Recent Posts - DAFNE Online

Nov 5, 2014

novorapidboi26 1,819 posts

Topic: Questions for HCPs / Review of BG Diary

if your waking up high, then you should try increasing your bedtime 16..............

do some 3 am tests to confirm its working and to identify the dawn phenomenon if it exists.......... Smile

if you can get your waking result down to a reasonable level, then you will be in a better position to make an AM BI dose change.........

if your carb free most mornings, that's an excellent opportunity to do hourly tests to see what your BI is doing over that time..........

Nov 5, 2014

novorapidboi26 1,819 posts

Topic: General Discussion / Insulin Pumps

how old is your pump Helen?

If I remember correctly you had to buy your own pump?

Does that mean you will be getting a new one soon?

It sounds as though your thinking of replacing the pump with a CGM, but obviously that isn't how it works........ Smile

Nov 5, 2014

Shafiq 6 posts

Topic: DAFNE Online Mobile / Can't set QA:CP ratios on iOS

Many thanks Simon
Really appreciated!

Nov 5, 2014

Simon 578 posts

Topic: DAFNE Online Mobile / Can't set QA:CP ratios on iOS

Hi Shafiq,

I've fixed this now as its in the latest version of the app which is now on the App Store (version 2.0.3). Sorry for the inconvenience!

Simon

Nov 4, 2014

BeccyB 50 posts

Topic: General Discussion / How to Remember If You've Done an Injection

I'm _exactly_ like you Teanosugar!

Thanks for starting this thread asI didn't think there was a 'memory' Novopen available - I'm getting straight on to my DSN!! Very Happy

Nov 3, 2014

Shafiq 6 posts

Topic: DAFNE Online Mobile / Can't set QA:CP ratios on iOS

Thanks Chris!

Nov 3, 2014

Chris Salter 8 posts

Topic: DAFNE Online Mobile / Can't set QA:CP ratios on iOS

Hi, I emailed the developer Simon about this. It appears to be a problem with iOS 8 and is due to be fixed soon!

I hope this helps!

Chris

Nov 3, 2014

Chris Salter 8 posts

Topic: Questions for HCPs / Review of BG Diary

Hi guys, fairly new to DAFNE and have made a few changes to my insulin, but am still not quite right. I recently reduced my lunch ratio from 1.5:1 to 1.25:1 as was having hypo sometime between afternoon and tea, but still feel my morning to lunch sugar is too high! I rarely have breakfast, so can only think of increasing my am BI to 16??? Any thoughts???

Nov 3, 2014

hypo 18 posts

Topic: Carbohydrate Counting / Jelly Babies

It's Jelly Babies for me 2 is usually enough and Bassett's are lovely and like Alan says they are a treat It's a good job it is only occasionally they are needed

Nov 3, 2014

BeccyB 50 posts

Topic: General Discussion / Cyborg Times (new BG meter)

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

Nov 2, 2014

marke 681 posts

Topic: General Discussion / Cyborg Times (new BG meter)

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.

Nov 1, 2014

HelenP 218 posts

Topic: General Discussion / Insulin Pumps

Hi,

Has anyone in Australia ventured to CGMs?

What is the total cost?
What is the learning curve...and who teaches you?
What is the upside? Downsides?

My pump runs out of guarantee in a few months and am thinking of going with a CGM (also thinking of changing manufacturers!).Have not had a happy experience with the two diabetic educators I have tried and am cautious of this next step. Both CDEs were more interested in building up a client base that they saw every month rather than "educating" you about your pump and how to work with it. AAARRRRGGGHHHHHHHHH!

Helen

Nov 1, 2014

SimonC 78 posts

Topic: Carbohydrate Counting / Packaged food without total weight

Moray Nairn said:
Has anyone else been UNBELIEVABLY annoyed by pacakaged foods which have the nutritional content included per 100g, but then fail to even report the weight of the item which is being sold?!!!

I'm looking at a range of Tesco cakes, and there are brownies and millionaire shortbread and rocky roads - all of which are high in carbohydrate, and I can see that the CHO content varies from 50 to 70g per 100g. Great. Now I can go ahead and estimate my carbohydrate consumption... but no, actually I can't because I have no idea how much of the food is in the package! There are 22 slices of millionaire shortbread, and there are the mini-nutritional content on teh front showing the calorie and fat content per unit, but not the carb. So I can laboriously calculate the per item carb content by figuring out what proprotion of the total calorific value each individual slice is, and then applying that ratio to the total carbohydrate content of the whole package!

Annoying. I had thought that all food products had to have a record of the total weight of each package, but perhaps not......

Moray - I agree, I find it extremely irritating that when you pick up something and there is the total per 100g but no total weight of the item - I am perfectly capable of doing a small bit of maths, but I need the info to work with.

What I also find bizarre is that - and again this was tesgrots but it's not exclusive to them, I picked up one packet of sandwiches to see the CHO, and they had them per pack - great, but a different flavour - in the same range, only had per 100g and no total weight. The problem was didn't really fancy the first one, and would have preferred the second, but had no idea what the CHO content was.

I accept that someone will say, then don't buy at Tesco's then, but what about my ability to choose what I would like - and on this occasion there were no other stores within 30 mins walking and I was on a lunch break on a course and only had 45 mins - so was stuck at Tesgrots. Also this isn't limited to just them - nearly all the big stores do this on some of their items - and IT IS REALLY annoying.

Nov 1, 2014

Garry 328 posts

Topic: Carbohydrate Counting / Packaged food without total weight

I sympathise. Some people find the necessary maths too difficult to do and make Carbohydrate intake errors as a result.
I've complained in the past about alcoholic drinks which show an alcohol unit value but no CHO value.
Now I see that there is a media supported push to get calorific values on drinks labelling.......but still no support for us. It really hacks me off. There are some 400,000 type 1s in the UK now. Surely we warrant some support.
Regards
Garry

Nov 1, 2014

NilesCrane 5 posts

Topic: General Discussion / Insulin Pumps

Have been informed on diabetessupport message board that the cellnovo pump is available on NHS so I'm still not sure. I'll ask my diabetic nurse when I see her later this month. I keep you informed.

Oct 31, 2014

NilesCrane 5 posts

Topic: General Discussion / Insulin Pumps

Cheers. I saw a video on Youtube - John from Swansea but don't know if he got his on the NHS.

This is the link :
http://www.youtube.com/watch?v=yO3_tIkrLww&edit=vd

Oct 31, 2014

Moray Nairn 3 posts

Topic: Carbohydrate Counting / Packaged food without total weight

Has anyone else been UNBELIEVABLY annoyed by pacakaged foods which have the nutritional content included per 100g, but then fail to even report the weight of the item which is being sold?!!!

I'm looking at a range of Tesco cakes, and there are brownies and millionaire shortbread and rocky roads - all of which are high in carbohydrate, and I can see that the CHO content varies from 50 to 70g per 100g. Great. Now I can go ahead and estimate my carbohydrate consumption... but no, actually I can't because I have no idea how much of the food is in the package! There are 22 slices of millionaire shortbread, and there are the mini-nutritional content on teh front showing the calorie and fat content per unit, but not the carb. So I can laboriously calculate the per item carb content by figuring out what proprotion of the total calorific value each individual slice is, and then applying that ratio to the total carbohydrate content of the whole package!

Annoying. I had thought that all food products had to have a record of the total weight of each package, but perhaps not......

Oct 31, 2014

Moray Nairn 3 posts

Topic: General Discussion / Insulin Pumps

As far as I know, the Cellnovo pump is only available as part of clinical trials. The company has had "issues" in getting the NHS to approve it due to the increased cost. I'd choose it in a flash if it was available

Oct 31, 2014

Moray Nairn 3 posts

Topic: General Discussion / Cyborg Times (new BG meter)

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.

Oct 31, 2014

Garry 328 posts

Topic: General Discussion / QA ratios on the weekend

Upping your Background Insulin for the weekend is unlikely to help and you may find that it upsets your Monday/Tuesday/Wednesday results as most of us find BI changes are notoriously slow to show an impact.
Far better to adjust your QA insulin ratios for the weekend.
Regards
Garry

Oct 30, 2014

mum2westiesGill 502 posts

Topic: General Discussion / BG diary help please (2) (mum2westiesGill diary)

Thank you very much for this.

Evening meal on the 29th was minced beef casserole (minced beef,onions, tinned carrots & tinned peas all thrown in), pastry ( the ready rolled puff pastry) & mashed potatoes (a small portion)

If I can I will try to do another test tonight

Not got to the daytime testing yet eeeeek!

Oct 30, 2014

novorapidboi26 1,819 posts

Topic: General Discussion / BG diary help please (2) (mum2westiesGill diary)

As long as you feel comfortable at a higher level then you still do a basal test, it will still show what that dose of BI is doing.......16.4 is a wee bit high, but you done it anyway, so valuable data none the less.......

what was your evening meal on the 29th? I can make out pasta, mash and pastry also with the mention of minced beef, which could have been fatty, which in turn may have extended the digestion time of the whole meal which may have already been quite high in carbs already....

I believe this meal may have had an effect past the time of your basal test commencing, 22:59, as it was only 4h 15 m......

When I test my background, I would be looking to get 2 consecutive days minimum with a small carb dinner on both nights with no food or insulin after dinner.......

this will give you the most reliable results from which to make a dose change from............try again tonight maybe.....?

DAFNE teaches to only analyse one thing at a time, which is right, but you can also try doing carb free basal testing during the day if you have time.....

Oct 30, 2014

BeccyB 50 posts

Topic: General Discussion / Insulin Stacking

That's really useful Gemsa, thanks!

I tend to eat little and often and worry about how much insulin is still in my system when I test my BG so this will come in very handy Smile


Nov 5, 2014 novorapidboi26 1,819 posts	Topic: Questions for HCPs / Review of BG Diary if your waking up high, then you should try increasing your bedtime 16.............. do some 3 am tests to confirm its working and to identify the dawn phenomenon if it exists.......... if you can get your waking result down to a reasonable level, then you will be in a better position to make an AM BI dose change......... if your carb free most mornings, that's an excellent opportunity to do hourly tests to see what your BI is doing over that time..........

Nov 5, 2014 novorapidboi26 1,819 posts	Topic: General Discussion / Insulin Pumps how old is your pump Helen? If I remember correctly you had to buy your own pump? Does that mean you will be getting a new one soon? It sounds as though your thinking of replacing the pump with a CGM, but obviously that isn't how it works........

Nov 5, 2014 Shafiq 6 posts	Topic: DAFNE Online Mobile / Can't set QA:CP ratios on iOS Many thanks Simon Really appreciated!

Nov 5, 2014 Simon 578 posts	Topic: DAFNE Online Mobile / Can't set QA:CP ratios on iOS Hi Shafiq, I've fixed this now as its in the latest version of the app which is now on the App Store (version 2.0.3). Sorry for the inconvenience! Simon

Nov 4, 2014 BeccyB 50 posts	Topic: General Discussion / How to Remember If You've Done an Injection I'm _exactly_ like you Teanosugar! Thanks for starting this thread asI didn't think there was a 'memory' Novopen available - I'm getting straight on to my DSN!!

Nov 3, 2014 Shafiq 6 posts	Topic: DAFNE Online Mobile / Can't set QA:CP ratios on iOS Thanks Chris!

Nov 3, 2014 Chris Salter 8 posts	Topic: DAFNE Online Mobile / Can't set QA:CP ratios on iOS Hi, I emailed the developer Simon about this. It appears to be a problem with iOS 8 and is due to be fixed soon! I hope this helps! Chris

Nov 3, 2014 Chris Salter 8 posts	Topic: Questions for HCPs / Review of BG Diary Hi guys, fairly new to DAFNE and have made a few changes to my insulin, but am still not quite right. I recently reduced my lunch ratio from 1.5:1 to 1.25:1 as was having hypo sometime between afternoon and tea, but still feel my morning to lunch sugar is too high! I rarely have breakfast, so can only think of increasing my am BI to 16??? Any thoughts???

Nov 3, 2014 hypo 18 posts	Topic: Carbohydrate Counting / Jelly Babies It's Jelly Babies for me 2 is usually enough and Bassett's are lovely and like Alan says they are a treat It's a good job it is only occasionally they are needed

Nov 3, 2014 BeccyB 50 posts	Topic: General Discussion / Cyborg Times (new BG meter) 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 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 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!

Nov 2, 2014 marke 681 posts	Topic: General Discussion / Cyborg Times (new BG meter) 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.

Nov 1, 2014 HelenP 218 posts	Topic: General Discussion / Insulin Pumps Hi, Has anyone in Australia ventured to CGMs? What is the total cost? What is the learning curve...and who teaches you? What is the upside? Downsides? My pump runs out of guarantee in a few months and am thinking of going with a CGM (also thinking of changing manufacturers!).Have not had a happy experience with the two diabetic educators I have tried and am cautious of this next step. Both CDEs were more interested in building up a client base that they saw every month rather than "educating" you about your pump and how to work with it. AAARRRRGGGHHHHHHHHH! Helen

Nov 1, 2014 SimonC 78 posts	Topic: Carbohydrate Counting / Packaged food without total weight Moray Nairn said: Has anyone else been UNBELIEVABLY annoyed by pacakaged foods which have the nutritional content included per 100g, but then fail to even report the weight of the item which is being sold?!!! I'm looking at a range of Tesco cakes, and there are brownies and millionaire shortbread and rocky roads - all of which are high in carbohydrate, and I can see that the CHO content varies from 50 to 70g per 100g. Great. Now I can go ahead and estimate my carbohydrate consumption... but no, actually I can't because I have no idea how much of the food is in the package! There are 22 slices of millionaire shortbread, and there are the mini-nutritional content on teh front showing the calorie and fat content per unit, but not the carb. So I can laboriously calculate the per item carb content by figuring out what proprotion of the total calorific value each individual slice is, and then applying that ratio to the total carbohydrate content of the whole package! Annoying. I had thought that all food products had to have a record of the total weight of each package, but perhaps not...... Moray - I agree, I find it extremely irritating that when you pick up something and there is the total per 100g but no total weight of the item - I am perfectly capable of doing a small bit of maths, but I need the info to work with. What I also find bizarre is that - and again this was tesgrots but it's not exclusive to them, I picked up one packet of sandwiches to see the CHO, and they had them per pack - great, but a different flavour - in the same range, only had per 100g and no total weight. The problem was didn't really fancy the first one, and would have preferred the second, but had no idea what the CHO content was. I accept that someone will say, then don't buy at Tesco's then, but what about my ability to choose what I would like - and on this occasion there were no other stores within 30 mins walking and I was on a lunch break on a course and only had 45 mins - so was stuck at Tesgrots. Also this isn't limited to just them - nearly all the big stores do this on some of their items - and IT IS REALLY annoying.

Nov 1, 2014 Garry 328 posts	Topic: Carbohydrate Counting / Packaged food without total weight I sympathise. Some people find the necessary maths too difficult to do and make Carbohydrate intake errors as a result. I've complained in the past about alcoholic drinks which show an alcohol unit value but no CHO value. Now I see that there is a media supported push to get calorific values on drinks labelling.......but still no support for us. It really hacks me off. There are some 400,000 type 1s in the UK now. Surely we warrant some support. Regards Garry

Nov 1, 2014 NilesCrane 5 posts	Topic: General Discussion / Insulin Pumps Have been informed on diabetessupport message board that the cellnovo pump is available on NHS so I'm still not sure. I'll ask my diabetic nurse when I see her later this month. I keep you informed.

Oct 31, 2014 NilesCrane 5 posts	Topic: General Discussion / Insulin Pumps Cheers. I saw a video on Youtube - John from Swansea but don't know if he got his on the NHS. This is the link : http://www.youtube.com/watch?v=yO3_tIkrLww&edit=vd

Oct 31, 2014 Moray Nairn 3 posts	Topic: Carbohydrate Counting / Packaged food without total weight Has anyone else been UNBELIEVABLY annoyed by pacakaged foods which have the nutritional content included per 100g, but then fail to even report the weight of the item which is being sold?!!! I'm looking at a range of Tesco cakes, and there are brownies and millionaire shortbread and rocky roads - all of which are high in carbohydrate, and I can see that the CHO content varies from 50 to 70g per 100g. Great. Now I can go ahead and estimate my carbohydrate consumption... but no, actually I can't because I have no idea how much of the food is in the package! There are 22 slices of millionaire shortbread, and there are the mini-nutritional content on teh front showing the calorie and fat content per unit, but not the carb. So I can laboriously calculate the per item carb content by figuring out what proprotion of the total calorific value each individual slice is, and then applying that ratio to the total carbohydrate content of the whole package! Annoying. I had thought that all food products had to have a record of the total weight of each package, but perhaps not......

Oct 31, 2014 Moray Nairn 3 posts	Topic: General Discussion / Insulin Pumps As far as I know, the Cellnovo pump is only available as part of clinical trials. The company has had "issues" in getting the NHS to approve it due to the increased cost. I'd choose it in a flash if it was available

Oct 31, 2014 Moray Nairn 3 posts	Topic: General Discussion / Cyborg Times (new BG meter) 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.

Oct 31, 2014 Garry 328 posts	Topic: General Discussion / QA ratios on the weekend Upping your Background Insulin for the weekend is unlikely to help and you may find that it upsets your Monday/Tuesday/Wednesday results as most of us find BI changes are notoriously slow to show an impact. Far better to adjust your QA insulin ratios for the weekend. Regards Garry

Oct 30, 2014 mum2westiesGill 502 posts	Topic: General Discussion / BG diary help please (2) (mum2westiesGill diary) Thank you very much for this. Evening meal on the 29th was minced beef casserole (minced beef,onions, tinned carrots & tinned peas all thrown in), pastry ( the ready rolled puff pastry) & mashed potatoes (a small portion) If I can I will try to do another test tonight Not got to the daytime testing yet eeeeek!

Oct 30, 2014 novorapidboi26 1,819 posts	Topic: General Discussion / BG diary help please (2) (mum2westiesGill diary) As long as you feel comfortable at a higher level then you still do a basal test, it will still show what that dose of BI is doing.......16.4 is a wee bit high, but you done it anyway, so valuable data none the less....... what was your evening meal on the 29th? I can make out pasta, mash and pastry also with the mention of minced beef, which could have been fatty, which in turn may have extended the digestion time of the whole meal which may have already been quite high in carbs already.... I believe this meal may have had an effect past the time of your basal test commencing, 22:59, as it was only 4h 15 m...... When I test my background, I would be looking to get 2 consecutive days minimum with a small carb dinner on both nights with no food or insulin after dinner....... this will give you the most reliable results from which to make a dose change from............try again tonight maybe.....? DAFNE teaches to only analyse one thing at a time, which is right, but you can also try doing carb free basal testing during the day if you have time.....

Oct 30, 2014 BeccyB 50 posts	Topic: General Discussion / Insulin Stacking That's really useful Gemsa, thanks! I tend to eat little and often and worry about how much insulin is still in my system when I test my BG so this will come in very handy