Cyborg Times (new BG meter)

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sarahg DAFNE Graduate
South East Essex Community Healthcare
29 posts

Hi I have started my kit yesterday, with out a huge amount of success. First sensor appeared to be faulty, as it continually read low, for the first 6 hours. I then contacted abbots who advised to wait a few more hours for the sensor to settle down,and if it did not start to function correctly, wait a total of 24 hours, before speaking to them again, which I have done and was then told that the sensor did appear to be faulty. Thankfully abbots have said they will replace this sensor, and requested me to return this sensor back to them. Getting the sensor off because it had only been for round 25 hours, was a bit of a pain, as the sticker part was still very sticky, hopefully the new one will be easier to remove if it lasts the 14 days . This one does appear to be giving similar results of my normal blood machine which is cool.

stephenbrowne DAFNE Graduate
University Hospitals Birmingham NHS Foundation Trust
37 posts

Hi, I have really appreciated all the helpful contributions and information on this forum. I'm in the early days of learning about this newsystem.
My consultant thought I might find this system helpful as I need to do about 10 blood test a day on my pump. I've been on the system for 48 hours now and have found it very helpful in showing trends especially with exercise. I can scan through a shirt, cardigan and even winter coat. When I first started injectons 47 years ago I was advised to use industrial spirit to sterilise the skin before injections but abandoned this practice quickly as it caused thickening of the skin. I have always used aqueous disinfectants to clean the skin e.g. for inserting pump cannula - Boots anti viral foam hand cleanser is great. However when I applied the first Frestyle libre sensor I didn't use the spirit swab but an antiseptic wet wipe. This was a mistake as it was very difficult to remove the applicator without the sensor coming adrift. I managed to get the sensor to stick with Bostic adhesive in the end! I'll use the spirit swab next time.
I'm seeing my diabetes nurse next week to discuss the system further. One can record one's insulin bolus doses down to 1 unit and a health worker witht the secret code can enable you to record down to 0.5units but as my pump does doses down to 0.1 unit increments I'm able only to record to the nearest 1 unit at present..

BeccyB DAFNE Graduate
NHS Birmingham East and North
50 posts

Mine's on it's way! Am really excited about the potential (and the excuse to build a fantastic spreadsheet to analyse all my results, but I'll be in the minority there I know Laughing Embarassed )

I normally get £100 from grandparents for xmas so that's another couple of sensors, I never thought I'd be wanting to spend xmas money on glucose testing kit! Shocked

Only thing I'm concerned about is getting obsessed with the numbers and resisting the temptation to keep giving tiny correction jabs - may have to consider a pump if that starts!!

Will let you all know how it goes....

Moray Nairn DAFNE Graduate
NHS Lothian
3 posts

Thanks for the blog Mark. I've been very interested in the LIbre since it was first rumoured to be in development some years ago. The main issue which everyone is worrying about is, unfortunately, very unlikely to be resolved under the current climate. Namely, inclusion of Libre sensors on the NHS drug tarriff.
For every clinical product (whether a drug, a device or a test) manufacturers have to submit evidence on the clinical and cost-effectiveness of their new item to EMEA (European Medicines Agency) and/or MHRA (Medicines and Healthcare Products Regulatory Agency). It's more complicated than that actually, but for simplicity, it's relatively easy for a device (like a blood glucose sensor) to obtain a CE mark. It just needs to prove that it is fit for purpose - ie, it does what it says it does and measures blood glucose. It doesn't need to show that it performs better than other devices, or that it is cheaper or more useful. It just does what it does.
Great. Now your product is licensed. However, the NHS has limited funding (as we all know...) so it doesn't allow use of every licensed item available. It carries out its own judgements about what gives best value for money. The way this works is complicated, but to simplify drastically, it's at this point that someone makes a decision about whether a particular drug or device offers incremental benefit to patients. in other words, if a new drug or device comes along, and it outperforms the competition for the same price, it will be approved. If it performs to the same level as the competition but is cheaper, then it will be approved. If it is less effective than the competition then it won't be approved. The complicated situation is where it outperforms the competition but is more expensive. This is what happens with most new products - the extra performance is a result of the years of R&D which pharmaceutical and device manufacturers put into product development, so although they create something better, they need to recoup costs by pricing their new item above the older competitors. There are other factors too, such as generic vs proprietary versions of drugs, but let;s leave that out for now.

For the Libre, while we all think that it's likely to be really exciting and make out lives a lot easier, the authorities will ask - does it perform better at a specific clinical outcome than the competition? If the outcome is point estimation of glucose, then the answer may be no. It probably performs as well. Bearing in mind Mark's comments about variability between the Libre and the fingerprick blood tests, I'm sure the range will be within the required limits for product registration (all meters have a threshold of variability from hospital based gold-standard assay testing which they have to keep within).
The key for us will be to get the NHS to understand that while the Libre is no more effective in measuring glucose than traditional tests and is a lot more expensive, it offers improvements in quality of life and confidence around perception of control. These may be too soft outcomes for the accountants to jump to add it to the tarriff however, and the sooner that clinical trials can be done on long term glucose control using the LIbre, the better. If we can show that after 5 years of continuous testing, HbA1c is kept below targets more consistently than with standard testing, and that overall NHS costs are lower because of a reduction in diabetes-related complications / hypoglycaemia / DKA then the authorities will start to take notice.
Not surpringly, Abbott have rushed this to market, having only achieved their CE certification in Septemener, I think. They are actively pursuing the license for use in children which is where they will hope to breakthrough as an innovative "first in class" product. At present it is only licensed for use in adults >18 years.

Some other points about the system. it is being actively piloted by a number of individuals around the country to gather the kind of user data that Abbott have failed to collect so far, so I do hope that they take note of your comments, Mark. I had heard that the sensor takes a few days to calibrate readings more closely to those which you get from glucose testing, and some users have said that the results improve in consistency towards the end of the 14 day cycle. I'm very interested to see what level of tweaking Abbott make to the technology over time. They may have a massive mountain to climb if patients hold back from trying it out in the expectation that it will get suddenly cheaper in a short period, though that won't happen until the company start to accrue a user-base and some income to offset their expenditure.

Thanks Mark.

marke Site Administrator
South East Kent PCT
669 posts

Update: I am still chasing Abbott for a response on backup of device data but their customer service doesn't seem to have improved since the launch of the device. Working in IT as I do, backups come to be a bit of an obsession so I would really like an answer from them. To remind you it seems to keep all of the data on the device and does not transfer it to the PC. The PC software they provide only works with the device connected to the PC and doesn't appear to transfer the data onto the PC. Yes you can create PDF's but that is not, to me, an acceptable means of backing up my data. The device holds 90 days of data apparently which is a lot to loose if you mis place the meter.

BeccyB DAFNE Graduate
NHS Birmingham East and North
50 posts

Well I'm on day 3 now and loving it!

As others have said, inserting the sensor was ridiculously easy and pain free - I thought I'd done it wrong and it hadn't attached at first as I felt literally nothing! I've only knocked it once, and got my strap caught on it once and neither time did it seem to be any problem. You really do forget it's there most of the time.

On the first day the libre was running approximately 3 mmol/l below my normal meter, and when I dropped low it seemed that the meter's result matched how I felt. I haven't done the comparison since Saturday as I decided to just run with the libre result. I had a hypo last night though and again the libre result was a lower than I actually felt. To be honest I'm not too worried about this at the moment though as I have a horrendous hba1c and rarely test, so just having some info and being able to see when I'm creeping up is enough for the moment Embarassed

I went out on Saturday night and I considered wearing clothes to cover the sensor, or putting a flesh coloured plaster over it (anyone know if this would be ok?) but just went for it in the end. I had one person approach me to say 'excuse me but you have something stuck on your arm' but I just thanked them and said it was meant to be there. I think probably from a distance it just looks like a nicotine patch possibly? And it was great to be able to just slip the libre out my little handbag and do a quick check to see if the wobbles were hypo or alcohol induced Shocked

I haven't tried the software yet but like marke would be concerned at having no ability to store the data on the pc, will be interesting to see what Abbott have to say.

Overall I'm really pleased with it and certainly feel more in control than I ever have before - even though my levels aren't actually controlled yet! Very Happy

BeccyB DAFNE Graduate
NHS Birmingham East and North
50 posts

Bit of an update to the last post - I'm now on Day 5 and the latest Libre result is still about 3mmol/l below my usual meter. I also did blood test using the libre with the same finger prick (I already use a freestyle meter so have the right strips) and interestingly it matched exactly to the 'normal' libre result which could suggest they are right about the shorter delay between the 2 types of reading.

I'm still left with the dilema of which machine do I trust - if the libre says I'm 6.0 do I celebrate at being in target, or correct because I'm probably actually at 9ish. I guess most people would be able to trust their feelings when dropping low and see which machine reflects it, unfortunately I've been uncontrolled for ages so if my results is 3.0 is it a true hypo or just me feeling low at 6.0 because I've been high for so long!! Confused

novorapidboi26 DAFNE Graduate
NHS Lanarkshire
1,800 posts

any meter with a delay [libre, CGM], just seems to be confusing for people...............why would you do it.......

these things are good for getting a good basal insulin delivery, what else........?

BeccyB DAFNE Graduate
NHS Birmingham East and North
50 posts

Is a 5-10 minute delay that relevant generally? If I have to get my kit out and do a blood test I would do it before the food was being served so my kit wasn't on the table in the way, with the FGM being easier and less faff I can scan those few minutes later so they are effectively measuring at the same time...

I can see that if you are doing strenuous exercise or something that will cause a rapid change it could matterl but for the everyday stuff my level a few minutes ago is more than enough info

stephenbrowne DAFNE Graduate
University Hospitals Birmingham NHS Foundation Trust
37 posts

Having been on it for nearly 2 weeks I've found it quite helpful. At times it is within 0.1 mmol/l of the Countour link finger prick result. I find it an advantage that you get a graph as well as an arrow indicating the rate of change of the blood sugar reading , i.e. steady , rising slowly, rising rapidly, falling slowly, falling rapidly. This makes it easy to avoid hypos while exercising as one can take appropriate amounts of rapid release CHO in good time. Usually when sugars are going low I have found the Freestyle libre gives a lower reading than the finger prick so this gives good warning. I have not found the 5-10 min delay much of a problem but I always use a finger prick test before driving or meals.