Hello

[Lucyr]

Not all GP surgeries by any means, use econsult.

Put your request in writing with a pen and paper and hand in at reception then. Given all T1s are eligible it isn’t really something to wait for an appointment over, might as well try luck with just asking.

 

[rebrascora]

Might be worth including a print out of the new NICE guidelines on prescribing Libre if you are going with @Lucyr's suggestion of a letter so that the GP has all the information to hand to effect the change to your prescription. And be prepared to chase it up a week or two later. And if you fail, then contact Dr Partha Kar to fight your case as he has I believe volunteered to do this because he feels so strongly about the benefit of Libre or other Constant Glucose Monitor (CGM)
It would be a good idea to go to the Abbott Laboratories Freestyle Libre website and enroll in the Libre Academy (which is free) and work your way through the modules so that you have more understanding of how it works and when you still need to do finger prick BG checks etc. It is a great bit of kit but it isn't perfect (what ever is) and you need to understand it limitations and when to recognize it isn't giving reliable data etc. eg. When levels are changing fast. Far better to swat up in advance of getting it, so that if you need to have an debate about the value of it with your GP.... or that you still need test strips prescribed, you are more knowledgeable than the doctor, so they know you have done your homework and know what you are talking about and how to use it.

 

[RogerB]

Might be worth including a print out of the new NICE guidelines on prescribing Libre if you are going with @lucy's suggestion of a letter so that the GP has all the information to hand to effect the change to your prescription. And be prepared to chase it up a week or two later. And if you fail, then contact Dr Partha Kar to fight your case as he has I believe volunteered to do this because he feels so strongly about the benefit of Libre or other Constant Glucose Monitor (CGM)
It would be a good idea to go to the Abbott Laboratories Freestyle Libre website and enroll in the Libre Academy (which is free) and work your way through the modules so that you have more understanding of how it works and when you still need to do finger prick BG checks etc. It is a great bit of kit but it isn't perfect (what ever is) and you need to understand it limitations and when to recognize it isn't giving reliable data etc. eg. When levels are changing fast. Far better to swat up in advance of getting it, so that if you need to have an debate about the value of it with your GP.... or that you still need test strips prescribed, you are more knowledgeable than the doctor, so they know you have done your homework and know what you are talking about and how to use it.

Good News, I have just had an appointment in the post to see the nurse at the Diabetes Centre to discuss what new tech. I need. Your advice on swatting up in advance will be taken. And with all the other information I've been given on the forum I should sound like I know what I'm talking about.
Thanks to all who have contributed to this thread.🙂

 

[rebrascora]

Good luck. Do go prepared to be pushy if necessary. I remember my appointment with the consultant when I had psyched myself up to be really assertive about getting Libre. Then my appointment was with a new registrar who knew almost nothing but thankfully she went into see my consultant to query something I had asked and he then asked to see me and didn't quibble at all when I mentioned Libre and I almost left the department skipping I was so happy! It has been a revolution in my diabetes management.

 

[everydayupsanddowns]

Good News, I have just had an appointment in the post to see the nurse at the Diabetes Centre to discuss what new tech. I need.

Sounds promising Roger!

Look forward to hearing how it goes 🙂

 

[RogerB]

Sounds promising Roger!

Look forward to hearing how it goes 🙂

I've been using my Libre 2 for almost 2 weeks now (3 days left before fitting a new one). I am very pleased with how it's been going. My time in target has been 80%+ 🙂 untill today . Last 24 hours it's been 53%. This has been since starting my new insulin yesterday. (Tresiba for basul and NovoRapid for bolus)

The nurse at the diabetic clinic advised not starting off on the sort of doses I was using with my old insulin (18-20 units for bolus and 12-14 basal, she recommended starting on 8-10 units before meals of NovoRapid and 12 units of Tresiba. I'm certain I'm going to have to increase this, I will try to speak to the nurse tomorrow, but I'm wondering if you or anyone else on the forum has any thoughts about what sort of doses I may need. It would be interesing to hear the experiences of others using the same insulins.

Many thanks, Roger.

 

[helli]

There is no right dose. We are all different with different lifestyles, different body compositions, different other conditions, different ages, different diets, … The right dose for you is the one that works for you regardless what other peoples doses are like.

The usual advice is to get your basal correct first and the tweak your bolus. You may need different insulin to carb ratios at different times of the day (it is not unusual to need more insulin for breakfast than others times of the day).
To get your basal correct, consider that it should keep your levels stable in the absence of bolus and exercise and stress. As you are on one Tresiba dose a day and you have a Libre, you can check out what happens to your levels overnight and increase your dose slowly if you need to. Tresiba is very long acting so it is recommended to wait 3 or 4 days to see if the change you have made is sufficient.

 

[RogerB]

There is no right dose. We are all different with different lifestyles, different body compositions, different other conditions, different ages, different diets, … The right dose for you is the one that works for you regardless what other peoples doses are like.

The usual advice is to get your basal correct first and the tweak your bolus. You may need different insulin to carb ratios at different times of the day (it is not unusual to need more insulin for breakfast than others times of the day).
To get your basal correct, consider that it should keep your levels stable in the absence of bolus and exercise and stress. As you are on one Tresiba dose a day and you have a Libre, you can check out what happens to your levels overnight and increase your dose slowly if you need to. Tresiba is very long acting so it is recommended to wait 3 or 4 days to see if the change you have made is sufficient.

Thanks helli,
You are of course right in saying there is no right dose for all, but what you say about getting the basal right first is very helpful, as is the way to go about doing that.

 

[Proud to be erratic]

I've been using my Libre 2 for almost 2 weeks now (3 days left before fitting a new one). I am very pleased with how it's been going. My time in target has been 80%+ 🙂 untill today . Last 24 hours it's been 53%. This has been since starting my new insulin yesterday. (Tresiba for basul and NovoRapid for bolus)

The nurse at the diabetic clinic advised not starting off on the sort of doses I was using with my old insulin (18-20 units for bolus and 12-14 basal, she recommended starting on 8-10 units before meals of NovoRapid and 12 units of Tresiba. I'm certain I'm going to have to increase this, I will try to speak to the nurse tomorrow, but I'm wondering if you or anyone else on the forum has any thoughts about what sort of doses I may need. It would be interesing to hear the experiences of others using the same insulins.

Many thanks, Roger

Levermir"Tresiba is a particularly long lasting basal insulin (typically 40 hrs); so after your first dose on day 1, there is already basal on board as you start day 2. I found 22 units of Levermir daily eventually was refined to 9.5 units Tresiba, which I've recently (gradually) brought to 8.0 units daily with this hot weather. That longevity means its not super critical to take basal at a particular time daily and it also allows you to be a frequent flyer and manage changing time zones more easily.

But, there is a limit to how much you can tinker with Tresiba basal doses. Firstly any changes take time to work - up to 3 days; then several days of leaving alone, to verify the change is working. It's akin to being the Captain of an ocean going container ship, course or speed changes take days to implement (BUT they are all controlled by sophisticated computers, analysing loads of meteorological data for the selected route, ship profile and weight of cargo). In practice the Captain is taking legal and commercial responsibility for a computer programme.

Secondly, it is not realistic to search for optimum 24 hour basal supply with any basal; Levermir gives you 2 bites at that cherry. Tresiba simply can't give you a perfect 24 hr solution. Your insulin needs across the 24 hrs vary a lot. So I've optimised my Tresiba to give me flat, hypo free, nights (when I don't want to be hearing alarms, taking bolus or jelly babies) and I EXPECT to manage my day with bolus doses on a response basis. If that means, on a bad daytime, extra bolus corrections or more aggressive food doses - so be it. Sometimes, not too often, I have to "feed the insulin" because there is too much on board; but I have an armoury of snacks available in many, many diffferent forms of size, volume and varying reponsiveness (GI). If I'm already 'fat and full' then a slurp of lucozade is my choice, or a latte with a small biscuit (or bigger cookie).

Its necessary to experiment, but Libre allows me to safely monitor, understand and respond without excessive finger pricking. I have my Libre alarm set at 5.6, then I'm alerted when falling, can monitor and snack if necessary. So, personally, now that I've found that wholly acceptable 8 hr night solution, I see no point in daytime basal testing.

This doesn't mean I never change my basal doses. Just sparingly and now only when a succession of nights are no longer satisfactory - either rising or falling.
With a shorter lived basal such as Levermir, I appreciate people can freely tinker with their basal doses, almost on a daily basis. But having moved from Levermir to Tresiba, which works well for me, I appreciate having one bit of the complexity of D management being out of the daily equations.

Comment about bolus ratios

Yes, my ratios have changed; but to be fair I was not sure I had these optimised anyway and they are something that I understand need monitoring and adjusting periodically as part of the D way of life.

I note what you say about disposable cartridges, and will look into this.

If you change to reusable pens, with their half unit dispensing and for some (eg NovoEcho pen) the last dose memory record, make sure you have at least 2 pens for one type of insulin. A spare reusable pen is a vital safeguard in the unlikely event of a pen failure. I actually have 3 pens, 2x blue for basal and 1x red for rapid. My 'in use' blue basal has a couple of tactile stickers on it to reinforce to me that it's different to my red bolus pen. My 2nd blue pen is a complete reserve, just in case; I know someone else who has 2x blue and 2x red for their own peace of mind.