NDSS

In the Line of Questioning

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I went down to my local pharmacy yesterday to order some consumables for my insulin pump. Specifically, I had chosen a box of Comfort infusion sets (thanks for the suggestion, Laddie) in response to some of my recent site failures. I pointed out to the Pharmacist that I had not purchased this item before, because I knew that the computer would notify her of this.

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“Why do you need a different one?” She asked me.

I explained that I wanted to try a different kind of infusion set, because I had been having some site failures recently.

“Have you spoken to a diabetes educator? You’re not really supposed to be changing without their advice.”

I found this line of questioning rather bizarre, because prior to the recent NDSS changes in Australia I could easily jump onto the computer and order whatever I liked with no questions asked. Besides, would you really expect me to call my educator if I wanted to change the colour, or length of my infusion site? Do you really expect that the needs of my diabetes aren’t going to change ever again?

I think she was only trying to make sure that I was ordering a product that would be compatible with my pump, and that I understood that I would not be able to bring it back.

There is a lot of uncertainty at the moment while the delivery of diabetes consumables is shifting from online to pharmacies, and she was probably making sure I wasn’t being wasteful. There is a lot of fear and sensationalism being spread around on social media. Many are over ordering in response, leading to shortages in the supply of diabetes consumables.

I made it clear that I had done my research prior to selecting the product, and that I was only purchasing the one box because I wasn’t sure if I will like using this type of infusion set.

Pharmacist questions always make me uncomfortable. Even when I walk in there with the flu requesting Demazin tablets, they always question me about the symptoms I am experiencing.

I just try to remind myself that it’s a Pharmacist’s job to ask the hard questions. It’s their job to make sure that we are ordering the correct medications for ourselves. It’s their job to make sure that we are not being wasteful.

I’ve been buying diabetes consumables from my local pharmacy since I was diagnosed. Having a good relationship with them over the years has really paid off. They’ve given me insulin when I presented an expired prescription once. They eventually gave me the test strips after I was told I had purchased too many last year (I wrote about this here). They know that I have diabetes and they understand what I need.

If there’s one golden piece of advice I would give to Australians affected by changes to the delivery of diabetes consumables, it would be to find a local pharmacy and build a good relationship with them.

Answering to people that I’ve known for well over six years makes those hard questions a little less uncomfortable.

Sidenote: You can read more about the NDSS changes here.

Changes To The NDSS From July 1, 2016

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From July 1, 2016, the Australian government is introducing changes to the way that people with diabetes access subsidised diabetes consumables through the National Diabetes Services Scheme (NDSS). This includes test strips, insulin pump consumables, needles and syringes.

People with diabetes will no longer be able to order their consumables through Diabetes Australia, or state and territory outlets. There will be a number of new NDSS access points created in response to this change, promising greater access and convenience for consumers.

I’ve always accessed consumables through my local pharmacy, which is an NDSS outlet. However, I expect that there are many people who would prefer the convenience of ordering in bulk. Prior to these changes, people were able to order a 6 month supply of consumables from Diabetes Australia and have them delivered to their door.

I know personally how difficult it is to purchase in bulk, or to “stock up” at a pharmacy without having uncomfortable questions asked about why I need so much. I try to get around this by making more frequent visits to the pharmacy and purchasing in smaller amounts, but doing so does take away the element of convenience.

Another big change will see people with type 2 diabetes who are not using insulin restricted to a 6 month supply of test strips. Further access to strips will be in the hands of a healthcare professional. To quote the Department of Health, “people with type 2 diabetes not using insulin do not need to constantly monitor their blood glucose levels with strips.” 

The decision to use glucose monitoring to manage any kind of diabetes is an individual one. This decision should be in the hands of the patient, and not the healthcare professional. By taking away this element, I don’t believe that we are empowering people to manage their diabetes. Although I’m a type 1, I’m a high user of test strips and I couldn’t imagine my life without them. I wrote about this change in more detail here.

6 month test strip limits will also apply to Aboriginal and Torres Straight Islander people with type 2 diabetes, who access their strips free through Aboriginal Health Services.

These changes are obviously designed to make the delivery side of the NDSS more efficient and cost effective. The government promises that funds saved will be reinvested into support and education programs run by Diabetes Australia, and state and territory organisations.

Most importantly, though, in my opinion, is that I won’t be forced to pay any more for my diabetes supplies as a result of these changes.

You can read more about the upcoming changes to the NDSS here.

Access to Supplies Isn’t a Question, It’s a Right

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My Blood Glucose Meter is one of the most important things in my life. Its one of the first things that I see on my bedside table when I wake up in the morning. I’ll zip it up securely in its little black case and tuck it safely in my satchel, where it will accompany me on my daily commute. I’ll open my satchel again before I start the car, just to make sure that its there. When I get to work, I’ll place it carefully on the shelf in my locker. It patiently sits there for much of the day, ready to be at my service as much or as little as I need it. Before morning tea. Before lunch. As a post-lunchtime reassurance. If I start to sweat or shake uncontrollably. At the end of the day, I’ll tuck it safely back into my satchel, before it finds its familiar place back on my bedside table at home.

When I’m dealing with a disease that is unpredictable and ever-changing, numbers are always on my mind. They plague me throughout the day. They plague me when eat. They even plague me when I stir in the middle of the night. I’m constantly questioning myself. Thinking to myself. Doubting myself. ‘I wonder what my blood sugar level is right now? Did I give myself enough insulin at lunchtime? How much will I drop in the next hour? Am I feeling hypo? No, it must just be this afternoon’s task that’s exhausting me. Wait, maybe I am hypo? No, no way. Well, maybe…’

Last week alone I had 58 moments of uncertainty. Last fortnight there were 125. And in the last month there were 257 of them. And I have this one little device that has the power to sweep my mind clean of all the thought processes scattered there. To dismiss all of my concerns and rid me of my fears. To keep me grounded. To keep me sane. One little prick produces a number and I’m empowered again. I feel secure. I’m back in control. I know how to react.

I consider myself pretty lucky here in Oz to have unlimited access to blood glucose meter test strips, needles and other non-medication products that I use on a daily basis to manage my diabetes. Since registering with the National Diabetes Services Scheme (NDSS) upon diagnosis, I have been able to get my diabetes stuff at a heavily subsidised cost, without a doctor’s prescription, whenever I like. As little or as much as I feel I need it in order to manage my condition.

So, I’m pretty devastated to hear that some Aussies with type 2 diabetes are about to have that freedom taken away from them. If their diabetes is not treated with insulin, it will be up to their doctor to decide whether they will benefit from blood glucose monitoring after an initial 6 month supply of test strips.

Yes, a type 2 would not use blood glucose monitoring as much as a type 1. But I’ve no doubt that they would go through those exact same feelings and thought processes. I’ve no doubt that at some point during the day, the week or the month, a type 2 would need to rely on the security of a blood glucose test. If they’ve eaten something different at dinner. If they’ve done more exercise than normal. If they’re not feeling well. Diabetes causes A LOT of uncertainty.

Its like being handed a box of test strips and being told “you have 6 months to get your diabetes under control.” And then in 6 months your blood glucose meter is taken away and you’re told “you now have to keep your blood sugar levels between 4 and 8 all the time.”

Diabetes is not something that we can always “get” under control in 6 months, let alone maintain all the time. Our lifestyles are ever changing – work, travel, diet, families, physical activity – all of which have significant impacts on our diabetes. Doctors aren’t by our side 24 hours a day to see, let alone understand, what we’re going through. The only person who knows you best, is you.

We are blessed to have all of these fantastic tools available today to help us manage our diabetes. For many, a blood glucose meter gives us a sense of security and control. It should never be a question of who gets them. I only wish the people making these decisions would understand.

Source: The inspiration for this story came from Renza at the Diabetogenic blog. There are more details about this decision process over on her blog.