Fight for your test strips!

Driving and Diabetes

Driving and the EU law
News release: EU changes night-time hypos driving rules for people with diabetes
Driving and hypoglycaemia – what are doctors being advised to do?
Test Strips – Department Of Health Warning For Doctors And Pharmacists
Vehicles You Can Drive
Medical Assessment Forms
Insulin and Driving Taxis
Hypoglycaemia and Driving
Driving and Medicines
Driving and Visual Field Loss

Living with Diabetes


Test Strips – Department Of Health Warning For Doctors And Pharmacists

In response to reports that people with Type 1 diabetes are being denied the number of blood glucose test strips they need, in February 2013 the Department of Health sent a letter to GPs, Hospital Doctors. Community Pharmacists, Chief Executives and PCTs entitled “Safe care of people with Type 1 diabetes”.

The letter stated that self blood glucose testing for people with Type 1 diabetes “is essential for safety checks when feeling unwell, or in situations when the blood glucose might fall too low or too high”. It reminds them that there are specific issues for drivers with insulin-treated diabetes and that the DVLA states, “You must always carry your glucose meter and blood glucose test strips with you. You must check your blood glucose before the first journey and every two hours whilst you are driving.”

The letter states that it is essential that people with Type 1 diabetes are prescribed sufficient test strips for their clinical need stating:
“In the context of wider education, this enables people with diabetes to self manage, including understanding sick day rules, recognising symptoms of DKA, early action and how to seek help, and any specific considerations in the light of any job they may carry out, especially if it involves driving.”

Addressing the costs…
The letter also points out that while test strips dispensed in primary care may appear to have a premium cost, the wider costs to the patient’s quality of life, their safety and ability to work and to the NHS of complications of uncontrolled diabetes far outweigh these costs.

It’s a shame the letter omits…

  • The importance of day to day avoidance of hypoglycaemia for people taking insulin. This is one of the main reasons many people test – to feel secure or simply to check whether to and what to eat.
  • The letter could, and should, have included in more depth people with Type 2 diabetes being treated with insulin and/or tablets some of hich can cause hypoglycaemia.

But the letter is a start in the right direction and let us hope that it helps to ensure that people with diabetes receive the number of blood glucose test strips they need.

Note: if you do not receive the test strips you require, then it may be with reminding your doctor of the letter, here are the details:
it was sent on February 4th 2013 from the Department of Health and signed by Dr Rowan Hillson, National Clinical Director for Diabetes, Dr Keth Ridge, Chief Pharmaceutical Officer, Claire Howard, National Lead Medicines Use and Procurement and Susan Grieve, Principle Pharmacist.


Self- Monitoring – A Change In The Evidence!

As we regularly report, one of the most common problems that people express to us is the restriction on the supply of blood glucose test strips, or in many cases of people with Type 2 diabetes, the refusal to prescribe any at all!

The evidence for this from a review was that self-testing in Type 2 diabetes made no improvement in HbA1c and this was the message health professionals took on board even though the review did not take into account the benefits of testing if you live with diabetes. These are the feeling of safety when you know what your blood sugars are doing, reducing the risk of hypos, learning the effects of different foods on blood sugars etc.

A review of the review!
A large scale Cochrane Review has looked at the evidence again and found that newly diagnosed people with Type 2 diabetes who are not on insulin are achieving significantly better HbA1cs if they have access to blood glucose testing.

Why the difference? One of the reasons is that the studies included in the first review excluded people who had previously shown interest in self-testing many of whom buy their own test strips. So the studies that excluded these people did not, and cannot, give a true representation of people with Type 2 diabetes in the UK.

‘Fighting for your test strips’
As we know it is not possible to ‘fight’ this matter nationally because the Department of Health has placed no restrictions on blood glucose test strips. The decision to not prescribe or restrict numbers of strips, is a local one, so IDDT’s advice has always been to explain to the practice manager why you need strips, or need more strips and if this has no effect to take the matter up with your local Primary Care Trust [PCT]. However, from April 2013 PCTs will no longer exist, so it is a matter of taking this up with your GP.

Here are the key points to use.
For people with Type 1 diabetes and those with Type 2 diabetes taking insulin:

  • To maintain the tight control that is necessary and with present 4 plus injections a day, at least 125 strips a month are necessary.
  • To take into account times of illness or stress, additional strips are needed.
  • The new driving regulations state that people have to test before driving and at least every 2 hours on long journeys. The extra number of strips to conform to the regulations will vary from person to person.

For people with Type 2 diabetes not taking insulin:

  • The Cochrane review shows that people with Type 2 diabetes do benefit from testing and their HbA1cs are improved and this should be pointed out if you are refused test strips.
  • The only tablet that does not cause hypoglycaemia is metformin, so for people taking any of the other tablets for Type 2 diabetes there is a risk of hypos and therefore, the driving requirements to test before driving apply to them too to reduce the risk of hypoglycaemia.

Whatever type of diabetes you have and however it is treated, NICE guidelines say that self-testing should be available as p[art of the education people with diabetes should receive and everyone with Type 1 and Type 2 diabetes should receive education to help them manage their condition. So don’t be fobbed off without test strips or without the number you require – it’s your health and welfare that is at stake!