Doctor rant

Man I'm pissed. I got a kick ass disease about a year and a half ago. Diabetes is fun. My doctor is very good and, up until a few months ago, I've been very happy with him. Because there are no construction jobs near Chicago, I'm now out in the middle of nowhere out in Montana. Its 80 miles to the nearest pharmacy or anything else.

So I call the pharmacy today to get a refill. Sorry, you're out of refills. This is great. Its Sunday. I'm screwed. I cannot eat until tomorrow.

I don't understand this. Diabetes is permanent. I need this stuff to LIVE for the rest of my life. I see the doc every three months for a blood test, why can't they just give me enough refills until the next appointment? I don't have enough money to "stock up". I've explained to them by phone and in person that I can't run down to the local pharmacy. There IS no local anything. I don't think they have any concept of 80 mile to anywhere.

Perhaps there are laws that prevent extended prescriptions. If they would give me a reasonable explanation, I'd be OK with that. I get to see them in about a week. I fear I'll come unglued.

Rant over.

But you're probably some degenerate that selling his diabetes meds to local highschool kids so they can, uh, not have diabetes or something...

Looks like I'm going to be paying $500 a month for one of my 78 year old mother's medications because the insurance company won't and she can't. Her insulin is cheap. The expensive stuff is for the liver.

Appleseed, Ask your doc to write the prescription and wherever he lists the number of refills, strike out the number and write in "x 3 months." Prescriptions are written in a language all their own. When you see him and he hands you the prescription, ask him to show you where it says that.

Oh, and some time back, there was a physician that cured Type II DM. He would put the patients in a hospital room, hook them up to IV's and starve them until their cells started recognizing insulin again. Type I DM, you're just screwed until gene therapy gets figgered out or they figger out how to stop your body from killing your pancreas cells.

Appleseed,

Not sure what pharmacy laws are like up there, but here in FL a pharmacy can supply up to 72 hours of maintenance medication without MD authorization of a refill. It sure would stink to have to make two 80 mile trips though to the pharmacy.

Snowdoggie - what medication is that?

In reply to Dr. Hess:

great for those w/ type 2 diabetes ( insulin dependent ... ) now hope someone can come up w/ something for those of us with type 2 diabetes ( insulin resistant )... my body makes plenty the cells just wont take what's offered

wbjones wrote: In reply to Dr. Hess: great for those w/ type 2 diabetes ( insulin dependent ... ) now hope someone can come up w/ something for those of us with type 2 diabetes ( insulin resistant )... my body makes plenty the cells just wont take what's offered

I think you misread the docs quote. He was saying if you starve the cells they eventually start to respond to insulin again.

I don't know if you can get on their program, but there's something called Caremark which will drop stuff in your mailbox. https://www.caremark.com/wps/portal My wife's stuff comes through them. You'd still have to get with the doc about the length of time for the prescription, though.

bequietanddrive wrote: Appleseed, Not sure what pharmacy laws are like up there, but here in FL a pharmacy can supply up to 72 hours of maintenance medication without MD authorization of a refill. It sure would stink to have to make two 80 mile trips though to the pharmacy.

Works like that up here too... if you throw yourself on the floor, kicking and screaming, they'll hand you an envelope with ten pills, to be subtracted from your next prescription. :)

Dr. Hess wrote: Appleseed, Ask your doc to write the prescription and wherever he lists the number of refills, strike out the number and write in "x 3 months." Prescriptions are written in a language all their own. When you see him and he hands you the prescription, ask him to show you where it says that.

Thanks Doc, I need to hear something good. Bad thing is I get things sent electronically. I fear that if I start asking for a paper prescription, he might think somethings up. Perhaps I could set something up with the pharmacy to automatically sent out a note to the doctor that I need a refill once the current one is up?

Sidebar: Insurance? What's that? I'm a white American male. Of course I don't have insurance. Do I look Canadian? (said tongue in cheek)

Lesley wrote:

bequietanddrive wrote: Appleseed, Not sure what pharmacy laws are like up there, but here in FL a pharmacy can supply up to 72 hours of maintenance medication without MD authorization of a refill. It sure would stink to have to make two 80 mile trips though to the pharmacy.

Works like that up here too... if you throw yourself on the floor, kicking and screaming, they'll hand you an envelope with ten pills, to be subtracted from your next prescription. :)

Man, that's kind of sad! At my pharmacy, neither kicking nor screaming are required. In fact, I try to always ask first if it's a weekend day as I assume people may be out of medication. We're definitely not in the business of denying those in need. Now, if it's a controlled substance, that's a different story....

Appleseed wrote:

Dr. Hess wrote: Appleseed, Ask your doc to write the prescription and wherever he lists the number of refills, strike out the number and write in "x 3 months." Prescriptions are written in a language all their own. When you see him and he hands you the prescription, ask him to show you where it says that.

Thanks Doc, I need to hear something good. Bad thing is I get things sent electronically. I fear that if I start asking for a paper prescription, he might think somethings up. Perhaps I could set something up with the pharmacy to automatically sent out a note to the doctor that I need a refill once the current one is up?

CVS automatically calls my wife's doctor and us when her meds are getting low.

I am on courtesy refill on most of my meds. When one runs out, the pharamcy calls the dr and gets a renewal. The only problem is caused when soemthing expires that calls for a blood test (like Lipitor). The dr just calls and says to come in and have blood drawn. I'm surprised you have that much trouble with a diabetes medication. Its not like the medication is an addictive narcotic.

EDIT

Oh by the way, some drs are now charging to call in refills. That may be your holdup.

I had trouble keeping current with a prescription, and eventually it was such a pain in the butt that I just gave up and stopped taking it. My illness disappeared soon after. Mind over matter perhaps?

Probably wont work for diabetes though.

OK, then, electronic prescription: You add up how much you're going to need. For example, two a day times 90 days, 180 doses. You ask the doctor or whoever you see last (nurse replacement, whatever), to show you in your chart where your prescription is set for 180 doses or three 1 month refills or whatever so that you get 180 eaches. Just don't leave the room until someone shows you. And don't think that the pharmacy won't screw it up too. I would guestimate that the pharmacies here screw up something on 25-50% of the prescriptions, based on what I have personally seen. It might be small, like the wrong number of refills (very common), or it might be big like the wrong drug or telling the patient they really don't need that anyway. So, after you get your first prescription filled, you look at the label on the bottle and see how many refills you have left and if that jives with what you learned at the doctor's office. If it doesn't, you tell the pharmacist that's not how many refills you had and fix it now, before you leave the pharmacy (or pay them).

Type I Diabetes Mellitus (sometimes called Insulin Dependant Diabetes): Usually strikes teenagers. Something happened, probably a virus. Something else happened in response, probably your immune system making antibodies to the probably a virus. These antibodies somehow lock onto the cells in your pancreas that make insulin, more immune stuff happens, cells get killed, you have no insulin, your blood sugar goes through the roof, you die without insulin.

Type II Diabetes Mellitus (sometimes called Insulin Independant Diabetes, whether you take insulin or not): Usually strikes the elderly or older adults, especially the overweight. Your pancreas kicks out plenty of insulin. Insulin is a hormone molecule that tells the cells "DINNER TIME" and to start sucking up the food (sugar). The cells have receptors for the insulin molecule. In Type II DM, the cells don't have as many receptors or the receptors aren't working properly or for some other reason, the cells don't respond the same to insulin. Cells don't take in sugar, blood sugar goes way up, you could die. A blast of extra insulin makes the cells take up more sugar. Sort of like cranking up the volume of the message. Oral drugs can make them take up the sugar as well.

I was just figuring out how many refills I need between check ups. I see my doc about every three months. I burn through a vile in about 2 and a half weeks, so lets say 6 refills between visits. Six. Is that too many to ask?

I will be saying this, verbatim, to my doctor.

Thanks, everyone, for your help (or at lest funny comments ) especially Dr. Hess.

A supply to last until your next visit is not too much to ask. Typically, refills are for a month. Instead of writing the script for 1 vile and 6 refills, he could write for two viles and 3 refills, or 7 viles with no refills, etc. Talk to the doc and tell him your needs. Some insurance plans won't pay for more than 30 days of meds at a time, then have a 90 day mail in program. You'd need two scripts, one for the 30 day supply (now) and a separate one for a 90 day supply to mail in. It is very common for patients to explain to the doctor what their refill needs are to work with the insurance plan. In your case, your doctor should have figgered how much you need to get you to the next prescription. Perhaps you're taking more than he anticipated. He may want to change the type or if what you have is working, just let it fly.

Appleseed wrote: I don't understand this. Diabetes is permanent. I need this stuff to LIVE for the rest of my life. I see the doc every three months for a blood test, why can't they just give me enough refills until the next appointment? I don't have enough money to "stock up". I've explained to them by phone and in person that I can't run down to the local pharmacy. There IS no local anything. I don't think they have any concept of 80 mile to anywhere. Perhaps there are laws that prevent extended prescriptions. If they would give me a reasonable explanation, I'd be OK with that. I get to see them in about a week. I fear I'll come unglued.

It's cool tho. There is nothing wrong with corporate for-profit insurance or our medical/healthcare service in this country. There isn't any need to change a thing at all. Watch Fox news.

I'm kidding above of course.

I'd say follow Hess's advice. Sounds like you and Dr. need to figure out some way to keep you in meds for more than a month at a time. If you're insurance company won't allow that please come back and let us know. Then maybe we can all put our heads together and figure out a way around this. We've got a group of smart and diverse people who read this board.

MrJoshua wrote:

wbjones wrote: In reply to Dr. Hess: great for those w/ type 2 diabetes ( insulin dependent ... ) now hope someone can come up w/ something for those of us with type 2 diabetes ( insulin resistant )... my body makes plenty the cells just wont take what's offered

I think you misread the docs quote. He was saying if you starve the cells they eventually start to respond to insulin again.

I think you're right... I did miss read... probably because all most all articles about diabetes deal with insulin dependent diabetics ... and I read and ASSumed...(blushes) ....

I don't understand the problem.

Like Dr Hess said, pills are usually written in monthly amounts (30 pills for a once daily, 60 for a twice daily, etc), because one month is what the insurance covers at a time. And they usually have enough refills to correspond to your next Dr visit (3 refills for a quarterly Dr visit, 6 refills for a twice-yearly visit, etc).

Something is wrong - usage, dosage, the Dr's script, or the Rx's computer.

Dr. Hess wrote: Type II Diabetes Mellitus (sometimes called Insulin Independant Diabetes, whether you take insulin or not): Usually strikes the elderly or older adults, especially the overweight. Your pancreas kicks out plenty of insulin. Insulin is a hormone molecule that tells the cells "DINNER TIME" and to start sucking up the food (sugar). The cells have receptors for the insulin molecule. In Type II DM, the cells don't have as many receptors or the receptors aren't working properly or for some other reason, the cells don't respond the same to insulin. Cells don't take in sugar, blood sugar goes way up, you could die. A blast of extra insulin makes the cells take up more sugar. Sort of like cranking up the volume of the message. Oral drugs can make them take up the sugar as well.

this is mine... my Dr. calls it insulin resistant ... sameo sameo... "the elderly or older adults, especially the overweight"... damn I hate it when someone calls a spade a spade... I'm 60 6'2" and 210# , for more than 30 yrs I've been a runner ( 'till the knee surgeries ..) now spend 3 - 5 days in the gym on the stair climber and/or lifting wts... but still have what's called abdominal syndrome ... oh well guess it's the age..

my apologies to Appleseed for the thread jacking...

now back to regularly sched. programing...

I can see problems with insurance, except I can't afford insurance. Maybe the doc/secretaries are more familiar with dealing with insurance that someone paying out of pocket.

It sounds silly, but I'd give anything to be type II.