Started Freestyle Libre today

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There are quite a few of us who have been using Libre for a number of years and have shared our experience and lessons on the forum.

CondorX said:

I wonder if it is the sensors that differ or exactly where the needle and sensor end up in the interstitial / subcutaneous tissue.....

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It can be both.

The filament can sometimes be pressed up against a tissue surface, which limits exposure of the sensing part to fluid so it can't measure properly.

Depending on randomness of biology, some filaments can become "biofouled", clagged up with biological detritus, which, again, covers the sensing part.

There's a lengthy article here about the factory calibration libre uses:

https://www.liebertpub.com/doi/full/10.1089/dia.2017.0025

They were overly optimistic about it. Many of us find there are major differences in the reliability of each sensor, which is why regular users are keen on the third party transmitters like blucon and miaomiao ad the related apps xDrip+ and Spike let us calibrate the output by typing in an actual bg reading each day to tell the app that the libre reading of 4.7 is actually 5.5. This tightens up subsequent readings very well, but needs to be done typically once a day as it can still drift.

Version 1 of libre is "batch calibrated", meaning they make a batch of them, then pull a few for calibration against a known glucose concentration, then apply that to all in the batch. Would be fine if they were all identical, but they're not, hence the occasional sketchy sensor. Version 2, out in Germany, UK launch date not known, will be individually calibrated, which will hopefully make a difference. There's been speculation they're already doing this as a trial run with v1 to get production processes figured out - my recent sensors have been pretty spot on but maybe just coincidence.

CondorX said:

Now I wish I also had one of those teccie thingys that send automatic sensor readings!!!! Must confess to always having liked technology, though.......

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If you're planning on using it long term, I'd highly recommend getting a transmitter for it.

Being able to type in a bg reading really tightens up accuracy, and the algorithm also takes care of the lag. I've frequently had readings which are only 0.1 to 0.4 out against a bg test (but, hey, it's technology, so there will be fliers too!).

The graphs are also way more detailed, being composed of blue dots for every 5 min reading, instead of the averaged graph which libre shows.

The first one out was Ambrosia System's Blucon. It's regarded now as a bit "betamax" compared to the newer MiaoMiao, but it's a solid piece of kit and served me well for over a year before I got mm.

Two versions, one waterproof, the other not, and both beat mm price wise, £114 and £86.

If you're prepared to put up with the minor hassle of taking the non-waterproof one on and off for showers, it's a relatively cheap way into cgm.

There's a £7 post office handling fee and £20 import duty but that's reclaimable as it's a medical device, don't have the reclaim form link handy.

https://www.ambrosiasys.com

The newer entrant is MiaoMiao
Pricier at £156 (no handling or import fee), but it's leaner and waterproof. Again, a solid piece of kit, been using it for about five months now.

https://miaomiao.cool/

You can still scan with the reader while using them, and take them on and off during the 14 day duration.

The inhouse apps for both are fairly basic and very few of us use them.

If on android, the preference is for xDrip+, which was originally started by the open source group Nightscout to deal with perceived inadequacies of the early dexcom devices, and has continued to develop as a research project by a bloke called jamorham and other co-developers. It's not authorised by any regulatory body but has a long pedigree and is widely trusted by grateful users worldwide.

https://jamorham.github.io/

https://github.com/NightscoutFoundation/xDrip/releases

Here's an idea of the output:

CondorX said:

Scott-C you must be a mind reader I found a brand new MiaoMiao for sale within the hour....from someone who had signed up to Dexcom and hadn't used it, so its on its way to me......hopefully later this week. The info is amazing via XDrip - am quite excited at the prospect of understanding my glucose levels better using this little transmitter thingy.

Only thing is, what App is available or recommended for iOs? They mention Spike but I can't find it anywhere - I have an iphone 7 Plus and have never used android.
EDIT found it - it's not on the app store. Looks a bit complicated to have to keep resigning it every few days or pay a Developer Licence.

Is Tomato no good?

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Spike is brilliant, but yes, it a bit of a hassle to get installed just now - I have an Apple developer license so only have to resign mine annually. But it only takes five minutes to do once a week if not.

Tomato is ok, but very basic.

CondorX said:

Only thing is, what App is available or recommended for iOs? They mention Spike but I can't find it anywhere - I have an iphone 7 Plus and have never used android.

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Aah, now, there are some issues going on there.

xDrip+ was being developed by the android open source community, a developer, Johan DeGraeve started coding an ios version, iosxdripreader, then he started working with the Spike people, and they came up with this, which is basically an ios version of xdrip, the coders for both apps talk to each other all the time:

https://spike-app.com

It was being used to great effect by ios folks, then a few months ago, Apple threw a big spanner in the works, by revoking certificates. Can't recall the political ins and outs of it, but it seemed that Spike were only paying for inhouse development licences, not licensed for wider distribution.

They were on the point of throwing in the towel, saying that's it, we're done, Spike is finished, but they had a change of heart, and spent a bit of time figuring out workarounds, those seemed to involve temporary certificates which worked for a while.

Some users were buying cheap androids to get round it with xdrip instead.

As I'm not on ios, I lost track of it after a while and am not sure if they have found a long term solution for it.

I was just about to tag @Mel dCP as an experienced Spike user, but I see she's just posted!

There will be a long term solution but it’s going to take many hours of work - and the devs have proper jobs and families on top of doing this, so it’ll take a little while. But we do have a few options to use Spike, they just require a little effort at the moment - but still totally worth it IMO. It’s not in the official App Store because it can be used for therapeutic purposes, and the FDA won’t approve it without them paying vast sums of cash, basically. I need a dev license myself so I can build a closed loop with my pump, but I’d probably have got it just so I can use Spike with no interruptions - I find it that essential to my diabetes management.

Mel dCP said:

Spike is brilliant, but yes, it a bit of a hassle to get installed just now - I have an Apple developer license so only have to resign mine annually. But it only takes five minutes to do once a week if not.

Tomato is ok, but very basic.

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'Get the shields up, Mr Sulu, they've launched the Cydia Impactor."

I have been using the FL CGM for about 4 months and I could not have done what I have without it. A couple of months ago I did a 3-way check between my old Bayer bg strip reader, my FL bg strips (both from the same prick) and the FL sensor 10 minutes later. I found that the Bayer was regularly the highest by up to 1.0. Over 7 days the bg test and sensor readings from the FL had a net total difference of 0.2. That's from more than 70 readings.
With reference to CondorX above, I do find that my left arm reads lower than my right arm. This is quite noticeable as I alternate between arms every 14 days. My thinking about this is that as I am ambidextrous but usually prefer my right hand, my body 'knows' to send more glucose to the muscles on that side. I generally assume that my body naturally knows better than me!
I have my next A1c tomorrow and hope to get to around 6%, down from 6.9% in February. The FL really helps me control the foods I choose within my low carb diet.

If I recall correctly the FL does not give out a BG reading over RDF (to a phone, transmitter or its reader), it gives out the raw data from a few different sensors that then get converted into a BG number by the software in the different devices. They have also not published the code to do this, hence 3rd party software developers have mostly had to work it out by trail and error.

The international standard for "none hospital" BG meter only requires a BG to be within 15% for over 85% of tests, hence without access to a lab, or hospital meter it is very hard to know the true BG value. Also remember BG is different depending where in the body the blood sample is taken.

@CondorX given your work, you may be best placed to get to the bottom of same of this.

My A1C was 6.5. A little disappointing as I was hoping for <6.0 but better than last May (8.5) and February (6.9). It was a fairly warm winter and it has been a cold spring and my bg always goes up when it is colder. Amazing how clever the body is to know that we need more energy to keep warm when it is colder.