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Oh jeezus, I pissed off the diabetics now.

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Ah look, the diabetics come out of the woodwork. WATCH OUT, I HAVE CANDY AND I’M NOT AFRAID TO USE IT! I would like to point out that below I refer to diabetes as a ‘condition’ and not a ‘disease’. See, those PC/sensitivity classes are paying off. 🙂
On the other hand, when I piss people off they come to the site to whine, read past entries which makes them laugh, then they keep on coming back. Just ask The *Angriest* Pharmacist (or is his case, copy me) :).

As a pharmacist it is none of your business haw many strips a patient
uses. Strips in no way can hurt a patient and one can not overdose by
using too many. If a doctor writes a prescription for an unsafe dosage
of a medication then the pharmacist is correct in questioning the
order, however this is not the case. As far the insurance company, one
should ask, are working for the insurance? are you the insurance
police? who made you in charge of determining how many times a diabetic
can test? I think you should go about your business of filling
prescriptions and leave the ordering to the doctor, and not worry about
how many strips the insurance company should allow.
Interestingly, if a person goes into a drug store and purchases 100
bottles of strips each month and pays cash for them you wouldn’t ask
those questions. You would be thankful for the business, but because
insurance is involved you feel you have a duty to limit the amount of
strips uses.

Woah, wait a second. You’re telling me that its not my business to deal with how many strips a patient uses for a condition that I fill Rx’s for? Since you obviously have no idea what goes on in a pharmacy, let me enlighten you. Every Rx you fill has a day-supply associated with it. If 50 test strips lasts you 10 days (and you aren’t on insulin), the insurance company is going to come to ME and want ME to submit documentation to justify a type-2 diabetic (who cannot control the dosage of his medication) testing 5 times a day. Do I have any? No. There goes 50 bucks from my next reimbursement check. Simple as that. If you want to pay cash for your strips thats fine, but if you want the insurance to pay for your strips then we all have to play by their rules, you dont like it then pay out of pocket for your strips. You want someone to pay for your life then deal with it.

Where in heaven’s name did you go to Pharmacy School? Didn’t they
teach you that a non insulin-dependent diabetic also needs to know how
their diet and stress are affecting them?
Every bite they put in their mouth will raise the blood sugar. To
avoid the complications of diabetes (yes, all diabetics are susceptible
to them, insulin-dependent or not) these people must know exactly where
their blood sugar level is at all times.
Another factor that can cause the blood sugar to rise is stress. When
the liver senses release of stress hormones, it releases sugar into the
bloodstream to fuel energy for the “fight or flight” response.
All of these things must be learned and then checked and rechecked.
Can you imagine someone wanting to make themselves bleed for the fun of
it? Being a diabetic is no fun, especially with people like yourselves
imagining how simple it all is.
Shame on you.

Yeah, thats great, the patient knows that eating a ton of candy raises their sugar into the 400’s. Thats maybe 2 or 3 tests at the absolute most to confirm that. What can they do about it? They can’t adjust their medications to compensate for this so why bother testing. If you eat something and it boosts your sugar sky-high twice, then obviously you know what NOT to eat. Is there justification for testing 5 or 6 times a day everyday for months upon months for something that you have NO control over? I mean how many months does it take for someone to learn what they CAN and CANNOT eat. After 6 months of trial and error of what works and does not work what excuse do you really have to test that often?
You say that they must know exactly where their blood sugar is at all times. Yeah, thats great, if they are insulin and can do something about it. What are you saying? That they should skip meals if their blood sugar is through the roof? Thats not healthy either. “Oh look, I ate birthday cake and my sugar is up to 400, guess I can do nothing about it since I already took my 2 glyburide bid and 1 metformin bid today.” At least the folks on insulin can compensate, oral meds not so much. Lets look at the gas gauge every 3 miles but not stop for gas when we’re at empty. Oh, and lets throw away $1 every time we look.
Oh, and guess who gets to suffer if the payer of your test-strips doesn’t like how much you are testing. Its me. Not you, but me. If you want to test 100 times a day and pay cash for your test strips, thats fine, more power to you. However when insurance companies are paying the bill then YOU need to abide by what rules they set up, and trying to get doctors to provide justification for a type-2 diabetic who burns through 5 strips a day for 9 months and is noncompliant as fuck on their medication isn’t my idea of a good time. In fact, it has cost me on more than one occation a filling or 20. Do the math at a little over $1 a test and tell me why i’m a bit pissed. Plus this puts me into a bind. The “diabetic” (I use that term loosely since they obviously don’t take any initiative in their care) needs their strips, but there is a good chance that the insurance company wont cover it. The patient can’t afford $100/month in test strips. Do I chance it and cost the store money or do I do what you all think is “right” and possibly eat $100/month x 20 patients/month.
My argument was that testing 5 times a day is an absolute waste if you can do absolutely nothing about it like most uncompliant type-2 diabetics. I know plenty of very compliant type-1 diabetics on insulin pumps or rock-solid awesome Lantus/Humalog setups and some very compliant type-2 diabetics who test once or twice a day and have A1c’s in the 5 range. I have patients who come to me (rather than their doctor) and say “Listen, I’ve been running in the 140’s every morning for the past week, nothing has change, can you talk with my Dr about increasing my medication?” As you all know, diabetes is one of those conditions that requires the patient to be an active part of their care and management, and I’d rather see the funds be used to paying for test strips for the complaint patients who actually /care/ about their sugar and test smartly than the non-compliant patient who throws tests away just so they wont get yelled at by the doctor during their next visit. Pissing away 5 tests a day does nothing unless you are doing something about it (and after 6 months when the insurance companies catch on, you should of done something about it).
Let me tell you a little secret. The reason why diabetes kills a ton of people is because the people who have it really don’t give a shit what happens to them and really want someone else to deal with their condition. Obviously there are people out there (ie: you) who *gasp* take an active part in their condition. If the insurance company audits me for test-strip usage and you get your meds filled every month as well as a blood sugar log printed out thats 20 pages I will gladly throw that back into the insurance companies face with a hard-on the size of the empire state building. However patients who actively manage their disease are few and far between. Most of my patients just take the pills, eat whatever the hell they want to eat, and just pretend that everything is okay no matter how many times I scream at them for having a 300 reading first thing in the morning. They dont feel pain, they dont really feel much of anything (other than peeing a lot) and life goes on. I can consult them until I am blue in the face, but until something BAD happens to them they will just pull the smile-and-nod game. Thats okay if they are paying for their stupidity, unfortunately they are on the system, so I tend to get a bit pissed since the taxpayers are footing the bill.
I know this sounds crass and crude, but I’m really surprised diabetes doesn’t kill more people than it does for the sheer lack of common sense and responsibility that I see on a daily basis, especially from “diabetics”.
Its sad really, but no matter how much you say they are going to die/go blind/renal failure/amputation most diabetics really dont give a rats ass about their condition.
Plus we need a token comment from someone who obviously arrived to the game LATE and with their shirt on inside-out:

You need to find a new occupation. This obviously is not your expertise or passion. While you are at it, go to school and learn how to use the English language to express yourself. If you can only use foul language, obviously you need some serious help in learning to express yourself intelligently.
oh….. have a nice day! 😛

Uh, what site is this again? I’m sorry, last I checked I was the ANGRY pharmacist. Obviously you need to go to school and learn to realize the obvious: that a site that has the word ANGRY in it is going to have some swearing and other ANGRY things in it.

Comments #

Comment by the little tech that does….. on 2008-03-15 01:44:48 -0700 #

For the comment about the patient paying cash and no comment about the quantity-YES! Why? Because when somthing is ran through insurance, they ask questions like how much, how often and how many days supply. Unless you are paying out of pocket for strips, there will be no unlimited supply. You don’t like being ripped off, neither does the insurance (I can’t believe I’m backing them up!) nor does the pharmacy.

Comment by on 2008-03-15 06:17:38 -0700 #

I’m not diabetic.
I understand your frustrations.
If people can become aware of how certain lifestyle choices impact their physiology, they become much more likely to make the good choices/forgo the bad in the future. These are your pleasant customers who try diet and exercise to control their blood pressure and cholesterol before starting their hydrochlorothiazide or lovastatin. They are the people who always know exactly how far they are into their deductible, and call panicked 3 months ahead of their employer changing insurances wanting to know how much notice we need to change their info in the computers.
Is this 99% of our customers? Hell no. Is it *generally* the ones who get a billion strips a month? No, it isn’t. Is it the ones who pay cash when they exceed their insurance beneft, all without batting an eyelash? You bet.
What people don’t realize is, we in the Rx don’t play insurance police. Your insurance does that for you. There’s this wonderful thing called computer networking, and we use it to send a small data file to your insurance carrier every time you fill a prescription. The carrier compares this file to their own records, and then gives us a either an authorization number or a reject message like this:

  • “TOX DIF GOITER NO CRISIS” (thank you drugmonkey)
    or my personal favorite:
    In any case, we have some ways of making these rejects go away, like the magic M0/1G or 2/2 override codes, but these don’t always work.
    Have a marvelous weekend.

Comment by Hope on 2008-03-15 07:24:47 -0700 #

Maybe that high blood sugar is affecting brain function….

Comment by rph3664 on 2008-03-15 08:03:38 -0700 #

One of the pharmacists I worked with in retail didn’t like Medicaid patients. This wasn’t the guy who possibly urinated in amoxicillin, but he did say it would be an hour and make them wait an hour even if it wasn’t busy (but not when I was there).
Anyway, Medicaid authorized a second meter and duplicate sets of strips for a 6-year-old Type I, so she could test at home and at school. This man, a noncompliant Type II himself, initially refused to fill it and tried to block me from doing so. He said, “Couldn’t she just take it back and forth?”
I’m not a parent but he is, and I said, “Remember when your kids were 6 years old? They could barely remember their book bags, let alone something like this! And if it prevents a single ER visit, it will pay for itself and then some.”
All I knew about her family situation was that she and her mom lived with her grandmother, and both adults worked low-wage jobs. Whatever her parents may have done, IT WAS NOT HER FAULT and her guardians were employed and appeared to take very good care of her.

Comment by on 2008-03-15 10:16:55 -0700 #

You have far more patience than I do. Perhaps I should re-title my blog to The Angry Paramedic.
My response to your haters would be much shorter it would simply be “Eh, get fisted, cocksmooch”

Comment by Mellee on 2008-03-15 11:46:50 -0700 #

I had gest. diabetes, it took shots for 6 months, and tested my blood sugar several times per day, when I first started to take the shots. I was able to figure out on my own with-in the first couple months. After that I tested 4 times per day and when I didn’t feel good, I would test it more often. That’s it max of 5 times a day and that’s when I was sick.
More power to ya if you go thru 100 strips in 3 days. No problem, buy new strips with your money, not mine!!

Comment by Heather the Tech on 2008-03-15 15:06:38 -0700 #

The non-pharmacy whiners that commented on your diabetic post have NO CLUE what you were talking about. This only reinforces my theory that 99% of people outside of the practice of pharmacy have absolutely no idea what a pharmacist does or has to deal with on a daily basis. TAP, continue to educate! Keep up the good work!

Comment by Long Time Diabetic on 2008-03-15 17:02:04 -0700 #

You certainly are an angry person. You assume that most diabetics that you see are non-compliant. Based on what? Do you see a lot of people asking for strips who have unhealed sores, amputations or are blind?
Of course there are diabetics who try to ignore their diet and blood sugar levels, but why assume most are like that? I would think that for the first year or so after a type 2 diagnosis, testing several times a day would make complete sense. Things that need answers for a diabetic: “Does a baked potato send me up to 300? Does it do it after an hour, two, three hours? Can my own pancreas and my medication return me to under 120 after a meal. How long does it take. What happens if I eat whole grain bread? Steel-cut oatmeal? Sugarless candy?”
Multiply this times the number of foods a person would choose to eat. It is very important to know how soon you return to “normal” blood sugar levels.
Then add stress, adrenalin, exercise, all of the things that can affect sugar levels. “If I’m not making to to the 120 level after a potato for dinner, does it help to take a 30 minute walk? A ten minute walk?”
You claim to know all about a person by the meds they take. Or by looking at them. Just how well do you really know your customers to make these claims? If the doctor determines the need for testing more often for some reason, isn’t it up to his or her office to get the PA (Prior Authorization from the isurance company)? Do you argue this point when people have a PA?
I don’t imagine that with this attitude, you’ve ever dealt with a life-threatening condition. Or that you have had someone marginally involved make a determination on your level of care. I have and it left me feeling powerless and wronged.
I pay exorbitant rates for my insurance. They should cover what I need in order to stay healthy, but they don’t. I need a PA for each scrip I need to fill one or two weeks early because I am planning a trip. I need a PA for each non-formulary med renewed each year. On and on. I sure didn’t choose to deal with diabetes, it chose me. Why do insurance companies and people like you choose to make my life harder?
You are a very angry person indeed. I hope you are able to get some help so that you might have more tolerance. You’ll live longer too without all of the angst.
A Longtime Diabetic

Comment by Em on 2008-03-15 17:54:24 -0700 #

Wow, people need to loosen up.You were clearly talking about the non compliant TYPE ONE diabetics…who do nothing to modify thier lifestyle or diet in order to help themselves fight the disease they have. I’m a tech, and I see this behaviour all the time. It’s frustrating.
This is the first time Iv’e commented here…though I check here almost every day and LOVE the site! I just finally got tired of all the “haters” with who take themselves too seriously, are looking to pick a fight, or who have never/don’t work in retail hell and share the same patient interactions those in retail do.
Keep being angry! =)

Comment by GC on 2008-03-15 20:41:00 -0700 #

so many haters so little time. keep up the good work TAP. we had a customer once that was diabetic…he was a real piece of work. he was legally blind due to his diabetes and he would play the blind card EVERY SINGLE CHANCE he got. not to mention he would order boxes of chocolate. initially we figured he was giving it out but it became a regular thing. we inquired him about the chocolate only to find out he was eating all of it, testing his sugar, and then injecting however much insulin he needed. we had to kick his ass out of the pharmacy.

Comment by Steph on 2008-03-15 20:52:30 -0700 #

Ohh…my head. Yes, the diabetics are defensive. Here’s the deal: It is MUCH easier to “take control” of your diabetes by testing and testing, which changes NOTHING, than to exercise and eat less. Exercising and eating less is really hard. Type II diabetics have a metabolic disorder resulting, usually, from being overweight. (I actually feel for those “skinny” type II’s, who are a tiny minority of the bunch.) Until the fat Type II diabetic loses weight, by exercising and eating FAR, FAR less, nothing changes–the blood sugars are ALWAYS going to be over 100. You see, the type of eating and lack of exercise that leads to obesity and Type II diabetes–it ALSO raises blood sugar–ALWAYS. Period. (Go ahead and test 10 times if you don’t believe me.) It’s NOT about the candy, the stress, the one piece of cake, etc., it’s about living an unhealthy lifestyle, and NO amount of testing will CHANGE ANYTHING! And in my opinion, it is immoral to ask the insurance policy holders to kick in higher premiums, so Type II diabetic patients can verify what they already know, any more than 2 or 3 times a WEEK. It’s immoral to expect the pharmacy to eat the cost of the strips. It’s everyone’s business if you’re fat, because everyone else is burdened with the rising-out-of-control healthcare costs Type II diabetics incur–right down to their expensive bypasses and dialysis, when, doh! all that testing didn’t do a damn thing about the metabolic disorder, which, again, for those of you paying attention, is caused by insulin resistance in a body that is too sedentary and too overfed for its own good. It’s really simple. But, you know, nobody wants to hear it, because fundamentally, it’s too much to ask people to take personal responsibility for their own lack of health. One could take serious inventory of one’s own choices, OR, one could direct a bunch of wrath at the pharmacist and keep on with one’s gluttony. Hmmm….

Comment by Intern Jason on 2008-03-15 22:55:08 -0700 #

I’m sorry for everyone who is a compliant DM type 2 patient. However, the majority of the people I know who are type 2 are people who have never watched what they ate and never exercise and as a direct result their BMI is now around 32 as an average. So lets recap here. Stress can affect your glucose or BS levels which ever way you like it titled, but the lack of a consistent healthy diet and a regular exercise routine (just walk 5 minutes a day) can really do wonders for your control. I agree testing 5 times a day is a waste after a month. My best friend was diagnosed type 1 at age 5, he tests twice a day and sometimes just once a day b/c he is knows his body. I really like how someone reads a pamphlet and they are right away an expert, but thats fine these are the same people that ask for our advice and then choose what the guy in line behind them told them what works for him. TAP keep it, loyal reader.

Comment by Type1Stu on 2008-03-16 06:51:25 -0700 #

And this is one argument that will never really be settled.
This is one more reason for the monitoring companies to develop non-invasive glucose testing… because then it wont matter how many times a day anybody tests… because there wont be any costs associated to each test. A bigger bill to pay out first off for the testing device would be justifyable for the technology and not having to pay for test strips for the rest of your life.
Role on non-invasive monitors!

Comment by -Aaron- on 2008-03-16 08:47:24 -0700 #

Long Time Diabetic
How can you read all these comments and still be clueless? Pharmacists have these things called computers, they tell us crazy things like when your medication was filled and how long it should’ve lasted. It’s pretty easy to tell if someone is non-compliant by looking at how long their medication should’ve lasted and when they are coming in to get it. It’s probably hard to imagine, seeing as you sound like a compliant patient, but there are a lot of people who come in to pick up a medication 2 or 3 months after their previous supply would have ran out had they been taking it as prescribed. I could be wrong though, as pharmacists we may only see 300-500 people a day, I’m sure you talk to way more people than that… who are we to make judgements off of what people actually do. Also, your view on insurance is exactly why your rates are so “exorbitant”. The way insurance works is pooling everyone’s money, so that when you do get sick there is money to pay for medical expenses. If everyone with insurance gets the most expensive option, prescription or diagnostic/lab test or anything, there’s not enough money to go around, so the insurance company raises your rates. Now if you have to get a necessary medication/test that’s expensive go for it, but if you are getting expensive meds/tests that you don’t need or have cheaper options shame on you. Your creating an un-needed burden for the rest of us, I call that selfish.

Comment by one_angry_tech on 2008-03-16 13:12:54 -0700 #

Tell them fat bastards to exercise…
Hows that for angry?

Comment by Paul Lozano on 2008-03-16 15:09:13 -0700 #

Hi There,
I’m not necessarily an angry pharmacist but check in with me tomorrow. It can change at any minute.
I love your stuff.
Fortunately, I have stayed away from retail. I work for a pharma company and do a bunch of relief work, mostly homecare and some hospital stuff. I also teach an IV cert class and work at a Phase I clinical trial pharmacy
I have an easy info blog,
If you don’t mind, I would like to put a link up to your site.
Keep up the great work,
If you have a chance, check it out.

Comment by Blondefabulous on 2008-03-16 19:15:44 -0700 #

My two youngest are diabetic, and I am good at asking the DOCTOR to write out our scripts for what we need before I go and annoy the pharmacist.The person who wrote you and whined about how “every bite of food” can affects her/them is correct, but if she already knows that, then why is she taking her frustrations out on you? Duh!! Life isn’t any fun if you don’t have someone else to blame it on. I blame the oatmeal guy on that Liberty Medical commercial for telling people to “Check your blood sugar, and check it often!”

Comment by Christine on 2008-03-16 19:57:25 -0700 #

The first time around, I really didn’t disagree with your message. But this time around, you’re kind of making yourself look like an idiot. Sorry, it’s true.
First of, to Em, either learn the types of diabetes, or read through your comments before submitting. Not sure which is relevant in this case, but you too look like an idiot.
If you think there’s a “one size fits all” diet you can follow, then you’re wrong. While candy is obviously healthy for no one, that’s a poor example. A slice of whole grain bread, a banana, berries, or other foods generally considered healthy may send one person’s blood glucose through the roof, but another may be able to carefully integrate it to their diet.
I currently get enough strips to test 10 times a day. I use an insulin pump, and have hypoglycemia unawareness. My last a1c was 5.2%, so I’m obviously doing something right. I know I’m not in the demographic you’re referring to, and I’m by no means non-compliant. But *gasp* I eat candy! Sometimes on a regular basis! I cover it with insulin, but I still eat it! Would I get 10 strips a day if I didn’t have insurance? No, probably not. I wouldn’t be able to afford it. Would my health suffer as a result? Probably. Have I bought strips out of pocket when I’ve used up my allotment? Yes! But instead of letting my health suffer or playing mind-games about what would happen if I didn’t have insurance, I make sure I maintain a job with health benefits.
I also recommend you consider the definition of angry. You can be angry without being a jerk too.
I’m a regular reader of your blog, and agree with a lot yo say, but this entry is off the mark in my opinion.

Comment by Em on 2008-03-16 21:16:10 -0700 #

Ugh, I meant to say Type 2 of course. I’M SO SORRY. I know about the types of diabetes, and the differences between them.I even proofread the entry before submitting it,but it was very late!So I guess I did look like a bit of a schmuck there. Though it may have been rather rude of you to refer to me as an idiot. Whatever, I’m not looking to pick a fight here.

Comment by Kitty!! on 2008-03-17 04:33:08 -0700 #

I’d like to hear your comments on this video

Comment by EBM doc on 2008-03-17 06:31:04 -0700 #

Evidence based medicine response:
multiple studies show NO EVIDENCE for benefit of self-monitoring of glucose in type II diabetics. It’s a waste of time money and effort for many if not most of the type II diabetics that I see.
Impact of self monitoring of blood glucose in the management of patients with non-insulin treated diabetes
BMJ. 2007 Jul 21;335(7611):132
“CONCLUSIONS: Evidence is not convincing of an effect of self monitoring blood glucose, with or without instruction in incorporating findings into self care, in improving glycaemic control compared with usual care in reasonably well controlled non-insulin treated patients with type 2 diabetes. ”
’nuff said

Comment by Ryan Frank on 2008-03-17 08:22:45 -0700 #

Actually I like these entries… I’m a type I diabetic, and most Type II’s I run into piss me the hell off. They just pop thier pills and don’t adjust thier lifestyle at all. You can try crap that will type I, but it will kill you a hell of a lot faster. Mostly they piss me off because idiots who don’t know the difference between type I and type II though… I’ve been berated when someone saw me injecting insulin in public once that it ‘served me right for eating crap’ that I was diabetic. (Note: I’m 5’9″ and ~160 pounds… how they decided they knew I was ‘eating crap’ I dont know)

Comment by KDUBZ on 2008-03-17 13:52:27 -0700 #

Wow Christine,
So you laugh when TAP flames people on welfare, tells the ass customer of the day story, and bashes other things such as the elderly and physicians. Yet when something hits close to home its not angry, but being a jerk instead. I work for a corpo-chain, and I still laughed when he ripped on those. (As a quick aside, I too have worked for an independent and there are certainly things I miss about it, but thats for another thread).
I think you missed the point on this post Christine, TAP was mainly speaking on people taking oral meds, in which case, what the hell are they really going to do if their reading is high? Your case may be a bit different since you are on insulin. But it certainly is strange to think that you are testing every two hours (less than that if you sleep 8 hours a night). I can draw one of two conclusions, either A) you are a really complicated case…fine, OK. or B) you are overly paranoid about managing your levels, which is often the case when patients have become hypoglycemia unaware.
Either way I would like to thank you on behalf of everyone else, because it is your “My insurance pays it, its free atitude” that is responsible for my ever increasing insurance premiums. Justify it anyway you want, but I can tell based on your post that you are just being selfish and wasteful. Like you said, you probably wouldn’t test as often if someone else didn’t pay for it.

Comment by Sara on 2008-03-17 17:47:44 -0700 #

“…and just pretend that everything is okay no matter how many times I scream at them for having a 300 reading first thing in the morning”
Maybe your clients are ‘uncompliant’ or noncompliant as most (all?) people refer to them because they have a pharmacist who would rather yell at them than counsel them.
The state of our health care industry is such that none of these patients get the amount of time with their doctor or endocrinologist that they really need. You could bridge that gap by providing the education that you seem so willing to share here.

Comment by AssBustingTech on 2008-03-17 21:13:58 -0700 #

Ok people put the claws away,comb back the horns and fucking settle down. Really why do some people come here just to say I’m a loyal reader, I love you but your a jerk! Come on now, TAP speaks the truth the sad, harsh truth and I think it might be hitting a little to close to home for some. Spend some time behind the bench just a few hours is all I ask. That’s rite put down the ho ho’s and ding dongs and pay attention to the stupidity that surrounds you. You would be ANGRY too.
As always TAP keep up the good work!

Comment by Christine on 2008-03-17 23:49:21 -0700 #

ABT- what’s wrong with being a regular reader and enjoying it most of the time but still disagreeing with something that is said occasionally?
It doesn’t hit home for me in the sense that I have the disease being referred to in these posts. I don’t- I have a disease that’s pathophysiologically different, but shares many traits and the name of the disease being mentioned.
It is offensive because short of some trauma taking my life first, diabetes is going to kill me no matter what I do, and likely at an age earlier than my peers. No matter how compliant I am, how low my a1c is, or how perfectly I balance my carbs and my insulin, diabetes will be my cause of death some day. And to have someone say “The reason why diabetes kills a ton of people is because the people who have it really don’t give a shit what happens to them and really want someone else to deal with their condition.” IS offensive, whether that person was originally correct or not about how often type 2s should test. And do you want to know what really sucks? I did nothing to “cause” my disease, but by the time I’m 40 or 50 when many type 2s are just starting to be diagnosed, I’ll have a few decades of diabetes under my belt. Like it or not, diabetes is a fatal condition for most who have it. It’s just not acutely fatal for most.
Cancer can be caused by being overweight, and asthmatics may be non-compliant with medications and end up needing costly ER visits as a result, yet people don’t seem to pick on them.

Comment by Biggest Fan on 2008-03-18 03:03:04 -0700 #

This is for whomever commented that TAP has no passion for his job.
If an individual had not passion for what he/she does, why would daily things anger them so much? If TAP had no passion, he/she’d be like – “ah, screw it – whatever”. He/She wouldn’t be on here pissed off about the injustices he/she see’s every day. I would say that TAP cares very much about what he does – as do most of the commenters on here. It would be so much easier to go to work each day and just let stuff roll of your back and not get your panties in a twist with all the crap. Much less stressful! However, anyone who cares about the integrity of their job and the folks involved in their job will easily be pissed at the injustices that occur.
As a physician, I get so friggin irate when the NPs underdose amoxil at 10 mg/kg/day for the 10 month old that’s had an ear infection for 3 months. I bitch to no end about it – BECAUSE I CARE. I get irate when the patient with cant-suck-it-up-syndrome comes to me with their triad of chronic fatigue, depression and (my favorite) fibromyalgia – but won’t follow any of my non-pharmacologic recommendations…after I’ve spent many hours with the patient in the hospital and clinic doing counseling – BECAUSE I CARE. Is it always because I care about the patient? No, honestly, not always. In the beginning it is. But, in the case of non-compliance – it’s because I care about the fleecing of the system and how it ends up costing ALL of us that are hard-working. It costs ALL of us who are honest and have pride. So, yeah, I’m going to bitch and complain about it. It helps me deal with the everyday BS. If TAP can get on here and complain about it and drop a couple of F-bombs – it’s a couple less he/she’s going to drop in the store. If getting on here enables TAP to do a better job at the store – that’s great, because I think that TAP is probably a great asset to his patients.
I ran into this when I taught school, too (didn’t invent Airborn, though – damn). I get asked all the time if I would go back to teaching. Hell no. I’d go to med school again 100 times before I taught school again. (And, I already wish I hadn’t done this whole doctor thing.) BECAUSE I CARE. As a teacher – it’s a whole hell of a lot of work if you care. It’s way more hours than I work as a doc. It’s dealing with noncompliant parents every single day. It’s a total uphill battle – if you care. I absolutely loved it – but would never do it again because of the complete burn-out.
My point – this site enables a lot of people to vent. Every single job out there sucks in some way. (although, I would like to be a frosting-taster!) Most of us are probably very good at our jobs. Most of us also know that we do what it takes to REMAIN good at our jobs. TAP needs to remain good at his/her job so the people that ARE compliant continue to get quality care. Also, part of TAP’s ‘problem’ – is that he/she probably still beats his/her head against the wall continuing to provide quality care to those that he/she knows are NOT going to be compliant in a million years. That, my friends – is the kind of pharmacist we all need to remain in the profession, and is the pharmacist I would like my patients to be able to visit.
People do not get angry over things they have no passion for.
Disclaimer – sorry if this is a repeat of another comment – I didn’t have time to read them all this morning.

Comment by John on 2008-03-18 08:14:19 -0700 #

How about a rant about the price of test strips? Talk about a drain on our resources. Can it really cost so much to make that they have to charge $.75 a strip? Christ, they make about 10 billion a year. When is the supposed benefit of mass producing them going to kick in? A dvd disk is cheaper for fuck’s sake!

Comment by Christine on 2008-03-18 09:01:51 -0700 #

Em- you’re right, it was harsh of me to call you an idiot when I’m sure you just mis-typed. My apologies there.
KDUBZ- You really can’t judge me because you don’t have the full story. I’m not a “my insurance pays so it’s free” type person. My insurance would pay for me to use a continuous glucose monitor, at a cost of $350 a month, but I didn’t find it beneficial for me, so I stopped using it and saved them the cost. My insurance would pay for me to get 50 reservoirs for 90 days, but I don’t use that many, so I only order them every other time I order supplies. Same with lancets, IV3000, and alcohol wipes- I don’t use them, so I requested I stop getting as much with my order as I was getting. If I had no concern for my insurance’s money, I wouldn’t have done this. It doesn’t cost me anything to get them, and I probably could even sell them on ebay at a profit if I was a real jerk.
As for getting 10 strips a day- consider this. You test before meals and at bedtime as a bare minimum if you use a pump- okay, that’s 4 tests right there. If you can’t always feel your lows well, you test before you drive if it’s been awhile since you last tested. This can easily add 2 more tests a day. If you feel low, you test to confirm it, and then you test again to verify you’re back up. That’s 2 more tests a day. We’re up to 8. If you use a pump, you do need to test in the middle of the night sometimes to check on your basal rate then. You also test again if you feel high or want to see how a food is effecting you. When I exercise, which is several times a week, if it’s been awhile since I tested, I need to test before exercising to make sure I’m not gonna go too low from the exercise. Etc, etc, etc. My point is it all adds up. Yet this is totally irrelevant to the original post, since it was about people not on insulin, so what I do is irrelevant. I just thought I would give you some insight.
Am I really complicated? No, not really. Not more so than any other person that uses a pump and leads an active life.

Comment by on 2008-03-18 10:39:51 -0700 #

John has provided a perfect point for me to chime in regarding the cost of rx medications…My father was diagnosed with a terminal brain cancer in sept 2007 (GBM4) and was to begin chemotherapy w/ an oral agent TEMODAR following a surgical resection of the lesion. Good fucking thing he and I own our own pharmacy because the low, low everyday net aquisition cost of this gem= $10,021.14 (THAT IS $7157.88 FOR #45 X 100MG CAPSULES & $2863.26 FOR #90 X 20MG CAPSULES—YOU SEE HE NEEDED 42 DOSES OF 140MG & MY WHOLESALER DID NOT HAVE THE 140MG CAPSULES IN STOCK. I had my staff bill medicare b for $12526.43 such that after they adjusted the claim to 80% we would break even w/o dad having to pay out of pocket.
We got paid approx $7,500.00 but after approx 6 weeks. however just this week I recieved a reject asking for that money back saying dad should have received it free of charge while in a skilled facility. Well he wasn’t in one during the time he took the drug. He was between a residence in Cleveland, Ohio and my home on the weekends. I will appeal the denial but you get the point…what person in most any walk of life can afford this therapy? The 20% copay would be over 2k by itself….the claim was rejected3 months after being paid…the patient is sick and dying….how many pharmacies would extend 10k of good will to a customer?
Everyone profits on the rx except the pharmacy that dispenses it….and at that we give away a $30 gift card to the customer to lure them to our store? where does that money come from? Right out of the front end….no wonder there is animosity between the front end and the pharmacy dept!

Comment by Mrs Fraser on 2008-05-07 23:54:08 -0700 #

I am a type II diabetic. And I completely and totally agree with you. I never test. Why bother? I know what I should eat, how much I should eat and when. My last A1C, just about a month ago, was 6.3. For anyone who doesn’t know, that is very very good. I control completely with diet.
I only have a meter because when I was first diagnosed I was curious. Once I did it for about a month? Couldn’t care less any more.

Comment by Google Account on 2009-01-08 07:05:00 -0800 #

My grandmother was recently hospitalised due to cellulitis and liver damage. She is in her early 60’s, works THREE MOTHERLICKING JOBS and is a full time carer for her mentally disabled daughter. She is also a diabetic. Now, with all that she does, you think she’d be in fairly good shape, considering she needs to watch what she eats due to her diabetes…right? WRONG.
Now, she was only diagnosed with Type-2 diabetes 12 months ago. Our entire family has, for the larger part of her life, tried to encourage healthy eating habits and regular exercise to her for her own wellbeing. However, she continued eating cakes, desserts, puddings, pies etc. FULL of refined sugars and extremely high sodium levels. What happened? Her diet, combined with the diabetes meds she was on, caused her to develop permanent and irreversible liver damage.
One phrase kids:
Since her hospitalisation, our family has essentially had to stage an intervention… I am vegan myself, and have given her a complete 6 month food and exercise plan to help control her blood-glucose levels (as she can’t continue her meds) and reduce her weight. It’s early days yet, but I’m monitoring her and am hoping it will have some effect. My point is: You can take whatever meds you want, but ESPECIALLY with diabetes, you need to accommodate your diagnoses with the lifestyle you have in order to manage whatever it is you’re afflicted with. It’s not your pharmacist’s responsibility, it’s not your doctor’s, IT IS YOURS. Testing yourself 5 times a day isn’t going to change your reading of 400+ if you just had a motherfucking cheesecake to yourself for lunch.
By the way, I’m a long time fan and lurker of TAP and TAestP and I want to say, keep on writing!! I’m going into BioMedical Science (majoring in Pharmacology) this year, and not only do I find your blog posts hilarious (same sense of humour) but also informative and often enlightening. Somehow I think I’ll continue lurking over the next 6 years of my degree…keep up the good work!

Comment by TechJess on 2009-05-17 21:20:42 -0700 #

Ugghhh….I hate these people. My fat ass sister in law is pregnant and at 16 weeks she was diagnosed with GDM. Her doctor suggested she walk at the gym every day (my brother in law is in the Air Force and works out every day; she doesn’t do shit she has plenty of time to go). But what does the stupid bitch do? She sits at home and eats Ho Ho’s all fucking day. Thanks for trying to kill my first nephew you fucking retard. She is due in two weeks and there is so much stress on the fetus the doctor is wanting to do an early cesarean. Fuck I hate her. I can’t even have kids and she won’t even care for hers before it is born.