I can't help. I know it's going to have flow-on effects here eventually, so I wish you well. I think you are going to need concerted efforts by many others in other forums to win this one. I'll repeat this post on asd, asd.uk and mhd.
Here is just one excerpt from the drivel: "Conclusion This paper suggests that many patients with type 2 diabetes are selfmonitoring blood glucose unnecessarily, at a cost to the NHS of £17 million annually. Much of this money could be saved by improving management for patients taking metformin or insulin plus oral therapy.
It is not possible from these data to estimate what proportion of testing was appropriate."
Wow Alan!!!!! How short-sighted can people become?
If there is anyone out there who hasn't added their support to my e-petition on this subject on 10 Downing Street then perhaps now is the time to do it. Moreover, get friends and family to add their support too. There are 355 supporters so far but we need to get this up to at least 500 to ensure that 10 Downing Street are certain to respond.
Immediate response in relation to having that thrown at me would be:
"My testing is appropriate. Here's my data, conclusions and Jennifer's testing protocol to show you the methodology behind it, which as much as the accountants would love you to, you can't actually argue effectively against. Now shut up and write my repeat scrip"
If that didn't work, I would have to go into a half hour critique of DIGEM and ESMON, comparing it with testing methodologies that do work ie. Jennifer. Then point out to the doc that the testing methodology which does waste money is what they originally suggested to me so perhaps they could actually suggest a testing methodology to new patients which is effective instead of wasting NHS funds.
You seem to have gone a bit red in the face, Doc. Are you all right?
Thanks Alan. Its depressing, but good to be forewarned.
This paper suggests that many patients with type 2 diabetes are selfmonitoring blood glucose unnecessarily, at a cost to the NHS of £17 million annually. Much of this money could be saved by improving management for patients taking metformin or insulin plus oral therapy.
I've managed to convince my GP that the opposite is the case. After initially having refused to prescribe strips and strongly advising against the necessity for a Type 2 to test, when he saw what I had achieved in less that twelve months by testing and changing my diet accordingly, he now prescribes strips for me on a regular basis because "It's cheaper than prescribing insulin". His words - not mine! I added that it is also cheaper than dealing with laser eye treatment, amputations, kidney dialysis, heart operations etc, etc. He nodded his head in agreement.
When will we ever convince the rest?
T2 Diag. Nov 2000 - Then HbA1c 5.7, Chol 7.0, BP 164/109. Metformin 2000mg > 1000mg; Simvastatin 40mg > 20mg; Ramipril 1.25mg; Bisoprolol 5mg > 2.5mg > 1.25mg; Aspirin 75mg. HbA1c progression following NHS advice: 5.7 > 6.7 > 7.4 > 8.2 > 9.4 > 7.2 > 6.7 > 8.5% HbA1c progression by self-management: 8.5 - 6.8 > 5.7 > 5.5 > 5.3 > 5.3 > 5.1 > 5.0% TC 3.7; TG 0.93; HDL 1.52; LDL 1.8 BP now averages around 115/70 Weight Loss: 118kg to 85kg
Of course this is based on a purely economic analysis of the potential savings that could be made if the published guidance was followed more closely.
In other words, what would be saved if the NICE guidelines, as interpreted by the parties involved and translated into a notional strip allocation, were followed to the letter. As such, it is unconcerned with clinical outcomes or the notion that doctors should be able to treat patients on an individual basis according to their needs.
It even explicitly says : " It is not possible from these data to estimate what proportion of testing was appropriate." And by implication it doesn't care. This is about money, not medical need, after all.
Of course the NICE guidelines include "to assess changes in glucose control resulting from medications and lifestyle changes." But the subsequent guidance from all sides on the number of strips required takes no account of lifestyle at all, only considering monitoring legitimate to check the effects of medication so amendments may be made to that.
In individual cases, if this study is used as a stick with which to beat diabetics, I reckon the best counter-argument derives from the "study limitations" where the authors acknowledge:"...it seems unlikely that such high proportions of some treatment groups would meet the NICE criteria for nonroutine use." If someone can show that they are using the NICE criteria (for lifestyle changes, as per Nige and John's responses) then the economic argument advanced here against non-NICE sanctioned testing should not apply.
T1 DX 06/2003 using Lantus and Novorapid. Dafne graduate.
Ziggy. T2 Since 22-May-2008 Chol:- May 09 Total Chol - 5.3, HDL - 1.53, LDL - 2.23, Trigs - 2.93 / Dec 09 Total Chol - 5.1, HDL - 1.49, LDL - 2.76, Trigs - 1.86 Ramapril 10mg, Omeprazole 20mg Exercise and Diet (am a lacto ova vegetarian and am trying to stay low GI/GL)Still on the Road To Find Out
I have an appointment next week at the "diabetic clinic" and will be given a meter. I was told by the nurse not to buy one (I have four already) as she didn't want me to panic about high levls until the Metformin kicked in properly. She seems like a reasonable person, but from reading about other people's experiences I just know she isn't going to prescribe me enough strips. I've been buying them myself for the last couple of months and I will probably carry on buying them because I don't know how to ask for more. I'm not good at confrontation or questioning authority and don't want to look like a smart arse by telling her she's wrong. I'll probably just sit there and nod dumbly and tell her I've been eating all the crap she recommended. I have been keeping a food diary for the last few weeks. Should I bring it along and show her and fess up to the fact I've ignored all her advice and am not shovelling a ton of carbs into my body every day or just use the pocket money I now save by not buying sweeties and Subway sarnies and buy my own strips? I am lucky that I can afford to buy my own strips but I do kinda grudge forking out about 20 quid a week on them when I now get free prescriptions. I would like to have a good relationship with her as I have to see her every 3 months and don't want the appointments to be awkward. I know, pathetic isn't it
Type 2 Dx 01/07/09 HbA1c Jul 09 - 11.6, Oct 09 - 9.0, Dec 09 - 6.6 2000mg Metformin
I think that you should show her your food diary and ask her for a metre and a script for testing strips cazirv. I get 100 strips per month and if you got that amount it would reduce the amount you are having to buy at he moment. But, if Alan's post is the future for type twos - the scripts for strips might be difficult to get
Ziggy
Ziggy. T2 Since 22-May-2008 Chol:- May 09 Total Chol - 5.3, HDL - 1.53, LDL - 2.23, Trigs - 2.93 / Dec 09 Total Chol - 5.1, HDL - 1.49, LDL - 2.76, Trigs - 1.86 Ramapril 10mg, Omeprazole 20mg Exercise and Diet (am a lacto ova vegetarian and am trying to stay low GI/GL)Still on the Road To Find Out
Healthcare professionals are positively obsessed with the idea that people panic over high bg figures and over-react. Worth explaining calmly that you are implementing Jennifer's advice to see how different carbs affect you, how exercise can be used to bring down levels and how you make adjustments for the future (types of carb, portion size etc) based on what you have found. You can point to any successes you've had so far.
Then explain that this is an intensive but shortish-term plan, after which much less checking may be necessary just to keep an eye on things. Then ask for as many strips as you genuinely think you need for a set period (three months?) and ask for an HbA1c at the end of that time to demonstrate to all whether it's working. It needn't be confrontation and the worst the DSN can do is say no. Worth a try?
T1 DX 06/2003 using Lantus and Novorapid. Dafne graduate.
If that doesn't work, or you can't quite face it....
How about writing a letter?
When faced with someone its often harder to argue a case particularly when its someone in a profession we are always taught to think of as an authority. Putting your case down in writing is often more effective since you can put your thoughts in order and explain things fully without being interrupted.
You could attach a copy of Jennifer's Advice to explain the process you are going through with your meter. You can also give highlights of your BG diary as examples of how it has already made a difference. If you like we could even give personal accounts of how Jennifer's Advice has helped some of us.
It could even serve as a template for anyone in the future facing the same situation.
Now here's the dirty part....
....they will reply in writing. Written records are a medic's best friend and their worst enemy. I happen to know a couple of senior psych nurses who have had to batter it through more junior nurses heads that everything needs to be recorded properly because when something goes wrong, they need to be able to point to the documentation to demonstrate they did the right thing at the right time.
This works to your advantage. If they receive your letter and deny your request for test strips, they have to be very very solid on the justification for that, in answer to all of your points. Your points will be hard to argue against because you are giving them a very logical approach towards your own DM management, backed up by facts and figures that you have already demonstrated to work. If they were to deny strips in the face of that they need to be very sure that they cover their arse - which is a problem for them.
The National Service Framework for Diabetes says that we need to be partners in our own care. If you provide a comprehensive proposal for your diabetes management as above (not very complex really) and they tell you to sod off, they are leaving themselves very exposed if they are ever called on it.
So they won't tell you to sod off
And thats just assuming the worst. At best, you may convince them that you are onto something and they might go along with you, learn something and improve the treatment of every other T2 at that surgery from then on.
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