Ah look, the diabetics come out of the woodwork. WATCH OUT, I HAVE CANDY AND I’M NOT AFRAID TO USE IT! I would like to point out that below I refer to diabetes as a ‘condition’ and not a ‘disease’. See, those PC/sensitivity classes are paying off.
On the other hand, when I piss people off they come to the site to whine, read past entries which makes them laugh, then they keep on coming back. Just ask The *Angriest* Pharmacist (or is his case, copy me) :).
As a pharmacist it is none of your business haw many strips a patient
uses. Strips in no way can hurt a patient and one can not overdose by
using too many. If a doctor writes a prescription for an unsafe dosage
of a medication then the pharmacist is correct in questioning the
order, however this is not the case. As far the insurance company, one
should ask, are working for the insurance? are you the insurance
police? who made you in charge of determining how many times a diabetic
can test? I think you should go about your business of filling
prescriptions and leave the ordering to the doctor, and not worry about
how many strips the insurance company should allow.
Interestingly, if a person goes into a drug store and purchases 100
bottles of strips each month and pays cash for them you wouldn’t ask
those questions. You would be thankful for the business, but because
insurance is involved you feel you have a duty to limit the amount of
Woah, wait a second. You’re telling me that its not my business to deal with how many strips a patient uses for a condition that I fill Rx’s for? Since you obviously have no idea what goes on in a pharmacy, let me enlighten you. Every Rx you fill has a day-supply associated with it. If 50 test strips lasts you 10 days (and you aren’t on insulin), the insurance company is going to come to ME and want ME to submit documentation to justify a type-2 diabetic (who cannot control the dosage of his medication) testing 5 times a day. Do I have any? No. There goes 50 bucks from my next reimbursement check. Simple as that. If you want to pay cash for your strips thats fine, but if you want the insurance to pay for your strips then we all have to play by their rules, you dont like it then pay out of pocket for your strips. You want someone to pay for your life then deal with it.
Where in heaven’s name did you go to Pharmacy School? Didn’t they
teach you that a non insulin-dependent diabetic also needs to know how
their diet and stress are affecting them?
Every bite they put in their mouth will raise the blood sugar. To
avoid the complications of diabetes (yes, all diabetics are susceptible
to them, insulin-dependent or not) these people must know exactly where
their blood sugar level is at all times.
Another factor that can cause the blood sugar to rise is stress. When
the liver senses release of stress hormones, it releases sugar into the
bloodstream to fuel energy for the “fight or flight” response.
All of these things must be learned and then checked and rechecked.
Can you imagine someone wanting to make themselves bleed for the fun of
it? Being a diabetic is no fun, especially with people like yourselves
imagining how simple it all is.
Shame on you.
Yeah, thats great, the patient knows that eating a ton of candy raises their sugar into the 400’s. Thats maybe 2 or 3 tests at the absolute most to confirm that. What can they do about it? They can’t adjust their medications to compensate for this so why bother testing. If you eat something and it boosts your sugar sky-high twice, then obviously you know what NOT to eat. Is there justification for testing 5 or 6 times a day everyday for months upon months for something that you have NO control over? I mean how many months does it take for someone to learn what they CAN and CANNOT eat. After 6 months of trial and error of what works and does not work what excuse do you really have to test that often?
You say that they must know exactly where their blood sugar is at all times. Yeah, thats great, if they are insulin and can do something about it. What are you saying? That they should skip meals if their blood sugar is through the roof? Thats not healthy either. “Oh look, I ate birthday cake and my sugar is up to 400, guess I can do nothing about it since I already took my 2 glyburide bid and 1 metformin bid today.” At least the folks on insulin can compensate, oral meds not so much. Lets look at the gas gauge every 3 miles but not stop for gas when we’re at empty. Oh, and lets throw away $1 every time we look.
Oh, and guess who gets to suffer if the payer of your test-strips doesn’t like how much you are testing. Its me. Not you, but me. If you want to test 100 times a day and pay cash for your test strips, thats fine, more power to you. However when insurance companies are paying the bill then YOU need to abide by what rules they set up, and trying to get doctors to provide justification for a type-2 diabetic who burns through 5 strips a day for 9 months and is noncompliant as fuck on their medication isn’t my idea of a good time. In fact, it has cost me on more than one occation a filling or 20. Do the math at a little over $1 a test and tell me why i’m a bit pissed. Plus this puts me into a bind. The “diabetic” (I use that term loosely since they obviously don’t take any initiative in their care) needs their strips, but there is a good chance that the insurance company wont cover it. The patient can’t afford $100/month in test strips. Do I chance it and cost the store money or do I do what you all think is “right” and possibly eat $100/month x 20 patients/month.
My argument was that testing 5 times a day is an absolute waste if you can do absolutely nothing about it like most uncompliant type-2 diabetics. I know plenty of very compliant type-1 diabetics on insulin pumps or rock-solid awesome Lantus/Humalog setups and some very compliant type-2 diabetics who test once or twice a day and have A1c’s in the 5 range. I have patients who come to me (rather than their doctor) and say “Listen, I’ve been running in the 140’s every morning for the past week, nothing has change, can you talk with my Dr about increasing my medication?” As you all know, diabetes is one of those conditions that requires the patient to be an active part of their care and management, and I’d rather see the funds be used to paying for test strips for the complaint patients who actually /care/ about their sugar and test smartly than the non-compliant patient who throws tests away just so they wont get yelled at by the doctor during their next visit. Pissing away 5 tests a day does nothing unless you are doing something about it (and after 6 months when the insurance companies catch on, you should of done something about it).
Let me tell you a little secret. The reason why diabetes kills a ton of people is because the people who have it really don’t give a shit what happens to them and really want someone else to deal with their condition. Obviously there are people out there (ie: you) who *gasp* take an active part in their condition. If the insurance company audits me for test-strip usage and you get your meds filled every month as well as a blood sugar log printed out thats 20 pages I will gladly throw that back into the insurance companies face with a hard-on the size of the empire state building. However patients who actively manage their disease are few and far between. Most of my patients just take the pills, eat whatever the hell they want to eat, and just pretend that everything is okay no matter how many times I scream at them for having a 300 reading first thing in the morning. They dont feel pain, they dont really feel much of anything (other than peeing a lot) and life goes on. I can consult them until I am blue in the face, but until something BAD happens to them they will just pull the smile-and-nod game. Thats okay if they are paying for their stupidity, unfortunately they are on the system, so I tend to get a bit pissed since the taxpayers are footing the bill.
I know this sounds crass and crude, but I’m really surprised diabetes doesn’t kill more people than it does for the sheer lack of common sense and responsibility that I see on a daily basis, especially from “diabetics”.
Its sad really, but no matter how much you say they are going to die/go blind/renal failure/amputation most diabetics really dont give a rats ass about their condition.
Plus we need a token comment from someone who obviously arrived to the game LATE and with their shirt on inside-out:
You need to find a new occupation. This obviously is not your expertise or passion. While you are at it, go to school and learn how to use the English language to express yourself. If you can only use foul language, obviously you need some serious help in learning to express yourself intelligently.
oh….. have a nice day! 😛
Uh, what site is this again? I’m sorry, last I checked I was the ANGRY pharmacist. Obviously you need to go to school and learn to realize the obvious: that a site that has the word ANGRY in it is going to have some swearing and other ANGRY things in it.
- Paying the PBM’s to service them.
- Im dreaming of a Crackhead Christmas.
- SOMABOTS, TRANSFORM!
- A pharmacist example for non-pharmacists.
- Trying to not kill your patients.
- An open letter to my patients.
- The FDA obviously hates the public and needs to lay off the crack pipe.
- How to make your pharmacy career less painful.