Thankyou for the welcome.
It’s all very much a learning curve for me at the moment. I’m insulin dependent and I’m on the tresiba and nova rapid pens. I also have to take creon with every meal/ snack.
I’ve been on the freestyle libre 2 sensor for a couple of months,I’ve had a couple of faulty ones but overall I’m happy with it.
Hi again Judy,
It was a huge learning curve for me also. I was started on Levermir 2x daily and NovaRapid 3x daily before meals. There was scant explanation about prebolus dosing, or carb counting. I was given a simple formula of so many units preferably before each meal and fixed units for basal. Initially I was recovering from surgery, adjusting mentally to my new lot and just drifting day to day. I then started chemo and even though that was ended early I was struggling while it was going on and in a chemo fog until Oct 2020.
During those 8-9 months I had regular contact with a Diabetes Specialist Nurse (DSN) and her colleague dietician. The DSN was very supportive, helpful and old school - keep it simple. She adjusted my dosing formula from time to time from scrutiny of my photographed logbook and reassuring when it all seemed out of kilter. However, it transpired that while she told me my diabetes was difficult, in practice she didn't appreciate that T3c needed a lot more management than T1 and this nearly became a big problem. The diabetes dietician was not unhelpful, but simply didn't understand; luckily the cancercdietician kept me on her books and was very supportive.
My first Endocronologist was hopeless; I never met him, just had a phone consult which started with his question: "how did I come to realise that I had Type diabetes?" Not only had he not bothered to read my notes before starting the call, in retrospect I realise that his first report on me showed he had no understanding of the difficulties of having no pancreas. He described me T1, with no caveat.
This is a recurring theme which you will encounter. Most medical people simply have no awareness that there is such a thing as Type 3c diabetes, never mind realising it is much more complex than T1. At first this really irritated me, when reports described me as T1, not T3c; but I've mellowed slightly. It was pointed out that since T3c is barely known about in the general medical community, better to have medical records saying T1, if you end up unconscious in A&E, so you're given insulin rather than treated as T2 because T3 is "less". I tested this observation with a local Dr, not my practice, who gave me my 2nd Covid jab. She confirmed she'd never heard of T3c, didn't recognise my Libre sensor (?!) and asked if I was born without a pancreas.
During Oct 20 I came out my chemo fog, and realised I had to play an active part in managing my own diabetes. I read "Think Like a Pancreas" did an on-line Carb counting course (Bertie) and asked my DSN loads of questions. She subtly helped me change my Endocrinologist, who at least knew something about T3c Diabetes; alas despite promising to assist on something, he just went silent and for me a commitment needs to be honoured, or explained why not. But something good did come from that, thanks to my surgical team, who recognised that T3c needs very special support and since last October I'm now under the Oxford Centre for Diabetes, Endocrinology and Metabolism - even though I live in Bucks. Those 3 words, Diabetes, Endocrinology and Metabolism very succinctly encapsulate the complexity and extremes of T3c diabetes.
Anyway in Jan 2021 I was put on a list for being fitted with Libre 2 and got that a few weeks later. So I spent over 12 months just finger pricking and a little less without carb counting; I call that my apprenticeship.
So about Libre 2: I'm in absolutely no doubt that Libre 2 is a huge improvement on finger pricking and a meter. To not have something like that is like having a car with no fuel guage - just a stick to dip the fuel tank with! It isn't always reliable and this is regrettable; but once you've realised your Libre isn't behaving properly, Abbott do replace them. I'm on my 9th replacement in 10 months. My GP is pretty strict about only prescribing 1 every 2 weeks but I now have gathered 2 extra and so feel less vulnerable; and will fit a new one if I'm unhappy with how my current one is doing. Having said I'm in no doubt about the benefit, like all technology it's great, but when it doesn't work it really is *#¥*... ! I would be even happier if Libre 2 was more reliable.
I fit, but don't activate, my next sensor at least 3 days before it is due to end. I found from trial and error that my body needs 3 days to accept this intrusion and settle down. Hence early fitting. But, if I'm slightly anxious about my current sensor I will promptly fit the next one; so I might be wearing 2 sensors for over a week, if my concern proved to be ill-founded. But that reflects how important it is to me to have a working sensor. If I go away overnight a replacement sensor is part of my luggage; if I was flying all my DM "stuff" would be in my hand luggage - too important to be misplaced or lost in hold luggage.
One of the apparent "unreliability" problems is when Libre 2 doesn't match actual BG, even after allowing for the inherent time-lag between actual and interstitial values. Freestyle claim this as 2.4 minutes for Libre 2, it was nearer 15 mins for the original Libre I believe. But my tests have left me feeling the lag was about 5 mins. If you are unclear about this there is a lot on this site, in these forums; just search. But be aware some people still refer to 15 mins, which is definitely wrong for Libre 2. Anyway, by the time your flash scan with your Libre reader or your phone has told you that you are at or close to the hypo zone ... your actual blood glucose got there 2.5 to 5 mins before and you are dealing with a developed low. Conversely if your flash scan gives you a reading below 4 you might already be recovering, and this can also be misleading. So it becomes confusing, by seeing conflicting numbers, just when you are feeling disorientated by the hypo; my advice is trust your finger prick more than Libre 2. Both have margins of error and if that error is within margin, but in the diverging direction for each ... the gap can look big! But Freestyle encourage you to test with finger pricking when both high or low. when in range, ie 4-10 I just go with my sensor data; it's close enough.
This problem is particularly awkward for us without a pancreas and our brittle (erratic) diabetes in low glucose circumstances. Without the pancreatic hormones to respond for us and help regulate, we can fall very quickly; and without Libre 2 more accurately quantifying how rapidly we are falling, it is not easy to see exactly what is going on, thus make the best response. For me this where my Diabox CGM app is a significant improvement; I found this app in June 2021 and having it has been a huge improvement on Libre 2 alone. Libre tells you of two rates of change: sloping arrow = gentle change up to 0.1 mmol/L/min (in 5mins you could change by 0.5mmol/L); vertical arrow = anything greater, which could be just a tiny bit more than sloping or dramatically more. Diabox puts a number to that rate of change and I frequently get told it is 0.4mmol/L/min and I've seen it up to 0.7mmol//L/min. So I get a better chance of recognising if my fall is dramatic and thus hit it hard with the JBs accordingly. But the real bonus is the CGM is informing me without having to flash scan, using a sophisticated alarm system worthy of the current decade. Libre 2 and LibreLink feel very dated in comparison.
The Libre low alarm caps you to an upper level limit of 5.6. Why Abbott set that limit defies any logic. Why shouldn't someone need a higher level? Why set a cap at all? I found, regularly in the early days that an alarm at 5.6 or below was too late, if the fall was with a vertical arrow; I couldn't intercept the forthcoming hypo in time. Now, with Diabox I have 2x low alarms, an upper low alarm which I use to tell me change is going on and a 2nd low for which I have a siren sound; this makes me pay attention!! And it wakes me in the night which stops hypos, other than brief dips below range.
From time to time you will get Libre readings greater than actual and in due course Libre will read less than actual. This is not only normal, but good; it confirms that Libre is providing readings that follow actual, yet are not hugely adrift; the actual is simply doing what it does, going up and down. If the Libre arrow contradicts that interpretation, it is because the Libre reading is a flash scan - ie an interpretation by the sophisticated algorithm of what it thinks is happening. My CGM gives an opportunity to see what is happening minute by minute and observe small changes from rise to fall and back again - of course it doesn't explain why things are changing, but that is for another day.
So, I think enough for now; I'll pause and give you time to digest all of this and earlier. As before, don't hesitate to ask. I have successive days when I diligently follow the blogs, then I get distracted and barely monitor. But dialogue and comments on blogs I'm following get flagged up on my email account, so I know there is further activity. If you want to get wider views on a specific topic, try raising a separate blog with a succinct title - which might attract others to comment.
Stay strong.