Libra 2

[rebrascora]

I thought MeowMeow was just to relay the results to a Phone app (similar to the Libre view app) which had an algorithm to adjust/interpret/predict the BG from the interstitial sensor reading ....basically just a transmitter.
If your levels are pretty stable when you test then Libre should be pretty much the same as a finger prick reading. It is only when levels are changing that the algorithm's extrapolations and predictions can become less accurate, particularly if levels are changing fast or not at a uniform rate or i the same direction as the example @helli quoted about treating a hypo. At 15 mins after treating a hypo you will almost always find that Libre is reading lower still and takes another 15 mins to come up, whereas a finger prick will show you that you have already recovered at the 15 min point..... which is why it is so important to use a finger prick at that time because otherwise you will almost always over treat your hypos.

 

[Proud to be erratic]

Wow yes I was thinking that today pen's would be awesome, memory loss, lucky its got last jab on top. But if it uploaded as well and alarm if you forgot that would be awesome, also alarm double jabbing.

During today's online T1 & Tech Conference there was a presentation about Smart Pens. I need to go back and view it again, because I wasn't clear if these are here already and being prescribed, with NICE support.
But the principle is that they seem to do a fair bit more than my NovoEcho pens and the presenter was explaining that trials seemed to justify these. If I remember correctly (lots of different details within the 4 hrs) the NovoEcho Pen 6 was one of the Smart pens and it seems that not all pens for the different insulin delivery systems do currently have Smart capabilities.

Also in the last session Partha Kar gave a Review (and explanation) of D Policy. He talked about the prescribing principle of not "best" practice, just "standard" practice - to continue the widening of availability of CGMs for insulin users. I see this is a clever, but subtle, play with vocabulary as part of the constant challenge of cost versus available cash. I think, but my memory could be playing tricks and I wishfully invented the thought, he also mentioned Smart technology in that particular bit of his review.

 

[Bruce Stephens]

During today's online T1 & Tech Conference there was a presentation about Smart Pens. I need to go back and view it again, because I wasn't clear if these are here already and being prescribed, with NICE support.
But the principle is that they seem to do a fair bit more than my NovoEcho pens and the presenter was explaining that trials seemed to justify these. If I remember correctly (lots of different details within the 4 hrs) the NovoEcho Pen 6 was one of the Smart pens and it seems that not all pens for the different insulin delivery systems do currently have Smart capabilities.

They are available. I don't think the price difference (between Novopen Echo and Novopen Echo Plus or Novopen 5 & 6) is significant. When I talked it over with the practice pharmacist she seemed fine with me getting whichever ones I wanted, anyway.

Right now I think they don't do anything extra unless you're using a phone app that's supported (diasend or mySugr), but LibreLink support is said to be "Available soon", so that'll be useful for lots of us. The pen itself just shows the last dose and the time since it was given (presumably the same as Novopen 5 and Novopen Echo).

 

[Bruce Stephens]

If I remember correctly (lots of different details within the 4 hrs) the NovoEcho Pen 6 was one of the Smart pens and it seems that not all pens for the different insulin delivery systems do currently have Smart capabilities.

If you want reusable pens for Novorapid or Levemir (or the other Novo Nordisk insulins) you're going to be choosing between Novopen Echo (or Echo Plus) and Novopen 5 (or 6). The Echo pens can do half units and the others can't, and the Echo pens have a lower maximum single dose (I think it's 20 units (or maybe 30)).

I suspect you'll just have the Echo Plus (or maybe 6) prescribed, which are the smart ones (with an appropriate phone app). I think the Novopen 3 and 4 (ones without any smart stuff) are no longer available. When I wanted reusable pens a month or so ago all the pharmacist mentioned were the smart ones, anyway. And the Novo Nordisk website no longer mentions any reusable pens other than those.

Injection devices and needles

www.novonordisk.co.uk

 

[Proud to be erratic]

So what's point in meow meow then?

Originally Miao Miao, from Denmark, was tech taking advantage of the Libre 2 releasing a signal every minute with one's interstitial reading. For whatever reason Freestyle chose to make you scan, whether with the Reader or your compatible phone, to capture that continuously available info and not make Libre 2 a real time CGM.

2 weeks after I'd bought my Miao Miao a geek released an app called Diabox, for both Apple and Android phones. Abbott objected and forced Apple to take it off the app store, then Google followed suit and removed it from Play Store. But it remained available for android through a different, unofficial site; this made Miao Miao obsolete - no need for an extra device on top of your Libre sensor. I had Diabox for 6 months and that tech advance was amazing; having true, or real time CGM on my phone and Smart watch was just brilliant. The Diabox app has since been updated. I had phone problems and had to uninstall Diabox and during the reinstal I never got Diabox to work again.

Same sensor, if its 15 mins behind.

The figure of 15 minutes is a legacy of Libre 1, or so I understand. Freestyle claims 2-3 minutes for Libre 2 and I think it uses an amended algorithm in its software to predict where your interstitial is in relation to actual and thus appears to reduce the lag.

In practice I find with Libre 2 that lag nearer to 7 mins, others talk about 10 mins. To prove this you have to be prepared to scan and finger prick at extremely frequent intervals and from your logged results it would be possible to get nearer the truth! That would be after applying all the normal statistical remits, including allowing for inbuilt tolerances of both the sensor and any meter. So it's relatively "rough and ready" whether you use a lag of 2.5 - 15 mins, I think!

I've tested on meter and libra they are usually spot on .5 each way.

If you are getting sensor and actual readings that close, consistently, you are just lucky. While wearing my Libre transmitting data through Diabox as real time CGM, I could see interstitial changes minute by minute, even while just sitting still and much more changeable as I moved around. So I deduced there was a fair amount of modest BG change going on all the time, whether from just digestion of carbs, or changes in my natural insulin resistance from activity or weather, etc. I could watch some exciting TV and see rapid increases, a stress response and see fairly rapid drops as I mentally calmed myself. I think Libre gives a great momentary snapshot, albeit not as accurate as a finger prick, but the trend arrow is the really good aspect. That gives a much better indication of what might happen in the next 15-30 minutes and if you are displaying 5 and falling then hypo prevention is realistically possible. But if displaying 4 and falling, then the chances are you are too late to prevent a mild hypo (or deeper).

 

[helli]

The figure of 15 minutes is a legacy of Libre 1, or so I understand. Freestyle claims 2-3 minutes for Libre 2 and I think it uses an amended algorithm in its software to predict where your interstitial is in relation to actual and thus appears to reduce the lag.

The figure of 15 is a biological delay between interstitial fluid readings and blood glucose readings. This affects all CGMs including Libre. Most apply an algorithm to minimise the delay with the numbers it displays. As I understand it, this algorithm was improved with Libre 2 so, typically, we only see the delay by a few minutes.
However, it is useful to know about the lag between ISR and BG as the algorithm is not that clever : it just extends the current trend line. Most of the time, this does not matter. Unless, the direction of the graph changes in the last 15 minutes. For example, if you treat a hypo, the algorithm will predict the BG is still falling and show a lower number. This number is overwritten when the true data is received.

I suspect this algorithmic function is often related to the “scan in 10 minutes” message. If Libre does see the change in direction of the trend, it doesn’t know what trend line to extrapolate.
And if a sensor starts to fail, the numbers may jump around a lot so have no trend at all to extend.