The Final Countdown...?

[Peely66]

Shocking results from my Libre for the last 24 hours. The alarm has been pinging off pretty steadily but everytime I do a fingerstick test it's a rock steady 6. I wondered if it's due to the end life of the sensor?

Thinking about this after posting it though, I suppose that is only a couple of mmols difference and within the bounds of the difference of the two ways of testing?

 

[Lily123]

If that was a new sensor, I’d be complaining to Abbott!
As it’s in its last few hours then I suppose it’s to be expected

 

[rebrascora]

Have you checked that it is still well secured. Sometimes they will read iffy like that when they become a bit loose, which can sometimes happen towards the end of their 14 day period. Since i started using an arm strap for the first few days of each sensor's life, I haven't had it happen.

 

[Dave-T]

Mine are like that all the time. Blood sugar consistently 1.5 to 2.5 higher than the sensor reading. For someone like me that sets sugars in the normal range it’s a pain, particularly at night. Wish that Abbott would make the system calibratable like the Dexcom system.

 

[everydayupsanddowns]

I wondered if it's due to the end life of the sensor?

Yup I reckon so. I’m currently nursing a Dex through its final death throes which has been similarly erratic and stop-start overnight.

Either it’s becoming dislodged as @rebrascora suggests, or the filament must just be running out of the special sauce that makes it work.

I’d have swapped it out already, but I prefer my sensors to end during waking hours so I’m keeping it limping on even though it’s mostly just making stuff up now

 

[SB2015]

I like to change sensor on a Sunday to allow a relaxed time for the 2 hour warm up that mine requires (Medtronic Guardian 4), but the sensors have a different plan and shift it when they give up the ghost before their time is up.

Like @everydayupsanddowns I will limp through the final night, reverting to a check in the night in the last day, possibly putting a tegaderm over it if it is coming unstuck, but usually it is too late once I have noticed the problem. If I was sensible I would put the tegaderm on before the problem arises!! It usually puts me back to using a tegaderm on day 1 for a while, whereas normally those are reserved for days when I am swimming.

Sensors still make life easier than not using them

 

[Proud to be erratic]

Sensors still make life easier than not using them

SO TRUE.

During my DAFNE course last Nov, the hosting DSN challenged me about why I bothered with Libre 2, after I'd commented on the mental challenge of juggling "numbers" when sometimes a sensor was 3+ points above actual and at other times 3+ below. This was during one of the "reviews of our daily charts". She clearly had no sense of how beneficial it could be to get any readings without the palaver and inconvenience of finger pricking before making any dosing decision. Trend arrows alone make life easier, and fortunately they seem reliable even if the Libre 2 number is less so.

I've accepted that my body and Libre 2 are not great friends; but I still do my best to "work with the Libre", rather than be without it.

One positive step forward has happened this year. After 10 months without Diabox, I (or more accurately my son-in-law) managed to get Diabox reinstalled and running on the new phone after the auto-upgrade to Android 13. Having real-time CGM displayed on my phone is amazing, without needing to scan (and without the frustration of repeated sensor errors because the NFC on the phone wasn't in the exactly correct place) (if only it made a different sound, then at least you'd know that a duff reading was coming?!). Real time CGM is so much more beneficial than flash scans - it's hard to quantify just how much more "piece of mind and reassurance" one gets from the instant reading, that is just always there on a screen. The Diabox algorithm also seems more stable than Libre 2; so far my readings are less variable than from Libre 2 on LibreLink. So that is a further bonus.

If only there was some way of getting NICE and ICSs around the country to understand that Libre 3 should be available to any insulin dependent person - if they want it. The current situation is deeply immoral; this real-time CGM technology exists, seems to work well, why on earth is it forbidden ......? Even for self-funding?? The extra cost is a smoke screen; the benefits outweigh the relatively small increase and the long-term outcomes can only be even better. Sorry, drifting into a rant and a digression!

 

[Eternal422]

I’ve had that happen to me on a couple of sensors, in their last day they gave false, consistently low readings. It looks like your chart is ok up to that point so I would guess it is the sensor coming to an end. The one sensor I had that read like that from a few days into its life I reported to Abbott and got a replacement sent out.

 

[everydayupsanddowns]

Even for self-funding??

I really can’t understand why Abbott have not allowed self funding (like Dexcom and Medtronic).

It is perplexing! And nothing to do with NICE.

The clinical trial data around CGM are certainly improving, but NICE need some fairly firm numerical improvements in outcome data, which (despite anecdotal user accounts) have been a bit thin on the ground in the published literature until very recently.

The T1 guidance worked really hard to look at all the published data in 2015 and created a new cost model based on an ‘average UK T1’, the likely A1c improvement from published data at the time, and the reduction in complications (and therefore potential savings) that could result. And cost-compared with 10x a day fingersticks. Unfortunately at that stage CGM still didn’t quite cut it - mostly because of their price ticket.

The situation is changing as hybrid closed loops make more significant improvements achievable. Fingers crossed this are creeping in the right direction 🙂

 

[Eternal422]

I wonder whether pumps will be available to at least all T1s at some point in the future?

 

[Proud to be erratic]

I really can’t understand why Abbott have not allowed self funding (like Dexcom and Medtronic).

Nor can I.

It is perplexing! And nothing to do with NICE.

I'm ill-informed, but my instinct is that NICE do have influence here and need to exercise a mix of vision and common sense. Why aren't NICE recommending Libre 3 now for all who want to progress?

Also, If NICE aren't challenging why Abbott are denying Libre 3 for self-funding, then who else will? NICE could rule out Libre 3 for any part of the NHS simply because it isn't being made available for self-funding and let the NHS concentrate on the remaining competitors. Then either Abbott will rethink their strategy or lose a share of the UK market.

The clinical trial data around CGM are certainly improving, but NICE need some fairly firm numerical improvements in outcome data, which (despite anecdotal user accounts) have been a bit thin on the ground in the published literature until very recently.

Again I'm ill informed, particularly on how clinical trial outcome data is collected, how frequently and by whom. There can't be many Consultants that don't believe that outcomes are or can be improved for a significant proportion of insulin dependent folks - with real-time CGM and not this scan nonsense. Again some vision is needed and the cost increase is not unduly huge; how many L2 users are there today?

The T1 guidance worked really hard to look at all the published data in 2015 and created a new cost model based on an ‘average UK T1’, the likely A1c improvement from published data at the time, and the reduction in complications (and therefore potential savings) that could result. And cost-compared with 10x a day fingersticks. Unfortunately at that stage CGM still didn’t quite cut it - mostly because of their price ticket.

But 2015 is in tech terms an obsolete reference point today. Who is looking at todays "snapshot"? Also, fingersticks are costable, but where does quality of life along with improved D management get assessed and costed? Judgement is needed as well as base costs and senior management is failing to do their bit of judgement.

The situation is changing as hybrid closed loops make more significant improvements achievable. Fingers crossed this are creeping in the right direction 🙂

I appreciate @everydayupsanddowns that you are, rightly, bringing your much wider knowledge and balance to this topic and I'm somewhat flailing around - frustrated by the blatant lack of common sense.

In a previous world I've had significant budget responsibility within a very big Gov't Dep't and been deeply frustrated by Treasury rules along with annual budget squeezes. But I've also found that when the right person is confronted with an obvious bit of nonsense that just needs a relatively low-cost solution to be approved, that approval can be gained. I do think that providing rt-CGM is necessary, achievable and potentially at little or no cost. After all Dexcom One, for all its current limitations, is already deemed no cost - yet its roll-out is floundering under ICS reorganisation and associated bureaucracy. I struggle to believe Abbott could not be persuaded (or coerced) to provide Libre 3 to self-funders and if they can't - then let market forces convince them.

 

[Proud to be erratic]

I wonder whether pumps will be available to at least all T1s at some point in the future?

I want to agree with you, but think this is such a significant cost and thus huge step, it is not going to be achieved quickly.

Apart from the extra hardware costs, the training , associated IT, technical support and consequent medical support are all making this just "a bridge too far" - for the next decade at least. Even if training and tech support is outsourced (more cost) and hardware leased (deferred cost!) - the medical support burden is currently not achievable and unsustainable for NHS HCPs. Even privatisation of this niche service would not be considered politically acceptable; too close to a slippery slope for any Government.

 

[everydayupsanddowns]

In a previous world I've had significant budget responsibility within a very big Gov't Dep't and been deeply frustrated by Treasury rules along with annual budget squeezes. But I've also found that when the right person is confronted with an obvious bit of nonsense that just needs a relatively low-cost solution to be approved, that approval can be gained. I do think that providing rt-CGM is necessary, achievable and potentially at little or no cost. After all Dexcom One, for all its current limitations, is already deemed no cost - yet its roll-out is floundering under ICS reorganisation and associated bureaucracy. I struggle to believe Abbott could not be persuaded (or coerced) to provide Libre 3 to self-funders and if they can't - then let market forces convince them.

This has been happening recently with Prof Partha Kar. Who effectively shook things up sufficiently to get Libre available on prescription (when many voices said this was impossible)

As far as NICE is concerned… its role I suppose is really to evaluate and balance all published evidence on a topic, and decide whether a particular treatment or option is likely to offer value for money. Or at least that’s one way of looking at its work.

What this can mean, I suppose, is that it is more difficult for fast-moving options to break through - although all reviewed evidence will be weighted and graded for quality, reliability and applicability to particular situation.