Thanks
@GracefulAng; that screenshot is very revealing, in that clearly there is a fault somewhere within either the Libre sensor or the Libre app. I would recommend that Paul seeks a replacement from Abbott and I would expect him to get that replacement.
Weirdly the patient has no mechanism for complaining to the NHS about a failed or failing sensors but must take that complaint direct to the manufacturer Abbott (or Dexcom if their sensors fail). So don't be too surprised if Paul's DSN is not overly helpful; she doesn't have a clear process for dealing with technical problems. If Paul is very lucky she might arrange a single replacement or suggest he changes to a different CGM; but I wouldn't hold my breath while waiting for a rapid solution from his DSN.
I had no CGM for my first 12 months. Then I used Libre for almost 12 months from Feb '21 to Jan '22. I had over 50% failures and initially thought that Libre's quality control was rubbish. However during those 12 months I did get replacements from Abbott for every single failure; I stuck with this thoroughly unsatisfactory situation because I did still appreciate that a poorly behaving Libre was better than no CGM; and even though the displayed nos were frequently useless, the trend arrows were very reliable. If it indicated I was going downwards I was - and I could depend on that info; I had to finger prick a lot to know where I'd got to! But most of all at that time there was no NHS alternative. By rhe end of the 12 months I concluded that my body simply was incompatible with Libre 2, rather than poor quality control by the manufacturer. Many others were getting great results from their Libre 2.
Once the NICE Guidance Note changed and made other CGMs possible for GPs to prescribe, I took advantage of that. Those included, then, the original Dexcom One which was different to Libre in both how the sensor worked and what the app offered. But the net outcome was greater reliability - or rather my body seemed to cope with Dexcom One better. I'm now using Dexcom G7, which is a fair bit more expensive - thanks to my Consultant helping me and getting the Hospital to fund my prescription; G7 is (I think) never funded by GPs. G7 is very reliable for me and I am extremely grateful to have it.
Even though Paul experienced dizziness, while that is far from pleasant it does confirm that Paul does have good hypo awareness. Before CGMs became as available as they are today, those Ds who were insulin dependent had no alternative other than to feel the hypo symptoms, finger prick to confirm they were too low and then treat [the rule of 15: eat 15 gms of fast response foods such as dextrose, lucozade or sweets like jelly babies; then wait 15 mins and finger prick again to get actual confirmation that recovery was happening; if not recovering wait another 15 mins then fp a 3rd time .... and so on]. So CGMs have really vastly improved our lifestyle and with sensible use of the alarms (when they work properly!) hypos can frequently be avoided.
Hence my thoughts about how can the present immediate unreliability of Libre 2 be mitigated against ... perhaps adding the extra app such as Gluroo (and there are others) to supplement existing tech could help. But also to try different tech, such as the recently launched Dexcom One+.
He could, but he has not yet been trained in adjusting his insulin (his diabetes nurse currently does this for him).
I realise this is currently Paul's default position, but this is not a realistic long term solution. The DSNs are very stretched - too few of them and too many Ds needing help. At some point Paul will have to take a greater ownership of his own treatment. This means he has to recognise that if he's going hypo he either has too much insulin on board for a working day in summer or he needs to consume more food and let that food keep his BG topped up. The 3rd option would be less exercise and/or activity; but I think that is not an option - Paul needs to work: not just for the financial return, but for his own self-respect and satisfaction. [Plus, I suspect, for your peace of mind
@GracefulAng. A working Paul is a happier Paul!]
This means Paul must do what almost every person who is insulin dependent has to do and get on with managing his D for himself. He does now know for certain that going hypo is not a pleasant experience - BUT it doesn't mean instant death! So some experimentation (trial and learning) has to be done. On hot work days he needs less insulin. I would try a 10% reduction for a few days and if that helps but not enough I'd try a 2nd 10% reduction. But Paul has to make his own decisions. Also experiment with different types of food. It may be that Paul definitely needs a certain amount of Toujeo to keep himself away from the high teens or low 20s (which will make anyone feel rubbish and "off"); so if he goes low during the working day because of that necessary daily Toujeo, he must snack more. If those snacks are high in fat or protein and give him better protection through the day - fine. He needs to find (trial and learning again) what works for him. I should add always stay well hydrated; drink lots of water or tea - this is great for one's metabolic behaviour.
I am extremely aware that Paul is in an unusual position: clearly got Diabetes but at present managing that by a combination of a single basal insulin of Toujeo and an eating regime more as if he is T2; controlled carb intake - because he has no faster acting bolus insulin to offset carbs eaten. I fully understand that Paul, despite his needle concerns, asked his DSN to move him onto Multiple Daily Injections (MDI). A brave request. I'm also aware that his DSN said not yet - and that medical decision does make sense to me (with no medical qualifications). I believe Paul can make his present treatment plan work - but HE has to get more into understanding what foods are best for him in relation to the unusual basal insulin only and learning about the effect on his D from the activity / weather regime that his work brings.
My non- medical opinion is that on a future date his T3c is likely to worsen and he will eventually be put onto MDI. So the more he can prepare for this scenario by learning and understanding now the easier that future transition will be. That would include learning to carb count; not essential today, but so very helpful in understanding what each meal is bringing to his daily parties!
Anyway, these are my thoughts; I could have it all wrong. I realise I'm talking about Paul and he will read this lengthy ramble. I also realise that if he's working tomorrow he might not get time to go through this thoroughly for a while. I'm fully retired and I still have days when there is too much to do in a single day.
If Paul could post a Libre graph screenshot for yesterday (Wednesday) we might have a fair chance of adding thoughts on how else he might adjust what he did yesterday. The trial and learning is not instant, getting reasonable BG management takes a lot of effort and the returns can be tardy; so don't be disheartened by how slow it all can seem to be! Good luck.
