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Freestyle Libre - worth every penny

Discussion in 'Type 1 Diabetes' started by Jason_Avoneg, Oct 3, 2017.

  1. tim2000s

    tim2000s Type 1 · Expert
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    +/- 15% as it happens, and that's from a sample tested against a very specific test. Then of course you have the values when glucose levels are below 4 mmol/l where that variance is subject to a slightly different comparison.
     
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  2. Celsus

    Celsus Type 1 · Well-Known Member

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    @Diabeticliberty, I presume that you are living in the UK? While I don't and therefore not following local developments that you may have in your regulations, I do note the standards set in this area for the UK since 2016 as described on this very website:
    -----
    Accuracy standards set to improve
    By the end of May 2016, new standards are being implemented to ensure that blood glucose meters meet stricter accuracy standards.

    Under the new standard, meters will need to meet the accuracy guidelines 95% of the time:

    • Within± 0.83 mmol/L of laboratory results at concentrations of under 5.6 mmol/L
    • Within ± 15% of laboratory results at concentrations of 5.6 mmol/L or more
    -----
    As you can also find them described on this website:
    http://www.diabetes.co.uk/blood-glucose-meters/blood-glucose-meter-accuracy.html

    And please notice the regulatory wording carefully:
    "...meters will need to meet the accuracy guidelines 95% of the time."

    So 5% of the time they can show whatever and still be compliant !!

    I used myself the Roche AccuCheck Mobile since it came out till I got the Libre, so know it as a solid trustworthy workhorse.
    But I think you mistook my point in my posting above?
    Me, you, everybody have to understand the fundamentals of the mechanics and biologics involved when taking a blood sample from a fingerprick to measure the bg level. Understanding these will enable you better to assess what your bg is and potential action you want to take with regards to your therapy. Even the Roche workhorse is way off one way or the other, depending on the situations you may be in and how you conducted the blood sample testing. Aka, does the blood come dripping out of a warm finger tip or do you squeeze a cold bitten finger for 1 minute to get just a micro-drop out? (the mmol/L will wary widely between these two)
    Same as well with your Libre sensor, where it is well known some of its shortcomings. E.g. you lay down on the side where the sensor is under the squeezed upper arm. You will then get much lower bg readings due to the restricted transfusion in the tissue around the sensor.

    In any case, regarding your sample above, you will probably decide to take some glucose.
    But as a veteran T1 you will really welcome the Libre indicator that the 2.9mmol/L trend is flat-lining!
    On the Roche you have no such information available. And I can assure you that 5.8mmol/L in a vertical drop is far worse than a 2.9mmol/L in stable flat. I dont have to state all the many benefits of CGM devices over the single point measure meters, as they are well described already on this website.

    You are btw the only I have ever heard of using the test solutions, so hats off to that!
    As diabetics we often tend to become somewhat complacent with the never ending routine of bg measures and insulin shots.
     
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  3. Diabeticliberty

    Diabeticliberty · Guest

    Not using control test solution? Quite frankly I find the concept of taking insulin or glucose on the basis of what an uncalibrated meter tells me to be ill advised at best and just plain bonkers at worst.

    I would ask you the same question I pose to all Libre users. Please do not however feel compelled in any way to reply. What is the difference between your most recent HbA1c result from your doctor or DSN and your predicted A1c reading from your Libre? If it is within 5 points hats off to you too. I think you will find you will be in a distinct minority.
     
  4. Diabeticliberty

    Diabeticliberty · Guest


    I have managed to confuse myself. Having gone away and checked this I am coming up with +/-20% for concentrations of 5.6mmols or more. I have always been under the impression it was only 10% for concentrations of 4.2mmols. I will take advice on this one
     
  5. Scott-C

    Scott-C Type 1 · Well-Known Member

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    If you get a Blucon transmitter from Ambrosia Systems, link below, pop it on top of libre with a plaster, it'll push readings to their iPhone app every five minutes.

    https://m.facebook.com/ambrosiasys/?locale2=en_GB

    I've used their app, LinkBluCon, on an android phone. After a few glitches in early versions of the software were ironed out in later versions, it worked well.

    I've no experience of using it in iPhone but Ambrosia certainly say they have an ios version of the app.

    Their app is incredibly basic, no alerts. However, xDrip+ has recently been modified to take data from blucon, so have been running it through that instead, so I get alerts and calibration. As I'm not a phone person, I've no idea whether there's an ios version of xdrip.
     
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  6. dazwalshe

    dazwalshe Type 1 · Active Member

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    Over 17 years t1.. mylowest hba1c has been 72. Libre started on it it January this year... the libre estimated 56 then 54 then 62..my results were 53 50 and 60. The best it's ever been. I'm on my 16th sensor.. 1 failed after 6 days. 1 never started 1 I knocked off.. I just keep showing hypo... 1 call to Abbott's.. replaced without question within 3 days. I finger prick every now and again.. always within 1 or 2 of the blood meter.. on the odd time it's more than 2 out.. it's always with an arrow pointing straight up or down.. which indicates it's rapid change.. . So you can see...whats happening.. . For me thankfully.. it sticks like...well you know what ! It's the best... a real game changer... brilliant device.
     
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  7. Diabeticliberty

    Diabeticliberty · Guest


    I am delighted for you that you have found it works so well. I really wish I could share your enthusiasm for it. I have used one now for 24 straight months without a break. Mine wander all over the place and my actual HbA1c results have never been within 10 points of what my Libre predicts. You are the only person that I have ever been in contact with results that are anywhere near what you might expect them to be. I wouldn't mind quite so much if my results were iffy with consistency. The thing is though they do really wander above and below what my finger pricks tell me.
     
  8. Celsus

    Celsus Type 1 · Well-Known Member

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    And notice @Diabeticliberty, for low bgs below 5.6mmol/L it simply states that it should be within the fixed range of ± 0.83 mmol/L of laboratory results. So for very low bgs the uncertainty can become a very high percentage, even near the absolute value you read on the meter. As I described above, you cant really trust any mobile meter when measuring low bg levels, down to the level of digits you showed on your screenshot.

    For calibration above, you have the calibration chip from Roche you have to use when starting a new batch of strips. Or it wont even allow you to read. That is the only 'calibration' if you will possible of your meter. If you start to consider using calibration liquids on top because you feel the need to double check that it works, then you are out on thin ice already if you don't trust yourself or the equipment you use. E.g. you would then need to measure with calibration liquid before every single test you do. And can you trust the calibration liquid is still good? The questions quickly start to pile up.
    I think you expect scientific precision, but there is none not even close. You get a good indication about your bg from your meter. That is it.
     
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  9. Clementine68

    Clementine68 Type 1 · Member

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    I wish I did have £100 a month to spare. I do not eat out, drink beer etc. Like most people I just get by every month.

    I did do the trial for two weeks and if it was on prescription I would definitely have it. In comparison it should be cheaper for my GP practice as I test my blood at least 6 times a day so get 200 test strips a month which my brother, who is also type 1 and had to buy some once, and they cost him £36 per 50 strips
     
  10. KenBachelor

    KenBachelor Type 1 · Active Member

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    According to the publicity the FreeStyle Libre will be available on prescription from 1 November, but when I was with my doctor yesterday he said 'don't hold your breath' as that is subject to local funding agreement.
     
  11. rockape37

    rockape37 Type 1 · Well-Known Member

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    I tried these sensors for 1 month and found them to be out by 2. Mmol or more. The only useful part was the indicator showing whicvh way your BG was going with the directional arrow.

    The manufacturer does state that it does not replace finger pricking and bolusing based on the sensor reading is clearly fool hardy.

    If accuracy improves and have the function to calibrate it with your finger pricking device then i would consider it.

    Regards

    Martin
     
  12. Bogie

    Bogie Type 2 · Well-Known Member

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    Just reading up on this thread about Libre and I had to check it out here in Canada. I love technology :)

    $227 CDN (just over £137) for the starter kit (free shipping) and $89 (£54) for each sensor after that. So that would be $180 CDN (about £109) per month for sensors.

    Will have to check with our company health plan to see if it is covered fully or even partially. They list several insurers that do cover it. I doubt our gov't plan would - but will check at our local pharmacy.

    I use the Dario right now, love it, but have trouble being consistent in testing - especially at specific times which are advised. The same designated pharmacy that I get my Dario supplies from also distributes the Libre for Canada (exclusive CDN source - Bayshore Speciality). Next day delivery.

    After watching a couple of user videos I see what Libre does not show about the sensor which is that it includes a relatively long sharp (needle) in your arm that stays in your arm until replaced in 2 weeks then repeat, and the adhesive removal process with a possible cover patch. Have to think about that. Dario finger pricks are hardly noticeable (most time I don't feel it). So it boils down to convenience for ease of testing frequently. Needs further thought :)
     
  13. Scott-C

    Scott-C Type 1 · Well-Known Member

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    Libre seems to work very well with some people, much less so with others.

    We're putting the sensor filament into a hostile environment, the immune system attacks it because it shouldn't be there (mind you, it also attacked our beta cells which should be there, maybe those guys should be invited in by HR for a performance review...), it gets "biofouled" or clagged up with protein, cells get trapped up in that which eat glucose so it can't then be measured by the sensor because it's already been eaten before it gets anywhere near the sensor.

    It's amazing that these things work at all. The papers I've read are way above the little I remember from O grade and Higher chemistry/biology 3 decades ago, but I wonder whether some people's particular body chemistry/immune system responses/random unknown factor just makes it more difficult for the sensor to do its job compared to others, hence some get decent readings and others get flyers.

    There's a lengthy article in link below dealing with the crazy complexities going on when you're trying to find out what bg is from measuring interstitial fluid glucose. Maybe those complexities just tank it for some people's individual chemistry, but not for others.

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2903977/
     
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  14. Scott-C

    Scott-C Type 1 · Well-Known Member

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    No, it doesn't. The needle is springloaded, pops in to insert the sensor filament, then retracts back into the applicator, leaving the 5mm long flexible filament in place. All that's in you for 2 weeks is the tiny little black critter in the middle of the sensor in this pic:

    20170527_113031.jpg
     
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  15. Jkarn83_

    Jkarn83_ Type 1 · Newbie

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    The freestyle Rep told me in the Uk they can't do offers/discounts on the Libre because the govt won't let them do it because it's a medical device, soz
     
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  16. Celsus

    Celsus Type 1 · Well-Known Member

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    I am no special promotor of Abbott's products and have no private or professional interests involved either.
    But happy to share some of the clinical factual data being gathered over past years, with evidence that the Freestyle Libre is as good as many other classic fingerprick meters out on the market, and even better than some. And that it certainly gives results within the market criteria for giving reliable results throughout the sensor lifetime. And that includes being within the 15% margin range as discussed above for the UK market and that without need for fingerprick calibration.

    When evaluating accuracy for sensor-based technology you use a standard defined as Mean Absolute Relative Difference (MARD). Here the Libre scores 11.4%, while just to compare the Abbott FreeStyle Navigator II CGM system scores 12.3% and Dexcom G5 Mobile scored 12.5%. All very good and reasonable results!


    A different metric used to demonstrate the clinical relevance of a glucose monitoring system is known as the Clark Error Grid Analysis (EGA). The grid show the clinical acceptability of glucose monitoring system results based on how close they are to a reference glucose result. The Error Grids have zones from zone A to zone E. Results in zones A and B are considered to be clinically acceptable, whereas results outside of zones A and B may have a negative clinical outcome. The higher the percentage of results in zones A and B, the more clinically accurate the glucose system is.

    The FreeStyle Libre system scored 99.7% within zones A and B.
    Abbott FreeStyle Navigator II CGM system scored 97.7%
    Dexcom G4 reported to be 98.6%3.

    All again excellent results.

    You find a link to the clinical study here:
    https://freestylediabetes.ie/freestyle-thinking/post/accuracy

    For comparison, here is a study of 5 of the classic fingerprick meters on the market:
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3317395/

    And here a study, though on a smallish sample size, on the FreeStyle libre accuracy:
    http://drc.bmj.com/content/5/1/e000320
    The correlation shown in the Clark Error Grid zone A is though very clear and comforting for me to trust the results using this meter on a daily basis.


    Please also notice the diffuse grid lines on bg below around 60 mmol/L, as supporting my notion above that no meter is expected to be trusted with regards to the exact absolute value when measuring hypo levels. I noted btw in the studies that the Freestyle Libre tend to show lower absolute number when in the hypo area, which I will take any day over a meter showing a bit too high when down there. Anyway, if your are LOW - Get some sugar in! ;o)

    Maybe I have been lucky, as we are all unique individuals in this world. But I have repeatedly been able to measure that my Freestyle Libre measurements correlated with my Roche AccuCheck mobile/compact meters. So after going through 8 sensors or so, with less and less check measures that kept confirming, I simply in the end dropped the old fingerprick meter all together. The sticky film Abbott used in the beginning has also been improved, so no rash or anything anymore on the skin below the sensor.

    Its not the cure I want - But I definitely agree with @Jason_Avoneg that its worth every penny!
     
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  17. hlt88

    hlt88 · Member

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  18. Diabeticliberty

    Diabeticliberty · Guest



    The AccuChek Mobile device does not use strips. It uses a cassette. Nor does it utilise a calibration chip. It uses control test solution. If you are happy to implicitly trust your Libre then I hope it brings you much happiness. For my own part I remain sceptical regarding its accuracy or lack of. My own Libre suggests that I have low blood sugars when I clearly do not. This is backed up by my AccuChek Mobile. My AccuChek Mobile is backed up by another AccuChek Mobile. Both are backed up by control test solution. My Libre suggests I have an A1c which is 10 or 12 points below my actual which is provided to me by my GP and / or DSN. Perhaps the Libre is giving me an A1c which is accurate and my doctor has got it wrong. All the evidence that I have available to me suggests that the results from my Libre are highly suspect. There is no other way this can be spun. I have stressed throughout the posts I have put up that my Libre gives me incorrect and inconsistent results. I am not alone with this phenomenon as there appears to be quite a lot of users who experience the same or quite similar issues.
     
    #38 Diabeticliberty, Oct 5, 2017 at 8:45 PM
    Last edited by a moderator: Oct 5, 2017
  19. hlt88

    hlt88 · Member

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    Hi there,

    I read your post with interest. My ds age 20 and diagnosed 3 years ago has gone into complete denial/diabetic burn-out and is not testing. BS and HbA1c are very high. He hates testing - finds it so laborious. He's just gone back to uni after coming home to attend a medical appointment and we've just had a huge row with him as he's not looking after his diabetes. Obviously we are very concerned. Heard that the Libre has been approved for use on the NHS and contacted our local diabetic nurse who advises it is unlikely to be rolled out to all - especially those diabetics that drive because DVLA driving requirements do not accept the Libre test - it has to be a finger prick - therefore patients who drive would require both the Libre but still need test trips and NHS can't fund both. Therefore because my son is a driver, he's unlikely to be considered for the Libre on the NHS. We are at our wits end and although don't have the funds to self fund the Libre on a continuous basis, thought might be able to do it on an adhoc basis. I note you say that the sensors are £25.00 each - but I've just looked on the Abbott website and it says they are £57.95 each lasting 14 days! Please can you tell me where you are getting your sensors from for £25.00. Many thanks in advance. Kind regards.
     
  20. Celsus

    Celsus Type 1 · Well-Known Member

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    I am sorry DL, I forgot I moved through many Roche meters through the years, think the last ones were Roche AccuCheck 'Compact' and then the last being the 'Mobile'. So yes, you have a control test solution. But it has nothing to do with calibrating the device. As you cant calibrate them.
    In any case, I am sad to hear the Libre system does not appear to work correctly for you. I think you mentioned that you even tried many sensors over a very long period of time, so you certainly gave it the chance to show its value. When 'consistently showing a lower bg value' versus classic meter. How much lower and was it throughout the scale from e.g. 4mmol/L to 12mmol/L?
    I would think the local Abbott rep would be delighted to offer you some attention and further free trial to understand your situation if your measures continuously are off by larger margins.
    The few T1 individuals I know of that have stopped using the Libre gave the reasons: Costing too much and/or the sensor generated too much irritation on the skin. Some of those have come back now with good results after Abbott improved the glue patch.
     
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