# Insulin without prescription?



## Amity Island (Feb 15, 2019)

Do you think we'll see the day when insulin is available in the UK without a prescription? 

If you're Type 1 and are under the care of a hospital diabetes centre, then why not allow diabetics to pick up insulin as and when required? It would certainly reduce g.p's workload, time spent ordering, time spent sending prescriptions etc. The pharmacist could do a standing order for your insulin ready for you to pick up each month. Plenty of drugs are readily available over the counter, so why not a non-drug like the hormone insulin. You can buy cigarettes, alcohol and sugar/junk food which are known killers, seems illogical insulin isn't available without prescription.

Your views most welcome.

Thanks


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## travellor (Feb 15, 2019)

Insulin is a killer, so I don't think it will become available generally.


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## Amity Island (Feb 15, 2019)

travellor said:


> Insulin is a killer, so I don't think it will become available generally.


Hi Travellor, I agree that it would never become available generally, but I'm thinking along the lines of Type 1 Diabetics under the care of a diabetes hospital.


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## Bruce Stephens (Feb 15, 2019)

There's a big (ginormous, even) price difference between buying aspirin over the counter and buying insulin.

If your idea is that people wanting the insulin wouldn't actually be paying for it, it sounds much more like some variation in the repeat prescription process. (Which is a perfectly reasonable line of suggestion, but doesn't seem like it would end with people buying it over the counter.)


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## Amity Island (Feb 15, 2019)

Bruce Stephens said:


> There's a big (ginormous, even) price difference between buying aspirin over the counter and buying insulin.
> 
> If your idea is that people wanting the insulin wouldn't actually be paying for it, it sounds much more like some variation in the repeat prescription process. (Which is a perfectly reasonable line of suggestion, but doesn't seem like it would end with people buying it over the counter.)


Hi Bruce, so Type 1's don't need to order through their GP, just pick it up from a pharmacy when they need it. All done with the approval of the Diabetes Hospital. Still free on NHS.


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## trophywench (Feb 15, 2019)

There is no current way possible for any doctor whether he works in a hospital or not, to issue an 'open ended' NHS prescription, even with a 30-day caveat.

If you think 'the system' needs changing, well perhaps it does - but there again the NHS most likely have enough on their plates already without asking them to get their heads round anything else at the moment IMHO.


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## Amity Island (Feb 15, 2019)

trophywench said:


> There is no current way possible for any doctor whether he works in a hospital or not, to issue an 'open ended' NHS prescription, even with a 30-day caveat.
> 
> If you think 'the system' needs changing, well perhaps it does - but there again the NHS most likely have enough on their plates already without asking them to get their heads round anything else at the moment IMHO.


Hi Jenny, I was thinking of insulin not requiring a prescription. For type 1 diabetics under the care of a hospital.


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## mikeyB (Feb 15, 2019)

I agree with Travellor. Insulin is deadly in the wrong hands, the perfect murder weapon. No fingerprints. It’s lunacy to suggest it should be available over the counter. Apart from anything else, you would have to pay retail price - to get it free, you will still need a prescription. In the UK that would be around £50-£60 for five pens of, say, Humalog. In the US, add a zero to those numbers.

A complete non starter, methinks.


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## Pumper_Sue (Feb 15, 2019)

From what I remember, insulin could be bought over the counter a few years ago and it was a few years  From very vague memories it was stopped because body builders were buying it and a few deaths resulted from misuse.


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## Amity Island (Feb 15, 2019)

Pumper_Sue said:


> From what I remember, insulin could be bought over the counter a few years ago and it was a few years  From very vague memories it was stopped because body builders were buying it and a few deaths resulted from misuse.


I think it is available in America at any pharmacy without prescription, quite cheap too!


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## Martin Canty (Feb 15, 2019)

Amity Island said:


> I think it is available in America at any pharmacy without prescription, quite cheap too!


Only in a few states, not sure of the price though as I'm not insulin dependent so never bought it....


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## Emma Lowery (Feb 15, 2019)

@Pumper_Sue off topic but why do bodybuilders want insulin?


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## mikeyB (Feb 15, 2019)

Bodybuilders use it because it stimulates glycogen production in a workout, and supposedly prevents loss of bulk produced by working out.  They still use it, prescription or not, because it doesn’t leave markers in the urine or blood.

Pumper_Sue is right, folk have died using it for that purpose.

It’s not really off topic, Emma, because it does relate to why insulin is prescription only.


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## Drummer (Feb 15, 2019)

These days though it would be possible to microchip a person for identification, interface with their internal reservoir of insulin and online records, identify the type and usage and refill as required - at least it would be if I had anything to do with it.
There is a big difference between identifying a person who needs insulin to stay healthy and alive and allowing just anyone to obtain what could be a dangerous substance. There would have to be a change in the way the NHS is run for it to happen, but perhaps some day technology will be seen as a right rather than a way to keep the people under surveillance.


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## nonethewiser (Feb 15, 2019)

Amity Island said:


> Do you think we'll see the day when insulin is available in the UK without a prescription?



Hopefully not, in the wrong hands its a dangerous drug, even experienced user can make mistakes with consequences.

Remember what Beverley Allitt did to those poor children, she was a nurse who had access to insulin, obviously she was mentally deranged and a wicked evil woman, but who knows what could happen if someone similar got their hands on insulin with the intentions to harm or kill.


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## Abi (Feb 15, 2019)

The only stuff availabe over the counter in America is the older,less effective,more dangerous stuff- regular (actrapid), NPH (isophane) and 70;30 (humulin M3/ mixtard 30). it is not free but about 10% of the cost of  the decent stuff


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## Lanny (Feb 15, 2019)

I've been sitting on the fence watching the posts on this thread progress & I'm still on the fence.

I WILL say 2 things!

1:- Given its importance to us diabetics, type 1's & insulin dependant type 2's of which I've been one for 7 years now, we can forget, or maybe don't even know given how films & tv programmes portray the use of & the dependance of insulin in diabetics, that giving it to non diabetics can kill them AND very fast too: plummeting blood sugars! forgetful duh on the head emoji.

2:- I like @Drummer 's use of imagination in the use of current, or can be quickly possible, technology. It reminds me of how the James Bond film "A View To A Kill" inspired a then government minister to make a reality of the then fictional face recognition software for use in passports. The story goes that said minister saw the film & thought that's a good idea & made it happen!


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## Northerner (Feb 15, 2019)

Drummer said:


> There would have to be a change in the way the NHS is run for it to happen, but perhaps some day technology will be seen as a right rather than a way to keep the people under surveillance.


Won't be needed - I was promised a cure 'within the next 10 years'


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## mikeyB (Feb 15, 2019)

I’m not being microchipped for any reason. Mind, I’ll probably be dead before any politician dreams that one up. Mind you, if I could get into Ewood Park or Old Trafford cricket ground without grubbing around in various pockets I might.


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## Amity Island (Feb 15, 2019)

Hi Mikey, 

I don't think I've explained what I was saying very well. I was specifically asking the question about insulin without prescription for Type 1 diabetics registered with their local diabetes hospital. NOT, over the counter for mass public consumption. Perhaps people with type 1 could have an ID card whereby they present that to a pharmacy wherever that may be, be it in England, or Europe or perhaps worldwide. The insulin would only be given to diabetics that use it (just as it is now), not to the general public to murder people. It would be absolutely no different to it is now, people self managing, just a bit easier for people that need it on a daily basis.


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## Bronco Billy (Feb 15, 2019)

Given that it’s a potentially lethal drug and we live in an era that doesn’t allow children to play conkers anymore for fear of injury and a resulting lawsuit, I can’t see it happening.


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## Amity Island (Feb 15, 2019)

Bronco Billy said:


> Given that it’s a potentially lethal drug and we live in an era that doesn’t allow children to play conkers anymore for fear of injury and a resulting lawsuit, I can’t see it happening.


Hi Bronco Billy, I don't think my question came across as it was written. Nothing would change, insulin would still only be given to diabetics that self manage as it is now, it would just take some pressure of GP's who must be writing the same prescription out, over and over again for the same insulin.


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## Amity Island (Feb 15, 2019)

nonethewiser said:


> Hopefully not, in the wrong hands its a dangerous drug, even experienced user can make mistakes with consequences.
> 
> Remember what Beverley Allitt did to those poor children, she was a nurse who had access to insulin, obviously she was mentally deranged and a wicked evil woman, but who knows what could happen if someone similar got their hands on insulin with the intentions to harm or kill.


Hi nonethewiser, I am asking about if you're Type 1 and are under the care of a hospital diabetes centre.


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## Northerner (Feb 15, 2019)

Amity Island said:


> Hi nonethewiser, I am asking about if you're Type 1 and are under the care of a hospital diabetes centre.


It's ok, I understand what you are saying  It does seem odd that we need this 'middleman' whose only role is to dish out the prescription


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## Amity Island (Feb 15, 2019)

You've got it! Precisely what I was pointing towards.
I just thought the fact insulin is something we are going to need indefinitely, why not allow us to manage it ourselves, pick our insulin up without the need for the middle man.
Strictly speaking, doctors prescribe drugs, my understanding of insulin is it is a hormone and not a drug?


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## Docb (Feb 15, 2019)

Maybe you should look at this issue from the point of view of the pharmacist. In the modern world they, like many other professionals, have to cover their backside.  Somebody rolls up to their counter asking for insulin - how can they be sure that the individual is going to use it for the purpose intended and knows how to use it?  Not a problem for regulars but if they refuse to serve somebody who needs it or serves somebody who is going to abuse it, then they will be pilloried.  Do something right a million times and you won't get a thank you but get it wrong once and you will be headline news and up to your neck in lawyers trying to rob your insurance company. 

If you are going to move away from the current system then something would have to be put in place to safeguard the pharmacist and I suspect that it would be more complicated and less secure than the current system.  Ordering stuff from your GP on line via emis and all the middle man has to do is to approve it to be sent on to a predetermined pharmacist to have the stuff ready for collection. Not a big burden for the "middleman."


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## Amity Island (Feb 15, 2019)

Docb said:


> Maybe you should look at this issue from the point of view of the pharmacist. In the modern world they, like many other professionals, have to cover their backside.  Somebody rolls up to their counter asking for insulin - how can they be sure that the individual is going to use it for the purpose intended and knows how to use it?  Not a problem for regulars but if they refuse to serve somebody who needs it or serves somebody who is going to abuse it, then they will be pilloried.  Do something right a million times and you won't get a thank you but get it wrong once and you will be headline news and up to your neck in lawyers trying to rob your insurance company.
> 
> If you are going to move away from the current system then something would have to be put in place to safeguard the pharmacist and I suspect that it would be more complicated and less secure than the current system.  Ordering stuff from your GP on line via emis and all the middle man has to do is to approve it to be sent on to a predetermined pharmacist to have the stuff ready for collection. Not a big burden for the "middleman."


Thanks Doc B for your reply, I appreciate that.
Insulin would still be under the direction of a consultant at the diabetes centre, only difference would be that there would be no need for the constant issue of prescriptions from the g.p. thus only people going to see a pharmacist for insulin would be those already under the care of a consultant. I was thinking of a diabetic I.D card.


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## Docb (Feb 15, 2019)

It might work but again, in the modern world, you don't need a system that is simple for sensible people to use.  What you need is a system that stops the odd complete idiot getting hold of insulin for nefarious puposes.  A diabetic ID card makes a lot of sense for more than just getting insulin but quite what it would look like and how it would be administered is far from straight forward.  Its not the technology, that's trivial.  Getting all interested parties to agree on it would be harder than organising Brexit.


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## Bruce Stephens (Feb 15, 2019)

Docb said:


> What you need is a system that stops the odd complete idiot getting hold of insulin for nefarious puposes.



Not just that, you need to account for the insulin. Since the pharmacy has to pay for it, someone needs to pay them. And someone needs to pay that someone and so on up to (presumably) the NHS.

It does feel like the current system could be simplified (reducing the tedious work that GPs do authorising repeat prescriptions), but I fear whatever it would end up as would still be basically some variant of a prescription.


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## trophywench (Feb 15, 2019)

Sooooo - are we also doing this with test strips since even if a T1 under the care of a hospital D clinic isn't on any other drugs for anything else, he/she will absolutely need a regular supply of test strips and/or Libre sensors.  Where do you draw the line?


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## nonethewiser (Feb 16, 2019)

Amity Island said:


> Hi nonethewiser, I am asking about if you're Type 1 and are under the care of a hospital diabetes centre.



Lets face it, if your proposal went ahead then everyone would want to be under the care of a hospital diabetes clinic, fair enough it would reduce the gp's workload but your just shifting that workload to the hospitals clinic which are already overstretched. 

Not forgetting the discrimination aspect, why just type 1's and not type 2's for example. Not being picky you understand.


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## AndBreathe (Feb 16, 2019)

Personally, I think an on-demand system would lead to increased dispensing. 

Of course, many T1s treat their insulin as a precious substance, and as a life preserver that's understandable, but in this throw away culture, if something is free, it is worthless. 

Of course, in UK insulin is dispensed free anyway, but there is a check in place to ensure it isn't being disposed willy-nelly because folks aren't taking adequate care or whatever.

Of course, I am expressing that very clumsily, but if you go to an all you can eat buffet or on an all inclusive holiday, I'd wager the amount of waste is higher than if individuals are paying per unit of food/drink or whatever.


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## Northerner (Feb 16, 2019)

AndBreathe said:


> Personally, I think an on-demand system would lead to increased dispensing.
> 
> Of course, many T1s treat their insulin as a precious substance, and as a life preserver that's understandable, but in this throw away culture, if something is free, it is worthless.
> 
> ...


I don't quite see that, there's nowt you can do with insulin that's wasteful  It shouldn't be overlooked, of course, that there are at least twice as many Type 2s on insulin as Type 1s in the UK (I seem to remember the numbers being in the region of 900k Type 2 and 420k Type 1). I suppose that the one possibility is that someone might get more than they need and then flog it to the Yanks!  

It's an interesting proposition @Amity Island, and I guess that any minister thinking of putting it in place should be directed to read this thread first!


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## Amity Island (Feb 16, 2019)

Docb said:


> It might work but again, in the modern world, you don't need a system that is simple for sensible people to use.  What you need is a system that stops the odd complete idiot getting hold of insulin for nefarious puposes.  A diabetic ID card makes a lot of sense for more than just getting insulin but quite what it would look like and how it would be administered is far from straight forward.  Its not the technology, that's trivial.  Getting all interested parties to agree on it would be harder than organising Brexit.


When you think about it, the current arrangement is far more open to insulin falling into the wrong hands, anybody can collect someone's prescription! At least with an ID card, only the user/carer can collect their insulin.


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## Amity Island (Feb 16, 2019)

Northerner said:


> I don't quite see that, there's nowt you can do with insulin that's wasteful  It shouldn't be overlooked, of course, that there are at least twice as many Type 2s on insulin as Type 1s in the UK (I seem to remember the numbers being in the region of 900k Type 2 and 420k Type 1). I suppose that the one possibility is that someone might get more than they need and then flog it to the Yanks!
> 
> It's an interesting proposition @Amity Island, and I guess that any minister thinking of putting it in place should be directed to read this thread first!


Interesting! I feel that insulin for a Type 1 is an essential, just like air, water and food. Having insulin readily available at a pharmacy seems like a natural arrangement.


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## Amity Island (Feb 16, 2019)

AndBreathe said:


> Personally, I think an on-demand system would lead to increased dispensing.
> 
> Of course, many T1s treat their insulin as a precious substance, and as a life preserver that's understandable, but in this throw away culture, if something is free, it is worthless.
> 
> ...



Hi, I'd use the example of water. Tap water is "free", but I don't drink any more because it's free at the tap. I only drink what I need.


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## Amity Island (Feb 16, 2019)

Northerner said:


> I don't quite see that, there's nowt you can do with insulin that's wasteful  It shouldn't be overlooked, of course, that there are at least twice as many Type 2s on insulin as Type 1s in the UK (I seem to remember the numbers being in the region of 900k Type 2 and 420k Type 1). I suppose that the one possibility is that someone might get more than they need and then flog it to the Yanks!
> 
> It's an interesting proposition @Amity Island, and I guess that any minister thinking of putting it in place should be directed to read this thread first!


I agree with you on not wasting insulin, I don't drink any more water from my tap because it's "free", I only ever drink what I need


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## Amity Island (Feb 16, 2019)

trophywench said:


> Sooooo - are we also doing this with test strips since even if a T1 under the care of a hospital D clinic isn't on any other drugs for anything else, he/she will absolutely need a regular supply of test strips and/or Libre sensors.  Where do you draw the line?


Hi Jenny, i'm coming from the angle of the essential, like water, air, food. I think insulin is a must for Type 1 Diabetics, just feels natural to make it readily available to them as and when required.


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## Amity Island (Feb 16, 2019)

nonethewiser said:


> Lets face it, if your proposal went ahead then everyone would want to be under the care of a hospital diabetes clinic, fair enough it would reduce the gp's workload but your just shifting that workload to the hospitals clinic which are already overstretched.
> 
> Not forgetting the discrimination aspect, why just type 1's and not type 2's for example. Not being picky you understand.


Hi Nonethewiser, i'm interested in what you said about everyone wanting to be under the care of a hospital diabetes clinic, does this mean that there are Type 1's who don't attend hospital? I didn't know this. I mentioned Type 1's in my original post as I've always understood them to require insulin. As far as I've understood (which it looks like i'm mistaken) type 2's using insulin is a more recent occurrence? I thought type 2 meant "insulin resistance" not "lack of insulin"?? My knowledge of type 2 is not very vast...


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## Northerner (Feb 16, 2019)

Amity Island said:


> Hi Nonethewiser, i'm interested in what you said about everyone wanting to be under the car of a hospital diabetes clinic, does this mean that there are Type 1's who don't attend hospital? I didn't know this. I mentioned Type 1's in my original post as I've always understood them to require insulin, as far as I've understood (which it looks like i'm mistaken) type 2's using insulin is a more recent occurrence? I thought type 2 meant "insulin resistance" not "lack of insulin"?? My knowledge of type 2 is not very vast...


Many people with Type 2 progress to needing insulin - there are a lot of people with Type 2, hence the reason for the ones using insulin being much higher than the Type 1s (who all need insulin, but Type 1 is relatively rare)  Not all Type 1s are under hospital care - at my last surgery they decided to move me to GP care because my diabetes management was good and stable, although I still had 'access' to the hospital DSN and consultant should I need it. Since I moved house I have been seen at hospital clinic, but was told at my last review that they would probably be moving me to GP care. Fair enough, there's not a lot they can do for me (or need to) at the hospital.


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## Amity Island (Feb 16, 2019)

Northerner said:


> Many people with Type 2 progress to needing insulin - there are a lot of people with Type 2, hence the reason for the ones using insulin being much higher than the Type 1s (who all need insulin, but Type 1 is relatively rare)  Not all Type 1s are under hospital care - at my last surgery they decided to move me to GP care because my diabetes management was good and stable, although I still had 'access' to the hospital DSN and consultant should I need it. Since I moved house I have been seen at hospital clinic, but was told at my last review that they would probably be moving me to GP care. Fair enough, there's not a lot they can do for me (or need to) at the hospital.


I'd like to go under my GP. but my GP said they know absolutely nothing about Diabetes, so I guess there wouldn't be much point going via GP


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## Docb (Feb 16, 2019)

Amity Island said:


> I'd like to go under my GP. but my GP said they know absolutely nothing about Diabetes, so I guess there wouldn't be much point going via GP



One of the more knowledgeable might care to comment but I was under the impression that primary care for diabetes was the GP's responsibility.  Maybe that only for T2's.


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## Robin (Feb 16, 2019)

Docb said:


> One of the more knowledgeable might care to comment but I was under the impression that primary care for diabetes was the GP's responsibility.  Maybe that only for T2's.


I was moved back from the hospital clinic to my GP because I was told they had a specialist diabetic nurse at my surgery. I presume if they didn’t, I’d have remained under the hospital care. Turns out my 'specialist nurse' was the lovely nurse who does everything, (asthma clinic, travel jabs, all aspects of general nursing) who had been given some training in Type 2 diabetes. Most of what she knows about Type 1, she’s learned from me!


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## Northerner (Feb 16, 2019)

Robin said:


> I was moved back from the hospital clinic to my GP because I was told they had a specialist diabetic nurse at my surgery. I presume if they didn’t, I’d have remained under the hospital care. Turns out my 'specialist nurse' was the lovely nurse who does everything, (asthma clinic, travel jabs, all aspects of general nursing) who had been given some training in Type 2 diabetes. Most of what she knows about Type 1, she’s learned from me!


To be fair, when I was in Southampton I spent most of the time with the consultant chatting about the people here (no names, of course!)


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## AndBreathe (Feb 16, 2019)

Northerner said:


> I don't quite see that, there's nowt you can do with insulin that's wasteful  It shouldn't be overlooked, of course, that there are at least twice as many Type 2s on insulin as Type 1s in the UK (I seem to remember the numbers being in the region of 900k Type 2 and 420k Type 1). I suppose that the one possibility is that someone might get more than they need and then flog it to the Yanks!
> 
> It's an interesting proposition @Amity Island, and I guess that any minister thinking of putting it in place should be directed to read this thread first!



Not refrigerate it, not finish vials/pens, really simply not treat it with any form of economy.


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## eggyg (Feb 16, 2019)

Amity Island said:


> Hi Nonethewiser, i'm interested in what you said about everyone wanting to be under the care of a hospital diabetes clinic, does this mean that there are Type 1's who don't attend hospital? I didn't know this. I mentioned Type 1's in my original post as I've always understood them to require insulin. As far as I've understood (which it looks like i'm mistaken) type 2's using insulin is a more recent occurrence? I thought type 2 meant "insulin resistance" not "lack of insulin"?? My knowledge of type 2 is not very vast...


I was diagonosed in October 2010 and have NEVER seen a diabetic/ endocrinologist consultant or for that matter a GP! I have attended the diabetes clinic a couple of times and been seen by a DSN ( a very knowledgeable one I must say) and that was just the last year of so at my insistent. Of course I am a “ weird” diabetic ( Type 2/3c/1) and no one wants me!


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## Northerner (Feb 16, 2019)

AndBreathe said:


> Not refrigerate it, not finish vials/pens, really simply not treat it with any form of economy.


Maybe, but that's perfectly possible under the current system


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## mikeyB (Feb 16, 2019)

eggyg said:


> I was diagonosed in October 2010 and have NEVER seen a diabetic/ endocrinologist consultant or for that matter a GP! I have attended the diabetes clinic a couple of times and been seen by a DSN ( a very knowledgeable one I must say) and that was just the last year of so at my insistent. Of course I am a “ weird” diabetic ( Type 2/3c/1) and no one wants me!


Aye, but fortunately there’s now a NICE protocol for treating Creonistas, though they call it pancreatic diabetes, so you never were T2 really. Trouble is, many diabetes consultants haven’t read the NICE protocol yet. 3c diabetics should always be under consultant care. GPs and surgery DSNs are almost completely ignorant on the subject, because it’s so rare.


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## AndBreathe (Feb 17, 2019)

Northerner said:


> Maybe, but that's perfectly possible under the current system


Of course it is, but at least there is some form of control there.

Don't get me wrong, I don't grudge T1s their life preserving medication for an instant, but there is waste out there, just like in every walk of life.


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## Northerner (Feb 17, 2019)

AndBreathe said:


> Of course it is, but at least there is some form of control there.
> 
> Don't get me wrong, I don't grudge T1s their life preserving medication for an instant, but there is waste out there, just like in every walk of life.


The control would come from the hospital clinic, who would be aware of how much was being ordered (and would know whether it was reasonable, whereas the GP may not have a clue). If all you need is insulin then no need to involve the GP.


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## AJLang (Feb 17, 2019)

How would the consultant know what is reasonable when levels even for an individual diabetic as they can change dramatically over a short amount of time which has happened to me recently. As Jenny said there are also testing strips. Should it also include disposable needles and pens? What about Type 1s on metformin? Where would collecting directly from the pharmacist stop? What if you cant’t see a consultant for 18 months which can happen, eg this happened to me through no fault of mine. Also, if we’re talking about ID what about if you rely on somebody else to collect your insulin?


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## Sally71 (Feb 17, 2019)

My daughter has always been under hospital care, although that might change when she becomes an adult! (My mum has always been under GP care for as long as I can remember.) The hospital team are fab, but don't do any prescribing, that has to go via the GP.  I think so that it can all be controlled in one place, could be dangerous if the hospital is prescribing one thing and the GP another and they don't talk to each other!  We recently got the go-ahead to get Libre sensors on prescription having self-funded them for 2 1/2 years, when we collect those now the instruction on the chemist's label says "use as per hospital instructions" or something like that, and the letters that go from the consultant to the GP every time we've had a check up now say "please continue to prescribe Libre sensors" every time! (I know because they always send us a copy). 

Last year I finally managed to get the amount of insulin we get per prescription increased, because the original amount which used to last 2 months now doesn't even last one, and I had to go through quite a palaver to get it changed, so there are checks in place.  And curiously, every time I ask for a glucagon kit, this stops the whole prescription from being sent electronically to the chemist and I have to faff about picking it up from the surgery and then waiting while the chemist gets it ready.  The GP said it's because glucagon is a restricted drug.  But the pharmacist says it isn't, insulin is far more dangerous than glucagon if it falls into the wrong hands and that comes through automatically!  So I can only assume that it's a glitch in their system that nobody has got round to correcting, after all you don't need glucagon kits very often!


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## Madeline (Feb 17, 2019)

Docb said:


> One of the more knowledgeable might care to comment but I was under the impression that primary care for diabetes was the GP's responsibility.  Maybe that only for T2's.


My primary care is hospital based, might be a regional thing?


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## mikeyB (Feb 18, 2019)

In your case, Madeline, it might be co-morbidities. That’s hospital speak for other interacting conditions.


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## Madeline (Feb 18, 2019)

mikeyB said:


> In your case, Madeline, it might be co-morbidities. That’s hospital speak for other interacting conditions.


Ah yes, they do treat me like I’m made of glass tbh. Got a few stares when I got given a cup of coffee in the waiting room


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## travellor (Feb 18, 2019)

Madeline said:


> Ah yes, they do treat me like I’m made of glass tbh. Got a few stares when I got given a cup of coffee in the waiting room



I get treated like I'm an imposter everywhere.
I order salad, my partner gets it.
I order diet drinks, I need to chase them to other tables.

Coffee, no one believes I don't take sugar.
Let alone double espresso and at least two cubes!


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## Madeline (Feb 18, 2019)

travellor said:


> I get treated like I'm an imposter everywhere.
> I order salad, my partner gets it.
> I order diet drinks, I need to chase them to other tables.
> 
> ...


People are weird though. So weird.


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## travellor (Feb 18, 2019)

Madeline said:


> People are weird though. So weird.



They're normally good though

And to be honest, I don't look like a salad person!


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## Madeline (Feb 18, 2019)

travellor said:


> They're normally good though


Unless they’re stealing your salad


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## travellor (Feb 18, 2019)

Madeline said:


> Unless they’re stealing your salad



Then, I feel justified to steal their chips !!!
There is only so far I can go.


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## Madeline (Feb 18, 2019)

travellor said:


> Then, I feel justified to steal their chips !!!
> There is only so far I can go.


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## Andy (Feb 18, 2019)

Amity Island said:


> Do you think we'll see the day when insulin is available in the UK without a prescription?
> 
> If you're Type 1 and are under the care of a hospital diabetes centre, then why not allow diabetics to pick up insulin as and when required? It would certainly reduce g.p's workload, time spent ordering, time spent sending prescriptions etc. The pharmacist could do a standing order for your insulin ready for you to pick up each month. Plenty of drugs are readily available over the counter, so why not a non-drug like the hormone insulin. You can buy cigarettes, alcohol and sugar/junk food which are known killers, seems illogical insulin isn't available without prescription.
> 
> ...


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## gail1 (Feb 19, 2019)

wot about those diabeticssuch as myself on insulin and have mental health issues who would od on it given half a chance and access to it


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## Amity Island (Feb 19, 2019)

gail1 said:


> wot about those diabeticssuch as myself on insulin and have mental health issues who would od on it given half a chance and access to it


Hi Gail, I'd guess anyone in the position whereby they are reliant upon another administering their insulin, would continue in that same arrangement? For those who self manage it's all got to be done with the supervision of a diabetes consultant, e.g those who already attend a local diabetes hospital.


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## Amity Island (Jul 9, 2020)

Amity Island said:


> Do you think we'll see the day when insulin is available in the UK without a prescription?
> 
> If you're Type 1 and are under the care of a hospital diabetes centre, then why not allow diabetics to pick up insulin as and when required? It would certainly reduce g.p's workload, time spent ordering, time spent sending prescriptions etc. The pharmacist could do a standing order for your insulin ready for you to pick up each month. Plenty of drugs are readily available over the counter, so why not a non-drug like the hormone insulin. You can buy cigarettes, alcohol and sugar/junk food which are known killers, seems illogical insulin isn't available without prescription.
> 
> ...


Insulin available to patients without prescription. 






						Indiana joins nation in allowing patients to obtain insulin without a prescription - TheStatehouseFile.com | TheStatehouseFile.com
					






					thestatehousefile.com


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## trophywench (Jul 9, 2020)

That has nothing whatsoever to do with what we do or need to do in the UK.  Prescriptions and the insulin or any other drugs whether directly for the diabetes or otherwise, are completely FREE for all PWD treated by drugs, already.


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## Amity Island (Jul 9, 2020)

trophywench said:


> That has nothing whatsoever to do with what we do or need to do in the UK.  Prescriptions and the insulin or any other drugs whether directly for the diabetes or otherwise, are completely FREE for all PWD treated by drugs, already.


You know my take on it. I'd like to be able to get insulin without putting a request in for it via a g.p. every month. . Insulin for type 1's is a b s o l u t e l y essential, a bit like food really. Clearly it can be given (in the U.S) to diabetics without the need for a prescription, although yes, they do have to pay for it.


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## Becka (Jul 9, 2020)

The issue with the U.S. is that people have to pay to see a doctor just to get a prescription, then pay for the prescription.  Which means if you cannot afford to visit a doctor you cannot get a prescription at all, even if you can afford it.

That is not a problem here as we do not have to pay to get a prescription, because the N.H.S. makes it free to access a G.P.  The American situation is a sloppy solution to one of the problems within their system of providing healthcare.


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## Amity Island (Jul 9, 2020)

Becka said:


> The issue with the U.S. is that people have to pay to see a doctor just to get a prescription, then pay for the prescription.  Which means if you cannot afford to visit a doctor you cannot get a prescription at all, even if you can afford it.
> 
> That is not a problem here as we do not have to pay to get a prescription, because the N.H.S. makes it free to access a G.P.  The American situation is a sloppy solution to one of the problems within their system of providing healthcare.


I know, it must be harsh out there, especially with insulin prices rising year on year.


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## Robin (Jul 9, 2020)

There are only two sorts of insulin available over the counter in the USA, both older types, not the more modern ones that most of us are on, and not in pens, just vials for which you need syringes, (I checked up on this when I went to the hot deserty bit a couple of years ago, and wanted a backup plan if I compromised my insulin in the heat. I came to the conclusion that I’d just better be very careful with what I'd got!)


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## Amity Island (Jul 9, 2020)

Robin said:


> There are only two sorts of insulin available over the counter in the USA, both older types, not the more modern ones that most of us are on, and not in pens, just vials for which you need syringes, (I checked up on this when I went to the hot deserty bit a couple of years ago, and wanted a backup plan if I compromised my insulin in the heat. I came to the conclusion that I’d just better be very careful with what I'd got!)


Hi Robin,
I hadn't realised the situation was so dangerous in America, it's a real national scandal. People working just to pay for the insulin they need OR the health insurance required to get it included.









						The human cost of insulin in America
					

Diabetics in the US are rationing insulin - and dying. How did we get to this point and what's the fix?



					www.bbc.co.uk


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## atoll (Jul 9, 2020)

Sally71 said:


> My daughter has always been under hospital care, although that might change when she becomes an adult! (My mum has always been under GP care for as long as I can remember.) The hospital team are fab, but don't do any prescribing, that has to go via the GP.  I think so that it can all be controlled in one place, could be dangerous if the hospital is prescribing one thing and the GP another and they don't talk to each other!  We recently got the go-ahead to get Libre sensors on prescription having self-funded them for 2 1/2 years, when we collect those now the instruction on the chemist's label says "use as per hospital instructions" or something like that, and the letters that go from the consultant to the GP every time we've had a check up now say "please continue to prescribe Libre sensors" every time! (I know because they always send us a copy).
> 
> Last year I finally managed to get the amount of insulin we get per prescription increased, because the original amount which used to last 2 months now doesn't even last one, and I had to go through quite a palaver to get it changed, so there are checks in place.  And curiously, every time I ask for a glucagon kit, this stops the whole prescription from being sent electronically to the chemist and I have to faff about picking it up from the surgery and then waiting while the chemist gets it ready.  The GP said it's because glucagon is a restricted drug.  But the pharmacist says it isn't, insulin is far more dangerous than glucagon if it falls into the wrong hands and that comes through automatically!  So I can only assume that it's a glitch in their system that nobody has got round to correcting, after all you don't need glucagon kits very often!


the problem with glycagon is that it needs to be mixed,then the syringe needs to have any air expelled before administering,failure to do so can result in embolism.

the first question a gp will ask is who will administer it,and what is their qualifying factor for use of the medication in the event that an ambulance cannot get there in a reasonable time period with trained first responders.


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## atoll (Jul 9, 2020)

trophywench said:


> That has nothing whatsoever to do with what we do or need to do in the UK.  Prescriptions and the insulin or any other drugs whether directly for the diabetes or otherwise, are completely FREE for all PWD treated by drugs, already.


currently you can only get 3 months supply of medication from the pharmacist,at one time which is free.
,those of us brits who are only resident half the year in the uk will have to purchase insulin somewhere else for the time that they are away,in europe currently my meds(metformin ,clopidogrel,lisonopril) and insulin(NR and abseglar),cost about 200-250 euro a month if bought over the counter with a prescption in france (unsubsidised by french NH).


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## JohnWhi (Jul 9, 2020)

Just a point, Amity Island. Some GP surgeries do not allow their Type 1 patients to be registered with their local diabetes hospital. For me, it took at least one letter of complaint to the CCG (or its predecessor) to be permitted to attend a specialist clinic there. Ordering on line and collecting from the pharmacy or dispensary at least leaves a record of insulin requirements. What you are suggesting sounds like the "tiers payant" scheme that operated in France about 38 years ago. One simply told the pharmaciste that one needed more insulin, and it was provided a day or two later, and the equivalent of the GP was informed. For those speaking of insulin over the counter in the USA, my consultant regaled me with a story of a patient of hers who was a GP and who ran out of insulin when she was there. A single vial cost her a lot more than 100$.


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## trophywench (Jul 10, 2020)

When we were going to Europe for longer than 1.5/1.6 months, because it wasn't regular as clockwork, I made arrangements with the GP being Head of Practice (also the one 'with a special interest in diabetes' who in truth knows very well the hospital clinic deal with it, not him, and happily continues to renew the scrips until he's told different by them - except when he needs to for whatever reason) so that I could order repeat scrips more than once every 28 days prior to setting off.  OK so our Moho fridge 'butter' shelf is a bit full of the stuff to begin with but so what?

OTOH if we can afford to bog off to Europe that's the lifestyle we chose, so some might say I shouldn't expect the NHS to pay for it.  I have chosen not to find out whether he's allowed to do this officially, I'd rather not ask frankly.  The tablets are more difficult being only 28 days per repeat scrip - hence I've often had a whinge about them being on 12 repeats - should be 13 if they're theoretically sposed to last a year!


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## atoll (Jul 10, 2020)

trophywench said:


> When we were going to Europe for longer than 1.5/1.6 months, because it wasn't regular as clockwork, I made arrangements with the GP being Head of Practice (also the one 'with a special interest in diabetes' who in truth knows very well the hospital clinic deal with it, not him, and happily continues to renew the scrips until he's told different by them - except when he needs to for whatever reason) so that I could order repeat scrips more than once every 28 days prior to setting off.  OK so our Moho fridge 'butter' shelf is a bit full of the stuff to begin with but so what?
> 
> OTOH if we can afford to bog off to Europe that's the lifestyle we chose, so some might say I shouldn't expect the NHS to pay for it.  I have chosen not to find out whether he's allowed to do this officially, I'd rather not ask frankly.  The tablets are more difficult being only 28 days per repeat scrip - hence I've often had a whinge about them being on 12 repeats - should be 13 if they're theoretically sposed to last a year!


i think going on holiday for up to 3 months or 90 days is no issue as you will have to return to the uk for 90 days if traveling to europe under the 90/180 day rule that will apply to brits in future.
post brexit,if you want to stay in europe longer than 90 days you will need to apply for residence  in a european country to get indefinite freedom to remain in the shengan area.longer than 90 days .

however having residence in europe might  have implications on your residence status in the uk and entitlement to free NHS meds here as the EHIC scheme is rolled back and private insurance becomes mandatory for temporary residents both in europe and the uk.of which there about 4 million currently who transit between homes in the uk and homes in europe.


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## trophywench (Jul 10, 2020)

Hardly the job of a diabetes forum to advise members of something that only affects people who do go abroad in excess of 90/180, it's hardly hidden info hence I'd expect anyone so affected to have discovered that for themselves before now.  Leaving the EU was never going to be easy for everybody, perhaps those who were so in favour of it didn't delve beneath the false message on the side of the bus?


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## atoll (Jul 10, 2020)

trophywench said:


> Hardly the job of a diabetes forum to advise members of something that only affects people who do go abroad in excess of 90/180, it's hardly hidden info hence I'd expect anyone so affected to have discovered that for themselves before now.  Leaving the EU was never going to be easy for everybody, perhaps those who were so in favour of it didn't delve beneath the false message on the side of the bus?


not trying to advise just asking the question,as far as i know pensioners are not effected as they can just join the eu system if they are residents,however there are millions of gap year students and others of working age who travel,many of whom are diabetics that may fall foul of the system where residence is not an option,,having to buy comprehensive health insurance for people with pre-existing conditions and purchase over the counter meds could prove to be a significant financial  barrier to extended travel for students and the like where before they had a degree of protection under EHIC (as diabetics) in europe.


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## trophywench (Jul 10, 2020)

Yeah, pensioners just ring Newcastle and get a form 1 sent to them.  Clueless as to 'extended travel for students' - but very often the 'Year Out' brigade go much further than boring Europe - well remember lads I went to school with joining VSO and going to eg Ethiopia for a while to help out with whatever before they went to Uni.  (One taught in a school and had 'digs' next door to the local brothel ..... wonder what happened to him? LOL)


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## leonS (Jul 10, 2020)

I believe that the solution would be to make insulin and certain other associated consumables "free issue", so that anyone with the correct authorisation from a prescriber could obtain supplise without a prescription.

We should be awate that there is a cost associated with issuing a prescription, both in the Dr's time and in the paperwork involved in arranging payment to the dispenser.

I have often thought it odd that when I go to a new GP I explain what I need and how much and he transcribes this verbatim to his pad. At the pfarmacy I am made to wait 20 minutes while they prepare a label to stick over other important information which says "Use as directed".


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## Amity Island (Jul 10, 2020)

leonS said:


> I believe that the solution would be to make insulin and certain other associated consumables "free issue", so that anyone with the correct authorisation from a prescriber could obtain supplise without a prescription.
> 
> We should be awate that there is a cost associated with issuing a prescription, both in the Dr's time and in the paperwork involved in arranging payment to the dispenser.
> 
> I have often thought it odd that when I go to a new GP I explain what I need and how much and he transcribes this verbatim to his pad. At the pfarmacy I am made to wait 20 minutes while they prepare a label to stick over other important information which says "Use as directed".


I too think it would free up a lot of g.p's time. It's not a temporary treatment, we'll always need it and it's not a drug (it's a hormone). My g.p openly admits they know nothing about diabetes, so why should they be given the responsibility of prescribing it, leave it to the experts.


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## Becka (Jul 10, 2020)

leonS said:


> We should be awate that there is a cost associated with issuing a prescription, both in the Dr's time and in the paperwork involved in arranging payment to the dispenser.



One time a G.P. prescribed me a medication contraindicated with the immunosuppressant prescribed by my hospital clinic.  It is only because I read the patient information leaflet, then looked up the NICE information that I knew not to take it.  I assume had it instead been a medicine the clinic managed and listed under their prescriptions the mistake would not have been made.

And for the same immunosuppressant I had regularly monitoring blood tests.  My various levels were always within the normal range, so the hospital was happy.  However my G.P., a different one, noticed that my kidney function had gone from being better than normal to the high end of the range.  After seeing a nephrologist I was able to stop that medication before it did any serious damage.  But those tests were only for the hospital, it was not even necessary for the G.P. to review them.  Luckily they did not worry about the cost and time involved.

I cannot remember the last time I had a prescription from my surgery which involved any paper work.  But there is also a cost involved in a G.P. not being aware of what is happening with a patient, which includes prescriptions being constantly monitored and kept under review.  They get to take a holistic view of a patient's care that a specialist clinic may overlook because of their limited focus.  To do this they need to be involved and not treated as though looking after their patents is an unnecessary cost.



Amity Island said:


> I too think it would free up a lot of g.p's time. It's not a temporary treatment, we'll always need it and it's not a drug (it's a hormone).



A drug is any substance which when taken causes a physiological effect, this includes hormones like progesterone, steroids, and insulin.  And insulin medication is not only a synthetic manufactured replacement for naturally produced insulin, but also consists of other ingredients to delay its absorption and avoid adverse reactions at the administration site.  It is very much a medication.

There are also many other prescribed medications which are also always needed and have to be taken for life.  That does not mean they are without risks and complications which need constant monitoring.

It is not as though you can just take one insulin everyday. You cannot simply take a like-for-like replacement for what is missing naturally.  The type, dose, and when it is taken need to be constantly tailored to an individual.  It is a dangerous and complicated drug that should be taking up the time of a doctor.  They should be aware of whether the time between prescriptions is increasing or decreasing.  A G.P. should always know precisely what you are taking, and be able to consider it alongside any other health issues.  It is their job and their responsibility.

And on a purely administrative level, they are the ones authorizing the payment.  And whilst it depends on the individual surgery, issuing repeat prescriptions takes very little effort.


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## Amity Island (Jul 10, 2020)

Becka said:


> One time a G.P. prescribed me a medication contraindicated with the immunosuppressant prescribed by my hospital clinic.  It is only because I read the patient information leaflet, then looked up the NICE information that I knew not to take it.  I assume had it instead been a medicine the clinic managed and listed under their prescriptions the mistake would not have been made.
> 
> And for the same immunosuppressant I had regularly monitoring blood tests.  My various levels were always within the normal range, so the hospital was happy.  However my G.P., a different one, noticed that my kidney function had gone from being better than normal to the high end of the range.  After seeing a nephrologist I was able to stop that medication before it did any serious damage.  But those tests were only for the hospital, it was not even necessary for the G.P. to review them.  Luckily they did not worry about the cost and time involved.
> 
> ...


I'd agree with you there, definitely a medicine not a drug, hence probably why it's available without a prescription in the U.S. My g.p. admittedly knows nothing about diabetes or insulin or diabetes management, hence id prefer to put my trust in the experts, hence why I have stayed with my consultant. That's one of the reasons why I'd like to be able to pick up insulin without a g.p's prescription.


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## trophywench (Jul 11, 2020)

That's fine, as long as you stay sane and don't feel the need to commit murder, I expect.  

How would you propose guaranteeing against that eventuality?


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## Becka (Jul 11, 2020)

Amity Island said:


> I'd agree with you there, definitely a medicine not a drug, hence probably why it's available without a prescription in the U.S. My g.p. admittedly knows nothing about diabetes or insulin or diabetes management, hence id prefer to put my trust in the experts, hence why I have stayed with my consultant. That's one of the reasons why I'd like to be able to pick up insulin without a g.p's prescription.



But you are not agreeing though, because insulin is a drug!  That is why people get insulin at a drug store in the U.S.

A drug is something that is introduced to the body to produce a physiological effect.

A medicine is a drug used to treat medical conditions.. 

And a G.P. does not have to be an expert in every condition.  Their job is to manage a patient's care.  This means referring people to specialists where particular expertise is required, and then acting on instructions from specialists, such as issuing and monitoring prescriptions.

If the G.P. was not issuing the prescription, the specialist would instead.  And aside from whether this is something a specialist should need to be doing, aside from the risks to patent health when G.P. do not know what they taking when judging overall health and issuing other prescriptions, it is actually very annoying.

For G.P. prescriptions (which includes ones they have been directed to prescribe by a specialist clinic) I go online, select the ones I want, and click submit.  A few days later I walk into the pharmacist at the end of my street and they hand them to me.

But for my immunosuppressant I have to contact the hospital to ask the department secretary to ask the doctor to issue a prescription.  This is then sent to the contracted pharmacy in the hospital reception, so I have to travel several miles to collect it.

I am sure my G.P. knows nothing about the drug because it is a non-standard treatment, but I wish they were managing the prescription.  It would have saved me once being prescribed a drug that was deemed too dangerous for me, and regularly going through a lot of hassle to renew it.

But whoever does the prescribing, no one is going to want to pay for and issue dangerous drugs without monitoring and authorizing it.  And nor should they.


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## trophywench (Jul 11, 2020)

Suggest you contact Dominic Cummings .......


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## Amity Island (Jul 11, 2020)

Becka said:


> But you are not agreeing though, because insulin is a drug!  That is why people get insulin at a drug store in the U.S.
> 
> A drug is something that is introduced to the body to produce a physiological effect.
> 
> ...


Hi Becka,
I know where you are coming from and don't disagree per se, but since I was diagnosed I've always thought of my type 1 diabetes being about the lack of a "hormone" (insulin) not the lack of a "drug". That's the only reason why I say insulin is not a drug. I've never felt I've ever lacked any drugs lol

I don't think anybody on or off this forum would dispute the fact that diabetes is the lack of a hormone and not the lack of a drug.


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## trophywench (Jul 12, 2020)

Yeah well so are the birth control pill and HRT for the older ladies and you need prescriptions for those too.  If you had certain things wrong with your prostate you might be prescribed female hormones (and grow  boobs) to counteract the production of testosterone feeding the prostate problems.


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