As you'll have seen quite a few people on the forum have faced similar issues and I'm sure will also be able to offer very helpful advice.

Brilliant stuff.

I would definitely suggest anyone with problems in this area reads the above or gives Bubbsie a tug,, if only we could get DNs to think the same way.

 

[Bubbsie]

Part of the challenge for motivated T2s who can and do successfully use self monitoring of blood glucose (SMBG) to improve their blood glucose management through adjusting their diet and exercise patterns (ie most members here who choose to self monitor) is that they need to be seen as the exception, rather than the rule of the T2 population.

There are significant studies into SMBG in T2 which are interpreted to show that 'It Does Not Work' (Farmer et al etc) and the NICE guidance is clear that self monitoring should not be routinely offered in T2 unless you are taking something more likely to cause hypos than Metformin.


https://www.nice.org.uk/guidance/ng28/chapter/1-Recommendations#blood-glucose-management-2

The old Farmer study (and a subsequent follow-up) conclude that self monitoring has no positive effect and actually causes people distress. It costs money, and it not only doesn't help - it actually makes people feel worse. And this I am sure we find very confusing. But it is evidence of these and similar studies that form the basis of the NICE guidance not to offer strips to T2s.

Of course, if some of our T2s look at the way that study was conducted, they will immediately see that of course it wasn't going to work if that was what they were doing! Because if I remember right, part of the initial study setup was to ensure that they kept eating what had initially been agreed and did not deviate. Rather than using their individual results to adjust their diet for better BG outcomes.

I find this paper from Australia really interesting in that regard - https://www.mja.com.au/journal/2015...sely-when-it-comes-monitoring-type-2-diabetes

Because it again demonstrates that you can't necessarily improve T2 outcomes just by spraying test strips around to people who really aren't interested in them (or people who have been given inappropriate advice on how to use the results). Again it shows that just testing alone is unlikely to confer benefit, and may cause problems. What really works is the test-review-adjust style approach that T2s here advocate.

For SMBG to be effective in people on D&E/metformin the people involved need to learn, or be shown what to DO with the information, how to adjust their diet and exercise in response to the results they see 1 and 2 hours after eating vs before the meal. How long they need to commit to the tiresome business of intensive self-monitoring while building up their understanding of how different foods affect them as an individual, before they can drop back to a more relaxed, occasional 'maintenance level' and give their fingers a rest. All this takes effort, and commitment. And it is not necessarily an approach that everyone will want to take.

My opinion is that people who are motivated to use self-monitoring to improve their BG outcomes need to convince their clinic/GP that they are unusual. That they are the exceptions to the rule. That they understand that SMBG doesn't generally work for people in their position, but how it will work for them, and improve their long-term health/reduce complication risk.

My guess is that many Drs and Practice nurses are not purely doing this to save money (though I am sure some are). They are doing it because there is substantial scientific evidence that it doesn't 'work'.

You need to demonstrate that you are one of the cases in which self monitoring offers real benefit.

What absolute nonsense Mike...first you make the point the NICE guidelines do not say not to offer strips to T2s...but 'do not routinely offer testing strips/meters'...yet later state the NICE guidelines say not to offer test strips to T 2's...conflicting information?...or can you just not make up your mind...secondly you refer to significant studies...which based on your own view...'if some of our T2s look at the way that study was conducted, they will immediately see that of course it wasn't going to work if that was what they were doing! Because if I remember right, part of the initial study setup was to ensure that they kept eating what had initially been agreed and did not deviate. Rather than using their individual results to adjust their diet for better BG outcomes'..given those circumstances that study was designed to fail from the outset...where is the science/objectivity in that?...I find the rest of your comments unbelievable...patronising...ill-informed...as a type 2 diabetic using Metformin only...I do not want to be seen as an exception to the rule...what is the rule...who would...I do not want to hear the standard NHS mantra paraded continually by DUK or their staff...I live with my diabetes daily...I manage/control my condition... know what I need in order to maintain that control...I do not find 'the business of intensive self-monitoring tiresome'...I find it liberating...invaluable...I am not unusual in that...I do not agree that SMBG does not work for people in my position...give type 2's the opportunity to demonstrate that...your opinion is subjective...unfounded (given the scientific data you quote...I use the term scientific loosely)...many/most type 2's are not given the option to test...strongly advised against it...deterred on the flimsiest of pretexts....where is the substantial evidence you refer to?...not contained in any of the references you make above...it does work...many of our members here have demonstrated that...many of our members have testing strips withdrawn...restricted...Mike there are many differences between the management of our respective conditions...I speak from personal experience here...I am tired of the constant distinctions 'subtly' inferred/drawn between type 1 & 2 diabetics...from the medical profession...failed non-scientific studies...but most of all DUK (just wondering why I have never seen a type 2 moderator... or member of staff feature prominently here...are there any)...the recent DUK campaign on testing strips was type 1 & 2 centric...focused on those dependant on hypoglycaemic medications...there was nothing there for me...or other members in similar circumstances...we are very much left to our devices...please don't make it harder by telling us SMBG doesn't work...'we need to prove we are the exception to the rule'...'we need to convince our GP's/Nurses we are unusual'...I couldn't believe I was reading that...type 2 diabetics reliant on Metformin or diet & exercise only appear to be 'the poor relations' of the diabetes world (my opinion only)..until that attitude changes...particularly within those organisations that are presumed to be our 'Voices'...Primarily DUK...Please do not seek to justify the vacuous excuses given to deny type 2's the equipment many of them need to control their diabetes...we are not unusual...not the exception to the rule (given most of us are denied the opportunity to prove otherwise routinely)...we are not uninformed...we are diabetic too.

 

[Bubbsie]

Hi @CHRISJK sorry to hear about the problems you've been having getting the test strips you need. You might find the Diabetes UK Testing Times campaign tools useful here. There's a free advocacy pack which sets out the current rules around test strips and gives you tips on how to make the case that test strips help you manage your diabetes.

We also have a tool to help you write to your local health care authority to challenge the decision, if you don't get anywhere with your GP. It gives you a template letter which you can then add the details of your own experience too.

Our research showed that 1 in 4 people living with diabetes had faced some sort of restrictions, so we started the Testing Times campaign on this issue earlier this year. There's more details on our website.

As you'll have seen quite a few people on the forum have faced similar issues and I'm sure will also be able to offer very helpful advice.

Stefan...this campaign was type 1 focused...extended to type 2's on hypoglycaemic medication...there is/was little in for type 2's dependant on Metformin or diet & exercise only.

 

[mikeyB]

Aye, Bubbsie, which is why your personal campaign is a valuable example for others to follow. I still think it shouldn't be so hard for motivated folk to get test strips.

 

[Bill Stewardson]

I was hoping this would not become an "Us and Them" scenario.

 

[Bubbsie]

Aye, Bubbsie, which is why your personal campaign is a valuable example for others to follow. I still think it shouldn't be so hard for motivated folk to get test strips.

Mike I have said this before...many member here have done exactly the same as I have ...albeit more discreetly...less directly...it is more than a personal campaign...there are a growing number of new diabetics joining the forum...with certainly more knowledge & insight than I had when I first arrived here...reading...researching...challenging the advice they are given...testing however strongly they are advised not to...all those actions are positive...thank you for your confidence in me...however I think you give me too much credit for it being MY campaign...I have used the advice...information & support given by other members on the forum...to challenge my GP's refusal to provide what I need on prescription...to challenge the CCG...I am very grateful for their input...I hope that small...limited success... will encourage many more here to adopt the same approach.

 

[Bubbsie]

I was hoping this would not become an "Us and Them" scenario.

Bill diversity of opinion is not an 'us and Them' scenario...it leads to discussion...debate...new perspectives...learning...this is a forum...what it's all about

 

[everydayupsanddowns]

@Bubbsie - I feel you are attacking me and calling me ill informed and patronising and that my opinions are unfounded. All I was trying to do was to explain to others reading this thread WHY their doctor says that an A1c is enough and that they do not need to test.

I am NOT saying that 'it doesn't work'. I firmly believe that it does - for the right people with the right support and knowledge. We see that on the forum all the time. We always suggest meters and self-monitoring for new arrivals here.

What absolute nonsense Mike...first you make the point the NICE guidelines do not say not to offer strips to T2s...but 'do not routinely offer testing strips/meters'...yet later you say the NICE guidelines say not to offer test strips to T 2's...conflicting information?...or can you just not make up your mind...secondly you refer to significant studies...which based on your own view...

I'm afraid I never said that NICE doesn't say not to offer test strips - because that's exactly what they DO say. How else can one interpret "Do not routinely offer"

I also never said that testing does not work for someone in your position.

What I said is that the evidence that NICE use to make their recommendations says that 'it doesn't work'.

The trials are published, reviewed, randomised controlled studies. As individuals, we may have concerns over the structure and study method, but these studies from part of the literature on which NICE guidance etc is based.

The conclusion of the 2009 Farmer study:

While the data do not exclude the possibility of a clinically important benefit for specific subgroups of patients in initiating good glycaemic control, SMBG by non-insulin-treated patients, with or without instruction in incorporating findings into self-care, did not lead to a significant improvement in glycaemic control compared with usual care monitored by HbA1c levels. There was no convincing evidence to support a recommendation for routine self-monitoring of all patients and no evidence of improved glycaemic control in predefined subgroups of patients.

You will see that there IS wiggle room there for an individual to go to their doctor to make a case for strips ('specific subgroups'). That was why I suggested forum members position themselves as 'exceptions to the rule'. This was not intended to cause offence to you as an individual.

I was trying to be on your side. But I'm afraid you have just made it feel like I am being attacked and shouted down for trying to explain why we are where we are.

That's not what I expect from the forum to be honest.

Incidentally you might be interested to know that we did have a respected T2 moderator for many years. They still visit the forum though are not as frequent a poster as they were.

 

[Vicsetter]

What absolute nonsense Mike...first you make the point the NICE guidelines do not say not to offer strips to T2s...but 'do not routinely offer testing strips/meters'...yet later you say the NICE guidelines say not to offer test strips to T 2's...conflicting information?...or can you just not make up your mind...secondly you refer to significant studies...which based on your own view...'if some of our T2s look at the way that study was conducted, they will immediately see that of course it wasn't going to work if that was what they were doing! Because if I remember right, part of the initial study setup was to ensure that they kept eating what had initially been agreed and did not deviate. Rather than using their individual results to adjust their diet for better BG outcomes'..given those circumstances that study was designed to fail from the outset...where is the science/objectivity in that?...I find the rest of your comments unbelievable...patronising...ill-informed...as a type 2 diabetic using Metformin only...I do not want to be seen as an exception to the rule...who would...I do not want to hear the standard NHS mantra paraded continually by DUK or their staff...I live with my diabetes daily...I manage/control my condition... know what I need in order to maintain that control...I do not find 'the business of intensive self-monitoring tiresome'...I find it liberating...invaluable...I am not unusual...I do not agree that SMBG does not work for people in my position...your opinion is subjective...unfounded (given the scientific data you quote...I use the term scientific loosely)...many/most type 2's are not given the option to test...strongly advised against it...deterred on the flimsiest of pretexts....where is the substantial evidence you refer to?...not contained in any of the references you make above...it does work...many of our members here have demonstrated that...many of our members have testing strips withdrawn...restricted...Mike there are many differences between the management of our respective conditions...I speak from personal experience here...I am tired of the constant distinctions 'subtly' inferred/drawn between type 1 & 2 diabetics...from the medical profession...failed non-scientific studies...but most of all DUK (just wondering why I have never seen a type 2 moderator... or member of staff feature prominently here...are there any)...the recent DUK campaign on testing strips was type 1 & 2 centric...focused on those dependant on hypoglycaemic medications...there was nothing there for me...or other members in similar circumstances...we are very much left to our devices...please don't make it harder by telling us it doesn't work...we need to prove we are the exception to the rule...we need to convince our GP's/Nurses we are unusual...I couldn't believe I was reading that...type 2 diabetics reliant on Metformin I diet & exercise only appear to be 'the poor relations' of the diabetes world (my opinion only)..until that attitude changes...particularly within those organisations that presumed to be our 'Voices'...Primarily DUK...Please do not seek to justify the vacuous excuses given to deny type 2's the equipment many of them need to control their diabetes...we are not unusual...not the exception to the rule (given most of us are denied the opportunity to prove otherwise routinely)...we are not uninformed...we are diabetic.

Unbelievable, you have obviously done lots of studies into the behaviour of T2 diabetics! I would be willing to bet that you are the exception to the rule, but unlike you I do not attack Mike who has only put forward the facts. If T2s were to be concerned about self testing then there would be a lot more members on this forum.

The NHS can only base it's guidlines, (under increasing pressure of rising costs) upon the scientific evidence that exists. I have posted at least twice asking if anyone knows of a study that proves SBMG is beneficial - and got no reply. NICE are not going to change their rules upon your experience. The weight of the evidence is that the supply of test strips has no affect on HBA1c.
The studies I have seen, including the latest from the USA was incredible in expecting 1 BG test a day to have any affect at all.

I had a friend who was T2 on Byetta and then Bydureon, who would test and then say " oh less than 10 thats good" and tuck into a piece of cake, he wouldn't take any advice and certainly wouldn't join this forum.
You are an exception and perhaps that is because of your mental attitude to YOUR diabetes.

T2s have problems in that the only control they have (unless on insulin) is to regulate their diet or potentially increase their exercise. I have never exercised and given blood pressure/circulatory problems and not going to start now. It takes an enormous amount of willpower (I would say from experience more willpower than giving up smoking) to radically change your diet, especially as there is no perceived benefit (except maybe weight loss).

 

[Bubbsie]

@Bubbsie - I feel you are attacking me and calling me ill informed and patronising and that my opinions are unfounded. All I was trying to do was to explain to others reading this thread is WHY their doctor says that an A1c is enough and that they do not need to test.



I'm afraid I never said that NICE doesn't say not to offer test strips - because that's exactly what they DO say. How else can one interpret "Do not routinely offer"

I also never said that testing does not work for someone in your position.

What I said is that the evidence that NICE use to make their recommendations says that 'it doesn't work'.

The trials are published, reviewed, randomised controlled studies. As individuals, we may have concerns over the structure and study method as individuals, but these studies from part of the literature on which NICE guidance etc is based.

The conclusion of the 2009 Farmer study:


You will see that there IS wiggle room there for an individual to go to their doctor to make a case for strips ('specific subgroups'). That was why I suggested forum members position themselves as 'exceptions to the rule'.

I was trying to be on your side. But I'm afraid you have just made it feel like I am being attacked and shouted down for trying to explain why we are where we are.

That's not what I expect from the forum to be honest.

Incidentally you might be interested to know that we did have a respected T2 moderator for many years. They still visit the forum though are not as frequent a poster as they were.

I'm sorry attacking you...really...since you ask 'do not routinely offer' means just that do not routinely offer clearly indicating there is room for discretion...deviation...it is not an absolute no...if you are unhappy with my comments...is it appropriate to say I am attacking you because I do not agree with your comments/opinion?..am able to justify that....is that the way forward?

 

[Bubbsie]

Unbelievable, you have obviously done lots of studies into the behaviour of T2 diabetics! I would be willing to bet that you are the exception to the rule, but unlike you I do not attack Mike who has only put forward the facts. If T2s were to be concerned about self testing then there would be a lot more members on this forum.

The NHS can only base it's guidlines, (under increasing pressure of rising costs) upon the scientific evidence that exists. I have posted at least twice asking if anyone knows of a study that proves SBMG is beneficial - and got no reply. NICE are not going to change their rules upon your experience. The weight of the evidence is that the supply of test strips has no affect on HBA1c.
The studies I have seen, including the latest from the USA was incredible in expecting 1 BG test a day to have any affect at all.

I had a friend who was T2 on Byetta and then Bydureon, who would test and then say " oh less than 10 thats good" and tuck into a piece of cake, he wouldn't take any advice and certainly wouldn't join this forum.
You are an exception and perhaps that is because of your mental attitude to YOUR diabetes.

T2s have problems in that the only control they have (unless on insulin) is to regulate their diet or potentially increase their exercise. I have never exercised and given blood pressure/circulatory problems and not going to start now. It takes an enormous amount of willpower (I would say from experience more willpower than giving up smoking) to radically change your diet, especially as there is no perceived benefit (except maybe weight loss).

Vic I am entitled to my opinion...there will be diversity here...that's the point of the forum...you are entitled to yours...Mike is entitled to his...why the forum is here...if Mike believes this is a personal attack...he can report it to the moderating staff...that's what they are here for.

 

[Juzzy1972]

Hi all sorry this is my 1st post and what a post my blood strips and needles have been taken off my repeat prescription without telling me after seeing my GP this morning who told me it's a government issue that they have been told they can't give the strips and bit out and quote " you have to fund them yourself sorry " I have made another appointment to see the diabetic nurse as in her words keep and eye on your bloods as I have got problems with kidneys and liver so will see what she says.
Let doctors and went next door to chemist asked the price of strips just under £20 pharmacies overheard and said no you don't pay your had them on prescription so repeated what GP said off she went to have a word with drs 10 mins came back and apologised and said she couldn't believe it neither myself I said.
Any advice would be nice ?

I'm type 2 diabetic on metformin oh and really fun part my bloods have only been high when diagnosed never had a hypo my bloods go low and lowest recorded 1.2 so fun time ahead of guessing I suppose sorry for blabbing on it just me lol cheers Justin

 

[Vicsetter]

Vic I am entitled to my opinion...there will be diversity here...that's the point of the forum...you are entitled to yours...Mike is entitled to his...why the forum is here...if Mike believes this is a personal attack...he can report it to the moderating staff...that's what they are here for.

Mike is a moderator!

 

[Bubbsie]

Mike is a moderator!

And?

 

[Vicsetter]

Vic I am entitled to my opinion...there will be diversity here...that's the point of the forum...you are entitled to yours...Mike is entitled to his...why the forum is here...if Mike believes this is a personal attack...he can report it to the moderating staff...that's what they are here for.

Starting off your post with

What absolute nonsense Mike

struck me as attacking.
I would like to see you justify your opinion with some facts (other than, it works for me)

 

[everydayupsanddowns]

Vic I am entitled to my opinion...there will be diversity here...that's the point of the forum...you are entitled to yours...Mike is entitled to his...why the forum is here...if Mike believes this is a personal attack...he can report it to the moderating staff...that's what they are here for.

I've now mentally reported the post to myself, to see whether I thought I was feeling attacked. I think I probably *did* feel attacked. That was why I said "I feel that you are attacking me". I suppose I hoped that it would show that I was feeling attacked. Sorry I wasn't more clear about that.