Re FreeStyle LibreLink . What is a realistic target for maintaining results in target range

[Nick25]

I started this thread 5 months ago and have read the responses with great interest - thank you all .
My own experience using the Libre system is that it has driven my HBA1 level after years at 48- 50 (taking a common sense but fairly relaxed view of hour to hour control ) to current 52 ( whilst supposedly monitoring far more ) so I am not hugely impressed.
It has been useful in providing “ evidence “ to my health advisors of what I have known for 30 years ( but they have consistently ignored) that my average is made up of fairly significant peaks and troughs. I did think being able to monitor them more closely might help reduce those extremes but actually has actually produced far more hypos after overreacting to fast rising readings, followed by fresh highs when I overdo the rescue chocolate. I understand the need to moderate my reactions , but find it hard to watch no reaction as the graph rises steeply through 12 , or sits stubbornly as 3.5 despite chocolate biscuits.
When I explained these issues the consultant merely said that the HbA1 of 52 was fine for my age - and 80% range was ok too and seemed unconcerned about the high / low issues that affect how I now physically feel at some point most days.
Can’t help feeling that medical profession are now relying too much a set of guidelines to base their advice rather than patients personal input.
I have glibly said for some years that I am by far greatest expert on my personal diabetic treatment , and this Libre experience has done little to change that view.

 

[ATLOVART]

Can’t help feeling that medical profession are now relying too much a set of guidelines to base their advice rather than patients personal input.

Hello, you are 100% correct! I feel the same! I'm the most interested person in my disease, and my medic neither has knowledge that the absorption of insulin change with the altitude pressure!

I want to inform that I inject the insulin in muscle in order to have the quickest absorption as well as the complete maximum effect! This is my level of control of the insulin! I really do not care of what the medic says, as they do not feel my body as I feel! I can arrive to hipo and then mentally cope with it until the adrenaline takes effect, in which the level of glucose will raise or maintain during a while!

With diabetes you need to feel your body, for instance, I'm not able to work with 100 as after a while I lose concentration, who checks it's diabetes in base to the aceptonic bodies? The insulin should be in base to the aceptonic bodies instead of only the glicemia!
But really who does it? What is the medic that teaches to do like that?!


My best regards


(Mod edit for safety reasons.)

 

[Deleted member 527103]

@Nick25 I hope you are not using chocolate as your fast acting carbs to treat a hypo. If so, I am not surprised that the LIbre would stay at 3.5. Chocolate is definitely not fast acting due to the high fat content.

That said, the advice is always to check hypo (and hyper) recovery with finger pricks and not to rely on Libre (or any CGM). The reason for this is a couple of the well known limitations of CGMs:
- CGM measure interstitial fluid and apply an algorithm to calculate the BG. Interstitial fluid reacts about 15 minutes behind blood when BGs change. The Libre algorithm takes this into consideration by extrapolating the current trend. This works well most of the time unless the trend changes direction in the last 15 minutes such as recovering from a hypo. IN that scenario, the trend "predicts" the current BG to be deeper for longer.
- CGMs are designed to be most accurate at "normal" levels. Therefore, it is advised to check highs and lows with a finger prick test before treating unless you are experiencing an obvious hypo.

Unfortunately, although experienced users of CGMs are fully aware of these limitations, HCP seem either not to know or reluctant to "confuse" new users.

 

[Antje77]

but actually has actually produced far more hypos after overreacting to fast rising readings

Have you tried finding a pattern to when those steep rises occur?
You may be able to prevent them, instead of reacting to them.

Many of us have found that our food reacts much quicker than our insulin, causing those steep risings (which can then trigger a too early overcorrection with insulin, starting the whole rollercoaster).

There are a couple of approaches that may all work reducing the fast rising after eating.
1. How long before eating do you inject?
If you consistently see a strong rise before dropping again, it can help to inject a bit earlier. That way the insulin and food start to act more or less at the same time.
2. What insulin do you use?
There are now quicker acting insulins on the market, Fiasp (by NovoNordisk, which can be used in a reusable Novopen should you already use this for NovoRapid), and Lyumjev (by Eli Lilly), For some, including myself, those newer insulins work much faster, reducing the peak.
3. If you consistently rise after certain foods, you could consider changing the foods. I know I can't eat a bowl of cornflakes for breakfast or 3 rolls for lunch without getting a sharp peak, no matter what insulin I use. So I choose to eat something else.

With any of those approaches, you'll have to closely monitor of course, to see what works best for you and to prevent lows and highs.

Libre is very good for finding patterns, and trying to find ways to change those patterns.
It's not so good if it triggers you to act too quickly after your last dose.

 

[ATLOVART]

The reason for this is a couple of the well known limitations of CGMs:
- CGM measure interstitial fluid and apply an algorithm to calculate the BG. Interstitial fluid reacts about 15 minutes behind blood when BGs change. The Libre algorithm takes this into consideration by extrapolating the current trend. This works well most of the time unless the trend changes direction in the last 15 minutes such as recovering from a hypo. IN that scenario, the trend "predicts" the current BG to be deeper for longer.
- CGMs are designed to be most accurate at "normal" levels. Therefore, it is advised to check highs and lows with a finger prick test before treating unless you are experiencing an obvious hypo.

Unfortunately, although experienced users of CGMs are fully aware of these limitations, HCP seem either not to know or reluctant to "confuse" new users.

I couldn't be more agreement with this, 100% correct! But I also go a little more further! If you put the libre in a zone with the borderline thickness of hipodermic grease and very near a muscle, the Valor of glucose it is acquired with less delay, also as the libre as a taxation in time, I recommend to use xdrip as it also permits a calibration of the intertesial liquid in relation to your blood glucose.