Libre for T2

[rah78]

*T2 and freestyle libre - apologies for the long post* Hi everyone. I was diagnosed T2 12 years ago at the age of 32 but unusually this followed a DKA. I buried my head in the sand for 10 years but started dealing with it 2 years ago. 14 months ago my hba1c was 89. I got it down to 54 and now it is 61.3 weeks ago I suffered a diabetic vitreous haemorrhage. I am currently trying a freestyle libre sensor and have spent 98% of the time between 3.9 and 10 giving me a predicted hba1c of 41. This is the best I've ever managed the diabetes as the sensor makes it so easy. I'm on 3 different tablets (no insulin). I'm at the diabetes clinic on Tuesday and hoping to be able to get the libre sensors (or similar) on prescription as they clearly help me manage. Do you think they will let me have it or can anybody give me any tips on how to persuade them please? Thanks for reading

 

[Lucyr]

Do you think they will let me have it or can anybody give me any tips on how to persuade them please?

It depends where you live and whether you’re on 2+ insulin injections a day.

 

[rah78]

It depends where you live and whether you’re on 2+ insulin injections a day.

Thanks Lucy. I'm not on insulin but I know some people who aren't can get the sensors. I'm in North East Lines, UK

 

[Lucyr]

Thanks Lucy. I'm not on insulin but I know some people who aren't can get the sensors. I'm in North East Lines, UK

The guidance is that you need to be on 2+ insulin injections a day so it’s unlikely you’ll get it funded. Even if you’re on insulin it isn’t guaranteed you’ll get it, I don’t in dorset on 5+ injections a day.

 

[Leadinglights]

Many GPs don't even recommend that Type 2 folk finger prick though as we know that is really detrimental to being able to manage blood glucose levels so the chances of getting a Libre on prescription is slim. There may be some circumstances, a disability for example where somebody might get one but unlikely.
Although new guidelines for Type 1 say they should there is still no guarantee.
Make good use of your free trial to make some sensible food decisions to move forward.

 

[rebrascora]

Congratulations on a great TIR result. What have you learned from it that is beneficial to your diabetes management? ie What are you doing differently?

Wishing you luck getting it prescribed but it doesn't sound like you meet the NICE guidelines and there are people here who do meet the guidelines and still struggle to get it prescribed, so by all means ask but don't hold your breath. I can't think of an angle you could argue your case on other than the improvement in HbA1c although the Libre predicted HbA1c isn't all that accurate for most of us and we usually find the actual result is several mmols higher. I would guess that most of the Type 2s in the country could argue the case that it improved their management, if only they had tried it. Do you get your test strips on prescription and has the Libre trial dramatically reduced the number of test strips you are using? The financial implications to the NHS are the reason why it is not prescribed (regardless of what your consultant may say), so you would need to be able to argue that it was cost effective and that you couldn't achieve those resul;ts through other means. I was able to significantly improve my HbA1c by more frequent testing.... For us Type 1s the criteria used to be that we needed to test 8+ times a day to manage our diabetes because that was the point at which the Libre supposedly became cost effective. I was finger pricking between 10 and 16 times a day to improve my management and I was having to buy extra test strips myself because they wouldn't prescribe enough to facilitate that level of testing.

If you are unsuccessful at persuading the doctor/consultant, then maybe look at self funding. Many of us Type 1s self funded until recently and some Type 2s self fund, so it depends what value you put on your health. I used birthday money to buy my first 2 sensors as I am low income and don't have holidays, so there wasn't much I could cut back on to finance them. It was probably the most useful birthday present I ever had and worth every penny. Perhaps consider self funding on an intermittent basis if you can't afford it full time. Once you identify the foods and exercise strategies which improve your management then you shouldn't need it long term.

 

[SB2015]

As @rebrascora says the Libre can be very useful, as you have found already. It is showing you the levels through the day as well as your TIR. People often use the sensors to find out about how specific foods/portion sizes impact their levels. This could be worth self funding for if you cannot get them on prescription.

 

[philipel]

Hi,
I started to use the Libre 2 when first diagnosed and intermittently thereafter. I have found it very useful to keep me on track.
The sensors are often on sale on Gumtree by people who don't need them at the moment --sometimes quite cheaply, just be aware of the expiry date.
Also with the buying power of the NHS they could make them available via our GP's at considerable lower prices--I'm not suggesting subsidies or prescriptions--just use the buying power !
best to all
Philip
ps Type 2 6.2%. 44

 

[Thatname]

Good luck, if you manage it please let me know how.

My records show I’m a T2, but when I was diagnosed 30 years ago if you were an adult you were automatically a T2, even though I couldn’t be controlled with diet or oral meds and ended up on a basal bolus insulin regime.

I do meet the NICE criteria for T2, and I’ve asked the nurse at my surgery but she can’t see the need, hasn’t referred me to the diabetic clinic and thinks I test too much. I work hard to control my diabetes, and have excellent control which seems to count against me.

 

[Proud to be erratic]

*T2 and freestyle libre - apologies for the long post* Hi everyone. I was diagnosed T2 12 years ago at the age of 32 but unusually this followed a DKA. I buried my head in the sand for 10 years but started dealing with it 2 years ago. 14 months ago my hba1c was 89. I got it down to 54 and now it is 61.3 weeks ago I suffered a diabetic vitreous haemorrhage. I am currently trying a freestyle libre sensor and have spent 98% of the time between 3.9 and 10 giving me a predicted hba1c of 41. This is the best I've ever managed the diabetes as the sensor makes it so easy. I'm on 3 different tablets (no insulin). I'm at the diabetes clinic on Tuesday and hoping to be able to get the libre sensors (or similar) on prescription as they clearly help me manage. Do you think they will let me have it or can anybody give me any tips on how to persuade them please? Thanks for reading

I suspect, as others have already said, you would be singularly fortunate to become eligible for Libre 2 at this moment. But despite that likely outcome I would definitely try - on the basis that there is evidence that the question has been formally asked. I would either take with me a written request or send an email and ask (politely insist) that the request is put on my records.

As a T2 not (so far) needing insulin, you would be an excellent example of someone who could take advantage of using Libre intermittently. Other equivalent CGMs are 2 part devices, involving a 10 day sensor and a 90 day transmitter; eg Dexcom One. Once that transmitter is activated it can't be 'paused' so is wasted unless it has a sensor to provide it data to transmit. But with L2 it is very viable to have a fortnight with it and then a fortnight or longer without; and repeat. Each time you have an active L2 test fortnight explore what foods are best for you, as well as what activities readily help and the relevant timings. These steps alone, albeit intermittently, will give you a much better sense of how your body behaves 14 x 24 hrs; what you are doing right; what you didn't do so well; and should reap dividends for you. If after (say) a year of intermittent self-funding and undeniable improved HbA1c - you will be in a much better place to create your own unique business case for NHS support in prescribing L2 for you. That business case would date back to your initial (written) request. This won't be easy or necessarily achievable within 12 months. But has to be worth starting. Also, if there is an improvement in NICE Guidance for T2s and CGM - you have done what you can to help your case.

Good luck.
NB: don't get too embroiled in what L2 is forecasting or estimating for your future HbA1c. It is well known this is not reliable enough to accurately overtake the need for an actual HbA1c. But the Time in Range statistics are much more convincing. Have you registered with Abbott for LibreView and the storage of your data on their Web portal? If not I would recommend that you do this, then your D behaviour can (your choice) be made available for external scrutiny by other Health Care Professionals and it should have a more permanent storage platform for the long term.

 

[Proud to be erratic]

Good luck, if you manage it please let me know how.

My records show I’m a T2, but when I was diagnosed 30 years ago if you were an adult you were automatically a T2, even though I couldn’t be controlled with diet or oral meds and ended up on a basal bolus insulin regime.

I do meet the NICE criteria for T2, and I’ve asked the nurse at my surgery but she can’t see the need, hasn’t referred me to the diabetic clinic and thinks I test too much. I work hard to control my diabetes, and have excellent control which seems to count against me.

@Thatname, it is certainly ironic that your hard work counts against you. But I would absolutely NOT accept a nurse at my GP Surgery refusing to refer me.

I would INSIST that the nurse decision is overruled by my named GP - you have such a strong case as a longstanding insulin dependent T2 and (with all due respect to a GP Surgery Nurse that individual will simply not have the breadth of understanding about insulin dependency that a Diabetes Specialist Nurse (DSN) from a Hospital clinic will have). And a DSN will work closely with Consultants in Endocrinology and specialist dieticians for diabetes, will see the regular submissions for approval of extra tech and have a good understanding of what is possible.

Your case to challenge this outrageous stance is actually strengthened by the Practice Nurse saying you test too much. It reflects a basic misappreciation of how important it is to test, test and test; and that misguided view shows that nurse in a poor light as a Health Care Professional. There is an analogy often quoted about driving a car without a fuel gauge .... to managing one's D without testing; I think it's more akin to even considering driving without a clean windscreen and correctly positioned mirrors - anything less is just downright unsafe. You need to see whatever is possible, not just be told when you are running out of fuel (or BG in this case).

How can anyone who is insulin dependent make their best effort at managing their D without taking full advantage of the tech that NICE have recently accepted is appropriate and necessary. Challenge this - politely but robustly. It makes no sense and that means it is NONSENSE which must not be allowed to continue.

 

[Paul Goldie]

Strangley and out of the blue my local diabetic service called om on wednesday to offer me the L2 on prescription. I am T2 and have been on insulin 18 months. when my diabetic service discharged me back to my GP in May 2022 she suggested trialling the L2 which I did and self funded a few just to see if i got on with it with a view to them becomiong available for T2 on insulin on prescription. When I saw my DNS at GP surgery in September last year she was aware that guidance had changed and said she would ask the diabetic service if it was possible for me to get them but they advised they were still awaiting further guideance from the local trusts etc but to speak to them again in early 2023. I tried to contact my DNS about another issue in January only to be told she had left and had not be replaced, so I contacted my diabetic service with that query and at the same time asked them again about the L2. they again said it wasnt available to T2. I responded by saying how good i thought it was and the trial and self funded ones had helped my awareness of for types and control had improved as a result and also helped with hypo control as i seem to get very few symptons when i do go low and could they keep me informed and let me know if the guidelines changed, i wasnt expecting to hear anything, then then low and behold they gave me a call on wednesday and I now have a meeting with them to take it forward.

So, if you dont ask you dont get is how i see this.

 

[everydayupsanddowns]

Good luck, if you manage it please let me know how.

My records show I’m a T2, but when I was diagnosed 30 years ago if you were an adult you were automatically a T2, even though I couldn’t be controlled with diet or oral meds and ended up on a basal bolus insulin regime.

I do meet the NICE criteria for T2, and I’ve asked the nurse at my surgery but she can’t see the need, hasn’t referred me to the diabetic clinic and thinks I test too much. I work hard to control my diabetes, and have excellent control which seems to count against me.

Is there a ‘GP with special interest‘ at your surgery @Thatname ?

Perhaps you!d have more joy discussing NICE guidance with them?

 

[Thatname]

Thanks for the suggestion. I’m seeing her again next month so will ask her. If I get nowhere with her this time I’ll look into going straight to the integrated care board and ask them directly.

 

[Thatname]

Well, I finally got referred, but reading the local ICB formulary they aren’t following NICE guidelines for T2, they’ve made up their own rules, which don’t include the number of tests done, so it looks like I’ll get turned down.

 

[Lucyr]

Well, I finally got referred, but reading the local ICB formulary they aren’t following NICE guidelines for T2, they’ve made up their own rules, which don’t include the number of tests done, so it looks like I’ll get turned down.

The nice guidelines are just that, guidance. Each area decides whether they want to adopt those or use their own rules. You will hopefully find in time that they change and adopt the nice guidance so do keep asking.