Relative with Type 2 diabetes needing blood sugar monitor (Libre)

We are currently trying to get our relatives GP to agree to prescribe a blood sugar monitor for the District Nursing Team to use each time they visit (3 times per day) instead of having to prick her fingers, as she is becoming increasingly distressed and agitated about this and we are concerned that she might start to refuse them testing her. We cannot do this ourselves as we live 60 miles away from her. The District Nursing team have also requested this. The GP has turned it down saying she doesn't fit the criteria but we know this is only guidance and that individual cases can be considered. We need some advice about how to get them to understand this is very much a case that should qualify?

Pipp said:

Hi @RedAdmiral18
Can you give more information, please?
Is your relative elderly, and confused, T2 on insulin? Are you seeking a Continous Glucose monitor rather than a standard finger pricking blodd glucose monitor?
In addition to her distress about the carers testing her, how are her blood glucose levels? Are they well managed?

Click to expand...

Hello. She is 79 this year. She had a diagnosis of mixed dementia- vascular and Alzheimer's in 2022. She has 3 visits from the District Nursing team to check blood sugars and to administer insulin. Despite this she often doesn't remember that they have called at all , doesn't remember why they come and insists that she is capable of doing it herself. Her blood sugar levels are very erratic, and, according to the nurses are often dangerously high. The District Nursing team suggested a Continuous Glucose monitor a while ago and we asked the GP then and were told she didn't qualify under the guidelines. The District Nurses have suggested it again as she gets so distressed and agitated. I've looked again at the NICE guidance and it does say that cases can be considered individually, The GP has stated:-

"Unfortunately the ICB stance on this is still the same.
As per BSol ICB policy, T2DM on insulin treatment eligibility:
• Patients with any form of diabetes on haemodialysis and on insulin treatment requiring intensive blood glucose monitoring > 8 times daily, demonstrated on a meter download/review over past 3 months.
• Patients with diabetes associated with cystic fibrosis on insulin treatment.
• For any patient who has a learning disability, which is recorded on their GP Learning Disability register"

As you can see the criteria is quite tight and ............ does not fit BSOL CGM eligibility.

I have requested a phone consultation with this GP but want to get my facts straight first.
Any advice is gratefully received,

lovinglife said:

Keep pushing, when my dad was in his care home he had dementia & T2 on insulin and he was getting the same way, there was a couple of other residents in the same position and they had CGMs. We were starting to go down the path for dad too but sadly he passed before we got to that stage.

One thing my dad taught me was “the squeakiest wheel gets the most oil” so don’t give up

Click to expand...

Thanks for your reply. Sorry to hear about your dad. I'll definitely be squeaking very loudly!!!

Pipp said:

Thanks for this- it clearly states in the guidance that it can be used for people with a cognitive impairment.

Click to expand...

I would say that Mixed dementia is classed as a cognitive impairment.

Yes,! That's what I thought too. The GP just quoted the ICB stance on it.. which is , in my opinion, about keeping costs down and applying a one size fits all approach that doesn't show any flexibility regarding the individual's context. I'm not giving up!