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By Angela Coffey, freelance writer, previously Editor of Diabetes Balance, Diabetes UK’s membership magazine April 2018

Testing your blood sugar regularly and acting on the results is a surefire way to help you manage your diabetes and understand what’s going on with it. So, why are people being asked to swap their trusted meters or refused test strips altogether? And, is there anything you can you do to get the right supply of the strips you need?

There’s an abundance of blood test meters on the market and, while they vary, they all have one main goal: to give you your blood sugar reading. With that, you can act on the result, help keep your diabetes under control and get on with your life.

For many people, using their blood test meter is second nature – like brushing your teeth – and it’s essential to help keep diabetes complications at bay. All sounds simple enough. But, over recent years, access to test strips is becoming a real struggle for some people. Diabetes UK reports that 1 in 4 people have problems getting the right amount of test strips they need. Some get their supply reduced or stopped altogether. Some healthcare teams make this decision based on personal circumstances, but it can also be down to a blanket restriction by the local NHS that hasn’t even taken a person’s needs into account.

Compounding the issue, Clinical Commissioning Groups (CCGs) have been choosing one or two blood test meters and only supplying certain blood test strips on prescription, meaning people need to change meters in order to keep getting test strips. A recent Desang reader survey found that 21.76% have been asked to change meters. While 8% of these didn’t want to and were able to stay with their original meter, 4% were forced to change.

So, is it a problem to be moved onto another meter? Many people think so. While meters recommended by CCGs meet the clinical standards, many people tend to find they aren’t as good as the one they were using. Like anything we’re used to and in a routine with, people can be very attached to their meters. And familiarity certainly makes it easier to keep up with the routine. So, swapping – often to a lesser quality meter – can be distressing.

The trouble is, one size doesn’t fit all. People rely on different features, so different meters will appeal to different people. Children, adults, elderly and disabled people all have different requirements. Even your type of job and hobbies can have an impact on what you need from a meter.

Some people will need a meter with a large memory to store their test results, or rely on software to download their results in order to discuss them with their diabetes team. Others may need a large display screen, bigger buttons, and easy-to-use menu options. Some people may not care what size their meter is, but very active people will most likely need a small, all-in-one meter. To only give one or two meter choices won’t cater for everybody’s needs – and that’s were problems can arise.

Out of pocket

Whether you’re facing an unwanted meter change or a restriction in test strips, some people will be forced to buy test strips, instead of getting them on prescription.

Having to buy your own test strips isn’t cheap – and can even be costly to health. If you have fewer test strips or a meter that’s harder to use, people may not be able to test as much as they were doing, or as much as they need to, causing problems with diabetes management, and increasing the risk of short- and long-term complications.

And, for those that drive, many people are worried about not having enough test strips to be safe on the road and meet the legal requirements (see ‘Testing guidelines, below).

Testing guidelines

Depending on your type of diabetes and treatment, you can be expected to test multiple times a day.

In short, everyone with Type 1 and many people with Type 2 (who use insulin or other medication that can cause hypos), need to test their blood sugar. So, they need to have access to test strips and the type of meter they need. But testing – of course – can also be useful for all people with Type 2 to help to keep on top of their diabetes.

Official guidelines differ depending on your circumstances. NICE says that everyone with Type 1 should test their blood sugar levels, as should pregnant women with any type of diabetes, or those planning to become pregnant, and people with Type 2 who use insulin or any other diabetes medication (like sulphonylureas or prandial glucose regulators) that can cause hypos.

With Type 1, it’s recommended you test at least four times a day, which includes before meals and before bed. Some people may need to test up to 10 times a day – even more – if they’re very sporty, if pregnant or if they have a lot of hypos.

And, when it comes to driving, if you use insulin, the DVLA/DVA states that you must test before, and every two hours during the journey. This will also be the case for people on other diabetes medication that can cause hypos. So you’ll need a good supply of test strips just to carry on with your normal life.

Fight for your rights

With the NICE guidelines and DVLA/DVA requirements, it’s not right to restrict test strips or force people to use a meter that isn’t compatible with their needs.

Nikki Joule, Diabetes UK’s Policy Manager, told Desang: “Self-monitoring of blood glucose levels is an essential part of diabetes management for people who treat their condition with insulin, so it’s important that they have access to blood glucose meters and other self-monitoring equipment that best supports their individual needs.

“Many other people with diabetes can also benefit from self-monitoring, and if people with the condition are refused their meter of choice this could affect their ability to manage their condition effectively, with potentially devastating implications for their health.

“While the only requirement for the type of meter prescribed is that they meet the recommended clinical standards, NICE is clear in its guidance that individual needs must be taken into consideration when making prescribing decisions about blood glucose meters.

Taking this into consideration, it’s important that you know your rights and to challenge any of the restrictions you face when it comes to test strips. Diabetes UK is calling on governments and the NHS to make sure people with Type 1 diabetes don’t face restrictions to test strips, as well as demanding a review of the national guidance about access to strips for people with Type 2. The charity has even created a pack to help you challenge your restriction to test strips, which can also help you if you’re being asked to change to a meter that won’t suit your needs. It covers how to approach challenging your restriction depending on how and why the decision was made, as well as how to make a case for why and how often you need to test.

It’s worthwhile to challenge it. Diabetes UK found that when people challenge restrictions to test strips, they’re almost always successful. So, if it’s affecting you, stand your ground, and do what’s right for you: a meter that suits your needs with the right supply of test strips.

Steps to success

Steps to take if you face problems:

  1. Talk to your GP about the decision. Have your own personal needs been considered, or is it a blanket restriction in your area?
  2. Ask for a Medicines Use Review. It’s free and offered by pharmacists to help you get the best out of your medicines. Talk about your problems with test strips or meter and how this affects your diabetes. The pharmacist will fill in an action plan and a copy will be sent to your GP. It should be clear the difficulties you’re facing with your meter, or in getting enough test strips and recommend an increase in the amount you’re prescribed.
  3. If your local NHS has set the restriction, ask to see a copy of the policy. Diabetes UK advises to not take for granted that your surgery manager or GP are following guidelines correctly. If you think your surgery is being too rigid in their understanding of the guidance, challenge it. Put forward your interpretations and try to reach an agreement with your GP or healthcare team.
  4. How to make your case for testing. Explain how and why testing helps you to look after your diabetes. Base it on the type of diabetes you have, the treatment(s) you use, and the particular problems you are experiencing in accessing test strips. Explain these points in full to stress the benefit that testing is giving you, and the impact any restriction is having.

RESOURCES

See Diabetes UK’s advocacy pack for more detail and advice.

Also see Diabetes UK’s Testing times campaign: diabetes.org.uk/testing-times

Nice guidance on Type 2 diabetes in adults: management: https://www.nice.org.uk/guidance/NG28

Government advice for Drivers with diabetes.

Diabetes UK’s advice for Drivers with diabetes.

News items and features like this appear in the Desang Diabetes Magazine, our free-to-receive digital journal (see below). We cover diabetes news, diabetes management equipment (diabetes ‘kit’ such as insulin pumps and continuous glucose monitoring equipment) and news about food suitable for a diabetic diet including a regular Making Carbs Count column. We just need your email address to subscribe you (it’s free, and you can easily unsubscribe should you wish to).

 

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