Preferred basal insulin for twice daily injections advice pls

[nonethewiser]

You’re absolutely right, I did show interest with the consultant and they didn’t object but no feedback on when. I’m waiting for the pasty or Daphne course invite, so I think that to be done.

Many clinics do insist on doing carb counting course first, also if & when you do get started on a pump there might be some pump training courses involved, either by specialist pump nurse or pump rep.

Keep reminding them that your still interested, good luck.

 

[mitchsi]

Well my DSN rang me this morning to discuss changing to isophane insulin or Levemir, she preferred I went to Levemir so that’s ok for me and she’s emailed my gp surgery to send out a prescription.
She’s put me forward to the pasty course as it’s now known or at least down here in sunny Plymouth, she thinks I’m ready for that. I’ll hear back within 6 months. Then pump could follow if I want.
Also she’s offered me to move to the dexcom G7 now if I want due to better alarms as a clinical reason for the swap. So I’m contemplating that.
I can’t fault my local DSN clinic, very supportive and quick to get back to me.

 

[Inka]

The G7 is brilliant @mitchsi !

 

[Inka]

Yeah, my DSN said Levemir too but I asked for both so I could make up my own mind. It’s me who uses it not them, after all.

 

[Proud to be erratic]

Hello @mitchsi,
I now have G7 which I mainly use through my android Samsung A52S phone. The G7 seems to not be compatible with so many phone types as Libre. My body and Libre didn't like each other at all, and Dex One was better but still mediocre with a poor app.

There is a G7 Receiver (equivalent to a Libre Reader) which I asked for as part of my transfer. Because G7 is provided (as far as I know) only through Hospital contracts I would suggest you ask for a Receiver as well as the sensors. Otherwise it's pricey at c. £250 and only purchasable direct from Dexcom. My Hospital contract gives me 3 monthly deliveries, so 9 sensors at a time. Dexcom customer service feels a solid place to have a dialogue with.

I find the G7 very accurate, pretty reliable and while the android app is a little more cumbersome than the LibreView phone app it's still OK (whereas the Dex One app was not OK). Certainly better alarms etc. Without reading back about why you might need a change of CGM I would say "go for it" - I certainly have no regrets. Sensors only last 10 days, which is a slight nuisance but can be worn on your abdomen as well as arm and the warm up period is only 30 mins max, usually a fair bit less.

I've had my app fail (twice now), which was very tiresome and became the justification for asking for the Reader. I've documented this elsewhere, once under my own post last September and further detail in the current posting titled "Ensuring Silence with G6". In the first case the Reader would have been invaluable (if I'd had one!) and this year it was invaluable. Just ask if you can't find these.

 

[mitchsi]

Yeah, my DSN said Levemir too but I asked for both so I could make up my own mind. It’s me who uses it not them, after all.

I could have pushed but considering a lot have experience with Levemir I thought it’s a safer start, I can change later on if need be. But thanks for the heads up on the isophane types, it was useful.

 

[mitchsi]

Without reading back about why you might need a change of CGM I would say "go for it"

The thread was only about splitting basal, todays conversation with the DSN included going low with sport so she offered the G7 because of predictive alarms allowing me to pre-empt and treat early. I could manage with the libre2 but it sounds like the G7 is a different level so I’ll probably go for that. It’s also a bridge if I go for the pump later on.

Thanks for the heads up for the reader, I’ve seen your recent post but haven’t read it as I use libre2.

The G7 will also come from the clinic and not my GP in 3month supplies son it’s the same as for you.

 

[JJay]

Well my DSN rang me this morning to discuss changing to isophane insulin or Levemir, she preferred I went to Levemir so that’s ok for me and she’s emailed my gp surgery to send out a prescription.
She’s put me forward to the pasty course as it’s now known or at least down here in sunny Plymouth, she thinks I’m ready for that. I’ll hear back within 6 months. Then pump could follow if I want.
Also she’s offered me to move to the dexcom G7 now if I want due to better alarms as a clinical reason for the swap. So I’m contemplating that.
I can’t fault my local DSN clinic, very supportive and quick to get back to me.

I like the idea of a pasty course! (Love a pasty!)

Only joking, I’m glad everything has worked out for you. Changing from Glargine (Lantus in my case) to Levemir was the best thing I ever did - time in range improved by 10% within a very short time.

 

[mitchsi]

I like the idea of a pasty course! (Love a pasty!)

Only joking, I’m glad everything has worked out for you. Changing from Glargine (Lantus in my case) to Levemir was the best thing I ever did - time in range improved by 10% within a very short time.

yeah can't beat a good pasty but doubt they'll have any.

Thanks, nice to hear that your TIR improved and the change was positive, that's encouraging.

 

[Proud to be erratic]

The thread was only about splitting basal, todays conversation with the DSN included going low with sport so she offered the G7 because of predictive alarms allowing me to pre-empt and treat early. I could manage with the libre2 but it sounds like the G7 is a different level so I’ll probably go for that. It’s also a bridge if I go for the pump later on.

Currently (or at least as at last November) the G7 is not a bridge for anything, since it doesn't yet have the necessary accreditations. The G6 is, but that is an older, slightly bulkier, 10 day sensor that needs a 2nd component of a 90 day transmitter that is moved from sensor to sensor as each sensor expires. So slightly different procedure. So the G6 might be a slight step backwards, I'm not familiar with the G6 finer details. Unless HCL is very close I'd park that issue for now. Because of the 10 day one part sensors you could revert to Libre if the G7 really didn't suit you and I can imagine that your DSN team would snatch any surplus G7 sensors out of your hands for other patients.

Thanks for the heads up for the reader, I’ve seen your recent post but haven’t read it as I use libre2.

My Libre originally came with a Reader and while I mainly used Libre from the app, I did appreciate having a Reader as well - for a variety of reasons. In practice that similar rationale applies now with the G7 Receiver and there are moments when the Receiver convenience is terrific. It is also smaller and lighter than the Libre Reader.

 

[SimonP]

Sorry I'm late to the party, I split abasaglar and reduce my morning dose for long days on the bike. I first started splitting dose to avoid overnight lows after exercise (and this was effective keeping the same overall dose and doing a 50-50% split) then moved onto more active dose changes to avoid running low towards the end of long days out.

 

[nonethewiser]

Currently (or at least as at last November) the G7 is not a bridge for anything, since it doesn't yet have the necessary accreditations. The G6 is, but that is an older, slightly bulkier, 10 day sensor that needs a 2nd component of a 90 day transmitter that is moved from sensor to sensor as each sensor expires. So slightly different procedure. So the G6 might be a slight step backwards, I'm not familiar with the G6 finer details. Unless HCL is very close I'd park that issue for now. Because of the 10 day one part sensors you could revert to Libre if the G7 really didn't suit you and I can imagine that your DSN team would snatch any surplus G7 sensors out of your hands for other patients.

My Libre originally came with a Reader and while I mainly used Libre from the app, I did appreciate having a Reader as well - for a variety of reasons. In practice that similar rationale applies now with the G7 Receiver and there are moments when the Receiver convenience is terrific. It is also smaller and lighter than the Libre Reader.

Not sureid agree that G6 is lot bulkier @Proud to be erratic , find it sits quite neatly on body but must admit not seen a G7, if given choice I'd opt for G6 over going back to Libre @mitchsi but choice is yours obviously.

 

[JJay]

Not sureid agree that G6 is lot bulkier @Proud to be erratic , find it sits quite neatly on body but must admit not seen a G7, if given choice I'd opt for G6 over going back to Libre @mitchsi but choice is yours obviously.

I wangled a free trial of both G6 and G7 as I had concerns over the waywardness of my Libre 2, and was frustrated by the lack of an app connection to Apple Watch.

I thought the G6 was a bit of a monster compared to Libre, and rather a faff with its 2 parts. It was hardly more accurate either. The G7 was indeed very small and neat, and very accurate, but constantly lost signal even with the phone right next to me. This was a real concern at night.

So I’m still with Libre plus a 3rd party app (xDrip4IOS), and have to say things are improving accuracy-wise. I just cannot understand why, with the explosion in smart watch usage, Abbott have not developed an app that can be used with them.

 

[mitchsi]

I wangled a free trial of both G6 and G7 as I had concerns over the waywardness of my Libre 2, and was frustrated by the lack of an app connection to Apple Watch.

I thought the G6 was a bit of a monster compared to Libre, and rather a faff with its 2 parts. It was hardly more accurate either. The G7 was indeed very small and neat, and very accurate, but constantly lost signal even with the phone right next to me. This was a real concern at night.

So I’m still with Libre plus a 3rd party app (xDrip4IOS), and have to say things are improving accuracy-wise. I just cannot understand why, with the explosion in smart watch usage, Abbott have not developed an app that can be used with them.

Oh that’s an interesting take on it.
The lost signal is a concern, was it at times of fast transitions eg high carb or exercise? How long ago did that happen in case since then they’ve worked through the bugs?
On the dexcom compatibility page iwatch series 9 is not mentioned but at least iwatch is there unlike Libre, I’ve had to use two apps to get the Libre on my iwatch.

 

[Inka]

I have the G7 and it’s very small and low profile. I was offered either the G6 or G7 and chose the G7 because of size and because there was no faffing about with the transmitter. The G7 is also good because you can basically have zero warm-up time. It’s amazingly accurate and it’s changed my life, no exaggeration.

@mitchsi Ask for the Dexcom receiver. I know Plymouth provides them if you have an incompatible phone, for example. My receiver never loses contact with the sensor unless I go majorly far away from it, eg the bottom of the garden leaving the receiver in the house. It never loses connection during the day when I move around the house and leave it downstairs. It has never lost connection at night. It’s literally if I go a long way away from it, which is to be expected.

 

[mitchsi]

I have the G7 and it’s very small and low profile. I was offered either the G6 or G7 and chose the G7 because of size and because there was no faffing about with the transmitter. The G7 is also good because you can basically have zero warm-up time. It’s amazingly accurate and it’s changed my life, no exaggeration.

@mitchsi Ask for the Dexcom receiver. I know Plymouth provides them if you have an incompatible phone, for example. My receiver never loses contact with the sensor unless I go majorly far away from it, eg the bottom of the garden leaving the receiver in the house. It never loses connection during the day when I move around the house and leave it downstairs. It has never lost connection at night. It’s literally if I go a long way away from it, which is to be expected.

Thanks @Inka , I always rely on my phone and not the receiver for the libra except finger prick testing.
Have you experience of the G7 with a mobile?

The features of the G7 are attractive and is smaller than the libre2 so I’d like to say yes. Connectivity issues are a concern but will check if a common issue or not, I’d be surprised if it was though, working in IC development medical and automotive I know how much these things would be tested and verified before release to the market.

 

[Inka]

No, I only use the receiver @mitchsi My phone isn’t compatible. I don’t find the receiver a nuisance at all. It’s tiny and the charge lasts brilliantly. I wouldn’t bother buying a compatible phone now because I’m so impressed with the receiver.

 

[Proud to be erratic]

Thanks @Inka , I always rely on my phone and not the receiver for the libra except finger prick testing.

Even if you intend to use your phone as your default @mitchsi - I suggest that you get the Receiver as well. Looking back over the last 3 years there has been a whole stream of screams as upgrades to both android and ios phones have unceremoniously left users high and dry for days, weeks and sometimes longer because of upgrades. When such things happen, the CGM manufacturs are deluged with cries for help - that they can't resolve promptly. Those clever enough to have looked ahead simply turn to their Readers/Receivers - until the tech folk get their acts together. The rest return to frequent finger pricking.

I’d be surprised if it was though, working in IC development medical and automotive I know how much these things would be tested and verified before release to the market.

I admire your confidence, which is not supported by the evidence of upgrades that went awry in recent years. I guess a major part of the problem is that an android or ios upgrade can't and won't necessarily be compatible with anyone else's app. Even if at launch a Dexcom or Libre app is thoroughly tested and medically compliant - that is still no assurance for compatibility with operating software upgrades.

 

[mitchsi]

No, I only use the receiver @mitchsi My phone isn’t compatible. I don’t find the receiver a nuisance at all. It’s tiny and the charge lasts brilliantly. I wouldn’t bother buying a compatible phone now because I’m so impressed with the receiver.

Fair enough

 

[mitchsi]

admire your confidence, which is not supported by the evidence of upgrades that went awry in recent years.

I’ll look into that, sounds like a systematic failure to build into their software robustness against iOS upgrades if that’s the case - very surprising, I’ve got petty apps that don’t have issues with upgrades in iOS! I have to say I’ve witnessed little issues with Libre albeit over the last 4 months.
I’ve noted from you to ask for the reader so appreciate that heads up 🙂