Libre patch v Blood glucose meter

[Kev C]

Hi, I have been using Accu-check strips and an Accu-Chek Performa Nano meter to test my blood glucose for some years now and last year, during lockdown, I had my annual diabetes check up meeting via a video call with my consultant who suggested I try a Libre patch (I assume its a Libre 2)! I said I had heard of them and that I was prepared to try these patches, but had a lot of questions so would like to see someone to show me how they work, what they do etc. As we were in lockdown I understood that I would be given given the opportunity to have a Libre patch when I could again visit the diabetic clinic. My consultant did however mention that there is a slight variation in the glucose readings between tests done using the test strips with a meter and those provided by the Libre patch and so I should still do a blood glucose test before driving! I have always done a blood glucose test before driving anyway, but am concerned that there is a difference between the blood glucose readings between these two devices! Hopefully when patients can again visit diabetic clinics, I will be able to see someone to explain all about the Libre patch, so I'm interested to find out from those who are using or have used the Libre patch, as to what they think about the Libre patch and if anyone has had any experiences of different readings between a blood glucose test using a meter and readings from a Libre patch! 🙂Thanks

 

[rebrascora]

Hi and welcome

Libre sensors are brilliant and there are very few people who try them, that don't find them a game changer as regards their diabetes management and see an improvement in HbA1c, but you do need to do some training to understand how they work and to learn to compensate for the differences between what they read and a BG reading.
The beauty of them is that you can scan as many times a day as you like and even when you don't scan, it collects data every few minutes, so that you can see exactly what is happening between scans or finger pricks and throughout the night and that extra info is amazing in understanding how your body and diabetes works.
It also gives you a direction of travel arrow with your reading so that you can see if your levels are rising or falling or reasonably stable. If they are stable then the reading you get should be pretty close to your finger prick BG test result, but if levels are changing rapidly then there is a 15 minute lag between the BG reading and a Libre scan. That is because the Libre measures interstitial fluid rather than blood and it takes about 15 minutes for changes in BG levels to filter into the interstitial fluid. Once you learn to factor in that 15 min delay it is very reliable for most people.

You really should not be prescribed the Libre without having completed the training and there is an online facility for that through the Libre Academy on the Abbott website. There are various modules to work your way through and webinars which explain things. Prior to Covid, there were face to face Libre workshops run by Libre reps and DSNs I believe but I did my training online.

Since using the Libre I have reduced my HbA1c to 48 and I feel so much more confident in adjusting my insulin (basal doses particularly) to better balance my body's needs and as we all know, if your basal insulin dose is not correct, nothing else goes to plan or makes sense. I scan approx. 30 times a day. The convenience of just swiping the reader (or phone) over your sensor means that you can keep a much closer eye on things and head off hypos before they happen or correct highs without having to wait until your next meal. It enables me to exercise on my own with more confidence and going to bed at night with much less concern about night time hypos.

There are occasions when you do still need to do a regular finger prick test, particularly if the Libre shows your levels are too high or too low and when recovering from a hypo because 15mins after treating a hypo, the Libre may actually show your levels have dropped further due to the time lag whereas a finger prick will show recovery.

Libre is accepted as a means of testing before driving but you do need to have your BG meter with you in case your levels drop low as the BG meter needs to be used to clarify when you come out of hypo and 45 mins after that to show you are fit to drive, but the majority opf the time, the Libre is all I use and I often go several days without a single finger prick.

You are very lucky that your consultant is offering it as many people here on the forum, myself included, self funded for some time before they were able to get it on prescription and some people are still struggling to get it on the NHS. It is £100 a month to self fund, but even for someone like me on low income it is worth every penny for the improved confidence and convenience. I can wake up in the night, scan, eat dextose tablets and go back to sleep within 20 seconds without even having to put the light on, if I hypo. No getting out of bed and going into another room so as not to disturb my partner. It is just fantastic!

 

[helli]

To add to the great description above from @rebrascora - the Libre 2 was released at the end of last year. This has a couple of benefits over the first edition and is the same price so someone newly prescribed LIbre is likely to get the newer version.
- The algorithm it users to convert from interstitial fluid to blood glucose reading has been tweak and it is supposed to be better at accounting for the 15 minute lag. Some people have seen this improvement but I can't say I have.
- You can set alert thresholds. If the LIbre detects a reading higher or lower, the reader will alarm. This is brilliant. I have set my alarm thresholds such that I have an opportunity to correct before going too high or too low.

There are two options for the reader - a phone app or a dedicated reader.
The advantage of the reader is that it can also be used as a finger prick meter but it is a chunky beast so I prefer to use the phone and carry my dainty meter with me as a backup when I go out.

I second rebrascora's enthusiasm about having the LIbre - the benefits are huge if you know how to use it and make the most of the data it gives you.
My HbA1C was not too shabby before so it has not changed much but I was very surprised to learn how much my level fluctuated. The Libre has allowed me to greatly reduce that fluctuation - much less highs and lows.

 

[Fagor]

I've been using Libre 1 for about 6 months. I do very few finger prick tests, usually if low or high or how I feel doesn't match BG. In other threads, some users do much more frequent finger tests.

As it reads BG every 15 minutes (full data is availabe in CSV format when data uploaded to LibreView) it's much easier to see your trends eg response to certain foods, going low overnight or possibly dawn phenomenon etc

For driving, this link might be of use https://www.gov.uk/guidance/diabetes-mellitus-assessing-fitness-to-drive
It seems CGM readings are acceptable for car driving, but a finger test meter should be carried to confirm readings depending on situation.

I did all my training online due to Covid restrictions. Had to return one sensor (but problems possibly caused by leaning on left arm a lot) and have just received my third scanner, but this seems very unusual.

In Grampian, type 1's are encouraged to get CGMs if we meet criteria, even if we have good BG control.

Hope ths helps.

 

[trophywench]

The Libre 2 is more accurate than the L1 was for me. But since neither CGM nor Flash GM measure actual BLOOD - there will always be a difference, especially at either end of the scale, low or high BG. Today - Libre Reader says 3.6 - meter says 4.5. Too low anyway so needed to treat it - but now it's 6-ish, the difference is only 0.1.

Incidentally a lady on here, who lives in Penzance and has been using Libre on prescription for ages - her CCG still haven't authorised Libre 2.

So don't simply assume you'll automatically get Libre 2 is what I'm saying - we all know that assuming can make an ass out of u and me!

 

[mikeyB]

Rather than carrying a BG test meter around as well as the Libre reader, I just changed my prescription for strips to Freestyle Optium strips. They can be used in the reader - that’s what the slot at the bottom of the reader is for. It’s perfectly happy to do the dirty on its sensor reading. (2.8 v 4.2 is one I remember). In the normal run of things, the two readings match, or at least differ only as much as two different meters would.

These readings don’t appear on the BG record on the reader, only in the memory of the BG meter.

 

[Ljc]

If you get the opportunity to try the Libre I suggest you give it a go .
I’ve been using L1 for some yrs now and it has been a game changer fir me .
You do get the odd dodgy sensor but Abbott are good do at replacing them, they usually want the faulty ones back.

 

[DaveB]

I started Libre 2 a few weeks back. It's self-funded and I started using it without any NHS assistance; just looked at the Abbott's website and forum discussions. For me it's been a game changer. I have been able to adjust my Basal and minimise Bolus spikes. I was worried about allergy with the adhesive as I can't use Tegaderm dressings but all has been fine. I use my mobile phone and haven't bought the reader. I used the free trial Libre 2 for the first 2 weeks. I can thoroughly recommend the Libre 2 and the alarms are a great benefit. I expected a sharp pain in applying the sensor but there has been nothing and no pain in use at any time. The mobile phone LibreLink phone App is self-explanatory and very good. The website LibreView which receives data as well is not so good and poorly designed.

 

[Bruce Stephens]

The website LibreView which receives data as well is not so good and poorly designed.

It could be better, yes. It does allow us to share the information with our HCT.

And it can show the AGP (which the app can't) which is a nice summary page.

 

[nonethewiser]

Really like libre 2, especially alarms. Have low level set at 4.5 to give time to treat hypo if downward arrow is showing, much better than 1 version.

 

[trophywench]

Ditto with what Bruce has said above - my consultant had quite a lot to say about my Libreview records - being as I can't physically see him so was done by phone.

Prior to that when downloading my pump when I went, he'd pick on any hypo and want to know all about it. So when was this? Have I not been anywhere/done anything since then? - do you seriously expect me to keep written records of details about every ruddy hypo? Whereas instead he was saying something more useful - ie that my BG was regularly sinking between the hours of X and Y overnight so reduce my basal from X minus 2 until whenever and see what happens then.

 

[ellietj]

All of the previous comments are really good. The one thing I would add is that if you don't know what the sensor looks like, or how you apply it, then it would be a good idea to just familiarise yourself with that. The Freestyle Libre website shows you what it looks like and there's a demo video. The sensor sits on your upper arm and lasts for two weeks before you need to change it for another. The process of sticking it (and the cannula) onto your arm is all automated and is effectively pain-free: just a tiny twang that you hardly feel. Sticking the sensor on and inserting the cannula are done in the same movement, so it can be done in a couple of minutes and most of that is the time it takes to get it out of the box! Once it's in place, you just pair it with either your reader or the phone app and wait for an hour before it is ready to take a first reading. Good luck.

 

[Peely66]

I'm totally sold on it now but then I haven't had a dodgy sensor yet and I'm only on my 3rd sensor.
I have learnt how to prebolus to smooth out those post prandial peaks and can stay in target 80 or 90 percent of the time at the moment.
I feel better physically than I have for years and psychologically more confident and less like I'm operating in the dark constantly. To use a metaphor that Michael Caine used about the difference between stage and film acting...fingerpricking is like surgery with a scalpel; Flash monitoring is like surgery with a laser. If that makes any sense to anyone?!
A really powerful tool. IMHO.

 

[ellietj]

I'm totally sold on it now but then I haven't had a dodgy sensor yet and I'm only on my 3rd sensor.
I have learnt how to prebolus to smooth out those post prandial peaks and can stay in target 80 or 90 percent of the time at the moment.
I feel better physically than I have for years and psychologically more confident and less like I'm operating in the dark constantly. To use a metaphor that Michael Caine used about the difference between stage and film acting...fingerpricking is like surgery with a scalpel; Flash monitoring is like surgery with a laser. If that makes any sense to anyone?!
A really powerful tool. IMHO.

Yes. Rarely is there a need to blow any b** doors off!

 

[Kev C]

Hi and welcome

Libre sensors are brilliant and there are very few people who try them, that don't find them a game changer as regards their diabetes management and see an improvement in HbA1c, but you do need to do some training to understand how they work and to learn to compensate for the differences between what they read and a BG reading.
The beauty of them is that you can scan as many times a day as you like and even when you don't scan, it collects data every few minutes, so that you can see exactly what is happening between scans or finger pricks and throughout the night and that extra info is amazing in understanding how your body and diabetes works.
It also gives you a direction of travel arrow with your reading so that you can see if your levels are rising or falling or reasonably stable. If they are stable then the reading you get should be pretty close to your finger prick BG test result, but if levels are changing rapidly then there is a 15 minute lag between the BG reading and a Libre scan. That is because the Libre measures interstitial fluid rather than blood and it takes about 15 minutes for changes in BG levels to filter into the interstitial fluid. Once you learn to factor in that 15 min delay it is very reliable for most people.

You really should not be prescribed the Libre without having completed the training and there is an online facility for that through the Libre Academy on the Abbott website. There are various modules to work your way through and webinars which explain things. Prior to Covid, there were face to face Libre workshops run by Libre reps and DSNs I believe but I did my training online.

Since using the Libre I have reduced my HbA1c to 48 and I feel so much more confident in adjusting my insulin (basal doses particularly) to better balance my body's needs and as we all know, if your basal insulin dose is not correct, nothing else goes to plan or makes sense. I scan approx. 30 times a day. The convenience of just swiping the reader (or phone) over your sensor means that you can keep a much closer eye on things and head off hypos before they happen or correct highs without having to wait until your next meal. It enables me to exercise on my own with more confidence and going to bed at night with much less concern about night time hypos.

There are occasions when you do still need to do a regular finger prick test, particularly if the Libre shows your levels are too high or too low and when recovering from a hypo because 15mins after treating a hypo, the Libre may actually show your levels have dropped further due to the time lag whereas a finger prick will show recovery.

Libre is accepted as a means of testing before driving but you do need to have your BG meter with you in case your levels drop low as the BG meter needs to be used to clarify when you come out of hypo and 45 mins after that to show you are fit to drive, but the majority opf the time, the Libre is all I use and I often go several days without a single finger prick.

You are very lucky that your consultant is offering it as many people here on the forum, myself included, self funded for some time before they were able to get it on prescription and some people are still struggling to get it on the NHS. It is £100 a month to self fund, but even for someone like me on low income it is worth every penny for the improved confidence and convenience. I can wake up in the night, scan, eat dextose tablets and go back to sleep within 20 seconds without even having to put the light on, if I hypo. No getting out of bed and going into another room so as not to disturb my partner. It is just fantastic!

Hi Barbara, thankyou for providing me with so much information about Libre, very helpful as I've learnt a lot from the information you provided. I see that you scan your Libre patch about 30 times a day and I know that I am constantly doing blood glucose tests on my glucometer each day and so use a lot of test strips, so certainly a good reason to use Libre. I'm not sure why some people like yourself are asked to self fund Libre as surely in this day and age al type 1 diabetics should be prescribed Libre, if they want it! Wishing you well also and thanks again. Kev

 

[rebrascora]

Hi Kev
Just to clarify, I wasn't "asked" to self fund my Libre, it was just taking forever to get it authorized on the NHS, so I took the decision myself to self fund it in the meantime and it was money very well spent. I had just over 3 months of self funding before I got it prescribed but some people here end up self funding for a year or more before they manage to persuade their HCPs to write them up for it. They are expensive bits of kit and the NHS doesn't have bottomless pockets so they can't just dish them out willy nilly and some people might not cope so well with all the extra data but for people who have done the training and understand how to use them effectively, they are a fantastic bit of kit to have.

Anyway, pleased you found some of what I wrote helpful in understanding the Libre system and what it has to offer and I hope you get to trial one soon..... and that it blows your mind (in a good way!! 😳 )

 

[everydayupsanddowns]

I'm not sure why some people like yourself are asked to self fund Libre as surely in this day and age al type 1 diabetics should be prescribed Libre, if they want it!

Welcome to the forum @Kev C 🙂

There is allocated budget for approx 25% of the total T1 population, who meet criteria which effectively makes Libre cost-neutral (either because they can significantly decrease test strip use, or because it represents significant quality of life improvement)

There are details of the mandatory NHS England criteria here:

Flash glucose monitors (Freestyle Libre) and continuous glucose monitors (CGM)

How does a flash glucose monitor and CGM work? Flash glucose monitors and continuous glucose monitors let you check your sugar levels without you having to prick your fingers.

www.diabetes.org.uk

 

[Kev C]

Hi Kev
Just to clarify, I wasn't "asked" to self fund my Libre, it was just taking forever to get it authorized on the NHS, so I took the decision myself to self fund it in the meantime and it was money very well spent. I had just over 3 months of self funding before I got it prescribed but some people here end up self funding for a year or more before they manage to persuade their HCPs to write them up for it. They are expensive bits of kit and the NHS doesn't have bottomless pockets so they can't just dish them out willy nilly and some people might not cope so well with all the extra data but for people who have done the training and understand how to use them effectively, they are a fantastic bit of kit to have.

Anyway, pleased you found some of what I wrote helpful in understanding the Libre system and what it has to offer and I hope you get to trial one soon..... and that it blows your mind (in a good way!! 😳 )

Hi Barbara, hope you are enjoying the great weather we're having at the moment. Thanks for clarifying the bit about you 'self funding' your Libre and it's great to hear from someone who finds Libre to be a 'fantastic bit of kit', so I contacted my diabetic clinic about Libre and made an appointment to have a Libre 2 patch fitted, which they did on 4th June. I had numerous questions about Libre, which I'm sure we all had when trying out something new but diabetic nurse was very helpful and I asked me to try Libre out the two weeks and let them know how I got on. I'm now in my second week and find that I now have more questions to ask!! but I do find it to be, as you say - 'a fantastic bit kit'. I'm impressed on how easy it is to use and with the Libre Link on my phone, I can see at a glance various data, such as my daily glucose readings in my 'Logbook' and information in 'Daily Patterns,' Time in Target', 'Low Glucose Events', 'Average Glucose' readings etc. and of course all this info is downloaded to the diabetic clinic! I feel like a kid with a new toy!! 🙂 With the great weather at the moment and with people wearing short sleeves or sleeveless tops, I've noticed that there are a quite lot of people out there with Libre patches on their arms! I've already decided to use Libre on a long term basis but will still of course still be doing some blood testing on my glucometer, but will not now be doing so many! I've informed my diabetic clinic who have now given me a date for a tele con. to discuss what happens next i.e. supplies of Libre patches, notifying my GP, etc. etc.

 

[rebrascora]

@Kev C
Fantastic that you got a trial Libre and may be able to get it on prescription.
The Time in Range facility is particularly good as there are set parameters to aim for and it can be quite addictive (a bit like a rather slow but long computer game) trying to improve your stats and get a personal best... That's how I see it anyway.
It is quite important to do the training so that you understand the data it gives you and how it differs from BG readings and how best to use that data. There is a Freestyle Libre online Academy on Abbott's website which I would recommend joining and completing the modules and this may be a condition of getting it on prescription although different areas have different rules.

Having used it for a year now I am sufficiently confident of the results it gives me, that I rarely need to finger prick. Just checked my BG meter and it is 5 days since I last checked my BG and that was for a mild hypo according to Libre but my finger prick was 4.3. I often don't check hypos with a finger prick if I can feel them, but I probably didn't feel hypo with that one, so checked. In that situation I would just have 5 or 10g carbs rather than a full 15g because I wasn't technically hypo. I am very confident to bolus from the info it gives me, but I usually do a few "calibration" checks during the first day or two of a new sensor to ensure that it is in the right sort of range and not hugely out from my BG. My last sensor was consistently 2mmols below BG over the full 2 weeks even at the top end of the range, so I just took that into consideration when I calculated my bolus/corrections.

Curious to know how many times a day you scan?? We all know how addictive it is 😉 I still average about 30 a day 😳It is so quick and easy though and is great for keeping track of your levels when exercising or timing your food (breakfast in particular) to balance the insulin starting to work with the glucose hitting your blood stream.... 45 mins prebolus time for me at breakfast is the sweet spot to prevent a spike..... Not recommending that for everyone and it should be carefully adjusted by 5 mins a day until you find what works for you but I don't look at my watch anymore now, I just keep scanning and watch for my levels starting to drop and then eat my breakfast. Other times of day the timing is shorter usually just 20 mins but it is amazing to see the insulin start to kick in and then eat and see the glucose start to hit the blood stream. It just blows my mind how quickly carbs get broken down when you eat them and absorbed into the blood stream, even supposedly slow release stuff like porridge.

Anyway, good luck getting it on prescription and working on your PB for TIR and enjoy the rest of your current trial.

 

[Kev C]

I had my Libre 2 patch fitted last year (June 2021) and for some time I only took the 'blood glucose' results from my Libre 2 patch and did not do my usual finger prick tests using my glucometer apart from when I was going to drive my car when I of course did a finger prick test.

After several days just using my Libre 2 patch results, I noticed that when I was giving myself my usual insulin that the dosage for some reason did not appear to be quite right because of readings from the Libre 2 patch! I therefore started to do both a finger prick test and also a reading from my Libre 2 patch at the same time and noticed a discrepancy of readings between 2 and 3 between the two devices! This gave me some concern so over a period of just over two months, I decided to do some test results between my Libre 2 patches and my finger prick test results shown on my glucometer and compare the results!

I did a total of 88 tests on various dates and at various times but ensured that when I did both the Libre 2 patch test and the finger prick blood test that the tests between both devices were done either seconds apart or certainly no more than a minute or so, apart to try and get both tests done within relatively the same time frame.

The results were as follows - 21 tests showing a difference of up to '1' in readings between the two devices, 27 tests showing a difference of between '1' and '2' in readings between the two devices, 13 tests showing a difference of between '2' and '3' in readings between the two devices, 25 tests showing a difference of '3' or more in readings between the two devices and only 2 tests showing exactly the same readings between the two devices!

The Libre 2 patch is advertised as a 'Glucose monitoring system' with phrases like 'Monitor your glucose levels daily and at night giving you peace of mind,' however, my understanding now, is that the Libre 2 patches get a 'glucose reading' from the interstitial fluid, which is a thin layer of fluid that surrounds the cells of the tissue below your skin. They do not actually provide a true blood glucose reading!

There are no doubt many people who find the Libre 2 patches clearly work for them, but from my experience I no longer use the Libre 2 patches and so have gone back to testing my blood glucose levels with my glucometer.