I had a frustrating experience at the pharmacy today, and I wondered if you could give me your opinion. The pharmacist wanted to know why we test our four year old’s blood sugar seven to ten times a day. He seemed to feel that was excessive. I explained that, due to her age and inability to communicate her physical feelings to us reliably (e.g., high or low), it is necessary for us to test more frequently than the “recommended” four to six times a day. In addition, her sugars are frequently all over the map, and it’s rare that I guess very accurately where she is at any given time. How often do you think is “reasonable and necessary”? Everything I’ve read says, re-test after giving glucose for a low and re-test after giving insulin for a high. I try not to do that unless I have to and I still blow through seven to ten strips a day! Are we the only family with this problem? Why are strips so darn expensive anyway?

I hope I can address your concerns.

Why are the strips so expensive? Well, probably primarily because they can be. This is the profit margin for the manufacturers. However, in their defense, there have been some studies which show that the name brand strips are more accurate than the generic.

Your pharmacist really is clueless, isn’t he? As are the insurance people who “make the rules” of how often one can test. Their concern is that some enterprising person who has diabetes will “stock up” on bucket loads of strips for cheaper so as to not have to pay more (or so as to allow the insurance plan to pay for) later on, and I would, too, but I agree, that especially with small children, or those with communication barriers, or those on intensive therapies, people with diabetes should be able to test as they see fit. And you’re right: on a “good day” you might check before meals and at bedtime, and perhaps after a meal or two, but add in one episode of feeling low, then you have already added two more checks (you felt bad so you checked; you had to recheck after treating a low to make sure the glucose was appropriately higher). A sick day is even worse.

These are the limitations of health care in the US. I would suggest that you find the next time your meter’s strips are on sale and buy a bunch.

DS

[Editor’s comment:

The number of times that you test your child per day is between you and your child’s doctor (who writes the prescription), to a lesser extent between you and your insurance company, but not between you and the pharmacist. Intensive management requires blood glucose data, and the only way to get that data is through frequent blood tests. It is not uncommon to test ten times per day. In a poll conducted in October 2002 on the subject, over half of our readers report testing six or more times per day, with more than one third testing more than six times a day.
On the question of the price of test strips, it’s important to understand that the sale of a test strip funds much more than simply one blood test. From the sale of test strips, companies must pay for research and development, regulatory adherance, and large customer support staffs that are available around the clock, just to name a few. In the past 10 years, meter technology has advanced enormously. In 1990, for example, the best meter required an enormous hanging drop of blood which was placed on a test strip. After one minute, you wiped the blood off of the strip and placed the strip in the meter. After another minute, the meter produced a reading. (Yes, two minutes.) Today, meters produce results in as little as five seconds with a mere whisper of blood. These advances are made possible through the profits that companies make selling test strips, and there are more advanced products under development, including continuous monitoring devices that, I believe, have the potential to change the way diabetes is managed as significantly as did home blood glucose monitoring.
In the interest of full disclosure, the two largest financial supporters of this web site are companies that make blood glucose monitoring products: TheraSense and LifeScan. JSH]