Friday, 12 February 2010

Dear Doctor Valentine


With Valentine’s Day approaching, a sorry tale of a close relationship gone badly wrong, due to the ignorance, laziness or ineptitude of one of the parties…

One topic that crops up time and time again is the topic of the prescription of blood glucose test strips to people with diabetes, particularly in the case of diet-controlled Type 2s but also for those on medication and even, occasionally, those on insulin. The root cause of doctor’s reluctance to prescribe is generally cost – these strips are expensive, currently working out at about £0.50 per strip. The denial of strips is usually supported by reference to some largely outdated survey which purported to show that testing for Type 2 diabetics was unproductive and unnecessary. The survey concluded that knowing levels led to depression and no significant reduction in overall levels. However, what is not emphasised is that those in the survey (only consisting of 453 patients) had an average age of 65. The conclusions, therefore, were based on150 people who were testing and provided with education. In fact, this group did show an improvement, and whilst the numbers may appear small in such a small group, apply that to the 2.5 million with diabetes and you get an improvement for thousands of people. Interestingly, the person in charge of that survey (Andrew Farmer) is involved in the SMBG (Self Monitoring Blood Glucose) International Working Group. This is a group which is attempting to set guidelines for testing not just for the UK, but for diabetics everywhere. Their latest report is available by clicking the download at http://smbg-iwg.org/ and the conclusions are very much in favour of encouraging testing when accompanied by a structured education and patient/professional approach.

If people don’t want to test, then that is their decision and many are happy with this (particularly, perhaps, those in their later years of life). But if a patient shows will and determination, then they should be given the opportunity and fully supported.

Instead of daily self-monitoring, for those not on insulin, it is often believed that the three- or six-monthly HbA1c test is sufficient to show progress. However, this merely shows and average over the previous 6-12 weeks, and does not inform the person how certain foods and activities directly affect them so they can act on the information. Logic and evidence shows that if you know what foods to avoid, and act on that information, significant results can be achieved. This knowledge also enhances quality of life as the person is no longer constantly worrying in anticipation of their next Hba1c test, and anxiety about the possibility of developing horrendous complications is reduced enormously.

Some doctors are more enlightened and can see the benefits of testing, on whatever regime, and will duly prescribe strips and arrange education so that their patient knows how to react to the information gained. Many however, constrained by budgets, see it as an opportunity to reduce spending and are not foresighted enough to realise that happy, well-controlled patients are at far less risk of much more costly treatment in the future should they need major treatment such as dialysis or amputation.

There is tremendous anger generated by this short-sighted attitude – and rightly so! One forum members has set up a petition to persuade the government to reassess this discrepancy and penny-pinching approach. Please sign it, more than 500 signatures and the government have to respond.
For people on insulin, testing is even more essential in order to determine doses, check that levels are safe before driving, before and after exercise, fr lows and highs – the list goes on. Unbelievably, the need for strips is often questioned! ‘Why do you need to test so much?’ ‘You’re being obsessive!’ The most ridiculous – and dangerous – one recently encountered was for a pregnant lady whose online prescription service informed her that she had exceeded her allocated amount and could not have any more for several weeks! Pregnant women are in even more need of regular testing in order to keep their unborn child safe, and levels will be far more difficult to control as the pregnancy develops, so this amounts to a criminal disregard for both patient and baby. No-one, under our health care system, should have arbitrary restrictions placed upon them, in these circumstances in particular.

Do these doctors think that stabbing your finger several times a day with a painful lancet is some kind of perverse pleasure that must be discouraged? Let them walk a day in our shoes! So, today’s poem is rather barbed in response to those know-it-all, petty, uninformed, uncaring doctors who put misguided and erroneous ‘savings’ before patient welfare – a metaphorical death by a thousand fingerpricks!

Oh, let me hush those dulcet tones,
Your voice so warm and tender,
And crush your hand between these stones,
And stick it in the blender!

What? No, my love, I am not cruel,
Just close your pretty lips,
I’m crazy like a lovesick fool
When you deny me strips!

I cannot know as well as you,
So white coat worldly-wise,
But let me take this superglue
And squirt it in your eyes!

I’m flushed, I’m shaking with desire,
Let no more words be spoken,
It will be hard when you’re on fire,
And every bone is broken!

If only you had shown me love,
And let those strips be mine,
You’d be my fluffy lovey dove,
My Doctor Valentine!

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