Libre NHS Prescription and Libre 2 CGM

[Jon-Manchester]

Hi

One of the conditions my Diabetes nurse told me when I got the Libre for me to keep it on an NHS subscription was that I had to scan the Libre regularly ( I think it was 8 times per day). That hasn't been an issue at all, as most days I have been scanning 12-15 times per day.
Now that Libre 2 sends the figures straight to the app, I haven't been scanning. I have been assuming that the condition of having to scan to keep the Libre on prescription is gone, but I wanted to check.
Does anyone know the answer?

Many thanks, Jon

 

[Val1133]

I still scan 3 - 4 times a day, at mealtimes and bedtime so that I have readings that I can refer back to and add notes for the carbs I eat and insulin I use. It lets me know when I am eating and I find it very useful to help manage my diabetes.

 

[Proud to be erratic]

Good question and I don't know the answer! This is about transferring the data from your scans that you personally see on your app, LibreLink to the Web based software LibreView - that you've shared with your DSN.

LibreLink holds up to 8 hrs data, between scans, so if you always scanned at 8 hr intervals then 3x daily scans would suffice to include 24 hrs. Each scan transfers data to LibreView. My understanding is that the scan on a phone causes an automatic use of WiFi to transfer data from LibreLink to LibreView.

The chances are that a member of this forum does know the answer; or you could ask Abbott by phone or email; or ask your DSN - since he/she needs to know the answer! But I'm confident that that DSN does not have the time or energy to personally monitor your LibreView statistics and won't know that they might not be updating - until you have a periodic review with that person.

In practice, now that you have L2 on prescription I can't see any possibility of that being withdrawn in the future, notwithstanding the original declared conditions of supply. No great need to worry, I think.

 

[JJay]

I think the short answer would be - ask your DSN!

Personally I don't use the new rtCGM feature because I use a 3rd party app in order to get readings on my watch, which means I can't use bluetooth with Librelink. So I'm still scanning around 8 times a day as I always did, which keeps everyone happy (I hope!)

 

[helli]

The reason for scanning is to upload the last 8 hours of data to your phone. The scan does not upload the data to LibreView in the Cloud. I am not sure when this is done but it needs an internet connection and you can scan without wifi or mobile data. So the upload to LibreView, which your DSN will look at will be happening. Hopefully, if the Bluetooth connection is not lost, you will have no gaps in the data as you would in "them there olden days" if you had left more than 8 hours between scans.

So, to answer the question, you should not need to scan at least every 8 hours to maintain your Libre prescription.

(As a slight aside, I am not sure how often a DSN would have checked that you were scanning often enough. I think the condition is there to use as a stick for anyone who was wasting their Libre bt not looking at the data.)

 

[Bruce Stephens]

I am not sure how often a DSN would have checked that you were scanning often enough.

They can see in LibreView. (That was explained to us at the beginning when they said that was the only thing they were going to look at, unless we asked them (so in a consultation, for example).)

 

[Bruce Stephens]

One of the conditions my Diabetes nurse told me when I got the Libre for me to keep it on an NHS subscription was that I had to scan the Libre regularly ( I think it was 8 days per day).

That was the condition I had, but that was back in 2019. We should be well beyond that kind of trial conditions by now so I'm sure it doesn't matter. No harm in asking them just to make sure.

 

[Robin]

That was the condition I had, but that was back in 2019. We should be well beyond that kind of trial conditions by now so I'm sure it doesn't matter. No harm in asking them just to make sure.

I’m wondering where that came from, I remember in the early days that you could be eligible for a Libre if you had to finger prick more than 8 times a day, because that was the point when the Libre became cost effective. So I wonder if the nurse had got her wires slightly crossed. But from the Libreview data that the hospital can see, there wouldn’t be anything to show how often you scan, provided you’d done it at least every 8 hours to maintain the graph.

 

[Proud to be erratic]

The reason for scanning is to upload the last 8 hours of data to your phone. The scan does not upload the data to LibreView in the Cloud. I am not sure when this is done but it needs an internet connection and you can scan without wifi or mobile data. So the upload to LibreView, which your DSN will look at will be happening. Hopefully, if the Bluetooth connection is not lost, you will have no gaps in the data as you would in "them there olden days" if you had left more than 8 hours between scans.

So, to answer the question, you should not need to scan at least every 8 hours to maintain your Libre prescription.

(As a slight aside, I am not sure how often a DSN would have checked that you were scanning often enough. I think the condition is there to use as a stick for anyone who was wasting their Libre bt not looking at the data.)

The scan does trigger an upload to LibreView when WiFi or Internet connection exists. As far as I'm aware there is no periodic data upload on some sort of alternative automatic process. The scan triggers that.

But yes, the scan does also transfer up to 8 hrs of data from the sensor to the LibreLink app, regardless of whether there is Internet available. I'm always connected to WiFi or data, and sort of oblivious to the scenario of being i a WiFi-less bubble. So if your phone is isolated from WiFi or mobile data for more than 8 hrs, then no transfer to LibreView will automatically occur. Presumably once reconnected all data available will get updated onto LibreView.

 

[Bruce Stephens]

I’m wondering where that came from, I remember in the early days that you could be eligible for a Libre if you had to finger prick more than 8 times a day, because that was the point when the Libre became cost effective.

I'm pretty sure they were part of the common conditions back then. I think the idea was just to make sure people were getting value out of it, not some trap to catch people out. There were other conditions (at the end you were to have shown an improvement of HbA1c, a reduction of hypos, etc.) because at the time those were in the criteria. (In my case the 6 month review was to happen around January 2020 and I don't think it really happened because hospitals are busy in winter, and then they became even busier.)

 

[JJay]

I’m wondering where that came from, I remember in the early days that you could be eligible for a Libre if you had to finger prick more than 8 times a day, because that was the point when the Libre became cost effective. So I wonder if the nurse had got her wires slightly crossed. But from the Libreview data that the hospital can see, there wouldn’t be anything to show how often you scan, provided you’d done it at least every 8 hours to maintain the graph.

I did have to sign an undertaking to scan at least 8 times a day when I was first prescribed Libre back in 2018. The Monthly Summary in Libreview does show the number of scans each day, though as the DSNs said at the induction session, they really don't have time to be checking everyone's statistics!

 

[Robin]

I did have to sign an undertaking to scan at least 8 times a day when I was first prescribed Libre back in 2018. The Monthly Summary in Libreview does show the number of scans each day, though as the DSNs said at the induction session, they really don't have time to be checking everyone's statistics!

Oh yes, you’re right! I just happened to be on Libre view uploading my latest figures (I still use the reader) and found 'Average scans/views' and 'Time Sensor is Active', tucked away in the Snapshot section, and the times of the scans marked on the graph in 'Weekly Summary'. (I usually ignore those and just concentrate on the AGP report).
My original paperwork asked me to undertake to do 4+ scans a day, and use the Libre more than 70% of the time.

 

[helli]

They can see in LibreView. (That was explained to us at the beginning when they said that was the only thing they were going to look at, unless we asked them (so in a consultation, for example).)

I wasn't considering how, I was thinking about whether they would bother.
I also think it was every 8 hours rather than 8 times a day ... at least that is what I was told and as I used xDrip+ at the time, no data was uploaded to LibreView. I later did start using LibreLink and know that the upload did not happen on every scan because I scanned on a long haul plane (longer than 8 hours) when I had no wifi connectivity.

 

[Lucyr]

You don’t need to scan, libre view shows how often you’re opening the app.

If you want to keep notes in the logbook you can and it will automatically save a bg. Eg yesterday I did a basal test so I pressed add note and put “start basal test” at the start that I had the bg on my phone to compare against at the end. You don’t need to scan to save a bg in the logbook.

 

[Lucyr]

I still scan 3 - 4 times a day, at mealtimes and bedtime so that I have readings that I can refer back to and add notes for the carbs I eat and insulin I use. It lets me know when I am eating and I find it very useful to help manage my diabetes.

You don’t need to scan for those, just add the note for the carbs and it will save bg automatically

 

[Lucyr]

That was the condition I had, but that was back in 2019. We should be well beyond that kind of trial conditions by now so I'm sure it doesn't matter. No harm in asking them just to make sure.

I had the condition (within the last month) that I must check bg in libre app 8+ times a day, since I’m prescribed it on the T2 criteria of needing to check 8+ times a day. It’s only T1 where you’re automatically entitled to libre.

Libreview has the evidence that I open the app 8+ times a day. I didn’t scan once yesterday, did scan once on Sunday to fill in data after swimming. Libre view shows how many times I opened the app

 

[Bruce Stephens]

I was thinking about whether they would bother.

I'm not sure they ever did.

 

[Jon-Manchester]

Thanks all for responding.
I just went back and found the letter I had to sign, as it was still stored in my email folder.

Here is what i had to sign to get the Libre 2 prescription (I have just copied the relevant information but there was more stuff)

Patient must agree:

• To a personal target plan with your specialist
• To attend education on FreeStyle Libre monitoring, provided by the diabetes team (online or in person)
• To participate in regular reviews with the diabetes team (can’t miss more than 1 consecutive appointment)
• To scan glucose levels no less than 8 times per day, and use the sensor >70% of the time
• To upload FreeStyle Libre data online (Diasend) and share it with the diabetes specialist, for support on managing progress

I might call the diabetes nurses and just confirm that i no longer need to scan 8 times a day

 

[Jon-Manchester]

I think the short answer would be - ask your DSN!

Personally I don't use the new rtCGM feature because I use a 3rd party app in order to get readings on my watch, which means I can't use bluetooth with Librelink. So I'm still scanning around 8 times a day as I always did, which keeps everyone happy (I hope!)

Having BS reading on the watch is so useful!! I actually use 3rd party apps as well so I can do as you to get readings on my apple watch (I use xdrip4iOS and lately Sugarmate as I like the additional data i get with Sugar mate) but with both, you can set it up so you can use them as well as have the Libre app connecting via Bluetooth to the Libre. So if I dont have to scan, then great, as the data will flow anyway to DSN

I have left a vm with my diabetes nurse to get clarification on the scanning requirement

 

[Lucyr]

I might call the diabetes nurses and just confirm that i no longer need to scan 8 times a day

You’re taking it too literally. Libre View will confirm that you look at the results in the libre app 8+ times a day. The contract was just written when you had to scan to see any numbers. No DSN in their right mind would say “stop prescribing libre for him because he looks at his bgs in libre app but doesn’t scan to get them when he has no need to scan any more”