Surfing with Diabetes – by Helen May


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I’ve been surfing recently. No, this is not another of my post about the effect on my blood control of another extreme sport. This time I have just been surfing from the comfort of my sofa. On the internet.

I started with the recent news that diabetes accounts for 10% of the NHS budget. Through some Googling, I discovered that more than £1 billion is spent on diabetes drugs . Unfortunately, I could not find out what is covered by this definition of “drugs” so I decided to make the assumption this includes insulin, metformin, insulin pumps, test strips and the like.

Because I was in the mood for more Googling, I decided to investigate the contentious issue about test strips. As is commonly reported (including the latest issue of Balance), GPs keep restricting the number of test strips they will prescribe despite the counter logic when it comes to managing diabetes and the DVLA’s advice to “need to test within 30 minutes before the 1st journey and every 2 hours while driving.”

Taking one of the test strips I use (for no reason other than I am familiar with them), One Touch Ultra test strips cost £28 for 50 strips from Boots. Surely the NHS do not pay this much? I went back to my surfing and was very pleased to find the NHS drug tariff for 2013. Within this, I found that the NHS pay only £15 for the same pack. Nice to see they they have managed to negotiate a bulk discount.

But this still works out at 30p for each test which at an average of 4 tests a day every day of the year, that’s £440. In my opinion, I think that’s a worthwhile expense if it will reduce the chance of someone with diabetes ending up in hospital through complications and incurring fair greater costs to the NHS. However, with 3 million people in the UK diagnosed with diabetes, that would result in over £13 million spent on test strip each year. Is over one percent of the diabetes drug budget worth spending on test strips alone? This does sound like a large percentage when you consider the rest of the drugs that need to be paid for.

So my next surfing trip took me into the realms of “How do test strips work?” to try to work out whether they are really worth this much and whether someone (perhaps the NHS) could manufacture them cheaper. This took longer to find: there are many sites that tell you how to prick your finger and place a spot of blood on a strip, followed by beep beep and you have a reading. Eventually, I found an article explaining the science behind the beep beep. After the initial patriotic pride that the idea came from some engineers at Cranfield University in the UK. I set about understanding what these strips (and their meters) do. Whilst I trained as an Electronic Engineer, I am a bit rusty in that area now and when combined with a bit of biology, I needed to simplify the theory. but basically, this is what I understand:

• the strips suck up the blood
• the blood oxidises
• a voltage is passed over the oxidises blood
• the amount of blood glucose in the blood is related to the current over a set time

So if I was to manufacture some test strips, I would need to include a reservoir of a specific size to store the blood; I would need the ability to determine when this reservoir is full; I would need to include at least two electrodes to carrier the charge; I would need to manufacture it out of a material that was not sensitive to temperature; I would need to be able to detect differences in the make-up the blood (such as more red blood cells); and I would need to make them small and light. These strips are definitely more complex than a thin piece of plastic or the lancets (which, in case you are interested, the NHS pays just under 4p each).

I was starting to feel I was getting the limit of what I could discover online (and wondering how much I could trust 100%). I was pleased with my discovery that the NHS pays less than I would for my test strips. But I still think they are very expensive. And, despite the complexities, I feel it must be possible to manufacture them cheaper so it would not be necessary to limit prescriptions and overall save the NHS money spent on the complications of diabetes. Instead of reducing their costs by limiting test strip prescriptions, isn’t there the option to reduce the cost of each test strip? Anyone want to sent up a charity to manufacture cheap test strips?

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Like Dr Gray I buy from South Korea as well for my strips. Cheap for the ACCUCHEK Active. Just 18.99 for 2 boxes of 50. Take a look. It will give you peace of mind

Hi
I test as much as I want and buy my own, if necessary. My Diabetic Specialist Nurse gives me a lot of test strips a month and she asked me if I would change a to a cheaper meter. I said ‘Of course’ The new strips only cost £9.99. I think it is called NEXUS GLUCO RX. . It is a lot of money to ask NHS to pay for my health so if I compromise I now get more strips if I wish. I am happy because I think the other strips are over priced and a lucrative way of maintaining a continuous income stream. Interestingly other patients told her ‘No’ but why would they not want cheaper strips of which they could logically ask for more

I am a community learning disabilty nurse, and support individuals and carers to manage their diabetes. When a person with Type 2 diabetes cannot communicate effectively, and have a history of ‘challenging behaviour’ then the dispensing of testing strips is paramount to the diagnosis of hypo’s which in one person, look the same! we had a ‘little’ fight on our hands, and the parent of this person was not listened too until the professional spoke up. It’s not right.

Great post Helen. Thanks for sharing your wonderful insights on test strips. Some test strips can be quite expensive and we are left with no choice but to buy them. I guess it’s time that they produce cheaper yet reliable test strips.

Excellent and brilliant piece of research Helen. This was the first thing I thought of when reading Balance on test strip restriction by GPs. The answer is, as you say, development of cheap universal strips. This may well be something DUK could fund thereby providing possible future significant savings and benefit to all connected with diabetes, and a faster result than many pure research projects can achieve. I feel it would have to have Government/NHS support because drug companies would hate it.

Hi Helen,
I’m a type 2 and read on another site that Abbott who produce the Freestyle Lite will sell strips to the public at the NHS price. Their phone number is 0500 467 466. As I write a newsletter for the local group here in Scarborough I phoned them up to check if they were OK for me to print their number and they were pleased for the publicity.
Hope this saves someone some money.

Chris

Helen,

A great bit of investigative work done there. I too have wondered for a long time how much these test strips cost and more importantly how much do they cost to manufacture. I am constantly trying to get the point over to my doctor that prescribing 100 test strips per month does not cover the volume that is needed to carry out 4 tests per day over a 30 day period which equates to 120 strips and as I use these strips to calculate my carb intake there are times when it comes down to guess work if you are not able to carry out a blood test due to a shortage of test strips. But i feel the real reason is the massive profits the manufacturers make from these strips. What would be really interesting is finding out how much it actually costs to produce them?

Regards,

Ken

I agree the strips cost more than necessary for a reasonable profit. Manufacturers compete with each other by bringing out new meter models in an effort to capture the customer and thereby make a bigger profit on the test strips. It’s a bit like the cost of a printer and the ink cartridges.
You can get pirate ink cartridges for printers at a big discount on the printer manufacturers’ prices and I wonder why the same couldn’t apply to test strips. Perhaps prescribing doctors’ hand are tied (warranties voided etc.).
On another tack, if you try a blood test using different meters, the amount of variation in the results can be surprising. They seem to be interfered with to differing extents by differing haematocrit [Hct] levels and differing concentrations of non-
glucose sugars (maltose, galactose, xylose). Some meters are worse than others under different conditions. A subject worth considering when choosing your meter, as well as the cost of the strips.

Dear Helen

At last someone with sense who has managed to say all of this on a serious platform!

We have a small company in Macclesfield, who sell a lot of Glucose meters and strips all over the world, including to WHO and UNICEF but cannot get anyone in the UK interested, mainly because I think there is a virtual cartel of the “big boys”. Without naming names, I think we all know who they are, and yes they do supply Boots.

Coming to price, we must not forget quality! We buy from a serious and large company in South Korea called Standard Diagnostics, and for anyone who knows Korea, will realise that they pride themselves on quality. Furthermore, we have NEVER had a complainr from any of the NGO’s with whom we supply. They are CE marked for further protection.

Prices – we sell a pack of 50 strips at £7.50, that is 15p each, half the price the NHS pay. We are NOT a charity, but can/would sell these to anyone who is interested! One problem may be the requirement to have one of our meters, but we give 1 meter away with every 10 boxes (that is £75.00 spend) ordered.

I apologise for the commercial statemnts, but trying to sell to the NHS when you are the size that we are is tough to impossible!

I hope that this in some way may interest a few people or can persuade an organisation like Diabetes UK to push for lower costs for all usesr (by the way I am a Type 2 sufferer!)

Hope someone will listen

Robert

I quite agree that self-management is logically impossible unless one tests yet in my experience the NHS will not presceribe test strips to those not on insulin. Does it prescibe test strips for those that are on insulin?

If the NHS can buy test strips for half the retail price in shops, at the very least why can’t we buy them at NHS cost price – they might get an even bigger discount as volume of purchases might increase.