T1s on MDI - blood test strips

[imtrying]

Hi guys,

I went to my doctors yesterday to ask if I could increase the number of strips I could get at one time...mainly to save myself some time and them as no matter when I get them, I'm still going to need the same number! It's just frequency of how many times I ask for a repeat!

I put my case across - on MDI, carb-counting, I also drive everyday, and also go to the gym most nights. I explained if hypo I also need to test every 15 minutes until safe (at the moment, this is taking about 40 minutes). This results in probably over 8 tests on average per day.

They didn't get it. And then the fail-safe excuse of 'we're not allowed, it all comes down to budget'....which doesn't make sense because if they doubled it, I would be asking half the times I am at the moment! The cost will stay the same!

At the moment I am prescribed 250 strips. As you can see, this will probably last me a month, maybe 5 weeks. I am also ill at the moment so testing more, as well as working the wonderous method of trial and error with my gym workouts.

Just wondered what others are prescribed. (I know those with T2 have much bigger problems getting strips with this, so sorry for moaning guys!) I just don't like that I feel like I'm being greedy or something when all I'm trying to do is what the professionals have asked me to.

 

[novorapidboi26]

100 strips each time, so 2 tubs for the freestyle meters..........

so, about every week and a half, two weeks I go back I think.........doesn't bother me really, as I need to get insulin and BP meds regularly......

 

[Nyadach]

On a similar amount to you, but only get them monthly (easier really through Boots' repeat prescription system...but it does still go through the GP). Anyhow, when I tried to up them did have to report to the GP to get it increased, but sheesh "why" do I need them? Urmm let me see, remember that week when I got scraped up by paramedics three times? (that was before DAFNE and getting to see a DSN and consultant). They gave in after a bit of whining but they are too used to dealing with type 2's these days it seems and admin staff have a tendency just to see diabetic and not bother about types.

 

[Northerner]

I get 300 per repeat for my main meter, plus 50 for my spare meter which is a different type, if I need them, although I don't use the spare very much. I was on 200 per repeat, but my GP was happy to increase to 300 once I explained that I generally test 6 times a day and use 4 needles, so this would bring them both in line (I get 200 needles). I did have to explain why I averaged 6 tests a day, but this was accepted without fuss - I think I am very lucky with my GP, I've never been refused anything I've asked for 🙂

 

[novorapidboi26]

I get 300 per repeat for my main meter, plus 50 for my spare meter which is a different type

So two different types of strips, that's unusual.............and you would think not very cost effective as you can only use one meter at a time.......

 

[Monkey]

At the moment, 200. I'm testing loads just now (planning a pregnancy with a toddler in tow = lots of tests!) so that probably lasts about 3 weeks max.

I've noticed on my repeat that they put a next 'due date' which is 4 weeks from the last issue, but they've not complained yet that I've been asking for them sooner.

I should really get everything in line to be able to order the lot once a month, but haven't got that organised yet!

 

[Pumper_Sue]

Mines 200 PRN. which means can order as often as I like.

 

[Northerner]

So two different types of strips, that's unusual.............and you would think not very cost effective as you can only use one meter at a time.......

My main meter is an Accuchek Aviva, but I wanted an Optium Xceed for blood ketone strips. The Optium blood glucose strips are also handy for when I am out running on longer runs as they are individually foil-wrapped and I don't need to take a pot of strips with me (bulky even if there are only a couple of strips in it). I always make sure I use the strips before expiry so nothing is wasted.

 

[everydayupsanddowns]

Like Northie I was on 200 per repeat, but they were happy to up that to 300 a year or so ago. I just go and get a new lot when I'm on the last box - never seem to get complaints about frequency.

Will be changing my 'primary' meter to a Contour (for bluetooth transfer of results to pump). Hoping they will be happy to keep the same quantities.

I also test usually 6-8 times a day.

Incidentally I had to fill in the new-fangled (lots more pages of) driving license renewal form today. You now have to sign a declaration that you WILL test your BG before driving and at times relevant to driving. I don't remember that signature box on the old forms.

 

[trophywench]

No it wasn't there Mike - and that sig is in the MIDDLE of the form, but you still have to plod on regardless to the end, and sign it again there.

I complained about that (and made lots of other suggestions) when I was asked my opinion of it by DUK!

PS I used to get 150 strips PRN x 6 but when I changed the make when I got the pump the daft bugger put it down to 50. So I had to go and see GP who wanted to make it 100. Because the PCT say whatever. After some major arm twisting he put it back to 150. Which I order roughly every 3 weeks ..... But if you have a man from the SHA turn up at your door to complain, better be ready with your arguments. I said well just better warn him if he does come and say that I'll cordially greet him with a baseball bat then ...... (actually it's a pick-axe handle, but you get the gist ....)

 

[Tina63]

My son gets 100 per repeat, and 100 needles, but at the start we were putting a repeat in every 18-20 days and got them no problem. As he's not testing at the moment (still) we haven't ordered new ones for a while. I have often wondered if he does get back into regular testing if they may refuse them too often - only time will tell.

 

[Robster65]

The last time I looked at NICE guidelines on this subject, I think it stated approx 4 tests per day but needs to be reviewed for individual patient needs.

Ask them how they would propose you save strips and then step through each test and what they would do instead.

Then suggest that you can either stop driving, stop exercising or stop injecting. Or in each case, you can ring them up for advice every time you need to test, so they can advise you what to do instead, eg. when you want to go to bed and think you may be low but not sure. Or when you're about to inject for a meal that could require 8u or 10u depending on your BG. Or you assume you can drive to work but can't be sure on your BG so they'd better give you a letter to say they told you not to test.

ENd of rant.

Rob

 

[ukjohn]

They gave in after a bit of whining but they are too used to dealing with type 2's these days it seems and admin staff have a tendency just to see diabetic and not bother about types.

Nyadach

What is the connection between types and test strips, are you under the impression that type2s are different to you because they are not on insulin.I was put on MDI insulin the first day of diagnosis, by the way my repeat prescription is for 200 strips, and I order as and when I like

 

[everydayupsanddowns]

The last time I looked at NICE guidelines on this subject, I think it stated approx 4 tests per day but needs to be reviewed for individual patient needs.

I've seen Local Authority guides (eg one from Brighton) which set similar limits and refer back to NICE, but the most recent actual NICE clinical guidelines that I am aware of for T1 is CG15

Section 1.8 deals with SMBG

1.8.2 Self-monitoring of glucose

1.8.2.1 Self-monitoring of blood glucose levels should be used as part of an integrated package that includes appropriate insulin regimens and education to help choice and achievement of optimal diabetes outcomes.

1.8.2.2 Self-monitoring skills should be taught close to the time of diagnosis and initiation of insulin therapy.

1.8.2.3 Self-monitoring results should be interpreted in the light of clinically significant life events.

1.8.2.4 Self monitoring should be performed using meters and strips chosen by adults with diabetes to suit their needs, and usually with low blood requirements, fast analysis times and integral memories.

1.8.2.5 Structured assessment of self-monitoring skills, the quality and use made of the results obtained and the equipment used should be made annually. Self-monitoring skills should be reviewed as part of annual review, or more frequently according to need, and reinforced where appropriate.

1.8.2.6 Adults with type 1 diabetes should be advised that the optimal frequency of self monitoring will depend on:
? the characteristics of an individual?s blood glucose control
? the insulin treatment regimen
? personal preference in using the results to achieve the desired lifestyle.

1.8.2.7 Adults with type 1 diabetes should be advised that the optimal targets for short-term glycaemic control are:
? a pre-prandial blood glucose level of 4.0?7.0 mmol/litre and
? a post-prandial blood glucose level of less than 9.0 mmol/litre.

Note: These values are different from those given in the recommendations for children and young people with type 1 diabetes (See Section 1.2.6.7) because of clinical differences between these two age groups.

1.8.2.8 Monitoring using sites other than the fingertips (often the forearm, using meters that require small volumes of blood and devices to obtain those small volumes) cannot be recommended as a routine alternative to conventional self-blood glucose monitoring.

Nothing there to limit numbers of strips. Quite the contrary...

Use the meter that suits you best
Test frequently enough to do your best to hit the targets
If you control's gone a bit haywire test more often

I would ask to have a printed copy of the 'Guidelines' they are referring to. Bet you any money they don't come from NICE.

 

[Robster65]

I agree John. Anyone on insulin has a certain minimum requirement, which will be the same whether T1 or T2.

Other BG lowering meds have a similar requirement, but may be less intensive (I'm only guessing this and I may be wrong) and those on diet/exercise still need to find out what their BG is doing or they could be wasting their time over several months between GP visits.🙂

Rob

 

[Robster65]

Thanks Mike. That could prove very useful as ammunition for a lot of us.🙂

Rob

 

[Ruth Goode]

Usually 100 every time but I have asked for 200 every month on express repeat prescription which have been accepted 🙂

 

[FM001]

200 each repeat but not without a fight🙄

 

[Nyadach]

What is the connection between types and test strips, are you under the impression that type2s are different

As I said, THEY usually don't give out strips in any kind of quantity and as such questioned why I needed them as they saw diabetic and didn't look any further. And considering many type 2's get no strips at all, or so few (know one who has to buy his own), than yes they saw diabetic and classed us all the same which is what ticked me off, and what I was referring too.

Am curious about Northerner and the Optium Xceed strips, mostly as to how many of the ketone strips he can wrangle out of them? They gave me a cap of 10 a month (which is more than enough for a fair few months) but did make me wonder if he had seen any cap limit on them as well?

 

[Flutterby]

I get 200 a month but it's a struggle to manage with that number. If I'm ill he lets me have a few more but it's a battle.