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Dvla - Good News Re Interstitial Fluid Monitoring

Energize

Energize

Well-Known Member
I've just heard that the Minutes for the April meeting of the Medical Advisory Panel re Driving with Diabetes is now available. This meeting was dedicated to discussing devices that measure glucose in interstitial fluid, ie Libre, Dexcom etc.

The Minutes can be read here - https://assets.publishing.service.g...2018-extraordinary-diabetes-panel-meeting.pdf

One point I feel is rather ambigious is whether DVLA will only accept these devices if they are prescribed, or whether self-funded systems will also be accepted. See the wording Page 3, first para - " ... only glucose monitoring systems which have been approved and recommended for the management of diabetes by their treating clinicians can be used for the purposes of driving. Systems which do not measure either blood or interstitial fluid glucose cannot be used for glucose monitoring in the context of driving."

I'm interested to learn your opinions re this last 'ambigious' point ;)

Thanks
 
From reading that my understanding is that interstitial fluid methods are acceptable.......

but should they be, that's the question......

I think under normal circumstances its fine, for me at least, with normal hypo awareness......but what about folk without good awareness or the tendency to have quick, unexpected hypos......I suppose these are unlikely to have a license...;)
 
There is also the interesting issues of low carb type1 who have no hypos while always keeping their bg under 5, but are forced to increase bg to drive.
 
novorapidboi26 said:
From reading that my understanding is that interstitial fluid methods are acceptable.......
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Thanks, I'm pleased to hear this ;)

but should they be, that's the question......
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Could you elaborate on that? I feel my Libre is usually pretty accurate and, in addititon, shows the up/down trend too, which blood glucose doesn't do. Surely, as long as you've checked against a blood glucose to see it's reading on similar levels, it should give more information that a single blood strip does? In the same way that different glucose meters differ, the Interstitial fluid glucose readings are considered within accepted differences.

I think under normal circumstances its fine, for me at least, with normal hypo awareness......but what about folk without good awareness or the tendency to have quick, unexpected hypos......I suppose these are unlikely to have a license...;)
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I'm Type 2, not on insulin, so maybe I've got this wrong but I understand the one of the criteria for being prescribed a Libre is hypo unawareness. So, I don't quite understand your point here. Again, could you explain what you are meaning? Again, with the Libre showing up/down trends, surely this should help prevent a hypo and enable earlier intervention of off-set it?

As you mention, if someone is hypo unaware, presumably they don't drive ;)
 
Energize said:
Systems which do not measure either blood or interstitial fluid glucose cannot be used for glucose monitoring in the context of driving.
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I guess I can throw away the coloured pee sticks then......!

Energize said:
Surely, as long as you've checked against a blood glucose to see it's reading on similar levels
Click to expand...

Yes a cgm/libre can provide more info than a single drop of blood, cgm's need calibrating (other than the new Dexcom G6) so are less unlikely to give consistent false readings, the libre on the other hand could be way off the mark at times, if people don't manually 'calibrate' them there's a chance that they think they are 5 or above because thats what the libre says when in fact it could be reporting consistently higher than actual blood. Not everyone does finger pricks once they have a libre, except currently to drive, so if you take that requirement away..........

I've not read the link yet, but from your post and what was quoted my take on it is it doesn't mean prescribed, just that your clinic agree the device you are using/self funding is safe & can be used for driving - question is why wouldn't they? as it has to meet certain accuracy criteria anyway?

Libre prescription criteria varies slightly from one CCG to another, hypo unawareness was defo used as a marker for cgm funding though.

There could be some good old court cases coming up!
 
Energize said:
I understand the one of the criteria for being prescribed a Libre is hypo unawareness.
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Every area seems to have different criteria but my area has the opposite criteria for a Libre - if you have high BG.
I think (but happy to be corrected), you are more likely to be prescribed a CGM which can alert when your BG gets low if you are hypo insensitive - a Libre is only useful if you look at the graphs.
 
A lot of ccgs are hanging back on funding libre because of "lack of clinical evidence", so it's interesting to see in the link that they say on page 1:

"It is now clinically accepted that interstitial fluid glucose monitoring is established technology with acceptable levels of accuracy and can be included as a way of monitoring glucose levels as an alternative to capillary glucose testing whilst driving."

There's obviously a lot of politics going on at the moment about libre funding, but I reckon it can only be viewed as a good thing that a specialist panel, tasked with advising a Government Minister, is taking the view that libre isn't just a doubtful shiny new toy, but something that they're fine with ok'ing for us lot to rely on to drive potentially lethal lumps of metal.

A small step on the way to libre/cgm becoming the accepted new normal.
 
I got two things from this...

1) We don’t have to artificially raise levels to five if we’re running in the nicely normal mid fours according to the interstitial readings:

“Panel also advised that a confirmatory blood glucose level check must be made if interstitial readings are 4.0mm/mol/L or less.”

2) But we have to hang fire for now, because:

“However whilst these changes are under consideration and until implementation, it is essential that all group 1 drivers continue to use blood glucose monitoring only for the purposes of glucose monitoring at times relevant to driving.”

A step in the right direction!
 
I have been prescribed with the dexcom g6 because of hypo unawareness. I was told when I got this device to set the alert to go off when my sugars reach 5.5 so I can treat before hypo. However, yesterday I was told by the dvla that I wasn't having my driving license renewed because of no hypo signs. I've had no hypo's since having this device on and I really need to be able to drive. Any ideas on how to appeal this decision?
 
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