Where Have All the Test Strips Gone?

Imagine if you were told you were no longer allowed to access the tools that you needed to make proper decisions about your diabetes care. In a disease that requires us to constantly analyse our healthcare decisions, how would you manage your highs and lows if you didn't know they were even happening? How do you know how much that extra mouthful of dinner affect your glucose levels? Does the thought of having no way to tell how your body is being affected by your diabetes scare you? 

Stop imagining. This is now the reality for a lot of Australians living with Type 2 Diabetes.

"From July 1, all people with type 2 diabetes who are not using insulin can purchase an initial six months’ supply of subsidised blood glucose test strips.

After six months, people with type 2 diabetes who are not using insulin can access subsidised test strips if their doctor or an authorised health professional wants them to continue testing. This change follows the independent advice of the Pharmaceutical Benefits Advisory Committee.

Importantly, if a person needs access to subsidised blood glucose test strips for clinical reasons, they will continue to receive access. This may include people with gestational diabetes, on certain medications or people with inter-current illnesses."

Its hard to process exactly how awful these changes really are. I have Type 1 Diabetes, so I will continue to recieve subsidised test strips. However, all types of diabetes can end in the same dire consequences if we are not given the tools we need to adequately control our diabetes. 

The message that is being given to people with Type 2 Diabetes is that their diabetes care, and by extension, total health care, is not important or a priority. That their feet, eyes, kidneys or even lives are easily expendable in order to subsidise the debt and expenditure of Queensland Nickel. 

Many of the messages that people with diabetes see about their disease are the messages of prevention - the message that you should not end up like us, to be healthy, exercise, eat well, take the stairs, quit smoking and never drink alcohol. Yet in this case, that message is quite the opposite. Blood glucose testing is a reliable, in the long-run inexpensive way to prevent complications that are far more costly to the healthcare system than test strips. Furthermore, people with diabetes are encouraged to enjoy a healthy lifestyle to help prevent these complications  - but being healthy is much harder when people with diabetes are being denied access to an integral part of their diabetes care. Oral medications for Type 2 Diabetes can cause hypoglycaemia, which can be very dangerous, and needs to be treated immediately. Exercise may become a thing of the past to those who do not have access to test strips, as it can be very hard to manage safely, which anyone using any form of hypoglycaemic agents will know. 

Without access to blood glucose testing supplies, how do those with Type 2 Diabetes know when its time for them to move on from diet control to medication, and from medication to insulin? Without test strips, a person might remain hyperglycaemia for months on end with no idea, especially if they are not receiving regular HbA1c tests (which, with the changes to medicare subsidies for pathology tests, is more likely. I have even told my doctors that I will be moving from 3 monthly to 6 monthly blood tests in light of the extra costs). In some early-stage Type 2 Diabetics, where they are managed by a GP, they might only have an annual diabetes check-up. You also have to include those patients that are not inclined to seek medical advice often, and may ignore high symptoms if they are not encouraged to test their blood sugar levels.

The fact that there have been no provisions made for a patients right to take control of their own health is appalling. As stated, the ability to procure subsidised test strips will rest entirely with health professionals, and if they want the patient to continue testing. This further alienates the patient from their own healthcare, if they are not given the right to decide how closely they wish to monitor and control their own chronic illness. Access to doctors in some areas can be quite limiting, and this could negatively impact on the ability of a patient to receive that recommendation that they should continue testing. 

Having done my licence renewal recently, I note that this new policy doesn't seem to account for the requirement for anyone on any hypoglycaemic agent, oral or otherwise, to test their blood glucose levels before driving to ensure that they are above 5 and safe to drive. 

The implications of the decision to limit access to blood glucose testing strips to people with Type 2 Diabetes are already there. I hope that they will be realised before irreversible damage is done to any individual with diabetes.

Credit: Insulin Nation

3282

Yesterday, I talked about the 'T1D Looks Like Me' campaign which you can access here if you would also like to smurfify yourself.

Today, I'd like to show you what a different aspect of T1D looks like.

A year ago, on WDD2014, I started a collection, of sorts. The 'D365' project. It's not quite complete, but I thought I would share a preliminary look with everyone now that the initial collection is finished.

This is what a year with Type 1 Diabetes looks like:

125 Set Changes. 

125 times I pushed a cannula into my leg, stomach or back. That's  1 cannula every 3 days.

Some of them hurt. Alot. Some hurt for the entire 3 days they were in. We don't have any way to x-ray ourselves & find the nerve clusters before we put each cannula in.

3282

3282 Testing Strips. That's how many times I poked a sharp needle into my finger, hard enough to make them bleed. 

3282, is an average of 252 tests per month, 62 tests per week and 9 tests a day. Even when my fingers ache.

208. The number of hypoglycaemic events experienced. The number of times that my blood sugar was not high enough to sustain life long term and required immediate attention. That's 1 low blood sugar every 1.75 days. Sometimes, you can have 4 in one day, and sometimes, none for a week.

There is no way to predict a hypo (or trust me, we wouldn't have them!).

But in Diabetes land, we have this amazing tool to help us manage our diabetes. It's called CGM.

CGM is expensive. But it can stop hypos. Want to know why I was hypo free for 5 days straight? CGM. 

Think 3282 is an awful lot of pricking & poking? CGM gives my fingers a much-needed break.

I'm not holding out for a cure. I don't believe in one and I don't particularly feel like I need one. I can and do live my life just fine with my T1D. What I do want are the tools to HELP ME live with this disease, day in, day out. Like CGM. And in future, the artificial pancreas, or closed loop system, or the smart insulin patches.


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Reasons Why I'm Hypo:

The counter has been reset. I went Christmas shopping.

Having diabetes is so often about what we have done wrong, what we need to work harder at. When we go to our Endo, educator or otherwise, they don't spend a huge deal of time concentrating on the parts that we're getting right. They're trying to fix what's wrong.

When things are going well with my diabetes, it becomes a background nuisance instead of an in-your-face temper tantrum, so I don't really think about it. I often forget the self high-five. The only time I ever really think to congratulate myself is when the oh-so-wonderful-must-be-magic 5.5 appears on my meter. Then its stop whatever I'm doing and happy dance it out.

Last weekend, my diabetes put on its 'Mr. Nice Guy' mask. It wasn't a fluke. I have been trying really, really hard lately. I'm going to take the time to tell myself: "Well done Ash, well done".

I woke up and went for a walk in the ridiculous Brisbane heat both days this weekend. First thing in the morning. It was good for my BGLs. (N.B. - exercise gives amazing BGLs all day. Exercise more).

The rest of the weekend was just a bunch of self-high-fives and some fist bumps with my fiance as somehow we managed to get diabetes to do what we wanted it to do.







It made what was a great weekend even better. You know you're doing something right when you can go to somewhere called 'Eat Street Markets' (read: gigantic street-food markets) eat a calzone, a potato spiral, a honeycomb milkshake and a cronut and end up on a 5.8. Just for reference: Cronuts quite clearly do not cause diabetes, as might have been stated by some very silly cafe a few months ago. 5.8. Non-diabetic range.

Getting it right just gives me so much more confidence to live my life as I want to. The difference between feeling controlled and uncontrolled for me can very much impact on what I feel comfortable doing. I had always wanted to go to one of those colour festivals, and there have been a few that I have almost signed up for, and with everything going so well, I finally got to go to one. I got covered in colour, and diabetes behaved itself.

Which was a massive relief because despite the Springflare fesival being a celebration as part of the G20 happening here in Brisbane this month, there was obviously no budget allocation for first aid. Like none, none. I had more medical equipment on me than the 1st aid tent. There were about 2 young volunteers working the tent with limited supplies consisting of tissues, rubber gloves and bottled (not even saline) water. I found all this out because I had to wander up there to get a BGL check done - thankfully I had my own supplies because they had none - and needed them to clean off a finger so I could actually find real estate to test on.

Fair warning for any Diabetics wanting to do a colour festival or run - pack alcohol swabs so you can clean a finger off. And bring some little zip lock baggies for your diabetes supplies too - I remembered one for my pump but forgot about my BGL checking supplies, and ended up with a pink lancing device.

It was so awesome to be able to enjoy my weekend without stressing that diabetes was doing things it shouldn't. I hope I have more of them.