Dexcom

[Buttercup1988]

Hello @Buttercup1988,

The CGM market has changed quite a lot in the recent past with some being "higher spec" or more capable and able to help with managing a pump or even Hybrid Closed Loop ( HCL). Hence greater cost variations.

If I were in your position there are 2 CGMs that would suit your husband's possible needs: the Dexcom One+ and the Libre 2. They allow a user to wear a sensor for 10 days or a fortnight respectively, get some insight into what one's BG is doing over that period, then be without a sensor for a period and restart when one next chooses to get further insight. That way your financial commitment is controlled. You might get a cost effective purchase by purchasing more than one at a time; I think Dexcom in particular have deals for buying 3 ( hence 30 days) or 9 (90 days) at a time.

Libre offer a free 14 day trial, with no further commitment and Dexcom might do the same, but don't promote this so publicly.

HOWEVER, I think an initial process of finger prick testing would be well worth doing. Those fps need to be systematic to be truly informative otherwise they really are just random "stabs in the dark". A suitable system would be 1st thing after waking and last thing before going to sleep, which would give some reference or baseline as well as clarity about what is happening during the long fasting period. But also with each main meal immediately before the 1st mouthful and as exactly as is practically possible 2 hrs later.

The 2 hrs is a standard reference duration that allows enough time for the digestion process to start and metabolism to get properly underway - thus to reveal how high (or not) one's BG goes. The immediate target is to find meal types and portion sizes that limits any BG rise to no more than 3 mmol/L in those 2 hrs; preferably a bit less. That clarifies what meals are acceptable to each individual's body. Diabetes may be commonly found in many people, but how each individual metabolises food can be very different from person to person.

The next target is to be able to start a meal at no higher than 7, much better if 5, and ultimately end a meal at no more than 8.5. But this won't necessarily be achievable on day one! The important thing is to make a start at monitoring and use those first readings as markers to improve with time. In due course your husband will acquire knowledge about meals that are fine for him and may be happy to not always take fps for such meals; but should consider fps with a new/different meal type.

A sensor worn for 10 or 14 days allows the user to see more accurately not only what each meal is causing to one's BG but what the BG variation (Glycaemic Variability = GV) across a succession of 24 hr periods. During this sensor period the finger pricking would be much reduced, and really only needed to reassure the user that the CGM is "about right".

CGMs have limitations, they aren't perfect and those of us who are insulin dependent (as I am) and have much greater need for CGM to make our lives easier, tend to know and accept the limitations as part of the process. For us we are very alert to changes, and sensors display trend arrows plus alarms to tell us when a lot of change is happening. For a T2 who is not insulin dependent the daily graphs are the essential bit of a CGM and this can be an expensive aid, in relation to finger prick test.

To convert from the US mg/dl to the European and UK mmol/L units just divide by 18. So 100mg/dl is 5 5 mmol/L. I would expect any test meter purchased in UK to use mmol/L units, but might need a change making in the settings if it opens in mg/dl.

Superb thank you so much !

 

[Buttercup1988]

Thats good... the adverts as usual don't tell the whole story, you need some real world input.

Your husband needs to get his HbA1c down before he can have an op - is that right? Do you know hat his Hba1c is and where he needs to get to? Thats the starting point. You will then have to work out a plan to get it down and use testing to see if your plan is working. OK if it is, but if it is not you will need another plan.

You can do an awful lot for a lot less money by finger prick testing if you work out what you want to find out and test accordingly. A bit more information and I am sure you will get suggestions on how to go forward from the forum.

Your husband would qualify for a free 14 day trial of the Freestyle Libre2 system, provided he has a suitable smart phone. It is important to make sure he has a compatible phone for whichever system you use and Libre has a wider range of compatible phones than Dexcom, so would certainly worth doing the free trial. I find Libre works brilliant for me.
Most basic CGMs work out around the same price of about £100 per month, so yes it is expensive.
It is possible to get useful data from finger prick tests but you need to be systematic about it rather than random testing. What we tend to suggest is to test just before a meal and then 2 hours afterwards. If his levels rose by more than 2-3mmols then he had too many carbs and you need to reduce the portion of carb rich food in that meal (ie bread, potatoes, pasta, rice as well as the obvious sweet stuff that contains sugar.... be they natural from fruit or added sugar) and then test again next time he has that meal with the reduced carb portion. If he still spikes too high afterwards, then it needs more reduction and swap something lower carb for the high carb food. He should not have to go hungry, I like large platefuls of food but it is what is on the plate that is important. I mostly base my meals on meat/fish/eggs/cheese and plenty of vegetables or salad and coleslaw.

Absolutely fantastic help I am very grateful. Thank you.

 

[Leadinglights]

Absolutely fantastic help I am very grateful. Thank you.

You might want to review his dietary approach to help things along and in combination with some strategic testing should have some better outcome in a timely way. Have a look at this link for some ideas but you need to be cautious as he is on one of the 'flosin' meds about too low carb but 130g per day would normally be OK. https://lowcarbfreshwell.com/

 

[Clare153]

I have a slightly different view, and firmly believe that cgm for type 2 are hugely useful and can help a great deal. NICE are considering trials of this I believe, and my local primary care have a small number of libre to try with suitable type 2. Don't know what the suitability criteria will be, but it will be interesting.

The Dexcom 6 is £80 a month on a subscription, which can be cancelled any time.

One eye opening example for me was eating crumpets. Blood sugar was 5 ish before, 14 something 2 hours after. What I wouldn't have known by finger pricking alone was that it continued up to peak at roughly 3 hours post eating, with a blood sugar of 17 plus, and took almost 6 hours more to get back into single figures. I've not touched a crumpet since. And many more lessons like that.

Well worth getting, so long as you can afford it. And learn it's limitations, and let it be a tool not a burden. It's fantastic for learning what food does what to your body. My plan was just to get a couple of months worth to learn with, but I'm sticking with it now.

Oh and finger pricking gets very tedious, very quickly.

 

[Bruce Stephens]

I have a slightly different view, and firmly believe that cgm for type 2 are hugely useful and can help a great deal.

I'm sure eligibility will be widened at least a bit. I can imagine it being worth the money for everyone with diabetes having a sensor for a couple of weeks before a review. I think it's mostly dependent on prices coming down.

 

[Clare153]

I'm sure eligibility will be widened at least a bit. I can imagine it being worth the money for everyone with diabetes having a sensor for a couple of weeks before a review. I think it's mostly dependent on prices coming down.

Yep, and I really think it should be.
NICE unfortunately is concerned with money, so yes I think you are right that it will be dependent in the NHS being able to negotiate on price.
Brilliant tool for type 2's that are taking multiple medications, or are at risk of insulin for example.
There are some articles knocking about that suggest over use may cause anxiety, but nothing causes me more anxiety than the idea of my legs dropping off and going blind.

 

[Proud to be erratic]

@Clare153, I am genuinely supportive of many T2s having a CGM available. But if the self-funding cost is a challenge to someone then fp tests have a really useful place in monitoring.

Also, from my experience the G6 is a 90 day package from the moment it is fitted. The transmitter is wasted if sensors are used intermittently - eg 10 days with and 10 days without. And the G6 is overkill for what a T2 needs to just monitor, when the Dex One+ or Libre 2 provides the same thing for less money. In fact I'd go out on a limb here and say that the Libre 2 logging and subsequent reports available on the LibreLink app is way superior to the Dexcom process. Libre is potentially ideal for a low entry CGM requirement.

 

[Clare153]

@Clare153, I am genuinely supportive of many T2s having a CGM available. But if the self-funding cost is a challenge to someone then fp tests have a really useful place in monitoring.

Also, from my experience the G6 is a 90 day package from the moment it is fitted. The transmitter is wasted if sensors are used intermittently - eg 10 days with and 10 days without. And the G6 is overkill for what a T2 needs to just monitor, when the Dex One+ or Libre 2 provides the same thing for less money. In fact I'd go out on a limb here and say that the Libre 2 logging and subsequent reports available on the LibreLink app is way superior to the Dexcom process. Libre is potentially ideal for a low entry CGM requirement.

You are quite correct that the dexcom 6 is over kill! I meant the Dexcom one, which is £80 a month subscription or can be bought as singles, which might be better for intermittent use?

And I am acutely aware that I am very privileged to be in a position where I can afford it.

 

[Bruce Stephens]

I meant the Dexcom one, which is £80 a month subscription or can be bought as singles, which might be better for intermittent use?

I think Dexcom One needs a transmitter as well as sensors, so using those individually wouldn't make so much sense. I think the newer One+ is sensor-only. (I'm guessing One is a cut down G6 and One+ is a cut down G7, at least I suspect that's how they started.) It's also possible that One+ is replacing One, making the distinction no longer helpful.

 

[Clare153]

I think Dexcom One needs a transmitter as well as sensors, so using those individually wouldn't make so much sense. I think the newer One+ is sensor-only. (I'm guessing One is a cut down G6 and One+ is a cut down G7, at least I suspect that's how they started.) It's also possible that One+ is replacing One, making the distinction no longer helpful.

Yes, I stand corrected once again. Dexcom one + is the one I use.

 

[LieB]

Hi Buttercup,

Welcome to the forum. I’m a Type 2 and not on any meds and have used both Dexcom and Libre patches for some time.

First things first, neither is perfect / some will say they prefer the longevity of Libre 2+ some Dexcom.

Coming onto Dexcom specifically, the One+ if you’re not using a pump is enough. It’s around £79 per month (3 sensors each lasting 10 days and they have a 12 hour grace period once the expire) which is cheaper than the Libre 2+ which is around £103 - both ex VAT as you dont pay VAT if you declare yourself exempt.

There is no difference in the kit you need between the Libre 2+ or Dexcom One+ - a smart Phone and the sensor is all that’s needed. Here in my view the Dexcom is ahead for two reasons:

1) You get an over patch for free
2) The Dexcom can be easily used to send MMOL/l readings to your smart watch without the need for a third party app

Hope that helps.

 

[Lucyr]

The Dexcom can be easily used to send MMOL/l readings to your smart phone without the need for a third party app

Do you mean to your watch? They both send readings to your smartphone.

 

[LieB]

Do you mean to your watch? They both send readings to your smartphone.

Yes I mean a smart watch - that’s what I get typing when on a train! Post corrected above - thank you. I find that particularly useful in the gym so I can see which way my blood sugar is going during different kinds of workout.

It isn’t as good as the G6/G7 but it’s a lot better than the Libre equivalent which tends not to work. There are other apps like ‘Shuggah’ but that has a different blood sugar algorithms to the Libre so you get different results which I personally didn’t find helpful.

 

[Lucyr]

Yes I mean a smart watch - that’s what I get typing when on a train! Post corrected above - thank you. I find that particularly useful in the gym so I can see which way my blood sugar is going during different kinds of workout.

It isn’t as good as the G6/G7 but it’s a lot better than the Libre equivalent which tends not to work. There are other apps like ‘Shuggah’ but that has a different blood sugar algorithms to the Libre so you get different results which I personally didn’t find helpful.

Libre has apps that pull from LibreLinkUp so shows the actual same algorithm, but agree I’d like it if it was all in one app so would try dexcom one+ if offered if it does this

 

[Tdm]

Tagging on, dexcom are doing a free trial was well as libre, so you could get best part of a month free that way, and see if its worth buying? See 'possible scam' thread for info on dexcom trial free offer

 

[Bubbleblower]

Your husband would qualify for a free 14 day trial of the Freestyle Libre2 system, provided he has a suitable smart phone.

Only if he has never contacted Abbott before, otherwise they have registered him as a user (to create shareholder value) and he won't get it.

In Europe they stopped replacing sensors completely since August 2022, before that they would replace "one or two" sensors per year out of leniancy. If you were lucky.

If the Dexcom is £100 for 3 sensors that is cheaper than the FSL, which really only lasts 10 days by the way, the first and last two days it is too unreliable. The reason people "choose" the FSL is because the insurance company pays for it.

 

[rebrascora]

Only if he has never contacted Abbott before, otherwise they have registered him as a user (to create shareholder value) and he won't get it.

In Europe they stopped replacing sensors completely since August 2022, before that they would replace "one or two" sensors per year out of leniancy. If you were lucky.

If the Dexcom is £100 for 3 sensors that is cheaper than the FSL, which really only lasts 10 days by the way, the first and last two days it is too unreliable. The reason people "choose" the FSL is because the insurance company pays for it.

Yes, of course, the free trial is only available if you haven't used the product before, otherwise it is not a "trial"!

Libre customer services are very good about replacing any sensors which are problematic and in fact I suspect they replace sensors when it is likely not the sensor which is the problem but the person's phone in some cases.

Libre is very reliable for me from day one to day 14 but I tend to apply it a day in advance like some others here on this forum and then start it the next day, so it has a longer bedding in time than just the 60 min warm up, which does usually overcome any first day wobbles, but I suspect it is a body chemistry issue and some people will have more of a reaction to the application than others and therefore need that longer bed in time, before starting the sensor. This extra day on my body doesn't seem to adversely affect the sensor, but I do use an arm band to support it as it can be vulnerable to knocks and scrubs in my daily life so having extra protection is important for me. I might have one sensor failure a year if I am unlucky. I just had one that failed on day 12 and has been replaced but it is well over a year since my previous issue with one. In the early days of using them I dislodged a few on inanimate objects but getting the arm strap and better placement and more awareness and better skin prep has all contributed to a much more successful outcome with Libre.

As regards Libre being preferred because the insurance companies pay for it, that obviously isn't a factor here in the UK. I think Abbott got their foot in the NHS door with the Libre but also the design being stand alone and not needing a transmitter and being cheaper than the initial Dexcom options plus a wider range of compatible phones all gave it an advantage and especially a0s they have done a free 14 day trial for many years and that also gives them a big advantage with people self funding I believe. Their format for logging and storing data on the app is also better than Dexcom I believe, so there are lots of reasons why it is the CGM which is most popular here in the UK although Dexcom are now trying to challenge that, particularly with their new Dexcom One+ which addresses many of those Libre advantages.

 

[Lucyr]

If the Dexcom is £100 for 3 sensors that is cheaper than the FSL, which really only lasts 10 days by the way, the first and last two days it is too unreliable. The reason people "choose" the FSL is because the insurance company pays for it.

That isn’t true about libre, my sensors last 14 days and are reliable to the end as well as at the start. I do often insert it 24hrs before starting. Abbot replace it if it is outside of the allowed range of accuracy though.

 

[Chelseagirl]

You can also get a free trial of the One+ from Dexcom. I tried both as I am a self funder.

 

[Bruce Stephens]

As regards Libre being preferred because the insurance companies pay for it, that obviously isn't a factor here in the UK. I think Abbott got their foot in the NHS door with the Libre but also the design being stand alone and not needing a transmitter and being cheaper than the initial Dexcom options plus a wider range of compatible phones all gave it an advantage and especially a0s they have done a free 14 day trial for many years and that also gives them a big advantage with people self funding I believe.

I think when I started self funding there was no free trial but there was a nice simple offer: £150 got you 2 sensors and a reader and after that you could just buy sensors as you wanted. Dexcom was more set up for subscription. Now, a subscription can make more sense but I wasn't sure how much I'd get out of it. And the sensors were cheaper (less functional because it wasn't a CGM at the time, so no alarms or anything). So Libre was just the simpler thing to try, with no commitment.

Since then there's been something of a convergence, with Libre becoming a CGM and Dexcom introducing a cheaper One and then One+. I get the impression the offer from Dexcom to the NHS is now better than Abbott's, which is presumably why some people are reporting they're being encouraged to switch over.