Freestyle Libre CGM

Diabetes Technology Glucose Monitoring
#1

I just read a review of the Freestyle Libre CGM (FB: Integrated Diabetes Services) that states you can dose from it's numbers. Not approved in the USA but looks promising.

Unfortunately can only wear on your upper arm, has no low/high alerts and is not continuously read like the Dex, you must hold up your receiver to the transmitter to receive information at any given moment.

Those three things would certainly make me think twice about getting it, but to dose off a CGM would be ideal!

Any news that DEX is headed that way? Though I am sure that's a long way off. I'm just running out of finger real estate and the Freestyle "alternative" sites are not producing enough of a blood drop for me.

#2

Dexcom gen 6 sensor is supposed to be calibration-free, and may also support a dosing claim. We'll see :) Certainly years off.

Really that's just the official stance anyway... whether or not you can effectively dose off anything depends on your personal experience of how accurate and reliable it is for you, and how well you understand its behavior and limitations. (E.g. finger sticks are untrustworthy if you may have had food residue on your hands, or if the blood window didn't fill completely, etc.; dexcom's untrustworthy if you just started it this morning, or if your bg was in motion during the last calibration, etc. etc.)

I was really interested by the Libre news also, but don't think I'd be willing to give up low alerts, at this point anyway.

As for fingerstick problems, yeah I have that trouble a lot too. I gave up on alternative site testing after a few months of trying. The accuracy and lag are just too terrible (for me) to be useful. To help getting blood drops on the fingers, my doctor recommended using a moisturizing hand lotion daily until it gets easier; I do find this helps a lot. I use Aveena (Aveeno? something like that). But don't test with the lotion on your fingers!

#3

I'm interested in the Libre flash glucose meter, too. The comparable technology for the Libre is a fingerstick meter, not the CGM. I'd happily trade my daily fingersticks for the one-puncture site Libre.

The Dexcom CGM with the 505 software upgrade is close enough to dose off of if it's tracking well. Dexcom can't advertise it as such since the FDA hasn't bought off on it yet. Many users are already using Dex G4-505 numbers for treatment and dosing insulin.

#4

Linny, I routinely dose my daughter based on her Dex numbers. After months of pretty darn accurate numbers (+/- 7 or so points in either direction compared to her meter after the first annoying 12 or so hours after starting a new sensor) I feel just as confident about the accuracy of the Dex as I do about the accuracy of the meter, if not more so. Some things that I found to improve the accuracy of Dex readings: we only calibrate when the arrow is horizontal, and never calibrate if over 200 or below 50. My only complaint is that the Dex lags after correcting a low (and sometimes after correcting a huge high.) Based on the accuracy we get from the Dex, I'd never switch to the Libre because I depend on Dexcom's alerts.

#5

Link to review?

#6

This was from Facebook. But no blog post yet. From Integrated Diabetes Services

Integrated Diabetes Services
Yesterday at 6:44am ·
It's Lisa...a fun perk of working at IDS is getting to try some cool new things before they become widely available in the US. I completed a two week wear of the Freestyle Libre Flash Glucose Monitoring System this week.
I loved how accurate it was without the need to perform a single calibration. Loved the fact that I was supposed to wear it for two weeks--that's the approved wear time! I missed the safety net of having alarms to tell me I was out of my target range, though. I'll be writing a blog post on my experience, so stay tuned for more insights. Jenny is going to wear it next.

#7

I was at a TCOYD conference today and a lot of the endos were excited by it but they did say no alarms is a big deal. Also, one of the ends who is Type 1 does dose from his Dex.

#8

Linny - I went to the same conference. Valuable content.

#9

This was my second year. I went mostly for the information of what the future may hold!

#10

Lots of complaints in the UK about sensor accuracy. More then you ever wanted to know at:
http://www.diabetes.co.uk/forum/threads/freestyle-libre-on-sale.65900/page-121

#11

I had an original Freestyle Navigator for about 2 years until they were pulled out of the US. It was super accurate and I got into the bad habit of dosing off it, it was that good. So I'm not surprised they are advertising one you can dose off.

However no alarms would be a deal breaker for me. The Dexcom 7 was not as accurate as the Navigator, the G4 is actually pretty good most of the time, it is more sensor dependent- I'm sure over time Dex and the others will be good enough to dose from. In the meantime I hope you still find some real estate...

#12

Thanks, Chris! Why did they get rid of the Navigator?

And I agree - no alarms, no dice.

#13

Hi Linny,

I'm not exactly sure whey they got rid of it here - it had to do with health regulations I believe. They actually gave everyone money to turn in their units to go toward another CGM - that's when I went Dexcom, back in the Seven days. The Navigator had some things that I now look back on and appreciate more: The transmitter had a replaceable battery, and it went on the back of your arm; it had a spring loaded insertion unit so you could do it one handed. More real estate for pump sites and replaceable transmitter batteries! The sensors were smarter though and had some sort of electronics in them - you couldn't re-use them like you can with Dexcom.

#14

I do not use my blood glucose meter every time I dose. Sometimes I rely on my feeling, sometimes I just dose as much as is necessary for the food I eat, most of the time Imuse the Dexcom number as dosing base. But I never though about any regulatory / marketing information from the device manufacturer if I am allowed to do so. It’s my health and as long as it works for me I am fine with it.
From my point of view the missing alarms are the main issue with the Libre. My Dexcom wakes me at night in case lower or upper alarm limit is passed. I do a correction bolus or grab some fast carbs without checking BC. So I can fall back to sleep in a minute. Using my glucose meter would wake me up and keep me up for an hour or two. Also during the day the alarm is a good feature. I cannot have a look at the receiver all of the time (which would be the same like scanning with the Libre) and therefore need the alarm to be informed about high glucose levels.
Furthermore the Libre sensor cuts off after 14 days without any possibility to be turned on again. The Dexcom lasts about 20 days for me, longer for others. So also from the price side it is not much cheaper but with less features (alarms…).
Users in Germany report issues with allergy against the adhesive of the Libre and some have accuracy problems - especially in the first days.

#15

I read through some of the 135 pages, oldest and newest comments. You're right, lots of complaints about accuracy. They were talking in mmol/L so I had a little trouble relating BG levels.

There were even comments worried about legal discovery in a driving incident might examine the Libre number record and if the record incorrectly recorded false hypos when actual numbers were well in range. Try making that case to the judge.

Several comments from early users that are considering taking a Libre vacation as sensors are hard to come by, too.

The Libre appears to be having some groqing pains. Perhaps this is whay Abbott wanted to work out before they tried to take it to the North American market.

#16

Read further pages on this site. There are many positive comments about accuracy within +/- 1 mmol/L (+/- 18 mg/dl) range readings. Interesting technology.