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If you don't have a CGM

D

DancingStar

Active Member
Relationship to Diabetes
Type 3c
If you dont have a Continuous Glucose Monitor and you rely on finger pricking to check your blood glucose, how many times per day do you routinely test?
 
When I have a break from Libre for a few days as I do occasionally, just to prove to myself I can manage without it, probably about 8-10 times a day but I have by chance been scanning Libre an average of 35 times a day for the past 5 years so I do find I have to restrain myself quite a bit on the first day I am without Libre. Before I got Libre there were times when I was testing 16 times a day when I was trying to sort out prebolus times, particularly for breakfast, but routinely I would say about 8 times a day is what I would settle for.
 
I am going to be controversial and say the number of times is irrelevant.
It is what you do with the data that is important. You could prick and scan 35 or more times a day but if you do nothing with the results, it is irrelevant.
When I was finger pricking, I would test
- before every meal to use as a baseline for my meal time bolus
- before driving because it is a legal requirement
- before exercise so I could check my BG did not need a "glucose nudge" as most exercise causes my BG to fall
- whenever I felt "off" to confirm a hypo or a hyper and then afterwards to check recovery
- before going to bed to make sure I was within my required "night time range) and adjust accordingly.
- and when making adjustments to my insulin regime (e.g. prere-bolus time or basal testing), I would test more often.

Some days, I would finger prick 12+ times. Some days it was only 3.
 
Last edited:
I do have a CGM but before I got it, I’d test anything from 8 to 14 times a day. When I was pregnant, I tested more times than that.
 
Hello @DancingStar, I'm surprised (amazed really) that you don't have CGM. Has it been offered and you've declined this?

Since you are in a basal / bolus regime you should be treated as if T1 and your care team (Hospital or GP) should be encouraged, cajoled, or shamed into providing you with CGM. Are you in an obscure part of UK? You ought routinely to be under a Hospital care arrangement - particularly since your diagnosis came from a Whipples Procedure and total pancreatectomy (if I'm remembering correctly). Have your treatment arrangements changed since late 2019? Do you get the mandatory 8 annual diabetes checks? These checks ought to include a review and someone saying why don't you have CGM!

At first sight it looks as though the system has badly let you down - bu perhaps there is more to this than I'm seeing?
 
Hi @DancingStar , I've been using a CGM and certainly for me it's a game changer; wouldn't want to go back to finger-pricking. You can get a free trial sensor from Abbott if you wanted to try it out.....
www.freestyle.abbott

FreeStyle Libre Continuous Glucose Monitoring | FreeStyle Libre US

Get real-time glucose readings without fingersticks with FreeStyle Libre. Explore our newest sensor, the FreeStyle Libre 3 Plus, and see if you qualify for a free sensor.
www.freestyle.abbott www.freestyle.abbott
 
Yes absolutely!

CGM for me is very helpful, but my access to it is a very recent addition to my diabetes management toolbox.

For people with T1 the data suggests that checking 4-10(+) times is more cost effective than checking fewer tha. 4x a day (because of the impact of not being so aware of levels).

A basic routine might involve:

4x a day (once before each meal and before bed)
Plus
Checking before any driven journey, and every 2hrs during longer drives
Plus
Checking if you feel you may be hypo
Plus
Checking to confirm recovery after a hypo
Plus
Extra checks around illness or exercise etc

So I’ve always thought that 4-8x a day is pretty standard, with a few days being more intensive than that at maybe 8-12x

In the early years (35+ years ago) the advice I had was breakfast & eve meal one day, and lunchtime & bedtime the following day - so 4 checks over 2 days. But that would never be recommended these days, and 4x a day really is a minimum.

I used fingersticks alone to manage my diabetes from 1991 until 2014. So it’s only really a little over a decade where I’ve had any substantial level of access to CGM. Initially self-funded on a shoestring, but now funded by the NHS (for which I am hugely grateful.
 
Pre-CGM I'd average between 10 and 12 a day (depending what I was doing) - I knew and still know if I'm low or high so would tend to check before eating and/or doing something that required glucose or time (exercise/driving/etc)

With CGM I still do 2 a day (calibration checks) though if the cal is off that might be more like 5.
 
everydayupsanddowns said:
For people with T1 the data suggests that checking 4-10(+) times is more cost effective than checking fewer tha. 4x a day (because of the impact of not being so aware of levels).
Click to expand...
I think Abbott had some research showing that scanning significantly more often than that was correlated with better results.
 
Many thanks for your replies.

I do normally have a CGM. I've been having trouble with them lately, for some reason recently I've been having really disturbed, restless sleep and have managed to dislodge the last 3 off my arm while I've been asleep so have woken up with them not working.

Having used up my prescribed supply for this month and while waiting for a replacement from Abbott, I'm temporarily without a CGM so have been finger pricking. Although I started with finger pricking when I was first diagnosed, I couldn't remember how often I was supposed to be doing it. Even after a couple of days my finger ends are bruised and painful so I do the minimum possible, which probably isn't very wise.
 
Sorry to read of your bruised fingers (and problems with your Libre).
In the hot weather, our blood is closer to the surface so we shouldn't need to prick as deep. Are you able to adjust the depth of your pricker?
Other things to consider are
- Using all your fingers. I have always used all my fingers on a kind of cycle - left hand odd dates and right hand even dates with one finger per (and between) meals). At first, the right hand was a tad awkward but I got used to it pretty quickly.
- avoiding pricking the pad of your finger and using the side.

I hope your replacement sensors turn up soon although they don't remove all needs for pricking so there is still value in mastering your technique.
 
Fingers shouldn't be bruised, so perhaps you have the depth setting too high or you are squeezing and bruising them that way. I could certainly test 16 times a day for a whole week and not have sore fingers and many others here will also report similar. Good finger pricking technique is key and perhaps a good lancing device although I bought a FastClix and didn't personally find it any better than my regular one, but others here swear by AccuCheck FastClix.

As regards sensors coming off, good skin prep is really important and then personally I wear an arm band to support my sensors which consists of a 3 printed watch face surround which fits snuggly around the circumference of the sensor and an adjustable elastic strap to keep it in place. I think, particularly in this hot weather, sensors can benefit from a bit more support. The tossing and turning is likely due to the overnight warm temperatures too and without protection they can get dragged on bed linen. Placement of sensors is also a work in progress, finding a site where they are less likely to get caught on stuff and where the arm is "flat" enough for the sensor edges not to be vulnerable to lifting as muscles flex.
 
Bruce Stephens said:
I think Abbott had some research showing that scanning significantly more often than that was correlated with better results.
Click to expand...

Yes if I remember right the Abbott data showed people wearing Libre 1 who scanned 16+ times a day tended to have improved outcomes vs those who scanned fewer times. This was back before it was a CGM with continuous data, of course.
 
rebrascora said:
Fingers shouldn't be bruised, so perhaps you have the depth setting too high or you are squeezing and bruising them that way. I could certainly test 16 times a day for a whole week and not have sore fingers and many others here will also report similar. Good finger pricking technique is key and perhaps a good lancing device although I bought a FastClix and didn't personally find it any better than my regular one, but others here swear by AccuCheck FastClix.

As regards sensors coming off, good skin prep is really important and then personally I wear an arm band to support my sensors which consists of a 3 printed watch face surround which fits snuggly around the circumference of the sensor and an adjustable elastic strap to keep it in place. I think, particularly in this hot weather, sensors can benefit from a bit more support. The tossing and turning is likely due to the overnight warm temperatures too and without protection they can get dragged on bed linen. Placement of sensors is also a work in progress, finding a site where they are less likely to get caught on stuff and where the arm is "flat" enough for the sensor edges not to be vulnerable to lifting as muscles flex.
Click to expand...
I like the idea of an arm band for when I'm in bed, can you remember where you bought it from? I bought some of those fancy patterned sensor covers and they've been ok but they don't last for the life of the sensor and I dislodged a sensor trying to get the old cover off to put a new one on. I've bought some skin tac for when I get my new sensors.
 
I bought my arm strap off ebay and have not lost one since I started using it several years ago but have lost a couple on really hot days when I broke on or misplaced it. They come in a whole range of coIours from skin tone through pastels to loud and proud neons, so you can even match them to your outfit for a special occasion, although I generally don't wear my arm strap when I am dressed up as it is usually the time when it is least at risk. Working outdoors and with horses is when it is most at risk and dressing and undressing. For that reason, I wear mine almost all the time but I think the first 24 hours is probably the most important time when the adhesive is just forming a strong bond with the skin, so the sensor is particularly vulnerable to any disturbance during that time.
 
DancingStar said:
Many thanks for your replies.

I do normally have a CGM. I've been having trouble with them lately, for some reason recently I've been having really disturbed, restless sleep and have managed to dislodge the last 3 off my arm while I've been asleep so have woken up with them not working.

Having used up my prescribed supply for this month and while waiting for a replacement from Abbott, I'm temporarily without a CGM so have been finger pricking. Although I started with finger pricking when I was first diagnosed, I couldn't remember how often I was supposed to be doing it. Even after a couple of days my finger ends are bruised and painful so I do the minimum possible, which probably isn't very wise.
Click to expand...
Great to read, @DancingStar, that you do have access to CGM; but sorry you've run out of reserve sensors. You could well find that a personal phone call with your Surgery's in-house Pharmacist might result in you getting at least one or two extra sensors prescribed for you as a one-off reserve. This Pharmacist is not necessarily the same person as the dispensing Pharmacist, if your Surgery actually has a Dispensing Pharmacy. The in-house Pharmacist is part of the Surgery/Practice team and there to provide direct advice and support to the GPs for prescribing meds; nowadays this is is a mandatory part of GP Surgery teams. They have the authority and discretion to find helpful solutions even if the rules seem to make it difficult!

Sound advice already about reducing pain from finger pricking. There seems to be widespread agreement that the Accuchek Fastclix device is extremely good for this "lancing" business. I got mine from a Hospital clinic, but its easily purchased from chemist's or on line; typically £15= from Boots.

The Fastclix device has a much better range of depth settings than any other lancing device I've come across. You start on the shallowest depth and increase that depth setting until you find the optimum setting for you. I use all fingers and thumbs and need a higher setting for my thumbs, than my fingers and a very shallow setting on my smallest fingers. Changing depth settings is really easy. The other beauty of the Fastclix is that it contains a drum with with 6 built in lances and although in theory you click forward from one lance to the next every time you lance - in practice I reuse a lance very many times. My current drum has been in use since 2024, making this a very frugal device and really convenient because the finished drum has no sharp residual bits.

There is no rigorous answer to how often you should finger prick, but since you would normally look to your CGM I would suggest that during these days "between sensors" you must, of course fulfil the DVLA remit and addirionally I, probably, would fp on waking to get a sense of how my day is starting, then before each meal prebolus. If I was having a "difficult day" I might do some intermediary fps to reassure myself that I'm the boss (!) and "in control". I wish! Of course if I felt some hypo symptoms I'd fp and evaluate my possible response needs, including further fps if hypo treatment was needed - to confirm normality was coming back. I can manage a day with as few as 6 or 7 fps when my CGM is down and yet needing to drive, but on busy or difficult days my fp requirement can easily get into double figures.

My Hospital provided Dexcom G7 CGM behaves really well (happily almost always) and I can go 6 or 7days, sometimes the full 10 days, without a fp; my G7 can be calibrated from the phone app and is remarkably close to actual BG much of the time. I always do an fp after fitting and starting the sensor, just to confirm it's started well. With the G7 it's warm up time is only 30 minutes and once fitted it's clock has started, regardless of whether I pair it with my phone or the hand held pocket Receiver; so none of this 24hr settling in time which so many people need with Libre.

Anyway, do try your luck with the in-house Pharnacist for "reserve" sensors. Otherwise do ask if there are other challenges you might need some help with.
 
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