Dexcom criteria/Libre 2

[Sc0tty]

Hi all,

Does anyone know what the criteria is for Dexcom to be supplied by the NHS?

Had a meeting with my Diabetes Specialist Nurse today, and she advised me that I don't meet the criteria. Even though my last HBA1C was 56, I'm on Insulin (18 units at night) and Metformin twice a day.
My GP has asked me to check my BSL 6 times a day, as you can imagine this is painful.

When I checked how much Dexcom is to purchase myself, it's £100 a month!

Thank you

 

[Westley]

For type 1s I believe the guidelines now allow them to prescribe the Freestyle Libre without any further criteria, and I've not heard of any T1s having trouble getting it in recent years.

I don't have experience with getting a true CGM prescribed, but a quick search indicates that at least in theory they should also be available without further criteria, but I don't know how true this is in practise everywhere.

*edit - I'm sorry, I misread the T2 your profile.

 

[Rokaab]

For type 1s I believe the guidelines now allow them to prescribe the Freestyle Libre without any further criteria, and I've not heard of any T1s having trouble getting it in recent years.

Do note that Sc0tty's profile says Type2 though and it appears is only on a basal or mixed insulin rather than basal/bolus regime

 

[Deleted member 527103]

@Sc0tty your case maybe better if you are more / less specific.
For example, there are at least 3 different types of Dexcom available now. The criteria fir the Dexcom One is less than that fir the Dexcom G6 and G7. However, why does it have to be a Dexcom? What about the Libre 2 which has the same criteria (but more well known) as the Dexcom One.

I agree that it is very frustrating that someone with type 2 using insulin is not treated the same as someone with Type 1.
What is your reason for needing a CGM? How do you think you would benefit from it?
Assuming you live in England, have you read the NICE guidelines? These can easily be found in the internet using Google.
I recommend building your case based on these guidelines but also making it clear how you intend to use the data that the CGM provides.
Finger pricking six times a day does not sound particularly painful to me or a justification for a CGM. When Libre was first available to people with Type 1 we had to prove that we tested at least 8 times a day and many of us were testing more often. Less than 8 times a day, it was not cost beneficial for the NHS to fund the Libre.

If you are finding 6 pricks a day painful, you may need to derives your pricking technique. Do you ensure your fingers are warm? Have you adjusted the depth of the lancet? Do you ensure you use different fingers? Even with a CGM we still need to finger prick because there are limitations with all CGMs.

I am not suggest you would not benefit from a CGM but I recommend building a case beyond 6 finger pricks a day.

 

[Sc0tty]

@Sc0tty your case maybe better if you are more / less specific.
For example, there are at least 3 different types of Dexcom available now. The criteria fir the Dexcom One is less than that fir the Dexcom G6 and G7. However, why does it have to be a Dexcom? What about the Libre 2 which has the same criteria (but more well known) as the Dexcom One.

I agree that it is very frustrating that someone with type 2 using insulin is not treated the same as someone with Type 1.
What is your reason for needing a CGM? How do you think you would benefit from it?
Assuming you live in England, have you read the NICE guidelines? These can easily be found in the internet using Google.
I recommend building your case based on these guidelines but also making it clear how you intend to use the data that the CGM provides.
Finger pricking six times a day does not sound particularly painful to me or a justification for a CGM. When Libre was first available to people with Type 1 we had to prove that we tested at least 8 times a day and many of us were testing more often. Less than 8 times a day, it was not cost beneficial for the NHS to fund the Libre.

If you are finding 6 pricks a day painful, you may need to derives your pricking technique. Do you ensure your fingers are warm? Have you adjusted the depth of the lancet? Do you ensure you use different fingers? Even with a CGM we still need to finger prick because there are limitations with all CGMs.

I am not suggest you would not benefit from a CGM but I recommend building a case beyond 6 finger pricks a day.

@In Response thanks for replying

I wasn't aware their was different Dexcom's such as G6, G7 and Libre 2? Thanks for making me aware.

Oh yes, it's very frustrating being type 2 using insulin, not being treated the same as someone with Type 1.

Regarding wanting CGM, I tend to get become Hypoglycemic a lot. But lately for around 7 weeks, I've been Hyperglycemic (BSL around 22 - 24).
Both of which has resulted in myself being taken to A&E via ambulance. My last Hypo, my BSL was 3.1.
I was only diagnosed with Type 2 in March, and as you can imagine this has been a lot for me to process.

Thanks for replying though.

 

[Antje77]

I was only diagnosed with Type 2 in March, and as you can imagine this has been a lot for me to process.

Just wondering, have you been tested for T1?
Needing insulin this early in diagnosis and at a relatively young age can be a reason to do some additional tests to rule out T1.

Oh yes, it's very frustrating being type 2 using insulin, not being treated the same as someone with Type 1.

I absolutely agree that T2's (on insulin or not) would benefit a lot from using a CGM, provided they are motivated to use the information it provides. I hope the powers that be will realise this as well rather sooner than later.

CGMs haven't been funded for T1's all that long, it's pretty new technology and official guidelines are slow to change.

One of the main differences between T1 treatment and your treatment with only long acting insulin is that T1s (and some T2s) need to calculate their dose of short acting insulin before every meal, needing a closer eye on numbers not only to prevent hypos but to know how much insulin to take as well. I'm afraid this is one of the reasons why T2s on a single insulin aren't eligible for a CGM yet.

I tend to get become Hypoglycemic a lot. But lately for around 7 weeks, I've been Hyperglycemic (BSL around 22 - 24).

Are your doses being adjusted?
Do you test around meals to try and work out patterns on when you're going high and when you're going low? This can be really helpful in getting better insight in how your diabetes works and how to adjust your food if needed, even on fingerpricks.

You can always apply for a 2 week free trial for Libre, but keep in mind that this doesn't completely take away the need for fingerpricking.

Sampling | Diabetes Care | Abbott

Claim your 15 day free sensor if you have diabetes and have not tried the FreeStyle Libre 2 plus sensor before

www.freestyle.abbott

 

[Sc0tty]

Just wondering, have you been tested for T1?
Needing insulin this early in diagnosis and at a relatively young age can be a reason to do some additional tests to rule out T1.

Nope, I'm waiting for my GP surgery to get back to me. As you know, getting a GP appointment is very difficult.
Hopefully I hear back soon.

Are your doses being adjusted?
Do you test around meals to try and work out patterns on when you're going high and when you're going low? This can be really helpful in getting better insight in how your diabetes works and how to adjust your food if needed, even on finger pricks.

I started on 22 units of Lantus, but this was reduced to 18 units to see if my BSL remained the same or increased etc.
But I'm still having episodes of highs and lows.
I test 2 hours before food, and 2 hours after.
I mainly get Hypo's at night, My last Hypo, my BSL was 3.1.
As you can imagine, only being diagnosed for 6 months is a lot for me to process.
My partner doesn't sleep much at night, as the last Hypo really scared him.

Thank you so much for this. I've just applied for the trial!

 

[Antje77]

Nope, I'm waiting for my GP surgery to get back to me. As you know, getting a GP appointment is very difficult.
Hopefully I hear back soon.

But lately for around 7 weeks, I've been Hyperglycemic (BSL around 22 - 24).

Being in the twenties without being able to see your GP is a good reason to call 111 for advice.
Can you test for ketones?

 

[Sc0tty]

Being in the twenties without being able to see your GP is a good reason to call 111 for advice.
Can you test for ketones?

111 have been very helpful, especially early on when i was diagnosed.

My last ketones was 1.9.

 

[Antje77]

My last ketones was 1.9.

I'd keep a close eye on them, and call 999 again if they rise or if you develop a stomach ache, nausea or funny breathing.

 

[EllieM]

My last ketones was 1.9.

Here's what the NHS say about diabetic ketoacidosis

Diabetic ketoacidosis

Find out about diabetic ketoacidosis (DKA), including what the symptoms are, when to get medical help and how to prevent it.

www.nhs.uk

In your position I'd be pushing my GP for the tests to rule out T1 (if only because you'd be entitled to better medical goodies if you were T1 rather than T2). Given you are a fairly atypical T2 (young with early progression to insulin) I might try asking for a referral to a hospital diabetes clinic so that they can rule out other types of diabetes. (There are more kinds than T1 and T2 and the different types have slightly different treatments so it's worth having the right diagnosis. If you are T1 you'll probably get moved to a more flexible insulin dosing regime which should hopefully make it easier to avoid highs and lows and you should qualify for a cgm).

The initial T1 tests are cpeptide and GAD antibodies.

Good luck.

 

[MommaE]

@In Response thanks for replying

I wasn't aware their was different Dexcom's such as G6, G7 and Libre 2? Thanks for making me aware.

Oh yes, it's very frustrating being type 2 using insulin, not being treated the same as someone with Type 1.

Regarding wanting CGM, I tend to get become Hypoglycemic a lot. But lately for around 7 weeks, I've been Hyperglycemic (BSL around 22 - 24).
Both of which has resulted in myself being taken to A&E via ambulance. My last Hypo, my BSL was 3.1.
I was only diagnosed with Type 2 in March, and as you can imagine this has been a lot for me to process.

Thanks for replying though.

Regards the fingerpricks testing - I find it less uncomfortable to jab the side of my finger pad rather than the top or middle.

 

[Grandadfatboy]

I am a type 2 insulin injecting diabetic. I was diagnosed back in 2006 and everything was fine, up until I was diagnosed with Multiple Myeloma, which is a blood cancer.

My medication at the time just could not cope with the huge spikes in BS from the chemotherapy drugs, and my fingers were becoming so sore from all the finger pricking.

I received my routine diabetes check up phone call. I explained I was struggling to keep my BS at safe levels, and it was decided to start me on insulin and I was asked if I would like to trial the Libre 2.

The rest, as they say is history. The change it made to my diabetes care was almost instant, as I could see exactly what effect the chemo drugs were having on my BS, and for how long. I quickly learnt how to dose my insulin to prevent my BS from hitting mid to high 30's.

All I'm saying is, make your case to your diabetes nurse/doctor/specialist, as some type 2's are now being offered the Libre 2. It's been a game changer for me.

 

[DizzyChick]

I was diagnosed type 2 in 2015, really struggled with getting my HBA1C down, highest was 117 and lowest 81. Unfortunately I was told in July that my non alcoholic fatty liver had changed to cirrhosis after a fibro scan. I have completely changed my diet so got a free trial from abbot for the libre 2, I then self funded twice, this has really helped to see which foods cause me to spike. I went for my review on Thursday and my HBA1C is now 66 I showed my DN the readings from the libre and she could see that I had quite a few hypos, and now I have lost my awareness ( going down to 2.2 with no warning) so I am now going to get the libre 2 on prescription. I am with the diabetic medicine team at the hospital but since Covid I only get a phone call once a year so was shocked that my GP could do this.