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Question about the Libre CGM device.

TheBigNewt

Well-Known Member
Messages
1,167
Location
USA
Type of diabetes
Type 1
Treatment type
Insulin
This isn't available in the US. Somewhere I read that it will not alert the wearer when their BS head low. In contrast the Dexcom that my friends' kid uses will ring his cell phone if the BS drops below 75 (about 4.0). Since I see the main advantage of wearing a relatively expensive CGM to be to avoid nocturnal hypoglycemia, especially in kids, if the Libre doesn't offer that what good is it and why would anyone prefer it over Dexcom? Someone also said they had to buy a separate unit to monitor the results. Doesn't it transmit to a cell phone, or multiple (parents) cell phones?
 
You're right, the Libre doesn't monitor and alert you in the same ways that a CGM does - it's technically called a 'Flash' Glucose Monitor as it only gives a result when you flash/scan it.

There are definitely advantages of using it though. It still means less holes in your fingers and a much clearer picture of the patterns in your results, including those hidden ups and downs that occasional finger sticks can miss. It also allows a parent to scan the child while they are sleeping to put their mind at rest rather than waking them up and forcing them to test. It is also cheaper than the dexcom (although there is a debate over extending the life transmitters etc that may change that) so while it has fewer advantages it is the best option some people can afford unfortunately.

And you can now scan using an Android phone rather than a separate device but I don't know if it's setup to share your results or not.
 
OK so it does trends, and it's cheaper. Still if I had a kid I'd rather they use Dexcom especially during sleep. They only wake you up if you go below 75 (4.0) I think and maybe you can change to alert number.
 
Lorraine1973 said:
Who bases their bolos from the Libre or do you finger prick?
Click to expand...
My diabetic nurse told me to use my Accu-Chek Aviva Expert before meals to bolus. I have to finger prick when I'm 3.9 or below and I have to finger prick before meals.
 
TheBigNewt said:
OK so it does trends, and it's cheaper. Still if I had a kid I'd rather they use Dexcom especially during sleep. They only wake you up if you go below 75 (4.0) I think and maybe you can change to alert number.
Click to expand...

Sure, if I had a T1 kid, I'd likely go for Dexcom or Medtronic because of the alarm, but the plain truth is that not everyone can afford those.

Pricing of Dexcom can work out similar to Libre but only if sensor life can be squeezed out longer than recommended by the makers and that doesn't work for everyone.

As it happens, www.ambrosiasys.com is due to launch a libre transmitter at the end of April for a one-off cost of 110 dollars for their nightrider version. The main site doesn't say it but their twitter site says it will do low/high alerts - see post on March 20. If that's correct, and it actually works, then there's not going to be that much difference between libre and dexcom.

https://mobile.twitter.com/ambrosia_sys?lang=en

In the day time, no alerts on the libre aren't a problem at all.

Scanning is so easy it just becomes a habit. I've had quite a few situations where I scan, see the general direction it's going, see the downward arrow which appears when it reckons it's in the process of dropping rapidly, and I'll think about whether to have 5 or 10g. I've headed off plenty of possible hypos before they have even happened.

And take the occasional 1 or 2 u correction if it turns out my last bolus was underestimated, before it gets too high.

The general ability to steer it in a proactive way rather than responding once it's already too high or low makes strips feel like the Stone Age even without alerts.

Sure, night alerts would be great, but the reality is a lot of night hypos have their origins in what happened in the last few hours while awake, so being able to see what's going on before going to sleep provides a lot of steers.

It's made CGM available to a lot of people who wouldn't otherwise have it.
 
Lorraine1973 said:
Who bases their bolos from the Libre or do you finger prick?
Click to expand...

It's not recommended, but I've been bolusing from the libre without a blood test quite a lot over the last few months.

I've been finding over the last few sensors that if I activate a new sensor at a point where my sugars are stable and the difference between blood glucose and interstitial fluid glucose is likely to be quite close (for me, that's normally when I wake up), the sensor will be pretty accurate for the 14 days, to the point where I've become comfortable bolusing from it.

Looking back over my meter records for the last few weeks, there's a few days where I've done 5 tests a day, but the vast majority of them have been only 2 or 3, and on a couple only 1.

It's not really that different to Dexcom which will need a couple of calibrations a day anyway.

I've been using it for about 8 or 9 months, now, which I suppose might make a difference in the sense of getting used to it's quirks, but it eventually reached a point where I'd be testing before bolus and thinking what was the point in doing that, it's close enough to make no difference. The times when I do tests are when a gut feel tells me there's something not quite right here, or I just want to generally calibrate it.

I've maybe just had a run of good luck with a good batch of sensors, so maybe it'll change in the future.

I don't drive so there's no DVLA issues involved.
 
TheBigNewt said:
OK so it does trends, and it's cheaper. Still if I had a kid I'd rather they use Dexcom especially during sleep. They only wake you up if you go below 75 (4.0) I think and maybe you can change to alert number.
Click to expand...
As @Scott-C mentioned, it's easy to say that when insurance is paying for the equipment. It's a little more difficult when you're stuck paying several thousand dollars out of your own pocket.

Like you, I'm in the USA and lucky enough to have a Dexcom G5 CGM. Considering my insurance covers the cost at 80%, it's an obvious choice over the Libre, but keep in mind that this is a UK-based site so the majority of members are covered under the NHS
 
Just to weigh on this topic, the biggest turn off for most in the UK is set-up costs. For Dexcom G5, you have to outlay £200 for a transmitter and change it every 3-5 months depending on how you use it. You then need to get two weeks out of a Dexcom sensor for it to be equivalent in cost to a Libre sensor. Since you can use Libre on an Android phone, and it has a "Share"-like capability (LibreLinkUp) you get almost as much data, just not the alarms, and outlay less.

Essentially then, as long as you guarantee two weeks per Dexcom sensor, it only works out as being $1000 annually more expensive.

The other thing to bear in mind is that for a fair number of people, alarms on the Dexcom gear are an absolute nuisance. Many people hate them. A lot of people turn them off. What you get with the libre is continuous data, but at fingerpricking frequency, and that for many is more what they want, rather than the alarming.

So the two systems offer very different things, and for many, the directional and trend data is the main reason for using these things. In that context, why bother with the more expensive solution?
 
Just for info, in the UK neither the Libre or Dexcom is available on the NHS - unfortunately!
 
I love my guardian connect which works to my iPhone. Libre in my over used one arm was running at the end about 2mmol lower than blood readings. The connect in the back or bum is running pretty much 0.1 to 0.2 difference to my blood. It can alert up to 5 people as well, which for parents is really good.

Likely to cost about £475 for a 12 month transmitter and about £35 for a 6 day sensor.
Will be available for self funding patients to order shortly.

Accuracy wise, the Libre was good but because I could only insert in one arm then I think that was a problem to my intestinal fluid after 6 months of it being there. Much easier for the guardian connect and accuracy is actually spot on sometimes....
 

The NHS does not pay for any CGM monitors, they pay for pumps ect, but they feel they do not have enough evidence to offer CGM's on the NHS. I had a Medtronic one when the UK started paying for pumps but that was only because my Paediatrician paid for it via his charity.
 
In exceptional cases CGMs are funded by the NHS. I had funding from one CCG in 2012. I moved and lost funding.
Now due to unusual circumstances I have been awarded funding for 3 months, after this we have to reapply.

There are more patients in my CCG that have gained funding for CGMs due to exceptional circumstances.
Under the freedom if info act you can find out how many Cgms CCG's have funded. I did this prior to asking for my funding.
 


Wrong... it can fund in exceptional circumstances.

It depends on what each CCG has written on their "position statement". This is down to each individual CCG.

I do know one CCG that will fund without exceptional funding requests being made. It is down to Consultants in this CCG.

Type 1's only I think, not sure about insulin dependent T2's.
 
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Not withstanding what @Scott-C has said, I worry about the accuracy of this device. I have just taken a reading via LibreLink which registered 5.9, against the same sensor and Glimp (third party app which also works with the Libre sensor) 5.0 and my OneTouch Select Plus 4.4 (which less than 6 months ago was in sync with my surgeries meter). Maybe its just my intestinal fluid, but I have read several threads where others say the Libre can be out be 1 - 2 mmol. The convenience is brilliant, but if I were Type 1 or Type 2 insulin dependant I would be cautious of this device.

I will post my comparative fasting figure on this thread in the morning.
 
Sorry I do know this but I meant as a general rule!
 
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