December 8, 2013
Testing with a Purpose
For people with type 2 diabetes, having limits on the number of test strips can create real problems. Our medical professionals often do not tell us about blood glucose testing. Then our medical insurance companies limit the number of test strips they will cover. What makes me upset is the number of people with diabetes that refuse to learn the advantages of testing.
I have met individuals that are saying they are testing only for their doctors because this is what their doctors have requested. When I ask them if their doctors have looked at their testing logs or downloaded their meters, they admit that the doctor does not do either. At this point, I ask how many strips their insurance or Medicare/Medicaid pays for or reimburses them to use. Most have no idea and this tells me they don't care or don't understand the value of testing.
I even had two people say that they would not fill out and return the log required by Medicare to continue receiving testing supplies. Both had stopped testing as a result. I did take time to explain why Medicare wanted the number of times per day and month. One just said it was none of their business and clearly stated he would not do this. The other did ask for assistance and after I covered the first sheet, felt he could handle it. I took time to ask which medication he was using. He was on one of the sulfonylureas and had some days when he tested two to four times more because of a low.
Further investigation revealed the lows happened on days when he was not feeling well and often did not eat a meal or two. I advised him to talk with his doctor and see if he should not be taking one or two doses of his medication. He said he normally tested his fasting blood glucose level as soon as he was awake in the morning and that he did not have another test that day unless he felt sweaty or shaky later in the day. I asked him what his blood glucose readings were in the mornings. He said generally in the 85 to 105 mg/dl range, but about once a week or ten days, it could get up to 115 mg/dl.
He stated that he was supposed to take one pill in the morning and one in the evening. I asked if breakfast was one of the times he would not eat. He indicated that it was. I suggested that he not wait to talk to his doctor, but call immediately so that the doctor could call him back that day. I said that his blood glucose levels were such that taking his morning medication would cause hypoglycemia and thus his sweating and shakiness resulted when he did not eat.
I also suggested that on the mornings he was not feeling well and might not eat breakfast that he forego his testing and test before his evening meal to see what his blood glucose level was. He stated that his doctor had always advised him to test in the morning shortly after getting up for the day. I said that is often the case, but with what you are experiencing; he should allow what I suggested. I said because Medicare is only allowing one test strip per day, and with you on a sulfonylurea, testing alternatives should be allowed by your doctor.
At that point he opened up and said that he had a second meter and purchased extra test strips from a mass merchandise retailer and they were what he was using for testing when needed for lows. He had not told his doctor about this and I said there is no need. I said what the doctor is looking for or wanting you to look for is trends in your morning readings. He said the doctor is not looking at his testing log to see if there are trends. I asked if his A1c levels had varied up and down from one test to the next. He asked what A1c tests were.
I knew then I had to do more education. That will be included in my next blog.