CGM for Type Twos

[BlueArmy]

Interesting read - I guess it's obvious really.

Not sure the NHS can or should afford to do this though, but I wonder if it makes sense to invest in a CGM device personally.

CGM associated with better control in type 2 diabetics receiving basal insulin

A randomised controlled trial showed the effectiveness of CGM in type 2 diabetics using only basal insulin compared with the use of traditional blood glucose monitoring

hospitalhealthcare.com

Findings
A total of 175 participants with a mean age of 57 years (50% women) and with a mean HbA1c level of 9.1% were randomised in a 2:1 fashion to CGM or BGM. After 8 months, the mean HbA1c reduced to 8.0% in the CGM group and to 8.4% in the BGM group (p = 0.02). In the GCM group, the mean percentage of time in the target glucose range was 59% compared to 43% in the BGM group (p < 0.001). Similarly, there was a significantly lower time where glucose levels exceeded 250mg/dl (11% vs 27%, CGM vs BMG, p < 0.01).

In discussing their findings, the authors noted that the greater improvements seen in HbA1c in the CGM group were due to an increased period of time for which glucose levels remained with the target range. Nevertheless, a limitation recognised by the authors was the use of diabetic specialists, which is not standard practice in primary care and that this may have limited the generalisability of their findings. Despite this, they concluded that the use of CGM resulted in superior diabetic control compared with self-monitoring.

 

[Pumper_Sue]

If a type1 one was one of the lucky chosen few to have a CGM provided by the NHS then I would suspect if all they achieved was an A1c of 8% then it would be taken away a lot quicker than it was given. So suspect for type 2's it's a non starter.

 

[BlueArmy]

yeah agreed - the NHS should not provide these to type 2’s. But wonder if its something any diabetic should consider if they want better personal control and if these can be brought privately. I always viewed them as necessary for T1 only.

 

[Lucyr]

yeah agreed - the NHS should not provide these to type 2’s. But wonder if its something any diabetic should consider if they want better personal control and of these can be brought privately. I always viewed them as necessary for T1 only

Note that the participants in the study were on basal insulin only, so they improved a1c without actually being able to adjust much, and so may have had a better improvement if they were on bolus insulin too.

It always feels really unfair to me that T2 can’t have libre funded, even if on MDI. Obviously it wouldn’t work out cost efficient for all T2s but if like me you’re on MDI, testing before and after meals as well as before bed, driving, exercise, it probably works out as cost efficient as it does for T1s. This is why I self fund whenever I am able to manage that.

I especially find them useful as my pancreas does do “something” but what/when it does something useful is pretty random, I have phases where my doses will suddenly halve or double and libre is really useful in transitioning. Also useful for all the usual prebolusing, basal testing, alerting to need a correction, etc.

 

[rebrascora]

yeah agreed - the NHS should not provide these to type 2’s. But wonder if its something any diabetic should consider if they want better personal control and if these can be brought privately. I always viewed them as necessary for T1 only.

Yes, anyone can buy Freestyle Libre sensors or a starter kit and as a Type 2 you will benefit from a lot of the data they provide as long as you don't get overwhelmed by the amount of data and understand that it is not quite the same as BG readings...... But the huge benefit is that you can see what your levels are doing day and night and exactly how specific meals and exercise affect your levels and use it to better tailor your diet and exercise, if that is how you are tackling your Type 2 diabetes. They are expensive though (£100 a month) and would probably only be worthwhile on a short term basis to get your diet sorted. Beware though, they can be addictive and/or cause you to become obsessive. The novelty of being able to scan as many times a day as you like doesn't seem to be wearing off for me. I average about 30 scans a day. Anyway, if you are interested, look at the Abbott Laboratories website as the Freestyle Libre is the cheapest option available I believe. There is lots of information and training available which I would recommend doing if you are thinking of giving it a go.

 

[BlueArmy]

will chexk it out thanks. Sadly i do love a bit of data, wonder if i can claim it back on private medical insurance

 

[Ljc]

Personally I think it would be wonderful ifanyone who is on meds that can cause hypo’s who wanted the Libre , could have them prescribed . Don’t worry I know I am living in cloud cuckoos land.
I also feel that folks with T2 should not be denied glucose meters if they want one and most importantly taught how to use them properly ie , just like we explain on here, cloud cuckoo land again, I know.

 

[grovesy]

will chexk it out thanks. Sadly i do love a bit of data, wonder if i can claim it back on private medical insurance

I doubt private medical insurance would cover as they don't usally cover things like Diabetes.

 

[BlueArmy]

WIll check it out, have some sort of gold standard corporate policy where they cover all pre-existing conditions. Worth a try.

 

[everydayupsanddowns]

Personally I think it would be wonderful ifanyone who is on meds that can cause hypo’s who wanted the Libre , could have them prescribed . Don’t worry I know I am living in cloud cuckoos land.
I also feel that folks with T2 should not be denied glucose meters if they want one and most importantly taught how to use them properly ie , just like we explain on here, cloud cuckoo land again, I know.

Love your optimism @Ljc - I wish the same!

 

[everydayupsanddowns]

WIll check it out, have some sort of gold standard corporate policy where they cover all pre-existing conditions. Worth a try.

We’ve had a few T2s over the years who have self-funded CGM short term, and found them very helpful.

Hope your insurance comes up trumps!

 

[BlueArmy]

We’ve had a few T2s over the years who have self-funded CGM short term, and found them very helpful.

Hope your insurance comes up trumps!

Thank you, will engage them. Have subsequently looked into it and the potential cost of £100 a month just for a sensor is challenging. But I think your point is spot on - use it in a sprint method to complete the learning phase of the journey - say invest for 3 months - keep full diaries, map out how the body reacts to a variety of meals, social situations and exercises and then use that data to plan the journey going forward

 

[rebrascora]

Thank you, will engage them. Have subsequently looked into it and the potential cost of £100 a month just for a sensor is challenging. But I think your point is spot on - use it in a sprint method to complete the learning phase of the journey - say invest for 3 months - keep full diaries, map out how the body reacts to a variety of meals, social situations and exercises and then use that data to plan the journey going forward

Exactly!

 

[BlueArmy]

Exactly!

Turns out Freestyle Libre is offering a free 14 day trial. I've signed up, nothing to lose with a try before you buy approach!

 

[BlueArmy]

So libre sensor arrived and successfully stuck on arm and connected to phone.

Have a question though - anyone know how to link the libre app data to apple health app so I can pull the data over?

 

[Ljc]

I hope you find the Libre helpful. I started using one a few yrs ago when it was believed I was an insulin dependent T2 , the info it gave was a game changer for me, I hope it is the same for you.

 

[helli]

So libre sensor arrived and successfully stuck on arm and connected to phone.

Have a question though - anyone know how to link the libre app data to apple health app so I can pull the data over?

Please remember the limitation before getting frustrated by it.
The main ones I would highlight are
- typically, it takes time to "bed in". If you activate it the same day as you insert it, you may find the first couple of days appear to be very inaccurate. For me, it becomes a random number generator until my body gets used to the alien object inserted into my arm.
- it is less accurate when blood sugars are high or low
- it measures interstitial fluid not blood. It applies an algorithm to make the conversion Interstitial fluid is 10 to 15 minutes behind blood. Libre 2 algorithm has attempted to adjust for this delay but it is not perfect.
- the sensor only stores 8 hours of data which it downloads to your phone when you swipe. This means, if your swipes are more than 8 hours apart, there will be missing data.

Taking on board these limitations, Libre can be very powerful. Ignoring them and it is a waste of a sensor.

 

[BlueArmy]

I'm not frustrated with it, think it's great. Just would like to pull the data into my health app where all my other measurements (blood pressure, steps, active calories, heart rate, heart rhythm, weight etc) lives. I've emailed customer support to ask them.

Got my first alarm, 35 mins after eating 2 slices of wholemeal bread toasted (11g of carb a slice) with some sardines on top (1.2g of carbs) with an alarm level of 8.5mmol, did a prick test which came out at 9.1 (post edit - 15 mins after blood prick test the libre is now reading 8.9!). Seems pretty accurate to me. Although now it seems I should avoid bread full stop, or keep it to 1 slice! That will be tomorrows lunch to check.

 

[Bruce Stephens]

- typically, it takes time to "bed in". If you activate it the same day as you insert it, you may find the first couple of days appear to be very inaccurate. For me, it becomes a random number generator until my body gets used to the alien object inserted into my arm.

Some people find that. Others (like me) find it works fine after the required hour of starting up.

 

[BlueArmy]

Mine seems to be tying up to my BG meter, and worked straight after the hour. I was sent the libre 2 sensor so not sure if that makes a difference, noticed there are two types.

I would say though that their wording around the pain was a little generous, It didn't really hurt as such, but it hurt more than my finger prick needle does contrary to what they say in the setup manual and i had a dull pain in the arm for an hour or so. Nothing to worry about, it would be a 1 on the schmidt index, but, thought it was more noticeable than a pin prick. Guess that won't say that though!