May 8, 2013

Why Won't Some Doctors Prescribe Insulin?

This is one email I have suspected I would receive sometime, but the seriousness of this person's plight really puzzled me. She has been to three different doctors asking for insulin and wants to get off her oral medications. Her last three A1c's have been 6.7%, 6.9%, and 6.8%. She had been on Avandia for two years and then moved to Januvia when Avandia was pulled from the market. She has refused Actos and one other oral medication. She like me is allergic to sulfa which excludes the Sulfonylureas.

Her first doctor said he did not have sufficient knowledge to prescribe insulin and did give her a referral to a second doctor because he could agree with her. The second doctor just said no and until she failed with Januvia, he would not prescribe insulin. She went back to her first doctor and reported what had happened and he referred her to another doctor. This doctor just laughed her out of the office and asked her if she was giving up on Januvia. Like she said in her email, she has not been this humiliated by a doctor before.  When I received her email she had just come from the third doctor who had also said no to prescribing insulin.

I asked her if there was an endocrinologist specializing in diabetes near to her and she answered that she thought there was and would get back to me after talking to her first doctor. I had also asked her if she had been in the military and she was surprised I asked, but said she had been. I asked her if she had applied for VA assistance and she replied she had not. I asked if she knew where her DD Form 214 was and she said at the county courthouse. I told her to get copies of them and talk to her county Veterans Service Officer. Then followed a series of rapid emails as she asked many questions about costs by the VA as she only received social security income.

I said there was no way for me to know if she would have a copay and that she would be notified. I explained that the testing supplies would not cost her and that the total would depend on the prescriptions she needed. She stated that it should be only the insulin and I said that this could be $54 per quarter or less, and she said that made it worth going after. She has since submitted her VA application and is happy with the information she received from the local VA office. With her level of social security she may not have any costs.

She has returned to her first doctor and he is in the process of talking to the endocrinologist and she will receive an appointment with that office shortly. Since she is also an Iowa resident, I know that her county VA officer will take good care of her. She has confirmed this and is thankful I gave a push in the right direction. I have suggested that if she can continue with the Januvia until she receives her VA classification and her first appointment with the VA. She says she will; even with the information now out about Januvia. She says that reading my blog has been good for her and that when she needed help, I was there for her.

Yes, that makes me feel good, but this is why I blog and enjoy doing it. If I am able to help people, this makes blogging even more enjoyable. I know that we will continue to correspond so I may have another blog about her progress.

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