December 9, 2013

Knowing Your Test Results

This is a continuation of my last blog. The fellow had more to do that day, but wanted to continue our discussion. He asked to meet me the next day and I asked if he minded if I included a second person if he was available. He agreed and we set the following afternoon to meet. Then I called Allen and asked if he might be able to be present after explaining what was happening. Allen asked if I had said anything about the VA and I said that I had not, but that was part of the reason I was asking him to help.

We met the next afternoon and the fellow said he would feel more comfortable away from his house as his daughter would be there shortly. I asked if he had any of his lab tests available and he said he had them in the packet in his hand. He had a note on the refrigerator for his daughter and we went to Allen's for the rest.

After we got there, he pulled out quite a number of test results and we went over the most recent ones very carefully. Allen asked him if he had a computer and he said he did and I asked if he had interest in putting them on a spreadsheet or in a database. He said he was comfortable with a spreadsheet and Allen pulled up his and because I had taken my wife's portable, I brought mine up for comparison. He told Allen he liked mine and asked to see how it worked. He said it was the same version that he had and felt he could adapt it quite easily.

Allen said he did not like Lotus 123 and he could do the same in Microsoft Excel. I said if he has 123 he would need to work with mine and that if he gave me his email address, I would send him a copy of my blank spreadsheet and all he would need to do was start entering information. Since I had a blank in my wife's portable, I would rename it for him and we could start filling one in for him. First, we showed him what he was looking at on his lab tests and looked at the plasma blood glucose results and showed him the small variances he had.

Next, we went to the A1c results and showed him where they were on the lab reports. We showed him how consistent he was and that could be why the doctor was not looking at his blood glucose logs as he could see that there was small changes and not an upward trend. Allen commented that at one time he would have liked to have been that consistent. It was certainly better that the swings he had at that time.

We discussed the importance of being consistent and from what we could see; he was doing an excellent job of managing his diabetes. The fellow said we had only gone back two of the three years he had diabetes. I said that the last two showed that if he had problems the first year, he was now managing his diabetes very well. This surprised him and he thanked us for saying that. He was concerned about the lows he was having and said the doctor still wanted him testing only in the morning and he would ask for more test strips because of the lows, but could not promise Medicare would pay for them.

Allen stated that Medicare probably would not even with him being on a sulfonylurea. Allen said he was surprised they had not forced him to a different meter and test strips. The fellow said they had tried, but with him obtaining them from a local pharmacy, he was paying the difference after Medicare and his supplemental insurance covered what they allowed. He said that was the reason for his second meter, which he showed Allen. Allen said okay, that was why he was managing his lows so well and not burning up the more expensive test strips for them.

The fellow did say that the doctor had explained why he should not take his medication if he was not feeling well and would not be eating a meal or two. The doctor said if he was in the normal morning range, not to take his medication unless he was above 150 mg/dl. His doctor had said to use his meter if he felt like eating his noon meal and to take his morning pill at the noon meal if he was over 130 mg/dl, otherwise to only take his evening dose if he would be eating then.

Allen then asked if he had been in the military. When the answer was yes, Allen asked why he was not receiving VA assistance. The fellow asked what VA assistance was and Allen knew he had work to do. After finding out that he had his DD214 at home and could find them, Allen said for him to find them and he would take him to the courthouse, have them recorded at the Recorder's office, and then take him to the VA office to file for VA assistance. Allen asked if he would have them by Monday and they would do it then. The fellow said he would have them then, but he had a meeting in the morning and said he had the afternoon free. Allen said okay and he would be there at 1:00 PM. That was agreed and we took our leave and I drove him back to his house.

We talked briefly about the VA benefits and I said his testing supplies would not be a cost. His only cost would be for medicine and that would be means tested annually and his copay would be determined by that. I said he would need to talk to his pharmacist about his medications to determine which were generic and what their cost for a 90-day supply would be, as he would not want the additional cost from the VA. He said his two medications were already generic and he doubted he would need them from the VA for a copay. He said that his meter and test strips would be a great help. Before he got out of the car, he thanked me and reminded me to send him a blank spreadsheet. I just said I already had and it should be there or would be shortly. I said the email had my phone number as well.

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