Glucose testing for fun and profit

Why must people be obsessed with testing their blood sugar?  Its about 3 times a week where I run into the typical uncompliant patient who needs a refill on 100 test strips they picked up 2 weeks earlier.  A quick scan of their profile shows only oral meds, no insulin, and uncompliance.  So then the 20 questions starts:

• Are you on insulin? “No”
• Do you adjust your oral medications based on your readings? “No”
• Do you have any problems working your machine? “No, it works fine”
• Do you waste strips or get errors which make you waste strips? “No, this machine is easy to use”
• Do you bring your doctor your machine to look at? “No”
• Do you do anything with the readings other than just collect them? “No”
• Why do you test that often then? “Doctor told me to”
• So if the doctor told you to wipe your ass 20 times a day even though you dont need to, you would do it? (alright, so I didn’t ask this question.. 🙂 )
• Its been a month and a half since your glyburide refill, did doctor change the directions? “No”
• Then why do you test this often even though you don’t do anything with the results? “Doctor told me to, I dont know.  Is my vicodin due yet?”

At this point my head explodes as I fight the urge to say “Your doctor is an idiot”.  What doctor worth any sort of medical degree will tell their patients whom are solely on oral meds to test 5 times a day?  They aren’t adjusting insulin nor are they adding additional doses of glyburide or anything like that.  Does the doctor realize that test strips average about $1/test?  Oh, wait, $ + MD = ???

Patients on insulin is another issue because these patients are expected to adjust their dosage based upon readings (sliding scale) or will call the doctor for dosage adjustments (Take as Directed as sig).  So I very simply put that if they are on ORAL MEDS then they only need to test once maybe twice a day. 

Hell, I have patients who after getting 10 test results of 112 every morning they pretty much assume that the next one is going to be around 112 and test every other day or every 3rd day (These are the patients who pay cash for the strips, go figure).  But of course, being on Medicaid/Medicare with your FREE/Low copay test strips means that you can just waste them as you wish, because they are in fact “FREE” and the nanny government will in fact supply you with more because you are too fucking stupid to use some common sense.

Best dialogue I ever had:
Me:  “The F in Pharmacy stands for Free” 
Them: “But TAP, there is no F in pharmacy”
Me: “Exactly!”

Comments #

Comment by Christine on 2008-03-14 09:51:12 -0700 #

There’s plenty of reasons to test your glucose even if you’re only on oral meds. If let’s you get a picture of where your problem is if your a1c is high, how different foods affect you, and how activity level affects you. One test a day isn’t going to show you all that.
Granted, if you’re not even going to take your pills, it is kind of pointless.
Part of the problem is that lack of education. Using your ass-wiping example, everyone knows why they need to wipe their ass and when. But if someone is a newly diagnosed diabetic, and no one ever told them, they don’t know why they’re testing their blood sugar or when.

Comment by Mike on 2008-03-14 10:16:21 -0700 #

Moron.
First, oral meds and no insulin do NOT mean there are not other changes going on each day like exercise or big meals which would make frequent testing worthwhile.
Second, diabetes is a progressive disease (unlike smug stupidity) and many type 2 diabetics will progress to requiring insulin. Testing often will prepare them for that eventuality.
Third, many diabetics are mis-diagnosed as type 2 at first and the quicker they are correctly diagnosed, the less likely complication will set in. Best way to do that? Testing, especially 2 hours after each meal.

Comment by John on 2008-03-14 10:28:13 -0700 #

While there is certainly futility when non-compliance is factored into this equation, there is definitely benefit for regular testing in the case of a Type 2 on only oral meds or even on no meds. Controlling post-prandial spikes means being diligent in the type and quality of carbs that a diabetic eats, and those don’t show up on once or twice a week, fasting blood glucose test. I may not change my oral med, but I can certainly change my exercise and diet.

Comment by John on 2008-03-14 12:10:39 -0700 #

As a type 1 who is currently non-compliant, I tell new type 2’s or those soley on meds to test once or twice a day. Get two or three fasts a week and the rest a mixture of before meals and post-prandials.
I tell them their main objective is to look for trends.
BUT I also tell them to use their tester as a food discovery tool. Use it to find out if those potatoes are sending you high or whether that pizza is kicking in four hours after you eat it or whether that glass of wine is keeping you low or whatever!
I’d be more angry with the non-compliant diabetics. Gie them the shit for putting extra burden on our health care systems, not on the person working extra hard to stay healthy!

Comment by Long Time Diabetic on 2008-03-14 13:15:08 -0700 #

Where in heaven’s name did you go to Pharmacy School? Didn’t they teach you that a non insuin-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.
A long-time diabetic.

Comment by M on 2008-03-14 15:48:06 -0700 #

Why must diabetics test so often? Because it gives them the knowledge they need to beat the disease! Testing is THE tool that gives the power to control diabetes.
Diabetes changes with so many outside factors. The obvious ones are meals and exercise of course. But lets not forget hormone changes, sleeping patterns, foods that you’d expect to be innocent but aren’t, adrenaline, illness, etc etc.
No diabetic should ever assume their blood sugar will be predictable. No pharmacist, doctor or other health professional should ever limit strips as they are the best tool a diabetic could ever have towards the aim of a long and healthy life.
I understand that you’re talking about ‘uncompliant’ diabetics – but what you’re really talking about is UNINFORMED diabetics.
Many diabetics are given a short 5 minute diagnosis speech about avoiding complications, but no real info about how to handle diabetes day to day. Instead of complaining about their use of strips you could be helping them learn how to use their test results! Give them a chance of a better life – and save the world some money when they don’t have to have amputations, don’t need dialysis, don’t go blind… wouldn’t it be nice if you had something to do with helping people and saving millions of dollars for the health system?

Comment by rph3664 on 2008-03-14 16:02:41 -0700 #

Maybe those people are selling them?
Good grief, Type II diabetics have to be the most noncompliant patients on earth. Have you ever heard of a cancer patient who refused chemo because they thought doing so would make their cancer go away? I haven’t either, but this is what Type IIs are like. And they smoke, eat candy by the pound, defiantly refuse to exercise or lose weight, and then want everyone to feel sorry for them when it all crashes down around them.
I once had a customer for whom I put a note in the computer: “Put Rxs on hold – he never picks them up.” Okay, cut to the Saturday afternoon when my tech put an RX on hold for him – from the doc in a box for Phenergan suppositories! Sure enough, a couple minutes later, a truck pulled up with him in the passenger seat and his daughter driving. Those, he picked up.
One of his doctors once called us to ask when he last picked his meds up, and I told him the truth – never.
Weird thing is, health care workers are the absolute worst in this regard! You can falsify your test strip log book, but you can’t falsify an A1C test.
My hospital has a few Type I frequent flyers who are committing “suicide by noncompliance” but that’s a whole ‘nother issue altogether.

Comment by Nancy on 2008-03-14 16:05:36 -0700 #

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! 😛

Comment by monica on 2008-03-14 16:22:54 -0700 #

You didn’t ask the right questions. The question is: Do you go out and exercise or make different food choices next time based on your readings? And that answer would be emphatically yes for any type 2 that cares about avoiding the secondary effects of diabetes.

Comment by http://openid.aol.com/rgregg78 on 2008-03-14 18:20:23 -0700 #

Yes, the F in pharmacy does stand for free as in today I had a lady ask me to loan her enough synthroid to last her until she gets paid on Wednesday(today is FRIDAY). Sounds like someone needs to do a better job at controling her cash flow! How many of you go to the gas station or grocery store and ask to borrow ________ until you get paid, it don’t happen. Did I mention that while talking with this lady, she said last time they loaned me enough….guess what? I was the pharmacist and I didn’t do that AND she throws up in my face, she’s a tech and she knows this and that…I love my tech and she knows her stuff and I highly respect techs we NEED them…but don’t throw it up in my face when you have NO idea what you’re talking about and LIE to me!!!

Comment by Zelda on 2008-03-14 20:42:29 -0700 #

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 strips uses.

Comment by rxmonster on 2008-03-15 01:33:23 -0700 #

Well I don’t know where TAP went to school, but at my school we were taught to keep up with the newest information. You know, read journals, new studies, the pharmacist’s letter. And according to the Sept 07 Pharmacist’s Letter, in type 2 diabetics:
“Self-monitoring IS beneficial for patients using insulin. But it’s NOT yet proven beneficial for patients on other diabetes meds.”
and
“Recent evidence suggests there’s no difference in A1c levels in patients who monitor compared to those who don’t…even when they’re trained to interpret the results”
Do I still think testing is important? yes
Would I recommend frequent testing for someone starting or changing therapy? yes
Should everyone be testing frequently (ie. 5-6 times a day)? NO
Should I (as a tax payer) be footing the bill for unnecessary testing? HELL NO

Comment by Vulgar Foul Bastard Pharmacist on 2008-03-15 06:46:55 -0700 #

What a bunch of whining know-it-all bitches. TAP, you were right on except for one thing. Type 2 diabetics managed on oral meds don’t need 2-3 tests daily. Jesus, 2-3/week is plenty. And Nancy, I think TAP expresses himself fucking eloquently.

Comment by rph3664 on 2008-03-15 07:53:51 -0700 #

Now that I blew off my steam, I’ve known lots of women who had gestational diabetes and had to test regularly until they delivered. And I have known lots of women who had their kids before we knew about GD and they had huge babies and developed diabetes later in life because we just didn’t know. Most of them are not on medication.
One of my friends, who had her kids in the 1970s, had a daughter who weighed 11 pounds and a son who weighed 9 1/2 pounds. Both vaginal births, too. OUCH. She later became a Type II (she had become quite overweight in the meantime) but otherwise was very compliant with her meds. An unrelated illness a few years ago caused her to lose about 50 pounds and that drastically improved her control, in addition to improving the arthritis in her knees.
I stand by my statement that Type II diabetics are the worst patients on earth.
My mom’s been hospitalized a number of times, and the only time she REALLY heard someone bitch about the hospital food was when she had her tubes tied back in the day when that was a 3-day hospital stay. Her roommate was a 300-pound diabetic who had been hospitalized because she wasn’t taking care of herself, so OF COURSE she didn’t like what they gave her to eat!

Comment by Mellee on 2008-03-15 11:35:27 -0700 #

I just have a question…. Why is everyone (well the 95% of the people who left comments) getting so pissed off at TAP, he speaketh the truth. Becides he didn’t use your name did he? He didn’t say “Nancy” is stupid she tests 20 times a day….. blah blah, blah……………
People are too sensitive

Comment by jnsr on 2008-03-15 12:24:40 -0700 #

You are a pharmacist and don’t understand this disease. I’m type 2 or 1.5 The jury is still out. I’m active, eat low carbs.. each meal has no more than 60 carbs. I work out every day, yet I have glucose spikes first thing in the morning when I wake up. I test when I wake up, 2hrs after breakfast, when I get home from work, 2hrs after supper, and before I go to bed. Due to the morning phenomena I experience I test twice a year at 2:30am. Yea.. I really do. This is when my glucose drops and the liver reacts by dumping a glucose coctail into my bloodstream.
Testing is very important! I can actually predict what my A1C test results are going to be before I get them from the Dr.

Comment by OzPharmStudent on 2008-03-15 14:36:08 -0700 #

While you may want to test regularly to begin with to learn how food and exercise will affect your levels, you don’t need to keep testing 10 times a day if you are into a pattern that hasn’t changed in weeks. This is really no different to warfarin monitoring. Start off with a lot of tests but back off once you know what is going on. If something different happens then step up the testing. I don’t mind doing the occasional test (I work in a pharmacy specialising in diabetes so all my tests are free) but making my self bleed all that time to get the same results doesn’t excite me.

Comment by nursemary on 2008-03-15 20:27:08 -0700 #

My very own personal favorite inanity was that “frequent testing prepares you for when you convert to IDDM “(Picture these folks trying to use the buttons on the remote. The tiny one.)
peeed my self, I did.
Tap, I’m a long time lurker but I just had to come out and say you deserve a McArthur Grant.
Your prose, acid wit and sheer ability to get the shit out of the bullshit is genius.
Must have been that stellar education

Comment by D on 2008-03-16 23:54:15 -0700 #

Mike, I think ‘smug stupidity’ is not only a progressive disease in TAP’s case (and the cases of his followers), it is an infectious one as well!
TAP, you and your chums need to get OUT of the business of ‘helping’ people, especially if you are NOT going to help them!!!

Comment by Mike on 2008-03-17 11:36:07 -0700 #

nursemary,
Nice feel for the patients. Really hope I never need to be in the care of someone as feeling and caring as you. You go ahead & pee. I’d like to flush.

Comment by April on 2008-03-28 18:20:29 -0700 #

I quit work and gave up health insurance to enter the respiratory therapy program @ my local college and just found out this week that I have Type 2 diabetes. I’m trying to stay positive (my insurance was incredibly shitty to begin with, so I didn’t lose all that much). I’m learning as I go, and although I’m testing 3 times a day now, once I’ve got this under control (I have too much to live for…I WILL get it under control!), I’ll not test near as much. Those fucking test strips are expensive!!! But you knew that.
I like you…you’re cool.