Trouble with the GP

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Inland-Revenue Man

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Type 1
Hello all, first post on this forum.

I am 23 years old and have had type 1 since I was 18 months old.

I have never had any complaints with the treatment and support I have recieved in my local area, Wolverhampton. (If any other members know the area, Dr Anderson at the Childrens Diabetes centre at New Cross Hospital in the town was an amazing woman, who dedicated time and effort to diabetic children in the locality before retiring in 2006) However lately I have had some problems...

My diabetes is under good control (Last HbA1c 6.8, it hasn't been above 8 for more than 5 years) mainly due to the fact that I do around 8 tests a day. However, recently when I have ordered a repeat rescription of test strips, my GP surgery has told me, quite forcefully, that I am using too many test strips. I use around 50 a week, but have been told that this amount should last for 2 weeks - i.e. use half as many.

I have become quite hostile to the surgery over this, stating that prehaps they would prefer if I didn't test my blood, allowing them to save money and I will come back when I am blind and have kidneys like Swiss Cheese! I know that times are hard in the NHS, but we are told to manage our condition well and this attitude is extremely disappointing.

Has anyone else had similar treatment / What are your views?
 
If you search this board, you will find situations where some GPs have openly mentioned cost and have effectively reduced a much needed self control tool.
 
yes i have been told the same thing, i have been diabetic for about 6yrs and have been on insulin since feb when i was admitted to hospital with dka. my sugars are still not stable, but getting there. i was told by my gp that i was using too many test strips, he even told me i was using too much insulin and had to be practically forced to give me a repeat prescription,whilst mumbling about cost. i use approx 4-6 units humalog with meals and 24-28 units of levemir at night. he also told me not to prime my needles because it wastes insulin. i always prime using 2 units as i have had alot of blocked needles.
 
After learning how much test strips cost, I'm not altogether surprised that GPs are reluctant to issue lots of them but I think you're completely right to fight for them. I do see your GP's point though - even the most conscientious diabetics usually check their BGs four times a day, perhaps extra when they're ill or need to confirm hypos. Do you think you could manage or perhaps 6 or 4 a day? When do you test, if you don't mind me asking?

I'm lucky in that I now have a fantastic diabetes nurse, who I know would fight tooth and nail to get me as many strips as I needed. In fact tonight she's writing all of her DAFNE group GP letters to explain that we need 3 pots of strips a month, plus the super expensive ketone strips (?2.50 per strip!) to effectively manage our diabetes. What about your nurse or consultant, would they do something similar for you? I don't think your GP could really refuse to give you enough strips if other medical professionals with personal care for your condition backed you up.

I think it's important to see both sides and if you're unfortunate you might have to negotiate and have 150 strips a month on prescription and pay for a fourth pot yourself, or cut down the amount you test a little bit. I think the first thing I would do is call my nurse and explain the situation to her.
 
Outrageous! Makes me so angry when I hear these things!

I am currently testing arox 8 -10 times per day as been very unstable lately and bad nght hypos. Am almost anticiating same response from gp, not happened yet though

😱😱

just looked at spelling, bad, just coming up from 2.6, sorry
 
Thanks for your input!

Worzel, I do a test when I wake up (6am) at test at 8am (When I start work) a test at 10:30 (Tea break) 12:30 (Lunch) 15:00 (Afternoon break) 18:00 (Tea time) 21:00 and then another before bed (About 23:00)

Whilst this may sound excessive, I had two major hypos just after switching to my current insulin regime (Novorapid / Lantus Optiset) 4 years ago (Ended up in hospital twice, which hadn't happened to me since diagnosis)

I can understand why many see my approach as an over-reaction to these event, but before the two hypos, I would do 2 or 3 tests a day. I just feel that my approach gives me the control that I desire, but I can understand that many would not want to do this
 
i completely understand your reasoning. You should be able to test as often as you want/need to, no questions asked.
 
The importance of regular blood testing for Type 1

I have had type I diabetes for nearly 40 years since I was two years old. I test my sugar an averagoe of ten times each day and have found that this is necessary for me because when I have tested less my HBA1Cs have gone to 9 or above and I have had lots of problems with erratic blood sugars. There are a number of reasons why I test so frequently. First of all my job involves spending a lot of time lecturing/teaching University students. It would not be possible for me to deliver a lecture or advise students if I start having a low sugar. I have had two or three hypos whilst at work and had to excuse myself from meetings because I can't think straight because of the low sugar. I also walk my dog a lot and go swimming and to the gym. Also if I have had a particularly stressful day (which happens a lot in academia) my sugars can go up in the night. In addition to this I no longer recognise nocturnal hypos and have also had some sudden low sugars during the day that have no clear explanation. Therefore I do a lot of tests so that I can alter my insulin/carbohydrate intake before and after these situations, have a relatively good HBA1C and lead a reasonably nnormal life. Therefore in one day this could equate to:
Blood test upon waking - if sugar higher than 10 take extra insulin before walking dog to bring sugar down (if sugar low have lucozade) - then test whilst walking dog because the insulin dose doesn't have the same effect each day and sometimes leads to a low sugar (and sometimes doesn't seem to have hardly any effect at all!!)
Test before breakfast
Test before 9am lecture - if sugar is lowever than 7 have extra carbohydrate to prevent low sugar during 3 hours of non-stop teaching.
After teaching test again if sugar is above 10 have another jab to bring it down to a more "normal" level (this pattern can be repeated up to 3 times a day dependent upon number of sessions teaching/student appointments/meetings)
Test each time I drive the car - had several occasions when I'm rushing from something, about to drive, and then realised that my sugar is below 5. So, having had lucozade, have to test sugar again before driving to make sure that it has reached 5
Test sugar before lunch (unless I have very recently tested it afer teaching/exercise)
Test sugar before tea
Test sugar before bed - if sugar is up a little then inject extra humalog
Test around 3am in the morning because sometimes sugar goes up in the night when I have been very busy/stressful and inject insulin to correct
Obviously also test before and after excercise and when suspecting hypos.

To some this might sound "excessive" but the result has been that I've managed nearly 40 years of diabetes with only one hospital admission in nearly 25 years (which was because of a bad stomach bug), in that same time I have not needed assistance from others because of low sugars, I don't have any serious diabetic complications (although I do suffer badly from fatigue, frequent headaches and glaucoma) and I do live a relatively busy life (I say relatively because I have had a lot of "short-term" problems with the diabetes including extreme fatigue headaches, high blood pressure etc when I worked full-time and so had to reduce to a fractional post two years ago but for an academic that is still a relatively long working week - but the reduction plus the regular testing does mean that I can manage these other problems and no longer need blood pressure tablets). If I wasn't able to test my blood sugar this frequently I know from experience that I would have a lot more problems with my control and would have to keep my BGs at a much higher level because I coudn't risk having low sugars at work (that would affect my confidence) or when driving/doing exercise etc - had a low sugar two or three years ago when running on a treadmill and that was not a fun experience. However, in relation to an earlier post, because I've had to reduce my hours at work I can't afford to buy testing strips myself - but the trade off for my GP, who has been absolutely great, is that I am not costing with regard to diabetic complications needing to be treated.
 
I tend to get hypos mid morning so find I'm testing more often now than I was when first diagnosed to try to work out how best to balance my food with my needs. I'd rather do this so I can keep my overall control relatively tight than run a higher risk of additional complications.

Hate the implication that good control is somehow irresponsible due to the short term cost to the NHS

Difficulty in dealing with NHS fianance issues is that budgets are managed on an annual basis and my potential longer term complications are well into the future (I hope!)
 
My advice is first talk to your specialist doctor or a nurse, get them to write a letter explaining how often you need to test and why, and show this to your GP. Use the surgery complaints procedure, it that does not work go to the local Primary Care Trust. And look into changing GPs as well.
 
annemarie08 said:
i was told by my gp that i was using too many test strips, he even told me i was using too much insulin and had to be practically forced to give me a repeat prescription,whilst mumbling about cost. i use approx 4-6 units humalog with meals and 24-28 units of levemir at night. he also told me not to prime my needles because it wastes insulin. i always prime using 2 units as i have had alot of blocked needles.
Click to expand...

Any doctor who tries to restrict insulin to a diabetic because of it's cost should be struck off. I would at a minimum complain to my consultant and probably make an official complaint to the PCT.
 
annemarie08 said:
yes i have been told the same thing, i have been diabetic for about 6yrs and have been on insulin since feb when i was admitted to hospital with dka. my sugars are still not stable, but getting there. i was told by my gp that i was using too many test strips, he even told me i was using too much insulin and had to be practically forced to give me a repeat prescription,whilst mumbling about cost. i use approx 4-6 units humalog with meals and 24-28 units of levemir at night. he also told me not to prime my needles because it wastes insulin. i always prime using 2 units as i have had alot of blocked needles.
Click to expand...

Reading some of the posts on this forum, I am absolutely appalled at the ignorance shown by some doctors/health professionals! This is a disease that affects millions of people - every GP must encounter many, many diabetics in a working week. How on earth can they be so ill-informed about something that is so well documented and 'every day'? Fair enough, if it was some rare genetic disorder that only occurs in one in 5 million, but there really is no excuse for the attitude of the doctor quoted above. I use about 40 novorapid a day, someone else I read uses over 180 - everyone is different. And to suggest that the priming shot is wasteful is nonsense - it's done for a reason, to clear air or blockages from the needle before you stick it in your body. Perhaps the GP would be happier if we squirted those 2 units into a bucket, and in a month we might have saved enough for a whole new cartridge - except, of course, it would be unusable...GRRRR!!!! Rant over!😡

I have to say that my GP is very good, but that should be the minimum standard - they should all be excellent.
 
Just talked to my GP on the 'phone (he 'phoned me by appointment).
Emailed him my last six weeks' data, graphs, pie charts etc.yesterday.
He was delighted with the current situation and has told me to test when I think it is needed and to try random testing times except if I feel rough or am going to be driving.

No mention of being restricted on supply of strips.
He said that he considers each case is different.
Other tests done when INR was done included thyroid, kidney function and testosterone (ED 🙂 ) and is sending additional scripts to the local pharmacy.

When I read of others' experience I realise how lucky I am with both my local medics and my lovely caring companion (technically I'm her carer)
 
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