T2DM Free style libre

[Kaylz]

I use both methods, I do not bolus from the Libre as a difference of 1mmol can mean the difference of an extra half or reduced half a unit of insulin, I do not need to decide as I get prescribed both and my DSN and consultant are happy with the way I manage things but if you don't fit the criteria (which you don't) then they really have no obligation to prescribe you it just because you see it as the best method for you, the hoops people have to jump through to obtain it is unreal and I know many that haven't got it even though they fit criteria and you now no longer fall into any of it

 

[tedlambert]

I use both methods, I do not bolus from the Libre as a difference of 1mmol can mean the difference of an extra half or reduced half a unit of insulin, I do not need to decide as I get prescribed both and my DSN and consultant are happy with the way I manage things but if you don't fit the criteria (which you don't) then they really have no obligation to prescribe you it just because you see it as the best method for you, the hoops people have to jump through to obtain it is unreal and I know many that haven't got it even though they fit criteria and you now no longer fall into any of it

Thanks for your input. Time will tell.

 

[Becka]

My recent HbA1c was 7.4 mmol/mmoL.

Ignore the crossed out bits, I somehow repeatedly misread the above despite even going to the effort of quoting it!

I am sorry to tell you, but you are in a coma! The normal HbA1c range for a non-diabetic person is 30–41 mmol/mol and 7.4 is roughly equivalent to having an average glucose level of 1.5 mmol/L. Not that such averages are usually meaningful given how much the levels change, but to be that low you would have to be severely hypoglycaemic most of the time.

If you mean 4.7% on the older scale, that is 28 mmol/mol (an approximate average of 4.9 mmol/L). This is so far under the recommended target for type 2 diabetics of 6.5% or 48 mmol/mol that you will find it impossible to justify to any G.P. that your diabetes will be dangerously out of control without them prescribing a C.G.M. device.

As for Abbot Laboratories putting out websites and webinars saying how much amazing their product is and how much better it is than anything else, they would say that. They are hardly an impartial source.

Besides, something being the best often has no benefit over something that is just good enough. In most cases the extra provided by something that exceeds a required threshold is just wasted. In some situations it can be harmful. The body keeps glucose levels within a range for a reason, because going too low is more dangerous than too high.

It is still not clear why you need continuous monitoring. You say if you are 9 mmol/L first thing you wait before eating, which is understandable. So why do you need to what you levels were while sleeping. You will go high and low then, because everyone does. But if you are regularly that high in the morning, or while sleeping, how can your HbA1c be so low?

Do you have problems taking oral medications, because there should be a vast range of options between an HbA1c of 4.7% and needing an injectable treatment. Normally that requires having an HbA1c of over 7% (53 mmol/mol) when taking three oral medications.

And the N.H.S. drug tariffs are online, and they pay £35 per sensor. Equivalent to 112 of the most expensive test strips listed on the tariff.

Drug Tariff | NHSBSA

The NHSBSA produces the Drug Tariff each month on behalf of the Department of Health and Social Care.

www.nhsbsa.nhs.uk

 

[trophywench]

Surely Ted's HbA1c is the DCCT equivalent of IFCC 57 ish?

 

[Lucyr]

Surely Ted's HbA1c is the DCCT equivalent of IFCC 57 ish?

Yes I think Becka read it backwards, 7.4% not 4.7%. 7.4% is still within target at my hospital as they’re delighted with anything under 7.5%

 

[Drummer]

but that would mean a Hba1c of almost 60.
No wonder my aspiration to normal numbers seems excessive.

 

[Becka]

Yes I think Becka read it backwards, 7.4% not 4.7%. 7.4% is still within target at my hospital as they’re delighted with anything under 7.5%

So sorry, I have no idea how that happened. I did double check several times because it made no sense and somehow I must have misread it every time. Which is itself rather worrying!

Although a HbA1c of 7.4% though then leads to the question of why medication was discontinued rather than just reduced.

 

[tedlambert]

I really must apologise for getting my figures wrong. Have been T2DM for 19 years, my meter gives me my readings in mmol units. A few years ago the NHS started giving out the HbAc1 results in percentages. Not understanding this measurement I have downloaded a conversion chart. A recent email from my Doctor said I had a reading of 57mmol/mol. Looking at my conversion chart I have a reading of 7.4%. I therefore assumed that this means 7.4 mmol. My FSL also provides an estimated daily Ac1 reading which over a 90 day period is 6.7% (50 mmol/mol).

Notwithstanding this brief T3DM episode, my DSN said whatever I am doing keep on doing it. She also said that she would like every patient of hers to have the FSL flash glucose meter.

On 1st September 2020 Professor ROY TAYLOR from Newcastle University wrote an interesting article in the Daily Mail concerning T2DM. As I understand it, patients who had a gastric band fitted not only lost weight but had a dramatic reduction in their Ac1 levels. I therefore bought his book LIFE WITHOUT DIABETES. At the same time I bought the FSL system.

Using the FSL coupled with the Carbs & Calorie Counter book supported by Diabetes UK I have managed to achieve a reasonable AC1 and 15kg or 2.3 stones weight loss.

In respect of videos and Webinars by Abbot Laboratories, I would recommend that you actually take the time to watch these very informative programs, which by the way are presented by NHS DSN’s.

Moreover on YouTube there are lots of information on how to lose weight. The reason you need to lose weight is because your belly fat is strangling your pancreas and liver.

I would also recommend a course from OpenLearn Free Learning from The Open University

Finally I would like to mention that when I was 4 or 5, I had my tonsils removed. The Surgeon who made his living out of tonsillectomy thought it was a good thing. This is no longer recommended now. Perhaps Health Care professionals don’t want to learn new thing as they might be out of a job!

 

[grovesy]

Well your Nurse is unusual as many not on Hypo causing medication or Insulin , Type 2 don't even get prescribed test strips.

 

[tedlambert]

Well here in Wales you do get prescription test strips.

 

[grovesy]

Well not necessarily in England and I think to in Scotland.

 

[Kaylz]

You aren't entitled per say but it's up to the person in charge of your care whether they do or not and @grovesy your completely correct, my MIL's strips were stopped a couple of years ago even though her treatment regime hadn't changed, also have to bring up that not everyone needs to lose weight so the comment about the video could've been put across a bit better

 

[Becka]

She also said that she would like every patient of hers to have the FSL flash glucose meter.

I am sure that would be a good thing too, but unless you can persuade everyone to pay more in taxes, to do so would mean taking that money away from caring from other health conditions. And for the amount of testing the overwhelming majority of type 2 diabetics would require for good control they are more expensive than prescribing glucometer strips. And most of them do not even get that.

Whilst I can only guess at the numbers, I would assume the majority do not even pay for their own testing, it is easy to get a different perspective on forums but they are only used by a tiny percentage of diabetics. There would need to be something exceptional about someone's situation for them to need continuous monitoring to retain good control.

There are approximately 3.4 million people in the U.K. diagmosed with type 2 diabetes, if everyone was prescribed a Freestyle Libre that would cost the N.H.S. £3.1 billion in sensors. That being the cost of one per person every two weeks at £35. Even if you generously halve the cost due to the level of bulk buying, that is still a lot of money that needs to be found to cover it. And that is not including the around 350,000 type 1 diabetics, of which the majority are also unable to get a C.G.M. prescription because of the cost.

I am not criticizing the technology, it is undoubtably a good thing for those who need to manage their own insulin. The problem for me is your insistence on its necessity, particularly for type 2 diabetics where there is not the immediate danger of ensuring you do not let your levels go too low.

And this seems in part spurred on by webinars which, from the way you come across, seem to make you think it is impossible to get good control any other way. It is a bit worrying that you think health care worked would push bad advice to stay in work, but that a commercial company pushing their products are beyond question. A healthy scepticism of both is reasonable, but such a contrast between the two reactions is quite worrying. It is quite possible, indeed likely, that the recommendation regarding tonsils changed, as is normal in science and medicine, though greater understanding. And that while a Freestyle Libre is a helpful device, it is not a necessity for the majority of type 2 diabetics.

Incidentally, the change in the scale of HbA1c went from using percentages to mmol/mol. The old system was based on a major U.S. trial called the Diabetics Control and Complications Trial, so the percentages are referred to as being DCCT aligned.

However because different countries used different scales, in order to produce an international standard the International Federation of of Clinical Chemistry adopted using a measurement of the number of millimoles of glucose that had bonded with a mole of haemoglobin. So a few years ago the U.K. switched to using that system, although blood test results (at least mine) report both. Personally I was diagnosed towards the end of using DCCT so I tend to prefer percentages.

 

[tedlambert]

I am sure that would be a good thing too, but unless you can persuade everyone to pay more in taxes, to do so would mean taking that money away from caring from other health conditions. And for the amount of testing the overwhelming majority of type 2 diabetics would require for good control they are more expensive than prescribing glucometer strips. And most of them do not even get that.

Whilst I can only guess at the numbers, I would assume the majority do not even pay for their own testing, it is easy to get a different perspective on forums but they are only used by a tiny percentage of diabetics. There would need to be something exceptional about someone's situation for them to need continuous monitoring to retain good control.

There are approximately 3.4 million people in the U.K. diagmosed with type 2 diabetes, if everyone was prescribed a Freestyle Libre that would cost the N.H.S. £3.1 billion in sensors. That being the cost of one per person every two weeks at £35. Even if you generously halve the cost due to the level of bulk buying, that is still a lot of money that needs to be found to cover it. And that is not including the around 350,000 type 1 diabetics, of which the majority are also unable to get a C.G.M. prescription because of the cost.

I am not criticizing the technology, it is undoubtably a good thing for those who need to manage their own insulin. The problem for me is your insistence on its necessity, particularly for type 2 diabetics where there is not the immediate danger of ensuring you do not let your levels go too low.

And this seems in part spurred on by webinars which, from the way you come across, seem to make you think it is impossible to get good control any other way. It is a bit worrying that you think health care worked would push bad advice to stay in work, but that a commercial company pushing their products are beyond question. A healthy scepticism of both is reasonable, but such a contrast between the two reactions is quite worrying. It is quite possible, indeed likely, that the recommendation regarding tonsils changed, as is normal in science and medicine, though greater understanding. And that while a Freestyle Libre is a helpful device, it is not a necessity for the majority of type 2 diabetics.

Incidentally, the change in the scale of HbA1c went from using percentages to mmol/mol. The old system was based on a major U.S. trial called the Diabetics Control and Complications Trial, so the percentages are referred to as being DCCT aligned.

However because different countries used different scales, in order to produce an international standard the International Federation of of Clinical Chemistry adopted using a measurement of the number of millimoles of glucose that had bonded with a mole of haemoglobin. So a few years ago the U.K. switched to using that system, although blood test results (at least mine) report both. Personally I was diagnosed towards the end of using DCCT so I tend to prefer percentages.

I am sure that would be a good thing too, but unless you can persuade everyone to pay more in taxes, to do so would mean taking that money away from caring from other health conditions. And for the amount of testing the overwhelming majority of type 2 diabetics would require for good control they are more expensive than prescribing glucometer strips. And most of them do not even get that.

Whilst I can only guess at the numbers, I would assume the majority do not even pay for their own testing, it is easy to get a different perspective on forums but they are only used by a tiny percentage of diabetics. There would need to be something exceptional about someone's situation for them to need continuous monitoring to retain good control.

There are approximately 3.4 million people in the U.K. diagmosed with type 2 diabetes, if everyone was prescribed a Freestyle Libre that would cost the N.H.S. £3.1 billion in sensors. That being the cost of one per person every two weeks at £35. Even if you generously halve the cost due to the level of bulk buying, that is still a lot of money that needs to be found to cover it. And that is not including the around 350,000 type 1 diabetics, of which the majority are also unable to get a C.G.M. prescription because of the cost.

I am not criticizing the technology, it is undoubtably a good thing for those who need to manage their own insulin. The problem for me is your insistence on its necessity, particularly for type 2 diabetics where there is not the immediate danger of ensuring you do not let your levels go too low.

And this seems in part spurred on by webinars which, from the way you come across, seem to make you think it is impossible to get good control any other way. It is a bit worrying that you think health care worked would push bad advice to stay in work, but that a commercial company pushing their products are beyond question. A healthy scepticism of both is reasonable, but such a contrast between the two reactions is quite worrying. It is quite possible, indeed likely, that the recommendation regarding tonsils changed, as is normal in science and medicine, though greater understanding. And that while a Freestyle Libre is a helpful device, it is not a necessity for the majority of type 2 diabetics.

Incidentally, the change in the scale of HbA1c went from using percentages to mmol/mol. The old system was based on a major U.S. trial called the Diabetics Control and Complications Trial, so the percentages are referred to as being DCCT aligned.

However because different countries used different scales, in order to produce an international standard the International Federation of of Clinical Chemistry adopted using a measurement of the number of millimoles of glucose that had bonded with a mole of haemoglobin. So a few years ago the U.K. switched to using that system, although blood test results (at least mine) report both. Personally I was diagnosed towards the end of using DCCT so I tend to prefer percentages.

I am really surprised that some of you don’t get test strips on prescription. Why don’t you do something about it?

3 years ago I woke up and my eye was completely opaque, it felt like I was looking through a steamed up window. I went to the optician and was diagnosed as Posterior capsular opacification (PCO). The optician told me that all I needed was laser treatment which would take only seconds to do. Unfortunately there was a 10 month waiting list but I could have it the following week if I paid something like £300.

I went to see my Welsh Assembly member and asked why have I got to wait 10 months with only 1 eye working. He wrote to the CEO of the Health Board and she telephoned me to say there had been a mistake, I was a priority case, a cancellation had occurred the following week and an appointment was made.

Thanks Becka for the facts and figures you provided. Into the equation must be the NHS bulk buying the FSL. Also better management of diabetes might ameliorate the complications of diabetes.

 

[tedlambert]

I am really surprised that some of you don’t get test strips on prescription. Why don’t you do something about it?

3 years ago I woke up and my eye was completely opaque, it felt like I was looking through a steamed up window. I went to the optician and was diagnosed as Posterior capsular opacification (PCO). The optician told me that all I needed was laser treatment which would take only seconds to do. Unfortunately there was a 10 month waiting list but I could have it the following week if I paid something like £300.

I went to see my Welsh Assembly member and asked why have I got to wait 10 months with only 1 eye working. He wrote to the CEO of the Health Board and she telephoned me to say there had been a mistake, I was a priority case, a cancellation had occurred the following week and an appointment was made.

Thanks Becka for the facts and figures you provided. Into the equation must be the NHS bulk buying the FSL. Also better management of diabetes might ameliorate the complications of diabetes.

DIABETES BLOG​

Recommendations, testimonials and useful information for a better management of your diabetes​

WEIGHING UP THE COSTS OF DIABETES​

Disclaimer – The authors views are entirely her own and may not reflect the views of Abbott Diabetes Care

There’s no such thing as a free lunch. Most

people with type 2 diabetes and everyone with type 1 need devices and medicines to help control their blood sugar – and those have to be paid for. I’ve worked in many countries, and it never ceases to amaze me how lucky we are in the UK to have the NHS. Even if you pay prescription charges (and people taking medicines for diabetes don’t), the NHS covers the vast majority of the cost of tablets, monitoring equipment and injections. The NHS provides regular eye screening for everyone with diabetes – one of the only countries in the world to offer this screening service for all. Nobody has to go to an NHS outpatient appointment with their cheque book handy.
80% of the NHS spending on diabetes goes on managing complications1 – and this is precisely what medicines are designed to prevent. So if a medicine will prevent those costly complications down the road, it’s a worthwhile investment. After decades with only a handful of drugs available to keep blood sugar controlled, the last few years have seen an explosion in new options. Some have fewer side effects, so more patients will stick with them; some are more effective at lowering blood sugar.
But all new drugs are bound to be more expensive than older ones. Pharmaceutical companies invest hundreds of millions of pounds to get a single medicine licensed, and the 20 year patent period, during which they have exclusive rights to produce it, helps recoup the cost of drug development
So in 2010 the Government announced a new system of ‘value based medicines’2 – they weigh up the cost of medicines against how much they improve quality of life, reduce complications or save lives. This calculation works out the ‘cost per QALY’ (Quality Adjusted Life Year). Although it has to be done at a population level – the human and financial cost to one person getting a side effect can be huge, even if it’s extremely rare – these calculations are the best way we have of deciding if medicines offer value for money. They’re about looking beyond the upfront costs and recognising that just because a drug is cheap, it won’t be cost effective if it doesn’t work well.
But people aren’t statistics – they’re people. The NHS also recognises that everyone has different risks, preferences and concerns. One person might see a side effect as unacceptable; another would say the same side effect was a small price to pay for better long term health. If you have concerns over your medicines, tell your doctor why – they’re not mind-readers, but if they know what matters to you, they just might have a better solution.

References
1.Diabetes UK (2014) State of the Nation: challenges for 2015 and beyond. http://www.diabetes.org.uk/Documents/About Us/What we say/State of the nation 2014.pdf accessed 04.03.2015
2.Equity and excellence: Liberating the NHS, Department of Health, Jul 2010

 

[trophywench]

Had Oxford Uni not done the research project (Farmer et al) some years ago which concluded that too much testing for T2s with no hope of them ever changing anything with their life to change their diabetes progression to complications or anything else, maybe we wouldn't now have T2s unable to get test strips.

How to save the NHS money in one fell swoop.

Until the NICE Guidelines change to heavily emphasize that there are things which T2s can do which can and will help them - then I do not foresee any change for 99% of T2 patients.

 

[tedlambert]

Talked to DVLA today, if not taking insulin now no need to test before driving. Email to GP, took insulin off repeat prescription. Now don’t need to request funding as I can afford FSL 1,2 or 3 (coming soon) every other month.

 

[rebrascora]

Now don’t need to request funding as I can afford FSL 1,2 or 3 (coming soon) every other month.

I don't understand your post? What has changed that you can now afford to fund it yourself?

 

[Kaylz]

I don't understand your post? What has changed that you can now afford to fund it yourself?

I was thinking exactly the same myself! xx

 

[Drummer]

This all seems a bit baffling as I an controlling type 2 on diet and do not need to test - I got that sorted years ago and now know what I can eat, so year on year I have the same Hba1c, and if for some reason I dig out the kit and check, I have normal levels.
My Hba1c is not in line with my meter readings, it is higher, but that is just how it is, and it has always been the same for all the time I have been testing. I can only assume that my glucose goes much higher soon after eating and that puts me at the top end of normal rather than any lowed down - but I aim for normal, and I am close.