Diy Libre monitoring

[Deleted Account]

Are you another post code lottery Libre denied Type 1, if you don't mind me asking.

I am self funded because I did not comply with the criteria

 

[himtoo]

I am self funded because I did not comply with the criteria

Hoping in april with the announcement made last november things may get easier for you

have you investigated ABCD criteria ( as opposed to NICE )

this basically is about D affecting your quality of life , hypo awareness , fear of hypo's etc etc

 

[Mbaker]

I am self funded because I did not comply with the criteria

I really hope this situation improves, I would have thought being Type 1 would be an automatic qualification. When the news about the Libre being approved on the NHS came through, I thought this was massive progress. I not sure why but this really gets under my skin.

 

[Deleted Account]

I really hope this situation improves, I would have thought being Type 1 would be an automatic qualification. When the news about the Libre being approved on the NHS came through, I thought this was massive progress. I not sure why but this really gets under my skin.

To be honest, whilst I would like to think I should qualify, I do not think having type 1 should be an automatic qualification. Unfortunately, not everyone with diabetes takes their condition seriously. Therefore, one of the criteria for keeping a Libre prescription at the moment is that you have to scan at least 3 times a day. I have read of people having theirs taken off them because they do not comply with this.
Furthermore, I believe Libre prescription should come with training. I find it frustrating how many people seem to want to use Libre as a finger prick replacement. This is like having a smart phone and only using it for text messages and phone calls. Training does not come cheap.
I guess what I am saying is there is a cost for Libre and there has to be a return on investment type analysis done on the individual before giving them out. Just as the pump requires confirmation you are willing to put in the effort, so should Libre.
If that hurdle can be jumped, I agree everyone with type 1 should have access to Libre.

 

[DCUKMod]

To be honest, whilst I would like to think I should qualify, I do not think having type 1 should be an automatic qualification. Unfortunately, not everyone with diabetes takes their condition seriously. Therefore, one of the criteria for keeping a Libre prescription at the moment is that you have to scan at least 3 times a day. I have read of people having theirs taken off them because they do not comply with this.
Furthermore, I believe Libre prescription should come with training. I find it frustrating how many people seem to want to use Libre as a finger prick replacement. This is like having a smart phone and only using it for text messages and phone calls. Training does not come cheap.
I guess what I am saying is there is a cost for Libre and there has to be a return on investment type analysis done on the individual before giving them out. Just as the pump requires confirmation you are willing to put in the effort, so should Libre.
If that hurdle can be jumped, I agree everyone with type 1 should have access to Libre.

Obviouslay I'm not T1, therefore realistically have no skin in the game here, however, I was horrified to take a call from a T1 friend of mine who had been given a Libre for a trial. All great so far, but her Libre was applied for her, and no further information given to her. Her call to me was to ask what she should be expecting, or how she got meaningful data (she is an FCA).

Once I'd run through a few things and I explained what information I took f I'm reading my own data, she went off happy to get something meaningful out of it.

I was quietly disgusted to be honest.

 

[Listlad]

Furthermore, I believe Libre prescription should come with training. I find it frustrating how many people seem to want to use Libre as a finger prick replacement. This is like having a smart phone and only using it for text messages and phone calls. Training does not come cheap.
.

Training does not come cheap. Words I have used many times over the last couple of decades.

Training whilst desirable is often likely to be sadly absent, well judging from what I hear, see and read.

From my own angle, technology, measurement and trend monitoring has been a lifetimes work so I can foresee the benefits a Libre will afford. The more data the better. Once acquired then the interpretation of that data follows.

As a prediabetic I can see its advantages. Hopefully in the future these devices will become longer lasting (greater capacity) and cheap enough to be affordable for those that need or want them regardless of income or even free at the point of need.

When I phoned Abbott the other day the sales person talked of using their cloud and software to view the data in a meaningful way. I have not got round to looking at the link she sent me but it sounds quite useful? Anyone used it yet? Seems to be called Libre View.

 

[Scott-C]

Any idea why they last only 2 weeks? What is the limiting factor with them?

The sensor filament is coated with an enzyme, glucose oxidase, which reacts with passing glucose, breaking it down to other chemicals and measuring the amount of electronic current as amps coming from that chemical breakdown to produce a reading. After a while, the enzyme just wears out, so there's a practical limit to how long it can be used for.

Also, as time goes by, the filament gets "biofouled", clagged up by passing detritus and defence cells, and, just as, say, dirty spark plugs are going to cause problems for your car engine, a biofouled sensor is going to give an unclear reading because glucose can't get to it to be measured consistently.

Dexcom sensors officially last 10 days, but can be run unofficially for longer, sometimes much longer, 2 to 4 weeks in some cases, but they all eventually get too "noisy" to be relied on.

I suspect the same could have been done with libre, but it's been coded to time out at 14 days, presumably after discussions with the licensing authorities on what was felt to be the limits of reliability which they were prepared to approve. The USA version was originally only 10 days, later changed to 14. People have tried to hack it to get round the 14 days as can be done with dexcom but no luck so far (14.5 days with xdrip+ etc).

Go back 10 to 15 years, most of the early cgms would only run for about 3 to 4 days before the biofouling problem and enzyme issues became too much, so there has been major improvements in the biological limits of them as the science has developed.

The more recent Eversense involves a sensor being implanted by a doctor, uses fluorescence, not glucose oxidase, and lasts 3 or 6 months depending on version, but costs about 3 or 4 hundred a month.

All in all, the 2 week time out is a combination of the practical limitations of the chemistry and biology, alongside what the regulators are willing to approve, and there will also be an economic bottom -dollar aspect to it as well.

 

[Listlad]

The sensor filament is coated with an enzyme, glucose oxidase, which reacts with passing glucose, breaking it down to other chemicals and measuring the amount of electronic current as amps coming from that chemical breakdown to produce a reading. After a while, the enzyme just wears out, so there's a practical limit to how long it can be used for.

Also, as time goes by, the filament gets "biofouled", clagged up by passing detritus and defence cells, and, just as, say, dirty spark plugs are going to cause problems for your car engine, a biofouled sensor is going to give an unclear reading because glucose can't get to it to be measured consistently.

Dexcom sensors officially last 10 days, but can be run unofficially for longer, sometimes much longer, 2 to 4 weeks in some cases, but they all eventually get too "noisy" to be relied on.

I suspect the same could have been done with libre, but it's been coded to time out at 14 days, presumably after discussions with the licensing authorities on what was felt to be the limits of reliability which they were prepared to approve. The USA version was originally only 10 days, later changed to 14. People have tried to hack it to get round the 14 days as can be done with dexcom but no luck so far (14.5 days with xdrip+ etc).

Go back 10 to 15 years, most of the early cgms would only run for about 3 to 4 days before the biofouling problem and enzyme issues became too much, so there has been major improvements in the biological limits of them as the science has developed.

The more recent Eversense involves a sensor being implanted by a doctor, uses fluorescence, not glucose oxidase, and lasts 3 or 6 months depending on version, but costs about 3 or 4 hundred a month.

All in all, the 2 week time out is a combination of the practical limitations of the chemistry and biology, alongside what the regulators are willing to approve, and there will also be an economic bottom -dollar aspect to it as well.

Great explanation. Thanks.

 

[himtoo]

Training does not come cheap. Words I have used many times over the last couple of decades.

Training whilst desirable is often likely to be sadly absent, well judging from what I hear, see and read.

From my own angle, technology, measurement and trend monitoring has been a lifetimes work so I can foresee the benefits a Libre will afford. The more data the better. Once acquired then the interpretation of that data follows.

As a prediabetic I can see its advantages. Hopefully in the future these devices will become longer lasting (greater capacity) and cheap enough to be affordable for those that need or want them regardless of income or even free at the point of need.

When I phoned Abbott the other day the sales person talked of using their cloud and software to view the data in a meaningful way. I have not got round to looking at the link she sent me but it sounds quite useful? Anyone used it yet? Seems to be called Libre View.

I use libreview very regularly to examine trends and monitor progress when making changes to my basal insulin.
it is really easy to use too-- scanning the libre with my phone the data is automatically uploaded every time to my account in the cloud.
My DSN can log in to my account at the hospital and see all the same information

I also use a MiaoMiao ( bluetooth transmitter) which attaches to the libre
this transforms it into a CGM ( continuous glucose monitor ) which then provides warning alarms should my blood sugars go out of range
the same data is also transmitted to my smart watch so i can instantly see my blood sugar level just by looking at my watch

 

[Listlad]

Has anyone seen this:

 

[buckmr2]

The Libre trial I am on started last May.
All 20 on the trial were shown how to use it
Every 3 months there is a review with your diabetes nurse.
In the review there is a questionnaire to complete.
In order to keep it you must regularly upload your results to LibreView so the diabetologist and DN can .This can be done from the meter and/or phone .My S7 Edge with the Libre app automatically uploads results to LibreView.
Hba1c's also need to improve which it did in all but 1 of the "trialees" after the 6 month trial ended.
When I visited my diabetologist the other week he said they want to see >60% of the time in target and <5% of the time below target which I think is also a criteria for keeping it.
The questionnaire takes about 10 mins to fill in and asks a number of questions for you and your DN /diabetolist to fill in eg if there have been any hospital admissions through hypo or hypers/DKA / occasions where 3rd party assistance was needed / hypo awareness on a scale of 1 -10 , suggestions etc
They get a lot of info from the LibreView data including trends/mealtime patterns/ percentiles etc
Currently even though my trial has finished the team still provide prescriptions for the Libre which should switch to my GP from April once it rolls out nationally for T1's .
Spoke to the Abbott rep about when the Libre will be available as a CGM (like they currently have with the Libre in India) and was told it will be in 2020 in this country.

 

[Higgipop (wots it all about)]

The Libre trial I am on started last May.
All 20 on the trial were shown how to use it
Every 3 months there is a review with your diabetes nurse.
In the review there is a questionnaire to complete.
In order to keep it you must regularly upload your results to LibreView so the diabetologist and DN can .This can be done from the meter and/or phone .My S7 Edge with the Libre app automatically uploads results to LibreView.
Hba1c's also need to improve which it did in all but 1 of the "trialees" after the 6 month trial ended.
When I visited my diabetologist the other week he said they want to see >60% of the time in target and <5% of the time below target which I think is also a criteria for keeping it.
The questionnaire takes about 10 mins to fill in and asks a number of questions for you and your DN /diabetolist to fill in eg if there have been any hospital admissions through hypo or hypers/DKA / occasions where 3rd party assistance was needed / hypo awareness on a scale of 1 -10 , suggestions etc
They get a lot of info from the LibreView data including trends/mealtime patterns/ percentiles etc
Currently even though my trial has finished the team still provide prescriptions for the Libre which should switch to my GP from April once it rolls out nationally for T1's .
Spoke to the Abbott rep about when the Libre will be available as a CGM (like they currently have with the Libre in India) and was told it will be in 2020 in this country.

Ok quick update.. l went for the Dexcon g6 which you can trial before subscribing .. have had the first sensor which lasts 10days and now just changed to the 2nd.. you get x3 sensors in the trial pack and a transmitter which attaches to the sensor. This then bluetooths data to your downloaded phone app every 5mins.. gives great data and is quite accurate. I'm type 2 but the data is great as you can see what your doing right ie foods your body likes and dont.. l can see how long on different foods it takes to digest to then effect my bloods.
I can see what exercise does to get my sugers down etc.
Also great to to see what happens when you sleep to what your liver does.. tell you what it has opened my eyes.
So into day 13 lets see what else l can learn from it