D Technology, A day with Flash Monitoring

Melinda Seed writes for Twice Diabetes
Melinda Seed writes for Twice Diabetes

I’ve just spent the last 24 hours with people who also happen to have diabetes, specifically people who blog and/or are active in the diabetes social media space.  We met because Abbott invited us to trial their Freestyle Libre, which has just been approved for use in Australia.  Yes this was a marketing event, no I have not been paid to write about it. My travel and accommodation expenses were covered by Abbott and I was given a reader and 2 sensors but I am under no obligation to blog or otherwise write about or comment on their product.

I offer some information and my very limited experience of it in hopes they may be of interest to readers interested in new technology. The information is relevant in the Australian context, your situation, particularly on reimbursement and price will vary if you’re not in Australia.

What is it?

First thing to say the Libre is not Continuous Glucose Monitoring (CGM).  The Libre is being called flash glucose monitoring-it offers a replacement for blood glucose monitoring not CGM.

When you wave the Freestyle Libre reader (looks the same as the Freestyle Linx glucometer) over the sensor (a disc about the size of a $2 coin inserted in your arm-rather like a pump site),  it downloads your current and past 8 hours worth of glucose readings.  You can do an unlimited amount of readings.

The device measures the glucose in interstitial fluid.  With this particular sensor, the readings of interstitial fluid differs by about 4-5 minutes from your blood glucose reading. We think in terms of blood glucose, but Prof. Stephen Twigg (a Sydney endo) said there is debate as to whether interstitial or blood is the most useful measure.

The reader can be used to test capillary blood glucose using the Optium strips and your favourite lancet device.

The Advantages

You don’t have to prick your finger. I’m pretty ok with finger pricking but sometimes you do get blood splatter and the ends of my fingers are quite speckled & a bit calloused. It just felt kinda cool not to have to do jab to get a reading.

I found it comfortable to wear and painless to insert. The size and discomfort of the CGM I trialled a few years ago was a major downside but this sensor is very neat and you can’t feel it.

IMG_1676 You generate a lot of glucose data without having to do anything. So long as you wave the reader over your arm once every 8 hours your glucose readings every 15 minutes are recorded. It is great to see your overnight glucose readings-really useful to spot hypos or highs without having to wake up to prick your finger.

 

You don’t need to calibrate it with blood glucose readings as you do with CGM.

The sensors last 14 days.

I found the trend arrow really useful additional information when making treatment decisions.

Viewing your glucose readings in a continuous graph is cool.

The Disadvantages

The cost of the sensors is not subsidised.  The reader ($A95) should be reimbursable as a blood glucose monitior IF you have PHI and glucometers are covered in your policy. The sensors are not subsidised under the NDSS, each sensor costs $A95 and lasts 14 days.  Abbott are working hard on getting the product subsidised, so stay tuned.

The sensors last longer than CGM sensors BUT many people ignore the medical warnings and extend the life of their CGM sensors much beyond the recommended 3-4 days.  The Libre sensor shuts off and cannot be used after 14 days. As I don’t use CGM I can’t comment on the cost comparison here.

I’m still experimenting with how comfortable I feel with “accuracy”. The device has been extensively tested and meets safety and efficacy standards but the first 12 hours are less reliable and I found I was reading about 3mmol/l lower on the Libre than my glucometer. I seem to be tracking within 1mmol/l now so will keep an eye on it. One of the attendees at DX2 has been importing the Libre and he says he always inserts the sensor 12 hours before he takes notice of the readings.

Personal Preference Issues

I liked the fact that the device didn’t sound alarms. I have good hypo awareness and good awareness of when I am severely insulin deficient (like if my pump stops working) so I just find the alarms annoying, especially when there is a time lag between me feeling the symptoms and the device telling me.  Many people, especially parents of type 1 kids really value the alarms and built-in pump shut off features of CGM and I understand that. If that’s what you’re looking for then the Libre isn’t for you.

I have been pumping for many years so another device doesn’t bother me, some people may not like wearing the sensor.

Like all D tech, it will be personal preference as to whether this device is more useful to you than other glucose monitoring systems.

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