We recently took a look at some not-so-kosher ways to get your hands on cheap test strips. Today, we’re looking at how you can get the most mileage out of a limited number of these costly strips.
One if by land… and two if by… oh crap. There’s only one lantern! How on earth will Paul Revere get the memo if the British come by sea? It might be funny if people’s lives weren’t on the line, but that’s exactly the position that the vast majority of people with diabetes (PWDs) find themselves in these days.
Simply put, they’re being limited to one test strip per day, almost a symbolic signal of the status of the diabetes invasion by those writing the rules about how patients obtain needed medical supplies.
For a number of years now, the Centers for Medicare & Medicaid Services have set the following limits for test strips: one per day for PWDs on oral medications and three per day for PWDs who use insulin. And where the Feds have led, commercial insurance has followed.
We could spend all day arguing about how effective testing is, and how many strips per day various PWDs on various therapies should have to stay healthy. But we’re not going to talk about the ideal world today. We’re going to talk about how to maximize the number of strips we are given in the real world.
One is the Loneliest Number
The fact is that 74% of PWDs in our country are type 2s who don’t take insulin to control their diabetes. That’s 14 million people. For this rather large crowd, our health system provides a strip a day. What can you do with a strip a day?
Frankly, nothing useful.
Or can you?
Most PWDs limited to a single strip use it to check their morning blood sugar, a strategy that doesn’t provide much information, as an isolated number is meaningless. If you test once per day, odds are you’ll never learn much about your diabetes, much less take control of it.
But think outside the vial for a moment. You have one strip per day. Who says you have to use it every day? What if you shook things up a little? Saved your strips up for a day or two, or more, and redeployed them in a different way?
This concept is called “structured testing,” and it creates patterns that give blood sugar results context. And context gives numbers power. Here’s my favorite example: suppose you checked your blood sugar two hours after a meal and found it to be 362 mg/dL. What do you know about the meal?
If you said 1) that the meal had too many carbs or 2) you counted the carbs wrong or 3) you took your meds wrong or 4) your meds aren’t up to the task — you’d be wrong.
You know nothing at all. Well, nothing beyond the fact that you’re high. But you know nothing about the meal itself, because you don’t know where your blood sugar was before the meal. Yeah, if you were at 112 mg/dL two hours ago, the meal kicked you in the ass, and one of the four things above is likely to blame. But what if you were at 439 mg/dL before the meal? There’s still a problem to be fixed. But it had nothing to do with the meal.
Two at a Time
One very effective method of structured testing is called Testing in Pairs, pioneered by Bill Polonsky of the Behavioral Diabetes Institute and Roche Diagnostics, the world’s largest meter maker.
The concept behind Testing in Pairs is that you should view finger stick testing as a small-scale clinical study, looking at the before-and-after effects of something on blood sugar. That something could include food, activity, sleep, or stress. So pairs are commonly before and after meals, before and after exercise, or at bedtime and the next morning to investigate what happens with your blood sugar overnight.
Of course it’s a narrow view, and if you have only one strip per day, you can only test one pair every other day. But it beats the hell out of the traditional and futile one test per day. While Testing in Pairs adds a lot of power to the testing paradigm, it takes a great deal of time for patterns to emerge. Looking at breakfast trends for a week. Then lunch trends for a week. Then you drop your morning strip in the toilet by accident, and you’ve just lost half your pair for two days…
Or Maybe 21 at a Time?
More recently, Roche launched another creative way to learn more with fewer strips. (Does this mean Roche is reading the handwriting on the wall when it comes to adequate strip supplies for the foreseeable future?)
It’s called the Accu-Chek 360° View Tool. It’s not a waaaaay cool new gadget, device, machine, or physical object of any kind, as you might expect when you hear someone talk about a “tool.” It’s just an 8½ x 11 inch two-sided sheet of paper with orange, green, grey, yellow, purple, and blue ink. It looks like an accounting school acid trip. One entire side is the instructions. There are nine steps that, at a glance, look overwhelming enough to put you into a twelve-step program.
Hey, no one ever said diabetes was going to be easy.
But while the “tool” looks overwhelming, it’s really just a glorified log book. And here’s the best part: it’s only a three-day log book. The 360° View Tool guides you through a three-day intensive testing period. Seven finger sticks a day over three days. Before and after every meal, and at bedtime. That gives you and your doc a snapshot of blood sugar trends around all meals for three days, plus your overnight readings twice.
You log the numbers, but also graph them visually on the tool. That gives your doc a quick view of what’s happening in your diabetes world. It’s a view that fits better into the short office visit world we live in. Also, the mere act of filling out the form is a learning experience for you, as well as info for your doc. At one strip a day, you could do it every three weeks.
How well does it actually work? Damn well. A clinical study headed up by none other than Polonsky himself shows that using the tool lowers A1C levels. And a second study featuring the tool showed that it significantly increased the effectiveness of docs themselves, who are otherwise trying to make sense of a myriad of different reports from different meters, or trying to review a blood-smudged log book in 90 seconds, searching for patterns.
The Danger Zone… of Structured Testing
Personally, I think that structured testing is a great idea for anyone with limited test strips who takes diabetes medications that have no risk of hypoglycemia. Uh… and just who would that be, exactly? Well, not most of those 14 million people who get one strip per day, that’s for sure. Because the problem with diabetes medications is that they are designed to lower blood sugar, and as such, most of them occasionally lower it too much. With the exception of metformin, most entry-level diabetes drugs (the ones insurance plans insist that PWDs “fail” on before paying for more sophisticated ones) carry a significant risk of low blood sugar.
I like structured testing. I like the power it gives to finger sticks, and I like the way it makes the most out of not enough. But I’d like it better if we gave people what they really need, and I worry about some PWDs falling into the habit of not carrying their meters with them (Hey, I don’t need to test for three more weeks…), or being out of strips, and then having lows.
On one hand health plans insist on only covering first-line meds that carry a risk of low blood sugar; while at the same time they refuse to pay for strips to mitigate that risk.
Come on, Boys, you shouldn’t be allowed to have it both ways. Still, for the real world that we live in today, structured testing is the best game in town.
I actually found it really interesting on what the insurance would cover. When they gave my husband 100 test strips for a month I did the math and just shook my head. If he’s lucky he tested 4 times a day, each meal and bedtime. So, a minimum of 120 test strips a month. If he went to a hypoglycemic moment then you can add at least 2-5 more, depending on how low and how quickly it responded. We actually got a CGM, but still check 3 times a day to calibrate and if he gets a low (which does still happen, just not nearly as much), and the low doesn’t seem to be giving up (or the meter says he’s REALLY low), we have to add more to it.
Fortunately we found that Walmart has their Reli-On meter for 9.00 and 50 test strips for 30.00, which is lowest I’ve ever seen test strips go for. Still more than if he was paying the insurance copay, but unfortunately what the insurance approves doesn’t always fit a normal diabetics lifestyle.
Thank you! I’m a T2 wondering why bother testing. It shows the dawn effect, whoopee, so I seldom test. Now this makes sense! I’ll try it.
The cost of test strips is still lower than the bill the insurance company would get for ambulance rides, ER visits, hospital stays, amputations, dialysis, etc. Thankfully, my husband’s prescription insurance gets this. When the media prints scare stories about diabetes bankrupting nations, they never explain that most of the money is to pay for the horrible things that go wrong, not for test strips, insulin or Metformin, and education.
In my experience, my test strips are the MOST important in controlling my Type 1 diabetes. Too bad they cost so much.
This is definitely one of my pet peeves. As a Type I of 36 years on a pump with hypo/hyper glycemia unawareness my 150 strips a month is not enough. Luckily my prescription insurance company is ameable to my endo requesting an authorization for additional strips and they have approved an additional 200 striips per month at no cost to me (my 150 are also no cost because I am type 1, type 2s have to pay a copay).
So I am suggesting those of you who get minimal numbers of strips try seeing if your endo can get you an authorization for more. The number of strips we are allowed, I believe, is decided by someone who not only doesn’t have diabetes but knows nothing about it.
Joan– the sad truth is that most type 2s have never seen an endo and never will. The vast majority are under the care of PCP docs. There are no where near enough endos in the USA to see all the type 2s. I once saw a stat that it would take 30+ years for all the endos to see every person with diabetes one time if all type 2s saw endos.
Medicare will pay for more strips if you send in a log for a month to your supplier… they want to substantiate that you really used more.Since I use more than 6 strips a day I’m happy to send the log if it means free strips. Sometimes I have to hassle w/ the supplier to get the full supply however.
The test strips Medicare will pay for (above the minimum when I provide extensive documentation from my endo) are NOT “free strips”.
I pay a monthly Medicare premium, the yearly deductible and a supplemental insurance premium which covers the 20% that Medicare does not cover. If I didn’t pay for the supplemental, I couldn’t afford to pay for the insulin, let alone the strips or the pump supplies. Or the required endo visits at least once every 90 days.
Wow, I’ve never heard of this. I pay out of pocket for test strips all the time because they are so important. But it sucks because I could have taken my kids to Disney with that money by now.
The issue isn’t how to manage with X number of strips. The issue is that in the USA we have Wall Street deciding who lives or dies — especially with respect to T1D. Those with T1D deserve to live life to its fullest and to be able to test as often as necessary WITHOUT some Corporation deciding what is or is not “cost effective.” Test strips are the tip-of-the-iceberg regarding the way in which T1D is utterly (and criminally) disregarded by the CEOs of Insurance Corporations, Pharma, and device manufacturers. Who’s kidding who? The gold standard of care with T1D is entirely ignored by those in the USA with the power and influence to do what is right — and not have us worry whether we’ll be alive next year or not due to lack of care, lack of access, lack of funds for a disease that is no the fault of those who have it.
I just wrestled with Medicare for the first time on behalf of my 20 year old son who has Type 1 diabetes and Down syndrome. He was diagnosed at 18 months after I insisted that he be checked for diabetes because he had the classic symptoms. The doctor said it was highly unlikely but I held my ground and surprise he did. Jake checks his blood 6-8 times a day and I now know about the 100 test strip limit. We too are keeping a log to send in to the supplier. I shudder to think what will happen after I die and someone else has to learn to navigate the”system” for him.
Agree and I understand. I have the same concerns — as my comments are based on 20 years of fighting for my son, who is now 23. No matter how hard we have tried, his T1D has never had a pattern upon which he can rely and as a result he has to test at least 6 x per day. But this is really only the beginning. And I do, absolutely, live in fear of a time when I cannot help him navigate the medical establishment or help him financially. It’s a huge thing. I hear about this fear from parents of many children with serious chronic diseases–as our country has become more cruel as each year passes. Wall Street, and those in congress who are owned by big corporations, really do not care about the suffering of innocents. I have found that talking about this harsh reality is not welcome on diabetes blogs. Most blogs promote sharing tips/tricks — not the inhumane treatment faced by those with T1D or other severe chronic illness.
I found this article unnecessarily alarming. When I read it, I almost panicked since i use a dozen test strips a day. What the article should have pointed out is that, as long as your doctor is able to state you have a need for multiple testings a day [and it's easy for them to do that with Type 1s] this ought not be a problem. Of course it really helps the doc if you can document your usage [which your meter can provide].
This is helpful input. Thank you.
In our case, since my son was so young when diagnosed we have consistently made use of 3 meters: one at home, one in the backpack, one in the car (or school nurse’s office in earlier days). This has frustrated our attempts to track usage as our focus has been on convenient access. Still, though, so far the MDs have been willing to write the Rx — my concerns go beyond this detail to the time when access to an MD becomes [literally] the show-stopper.
The trend in this country, instead of providing care to those with chronic life-threatening illnesses, is to marginalize them…and, of course, blame them.
Seems to me this wouldn’t be a problem if the companies that make test strips didn’t charge so much for them.
Yes. Far far cheaper would be a good start. And yet, Wall Street Insurance corporations (equivalent to investment banks) should be OUT of the equation entirely.
Test strip technology is quite awesome. But it is time for the price to come way down. The manufacturers do need a business-sustainable way to ensure quality production which also meets the supply-demand requirements of a well run business. Once the price was lowered (substantially) then after about 6 mos to 1 year, manufacturers would get a more accurate picture of supply/demand and could set mfg goals accordingly.
And these manufacturers are likely to say No to price adjustments and point to other manufacturing sectors or economic sectors which receive Subsidies to produce at quantities designed to stabilize both production and consumer ends of the spectrum.
So here’s an example: we (taxpayers) through congressional legislation (laws) are required to pay Archer Daniels Midland (ADM) enormous sums of money so they can add an inefficient, expensive, dirty, additive to gasoline, i.e., ethanol. It’s a money machine for ADM and a ripoff for taxpayers. OTHER corporations look at this obvious gift to ADM in the form of a “subsidy” and decline to offer any sort of price breaks to consumers — yes, including supplies like test strips which are essential for LIFE — unless they too are “helped” by congressional law.
The notion of intervention to enhance the market supply and demand imperative is OK with me but to “enhance” profits for ADM with our taxpayer money while congress denies meaningful assistance to those with T1D is criminal. I repeat: criminal.
Test strips are one piece of the bigger (scary) pie regarding the barriers to care for those with T1D.
[...] sugar 20 times a day in what he calls “clusters,” with 2-3 tests within 15-20 minutes — testing in pairs taken to extremes. In Andy’s words, “Sugar levels rarely remain parked at one level. They [...]
I just want to say Thank You. This was the first thing that made sense to me on how to use my (1) testing strip(s) effectively.