FreeStyle Libre… The
new diabetes product that has been the talk of the town, or certainly the
Diabetes Online Community (DOC), for the past few weeks.
The technology
itself is called flash glucose. It isn’t marketed as a CGM (Continuous Glucose
Monitor) or a blood glucose machine, it’s something different… something
completely new (and very interesting) to the diabetes market. The way that the
Libre works is by reading
glucose levels through a sensor that can be worn on the back of the upper arm
for up to 14 days. The sensor itself (approximately the size of a two Euro
coin) measures glucose every minute in interstitial fluid through a small (5.0mm x 0.4mm) filament that is
inserted just under the skin of the arm. A touch screen reader is then used to
scan (flash) over the sensor (it can scan through 4cm of clothing) which then
gives the user their blood glucose result in a pain free, discreet and
convenient way, as many times as you like - No finger stick calibration is
needed. A historical trace is then formed over time and the also reader shows
the user which direction their blood glucose is heading in – Steady, slowly
going down, rapidly going down, slowly going up or rapidly going up.
The Freestyle Libre
has been marketed as;
“A
revolutionary new glucose sensing technology for people with diabetes”
“A significantly advance the field of glucose
monitoring”
“Offering a convenient and painless way to get more
frequent glucose readings, which should help to improve diabetes management”
But we all know that
marketing means nothing to a consumer these days if it’s not backed up with genuine
user reviews and opinions, especially when it comes to a medical device that
we, people who have diabetes and don’t just talk about it, need to use on a
daily basis… need to trust every second that we are using it… So that’s why
Abbott (the pharmaceutical company behind the FreeStyle Libre) invited me and a
group of other people with Type 1 diabetes to London last week, to be amongst the
first in the world to be able to try the Libre before it hit the shelves!
What
does the Libre look like?
Ok, so I was given a
starter kit to take home with me – 2 sensors and a reader. The shiny yellow
packaging with an orange butterfly is familiar to me and told me that it was an
Abbott product (I have a few Abbot products at home), but packaging is just a
barrier to me getting to what I want and really doesn’t mean much to me at all.
After ripping my way through that barrier, I found inside the sensor box the
sensor itself (in sterile packaging), an inserter (also in sterile packaging)
and an instruction manual. Inside the reader box is the reader, a battery
charger and USB cable, along with user guides, starter manuals etc.
The
sensor itself, when on my arm is about the size of a £2 coin and about the thickness
of 2x £2 coins. It has a super sticky adhesive to make sure it doesn’t ping off
and that’s all you can see. The needle
comes straight out with the inserter and gets throw in the sharps bin (if you geta Libre you
will need one of those MASSIVE sharps bins).
The reader is relatively
small (see pic below), easy to hold or pop in a pocket or handbag and is very
lightweight. It feels like it would bounce if it hit the floor (this is
something I won’t be testing out!), the screen, if you push gently on it, is
quite flexible and doesn’t seem like it would break if you accidently left it
in your back pocket and sat on it. Saying that though, it does feel a bit…
cheap. Though at the price it rocks in at I wouldn’t expect to be holding
something that would give the iphone 6 a run for its money!
The reader only has
1 button, it has a large colour screen that’s also touch screen, a decent sized
text for those who, like me, refuse to wear their glasses, and it well lit
(more about the reader later). A nice surprise that I wasn’t expecting when I
opened it is that it can also test blood glucose in the way that most of us
are used to, with a finger prick, and is also a blood ketone meter!
The Libre doesn’t
come with a case or any accessories to ‘funk’ it up but from what I’ve seen,
people in the DOC are pretty good at doing that themselves and I’m sure it won’t
be long before some of the more creative people have pimped their Libre's.
Is
it comfortable? Does it have to be worn on the skin?
It’s very
comfortable! I can’t feel a thing when I’m wearing it, sleeping on the side
that it’s on or when I’m moving my arm (not that I madly flap my arms around
anyway!) The only time I’ve felt it is when I pulled my handbag strap up my arm
and caught it but that didn’t hurt, I was just aware that I did it.
When I asked the
Abbott staff if it could be worn elsewhere I was told no, only on the back of
the arm for now. This has been the 1st time for me that I’ve had
anything on my arm (I've never injected there or inserted a pump cannula) so I wasn’t
overjoyed at the thought but as I said, I can’t feel it and often forget it’s
there.
How
much does it cost?
The starter kit
containing 2 sensors (lasting 14 days each) and a reader costs £133.29 +VAT
The reader on its
own costs £48.29 (with a 2 year warranty) +VAT
A sensor on its own
costs £48.29 +VAT
Note – People with
diabetes don’t pay the VAT on medical products. Please get in touch with Abbott
for more info about this.
Did
it hurt putting the sensor on?
Not at all! I didn’t
feel a thing and I was really surprised by this! I’m used to feeling a pinch
and a slight sting when I insert my insulin pump cannula but the Libre was pain
free – everyone else who tried one that day said exactly the same. One of the
staff from Abbott who was there on the day watched me as I inserted the sensor
and said that I scrunched my face up just before putting it on. I must have
been anticipating a sharp scratch, but I was very pleasantly surprised.
When
can I get one?
We were told that
the Libre will be available to buy online from the end of September/early
October. You might want to contact Abbott yourselves nearer the time to see if
they have a specific launch date.
What
does the reader do?
As I said before,
the reader is used to manually scan over the user’s sensor in order to see an instant blood glucose reading - all information is stored for 90
days. The reader also has many options to view the data depending on what you
want to know.
The main screen,
after scanning, shows the time, battery left, amount of time before the sensor
ends, the glucose reading, the trace history on a graph and an arrow to show
which direction your blood glucose is heading. Other options include; a
logbook, daily graph (with options to look back over other days), average glucose
in 4 time blocks (going back 7, 14, 30 and 90 days), daily patterns, time in
target (also above and below target) and your personal target range, low
glucose events (anything below 3.9mmol/l) and sensor usage showing the amount
of times you have scanned.
All of this
information can then be downloaded to your computer via a USB which is
included. I’m yet to download but I’ll blog about it when I do.
How
easy is it to set up?
It was really easy!
I’m not one to read instructions but for this I wanted to make sure that I
didn’t cock it up so I did have a look at the enclosed manual. Step by step the
process of inserting the sensor is explained with text and pictures – If I can
do it, anyone can!! When it came to setting up the reader you just need to
follow the instructions on the screen – date, time, target blood glucose etc.
and you’re all set! The reader takes 60 minutes before you can scan for the
first time (and I imagine this is the same when starting with a new sensor) but
has a lovely countdown clock letting you know when it will be ready for use. As
far as makig changes goes I’ve been able to re-set the time on my reader and
adjust my glucose target with no problems. There is only 1 button on the
reader, which makes navigation through the menu’s quick and easy, the rest is
done via the touch screen.
Who
can use it?
The Libre will be
available to people in the UK, France, Germany, Italy, Netherlands, Sweden and
Spain. Currently Abbott are only able to sell the Libre to people over the age
of 18, though they did stress that they are committed to actively pursuing its
use in patients under 18. Watch this space!!
Will
I still need to prick my fingers?
Personally I have
been using my old blood glucose meter but not as often as I was. For me, I need
to use my old blood glucose meter to calculate my insulin:carb doses and
correction doses, my meter also bluetooths that information to my insulin pump,
therefore eliminating the need to go rummaging around in my bra to press
buttons on my pump when I’ve stashed it in there.
Abbott did stress
that if someone is making decisions about taking insulin based on a reading
from the libre they should check their blood sugars on a separate meter as
there is a 5 minute time delay from the number you see on the screen to what
your glucose level is. There is an option for Health Care Professionals to work
with patients who use the Libre which will allow them to set the Libre up to
give insulin suggestions, however I haven’t been able to try this feature yet
as I’m not working with my HCP with my use of the Libre. Abbott did say that
they are trying to reach as many HCPs with the Libre as possible so they can
help patients if they have any questions or want to discuss their diabetes
management alongside using the Libre.
Something I’ve also
been doing when using the Libre and testing my glucose on my meter is comparing
the results to see what difference there is in the given readings. So far I
haven’t noticed differences that are jumping out at me and suggesting that the
Libre is way out when it comes to accurately measuring my blood glucose. As I
mentioned earlier, we need to be able to trust technology, which is why I’m
comparing it to other meter readings on occasion.
How accurate is it?
This is a tricky one... Upon meeting with Abbott we were told that they were very confident that the Libre was more accurate than the current technology out there, The first day went very well and after making comparisons with my trusted accuchek blood glucose meter I was impressed at how close the readings were - only 0.2mmol/l out at the most!
As the days went by this gap slowly widened and I did begin to question the accuracy (taking into account the 5 minute time delay) and if I would base any insulin calculations on the information given by the Libre.
About 30 minutes ago though I flashed and had a reading of 3.7mmol/l (hypo). I didn't feel low so I checked on my meter as Abbott had recommended we do to make sure we weren't
making decisions solely based on one reading and saw that my meter read at 4.0mmol/l. Which was correct?? I grabbed a third meter which showed 4.5mmol/l! I flashed 20 minutes later and the Libre says my glucose is 3.3mmol/l... I don't feel hypo at all and 2 meters say I'm not, but do I risk not treating in case the Libre is correct? What if I wanted to get into my car? Do I now need to wait 40 minutes based on the Libre but not the machine that I have used and trusted every day for the last year?
I think you would need to make up your own minds on this one...
What
if a sensor doesn’t work?
We were told that if
any problems occur with sensors or readers then to get in touch with Abbott who
will replace or refund. The staff that I spoke with said that they are
confident that the readings won’t ‘drift’ over the 14 days but if someone does
find a problem then to contact their customer service team.
My Pros and cons:
Pros:
- Convenience - It's so quick and easy to pull the reader out of my pocket or bag, flash it over my arm and look at the reading that shows I just 1 secon
- It's a pain free way to check blood glucose
- It has boosted my confidence - I feel much more able to get on with my day knowing that I can easily check my glucose as and when suits me
- I can 'flash' as many times as I like
- I can see how certain foods affect my blood glucose
- I can see which direction my glucose is heading in which enables me to act accordingly
- I can see trends that I've never seen before - in the last few days I've seen that my overnight glucose is between 9-15
- It's comfortable to wear and insert
- It enables me to download 90 days worth of data which I can analyse myself and send to my diabetes team if necessary
- It's incredibly cheap in comparison to some technology (some readers cost hundreds!)
- It's easy to set up - I often worry about this as I'd hate to make a mistake and not be able to use it
- It's aesthetically pleasing - colour screen, charts, large text etc.
- It's not bulky - one of my worries about having something 'stuck' on me is that it will be obvious through clothes. My pump is easily stored in my bra and I'm pleased that the Libre sensor is discreet enough to cover with clothes if I wanted to
- The battery life seems to be good, though this will depend on how many times you 'flash'
- It doesn't need a finger prick calibration
- It is enabling me to self-manage better and is making me feel much more involved in my diabetes care now that I am more aware of what my blood glucose is doing - It's strange how 'in the dark' I felt when restricted to finger pricking a certain amount of times a day
Cons:
- If you don’t scan for more than 8 hours you
can’t see a trace history – on the rare occasion I do sleep for more than 8
hours
- Low glucose events – recorded when bg gets to 3.9mmol/l or below but I often feel hypo when my glucose goes below
4.5 – this eliminates some of the personal element
- I could become reliant on the technology
- It could cause me to become obsessive about
testing my glucose levels
- It doesn’t completely eliminate the need for
finger prick testing
- It offers the option to test blood glucose and
blood ketones but doesn’t include a lancet, test strips or ketone strips
- If my HCPs didn’t want to help me with the
Libre/didn’t buy into the idea then I couldn’t use all of the options available
to calculate insulin doses (to allow access the insulin calculator need HCP
access code)
- When making notes I can only put rapid acting
insulin in whole numbers – Not accurate for pump users as we can use 0.1 units etc. on
pump and some insulin pen users can use 0.5 units
- Not as many options for looking at trends as my
current meter - accuchek combo which offers daily, weekly, charts, scatter
graphs, pie charts, standard deviation etc.
- Can only put on back of arm – I much prefer using my stomach
- And the biggie... I can’t afford it. Yes it’s an amazing price
compared to current diabetes technology that can be self-funded but as a
student who isn’t able to work full time, I can’t spare £96 a month.
So... would I buy this product (if I wasn't a poor student?) At this point in time, the jury's out on that. This is only my 3rd day of using the sensor and apart from the mixed messages with my hypo(?) I have been very impressed. I plan to make a few video blogs throughout the next few weeks so please keep an eye out for more updates. I hope this blog has been helpful for you! If you can afford it then perhaps it might be worth trying it out for yourself as the initial start-up cost is much lower than CGM technology... everyone is different and this may be the product you've been looking for!
Feel free to ask me questions on twitter - @ninjabetic1 or on facebook - ninjabetics and I will do my best to answer them all.
Ninjabetic x
For more details about Abbott's FreeStyle Libre please visit their website at https://www.freestylelibre.co.uk/
