Type 2 diabetics not on insulin technology discrimination

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HalfpipMarathon

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Relationship to Diabetes
Type 2
This is just my thoughts and opinions on the above: I'm one of the above. I'm not ashamed of it.

By being proactive about managing my condition I decided to try a cgm (Dexcom One) having tried Libre 2 (flash gm).

Some people believe diabetics like myself not on insulin don't benefit from either cgm or flash gm; my question is how do they know? One gets out what one puts in. We're all different.

Whilst I realise that the NHS doesn't have a bottomless purse hence the strict criteria for receiving Libre 2, Dexcom etc on prescription. I understand the argument with regards to that however if someone is self funding it's no one's business whether someone has a cgm or flash gm and how they interpret the data. M

I had someone on a FB group appear to blame people like me because she couldn't get a supply of the Libre for a week . The admin put her right that how someone manages their condition is noone else's business and a pharmacist will sell if it's available.

I'm grateful that noone on the forum has been judgemental about what I have posted. Everyone has been most supportive and helpful responding to my posts which has helped my mental health for this I thank you.
 
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Greetings from the USA! Myrtle Beach, SC.

Halfpip - I agree with you on the value of a CGM for diabetics who are not yet on insulin. I have been in the A1C range as high as 8.4 (once upon a time) and my insurance carrier at the time (2020) paid 100% for me to use a Libre Freestyle CGM. As a technical person I used the CGM readings to better understand the impact of various foods, exercise, rest and other factors that impacted my glucose levels - more or less in a real-time sense. I learned quite a bit about managing my glucose levels and as of recent months my A1C has leveled off in the 6.4-6.8 range. I attribute that to having gained a working knowledge of the direct effects of various foods and eating habits. To this day I am grateful for the year I had a CGM to learn these things. Alas, in 2021 my insurance changed and I lost coverage for the Libre Freestyle CGM and had to give it up.

I have since then been watching for new non-invasive CGM technology to come available. Apple Watch teased about this for the past 2 years but hasn't risen to the occassion. Samsung has likewise fed the rumor mill about their upcoming watch based CGM product. But as time drags on, I've come to believe that these rumors are pre-mature. Most likely the regulatory agencies involved have a squashing effect on innovation in the field of diabetes management. Anything that threatens the financial foundation of insulin manufacturers most probably draws push-back from said manufacturers. And regulatory agences tend to be quite reluctant to take them on. Meanwhile those of us who would willingly purchase such non-invasive CGM technology simply go without.

The sad truth (to me at least) is that having a tool to readily and conveniently monitor and manage one's own glucose levels serves the public good very well indeed. Having better knowledge of what you're doing to yourself when you down a Snickers bar - or drink a soft drink, can only serve to help each of us do a better job of managing our own pre-diabetes. And if it helps us manage our lives in ways that avoid more serious levels of diabetes then so much the better. I'd rather have this tool available than not. And I'm perplexed that the insurance industry isn't onboard with this as well.
 
Whatever allows you to manage your diabetes @HalfpipMarathon - I can fully understand why you’d want to use a CGM. A finger prick gives you a very limited amount of info to base food, activity, etc. changes on, while a CGM graph gives you the whole picture. The more tools we have in our self-management kits (whatever our type), the better!
 
I meet the criteria, have also been admitted to hospital for diabetes this year, and still can’t get libre on prescription. The nice reccomended criteria aren’t followed for T2 in most places it seems.
 
Hi thank you for reading and replying to my post.

I'm not eligible in the UK for libre 2 or anything else on prescription. I have tried Libre 2 but found my anxiety was not helped by scanning so I am trying out Dexcom One which doesn't require scanning. I have a receiver as my phone is not compatible with the Dexcom One app.

As I said in my post I am scared the anxiety I had when I was scanning is creeping back. How often should one check the app or receiver ? Or should you only check if you get an alarm saying low or high.
 
I’d check whenever I expected to need to act on the information (eg a correction), or whenever i wanted to know what my bgs is (eg before giving a presentation or exercising in case i was heading low) plus whenever an alarm goes off. So in reality at least every couple of hours.
 
Bloden said:
Whatever allows you to manage your diabetes @HalfpipMarathon - I can fully understand why you’d want to use a CGM. A finger prick gives you a very limited amount of info to base food, activity, etc. changes on, while a CGM graph gives you the whole picture. The more tools we have in our self-management kits (whatever our type), the better!
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Thank you. That is exactly what I feel yet I haven't posted about being on Dexcom One as I am aware some might think I don't need it if not on insulin or medication that might cause hypos.

I'm in the early stages with Dexcom One and I am trying to stop myself constantly checking my bg levels
 
Why are you trying to stop yourself? The whole purpose of dexcom is to be able to check your bg as often as you want to, so that you can act on it. If you aren’t acting on the information, then it may be that cgm isn’t for you and you could get the information you need to act on your blood sugars through finger pricking.
 
Lucyr said:
I meet the criteria, have also been admitted to hospital for diabetes this year, and still can’t get libre on prescription. The nice reccomended criteria aren’t followed for T2 in most places it seems.
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According to some unless you are type 2 on insulin no chance of getting it on prescription. My Dr said that eventually all diabetics regardless of insulin or not will be offered the Libre 2. I won't hold my breath. Some might prefer Dexcom One as it's same price roughly as Libre 2.

I have mixed feelings about getting it on prescription if I am honest
 
Lucyr said:
Why are you trying to stop yourself? The whole purpose of dexcom is to be able to check your bg as often as you want to, so that you can act on it. If you aren’t acting on the information, then it may be that cgm isn’t for you and you could get the information you need to act on your blood sugars through finger pricking.
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I'm not saying I am not going to check at all just when I was using Libre I had bad anxiety when I scanned and got a higher reading especially when I wasn't in a position to do anything about it .

When I am at work I am okay as too busy to check too often. I will check 2hrs after breakfast and lunch. It's the evening when I get a bit obsessed
 
HalfpipMarathon said:
Thank you. That is exactly what I feel yet I haven't posted about being on Dexcom One as I am aware some might think I don't need it if not on insulin or medication that might cause hypos.

I'm in the early stages with Dexcom One and I am trying to stop myself constantly checking my bg levels
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If you need the reassurance then check whenever you think you'd like to check - it is not going to wear the thing out or make the slightest difference to the functioning of the device, after all.
I am sure that most people check the speedometer umpteen times during their driving lessons and in the early days of driving - and then they check less and less as they become proficient at judging their speed. You'll probably do the same with your blood glucose levels.
 
John McDermon said:
And I'm perplexed that the insurance industry isn't onboard with this as well.
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I've no information about insurance companies, but NICE looked at things like reductions in hospital admissions for DKA and hypos (nice short-term effects) and reductions in HbA1c and decided that CGMs were appropriate for everyone with Type 1 (and some insulin users who have Type 2). I'm sure other criteria played some role but I suspect less of a role.

It feels much harder to justify offering them to people who aren't at risk of hypos and aren't at much risk of DKA, especially given that in the UK they aren't generally recommended to test themselves at all. (Other places are willing to spend more on health, of course.)

I can imagine things would change if there were some much cheaper technology for monitoring (even if it were much less accurate) but so far that just hasn't appeared.
 
Bruce Stephens said:
I've no information about insurance companies, but NICE looked at things like reductions in hospital admissions for DKA and hypos (nice short-term effects) and reductions in HbA1c and decided that CGMs were appropriate for everyone with Type 1 (and some insulin users who have Type 2). I'm sure other criteria played some role but I suspect less of a role.

It feels much harder to justify offering them to people who aren't at risk of hypos and aren't at much risk of DKA, especially given that in the UK they aren't generally recommended to test themselves at all. (Other places are willing to spend more on health, of course.)

I can imagine things would change if there were some much cheaper technology for monitoring (even if it were much less accurate) but so far that just hasn't appeared.
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Whilst I understand why it's not recommended for type 2 not on insulin or medication that might cause hypos I still don't understand why the aforementioned are told not to test. It could be financially motivated re cost of meters , strips and lancets orbit could be due to mental health risks.

My Dr said that if you don't test how do you know what your blood glucose is doing for example if one had a reading of 15 one wouldn't go and get a cake.

Using Libre 2 I managed to reduce my HbA1c and hope to have improved it further next time.
 
HalfpipMarathon said:
Whilst I understand why it's not recommended for type 2 not on insulin or medication that might cause hypos I still don't understand why the aforementioned are told not to test. It could be financially motivated re cost of meters , strips and lancets orbit could be due to mental health risks.
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Not sure that mental health risks are a bit factor. There are costs in asking people to test when there's not that much they can do about it. There are the financial costs and I'm sure that's the major reason in the UK. But there's also (I suspect) a limited value in testing, so it's worth trying to maximise the value compared to the cost. (And I'd agree that CGMs would be ideal if only they were vastly cheaper since they're nice and low effort.)

I think we ought to be offering testing for the first (say) six months together with advice on how to use it (to judge how particular foods are digested and that kind of thing). That seems fairly uncontroversial (based on the Cochrane survey).

 
I was prescribed strips initially, that was before CGM's were around.

The issue with constant testing can be a mental health issue though.

There are many unrealistic expectations that do upset people.
Be it from spikes, food issues, setting unattainable targets, trying to crash hba1c down in weeks, it goes on, and there are posts daily on this.

The "speedometer" analogy is good, it's like trying to drive on the motorway as if you are in a schoolzone, panicking and trying to keep the speed at 20mph when everyone else is comfortable at 70mph.

Then the amount of testing can be an issue.
Again, it's like driving continuously watching the speedometer, and not looking at anything else, eventually you will crash and burn.

So yes, testing can be useful, but not universally, I think it needs discussion with the HCP first, to ensure its not just swapping one issue for another.
 
Bruce Stephens said:
Not sure that mental health risks are a bit factor. There are costs in asking people to test when there's not that much they can do about it. There are the financial costs and I'm sure that's the major reason in the UK. But there's also (I suspect) a limited value in testing, so it's worth trying to maximise the value compared to the cost. (And I'd agree that CGMs would be ideal if only they were vastly cheaper since they're nice and low effort.)

I think we ought to be offering testing for the first (say) six months together with advice on how to use it (to judge how particular foods are digested and that kind of thing). That seems fairly uncontroversial (based on the Cochrane survey).

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Healthcare has always been about the money and how much money ought to be spent on any one individual to maintain optimum health.

And healthcare in the UK has always been rationed both pre and post 5 July 1948.

I saw a publication recently, published by Diabetes UK, which says that roughly 10% of the entire NHS budget is spent on diabetics (T1 and T2), but of that 10% 80% is spent on treating [preventable?] complications.

If that is correct - and I have no reason to disbelieve it - it does suggest that a "penny wise, pound foolish" approach goes on within the NHS concerning tech that would help diabetics better manage this condition.

It has never made sense to me - as a taxpayer - why diabetics who would benefit from it shouldn't be given the tools to better manage this disease, now that better tools exist.

Can anyone think of any other chronic medical condition where - for 95% of the time - one is left completely on one's own and to one's own devices to manage the condition?
 
travellor said:
So yes, testing can be useful, but not universally, I think it needs discussion with the HCP first, to ensure its not just swapping one issue for another.
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Yes, I think it's important to make sure that what you'll learn will be worth the effort.
 
travellor said:
I was prescribed strips initially, that was before CGM's were around.

The issue with constant testing can be a mental health issue though.

There are many unrealistic expectations that do upset people.
Be it from spikes, food issues, setting unattainable targets, trying to crash hba1c down in weeks, it goes on, and there are posts daily on this.

The "speedometer" analogy is good, it's like trying to drive on the motorway as if you are in a schoolzone, panicking and trying to keep the speed at 20mph when everyone else is comfortable at 70mph.

Then the amount of testing can be an issue.
Again, it's like driving continuously watching the speedometer, and not looking at anything else, eventually you will crash and burn.

So yes, testing can be useful, but not universally, I think it needs discussion with the HCP first, to ensure its not just swapping one issue for another.
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Is this reply for me? If so thank you for your reply and recognition that constantly testing can be a mental health issue.

I'm beginning to wonder in my case whether it's more to do with my posting about testing. I know people are trying to help and I appreciate that but maybe it's not the best thing for me to do and I should just get on with it.

I'm still waiting for a response to my email from Dexcom asking if it is okay to pay for the extra transmitter and sensor save the hassle of sending it back. I bought a special deal of 1 transmitter and 1 sensor but for some reason they doubled my order. I thought I would check as I could have misheard what the guy said when I ordered (I hadn't) as I didn't want them to think I was dishonest and they could have asked for it back when they did an audit.






I
 
BadaBing said:
If that is correct - and I have no reason to disbelieve it - it does suggest that a "penny wise, pound foolish" approach goes on within the NHS concerning tech that would help diabetics better manage this condition.
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I'm all in favour of NICE considering longer term reductions in complications and that was one of the considerations in recommending CGMs for everyone with T1.

I'm just not at all sure that that would support CGMs for everyone with T2. Maybe it would but I think it's unlikely. I can imagine it would support offering test strips (so SMBG) for everyone who wanted to use them, and maybe CGMs to at least some (perhaps those who wanted them and had some genetic or other factors increasing their chances of complications).
 
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