Recently I called Medtronic to place my infusion set and my test strip order. I have already received my infusion sets but not the test strips. So I called Medtronic to ask about the status of my order. The person I spoke with said that 'they' were waiting on chart notes from my doctor. This afternoon a veteran RN from my doctor's office called to ask "why do you test 10-15 times a day when Medicare clearly says you only need to test 3 times a day since you are on insulin"? She added "I've been a nurse for 35 years and never heard of anyone testing that many times a day".

She also said that because there are no indications of DKA (which I've never had) or other serious complications in my chart - that there is no need for me to have a pump either. I've had a pump for over 5 years and now she is going to make sure I get it taken away from me just because I'm trying hard to stay complication free? I'm scared.

A1C 6.1% 12-2-2011

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1) wake up, test bg
2) before eating test BG
3) before driving to work test bg
4) 2 hours after eating test bg
5) lunch test BG
6) 2 hours post lunch test bg
7) drive home test BG
8) get home, run 3 miles...oh wait, don't forget to test your bg!
9) post-exercise maybe, maybe not, maybe eat dinner and, you guessed it, test BG
10) 2 hours post BG, test BG ****AGAIN****
12) stay up late? Maybe squeeze in another one, what if you have errands to run, what if you want to exercise more (when it's nicer out, I'll run 6-7 miles during the week, more on the weekends...a lot of times, I'll run a long run on Saturday and then a 20ish mile bike ride for fun, speed and recovery on Sunday...there's several extra strips in there...). Oh please give us her info so we can give her an earful back...she'd probably hang up though. She really ought to consider coughing up some test strips. Is she on the take somehow?

But acidrock, you forgot about when driving to work that driver almost creamed you at the light so pull over and test BG. Then lunch was late today, test BG. Now test again so you can eat lunch. Oh, what about waking up in the middle of the night not feeling "normal" test BG. Well, then there is that party, or going out to eat, or sleeping late, or getting up early, or spending the entire day in a car going somewhere on vacation. Oh, I almost forgot about walking up the driveway to get the paper. Am I low? Test BG. Did I really use a bottle of 25 strips in 2 days. Wow, I must need a blood transfusion I have donated so much to THE TEST STRIP. But DKA - nope. Hospitalized secondary to a low or a high? Nope. A1C 6.0 on 1-13-2012, and they wonder why I just look at my finger tips and they bleed?
Mayumi, I wish you success in your work on getting the approval that is needed for you to keep yourself healthy! I too wouldn't be able to keep myself healthy if I didn't test continually - and I have the Dexcom also. But there are days where I test over 10 times per day! And my endo just says "It's a 6" with his eyes real big and a huge smile on his face. Priceless.

Sounds to me like that nurse needs to retire, if she can't find chart notes. I mean really.

BUT.... they will gladly pay for you to have a foot amputated or eye surgery!!
Completely agree with the others...find a new Dr.
It's ALL abut money not prevention and it's the insurance demanding this information, not Medtronics. Or it was needed by Medtronics so they would be reimbursed by insurance. I just went through the same thing, explained to my Dr.that they were demanding his "chart notes"(basically giving a reason for testing 10 times) and I had to turn in a hand written log of one months blood sugars with times and dates, and I had to make sure there were 10..not 8 or 9..every single day! Please note, I've been doing this for almost 37 years. My Doc basically said "ridiculous, don't worry, I know exactly what to do to get it covered."
Maybe what you should have said to her is the reason for no DKA after 8 years is BECAUSE I TEST 10+ TIMES A DAY!!!!!
Good luck.

I agree with you. I also had to give a hand written 31 day record of blood sugar readings. One time Medtronic called me and said "you only provided a 30 day record and not 31." I told them "I filled out the form that you sent me and if it didn't have 31 lines and spaces on it, whose fault is that?"

Now every time they send me a blank form to fill out, I count and number the lines so there is not any question.

You sound like you have a great Doctor, I'm happy for you.

Sheesh! Are you kidding me??? That's beyond absurd. Like we don't have enough BS to deal with in managing diabetes, now we have to deal with crud like this?? Ugh!

Mayumi, I don't know where you are with this? But, just a FYI, I'm switching meters, going with One-touch because it talks to my pump, which I'm starting on. Medtronic has done everything for me, on my behalf. Because I'm getting 400 test strips a month, they too had to send something to my insurance carrier for pre-auth. But, they've done everything. They called me today and said they'll send 2 boxes for the remaining days this month and 8 boxes on Feb. 1st. So, i'm not sure of your hold-up. I don't know if or what my Endo supplied to them prior, I know they had my trial CGM and current 30 day blood sugar logs..but, there's been no problem what so ever.

Oooh, that p***es me off.... She may have been a nurse 35 years but she clearly hasn't worked with Type 1 patients before. I test my son easily 8-10 times daily. Before all 3 meals, 2 snacks, bedtime, midnight, and first thing in the a.m., and any other time his BG seems wacky. And DKA is NOT a reason for getting a pump—if she thinks that you have to have a pump only if you're at risk of DKA, then she clearly has no idea what causes DKA! People with pumps are actually at HIGHER risk of DKA, not lower, because if the pump malfunctions or doesn't deliver insulin (and there are a lot of reasons why it wouldn't as you probably know) it can promote ketones. If you haven't had DKA with your pump it's a pretty good sign that it's working... Not to mention that your A1c speaks for itself. "If it ain't broke, don't fix it" — shame on her for quoting Medicare regs. to you when she ought to be concerned with what is working for you to control your diabetes. You have your pump to PREVENT complications, not because of them. 

Bottom line, she doesn't know what she's talking about; insist, and I mean INSIST, on talking to your doctor about it, because there is absolutely no reason you should be denied test strips. In fact, if she were to cause you to have to give up your pump,  you could make a legitimate case for a malpractice suit because she's preventing you from having the tools to manage your condition out of nothing more than sheer ignorance. Medicare be damned -- the need for frequent testing and the benefits of insulin pump use have been proven by research. IN particular, the findings of the DCCT (Diabetes Control & Complications Trial; the research very clearly -- and I mean VERY clearly -- shows that testing frequently is one of the key factors in avoiding the horrible complications everyone wants to avoid. The following is taken from the article with the URL I put in above:


Elements of Intensive Management in the DCCT
Testing blood glucose levels four or more times a day
Injecting insulin at least three times daily or using an insulin pump
Adjusting insulin doses according to food intake and exercise
Following a diet and exercise plan
Making monthly visits to a health care team composed of a physician, nurse educator, dietitian, and behavioral therapist


So if she gives you any more flack, just say, "I test frequently because the DCCT trial run by the NIH found that frequent testing and using an insulin pump are key factors in avoiding complications -- and it's obviously working since I have a great a1c and no complications. And since it's working, I intend to keep doing it."

Good idea to bring up the DCCT. This was like the pivotal study that found (not surprisingly) that diabetics who test more frequently have better A1Cs and better long-term outcomes. Duh! Also a good point re: DKA. The only time I experienced DKA was on a pump.

It has been just over 3 weeks since I requested a refill on my test strips from Medtronic. I keep getting the run around from both Medtronic and my Dr office. Medtronic says "we're waiting from the Dr. office". Dr. office says "we waiting for the fax from Medtronic". Medtronic is nice enough to inquire "how many test strips do you have left"? Do I have to run completely out before they will send them? You young folks take good care of yourself and try, if possible, to put a little money aside for buying test strips when you are old. There is no respect for older people anymore.

Sadly it seems you have been caught in having to substantiate your medical needs. Since medicare/medicaid requires something which documents the medical necessity of testing more than 3 times a day, your doctor has to write the letter and fax it over. This is routine for an endo, but not something a GP may do all the time. If you can get a copy of the letter or fax, it may be good to have on hand should your files get "rearranged" in the future.

I also make it a practice to maintain a hoard. And what I report to the insurance company and suppliers are what "I have been prescribed and what I need according to that prescription." The fact that I buy or maintain a hoard to protect myself is none of their fr*gg*n bussiness. The number I have left is zero when I get to the end of my three months and my prescription provided supply is gone.

And you are right, sometimes this just feels like a faceless corporate money grubbing machine, whether you are young or old.

Amen to that!




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