Alicia: UnLeashed! March 2018 monthly article

With so many new and emerging technologies I have been testing out a lot of different methods for managing my diabetes recently. So, when I got an emailed offer for all Dexcom users to get a free Freestyle Libre sensor and scanner I gave it a whirl.

Gary gave the sensor a try and rigorously crunched the numbers for accuracy, because it’s a meter, that’s what it is for right? To give us accurate blood sugar data. However, I took a different tack. I wanted to experience living with the Libre like anyone would for 10 days.

Day one was an interesting and novel feeling as I put my glucometer in a drawer. That little zipper pouch that has occupied its own little corner of my coffee table, nightstand, desk and purse for well over a decade went away for 10 days while I lived finger stick free. This is the first perk, and first draw back of the Libre system, no finger sticks! There is no calibration needed for this system, you insert and move on with your life. I did continue to test for the first day and a half. Initially it was to allow the sensor the first day to “warm up” as other sensors do, the rest of the time was for me to trust it with my life. But no calibration means that, should the system be off from a fingerstick blood sugar you can not calibrate it to improve accuracy. I found that elevated blood sugars were often measured higher by the Libre than my Contour Next meter (ranked as most accurate) This is disconcerting since I am accustomed to being able to use my dexcom data in place of finger sticks. I don’t want to switch to a device that is less reliable. That first day brought to light a second issue, losing a day of data with every new sensor, that’s minimum 10% data lost right away. The only way around this would be to acquire a second scanner and start/insert a new sensor a day before removing the old one. This would reduce the data gap, but it remains to be seen whether one could upload multiple scanners to one user profile to have complete reports.

Once I’d established relative reliability I set about my life with Libre. I loved the fit. The transmitter is circular so it did not catch on clothing. It is extremely low profile, so it did not catch on doorways as a Dexcom on my outer arm tends to do form time to time. And there is no space between the transmitter and the adhesive ring, so there was nowhere for water to sit or fabric to catch. I was pretty thrilled with the fit and feel of wearing it!

And the Downsides?

My dissatisfaction came quickly however when I was about to leave the house. I had my keys and phone in my pocket, my infant son packed and bundled and since I use a pump and a Dexcom that’s usually all I need to head out the door! Then I remembered, THE SCANNER! I set about the house in a mad dash looking for the small black device. (WHY do they keep making these things black?! The single most losable color possible!) needless to say that after searching long enough for my little boy to throw a complete fit about still wearing his coat, I finally found the scanner. I HATE carrying extra things. Small losable things are not going to last long in my life. I have my Dexcom info on my pump, just so I don’t have to carry my phone! So being late to an event because I can’t find my scanner was a big down side for me.

By the end of the second day I had the second disappointment, no alerts. I am very hypo aware and pretty in tune with my body’s responses so I was not scared about low alerts, though many people are. I was more concerned that I either had to keep an eye on the clock to check my post meal blood sugars, or wait until I had a headache from being above 180 to alert me that my blood sugar had not come down as expected. (We all miss a carb count here or there or have pump issues that leave us higher than expected) So by the time I swiped, rather than being alerted within a few minutes of exceeding 180, I might sit there for an hour or more until I swiped to get the reading to let me know to correct. This was really disappointing. My average went up 20 points in a week simply because I was not getting high alerts.

For many parents the greatest thing that a Dexcom gives them is a nights sleep! They no longer have to wake in the night to go to their child’s room and check to see if they are low. But since the Libre no longer gives them a real time alert, parents still have to set the alarm clock, wake up, go to their child’s room and scan them for a blood sugar and hope that they do not enter the room to find the child having been low for too long.

This lead me to what I really disliked about the Libre. Though it fit more nicely on my arm, it did not fit nicely in my life. It made me think about my diabetes so much more! I glance at my dexcom info like most people glance at their watch. In fact, I often am checking the time on my pump and just happen to also glance at my blood sugar. Having to swipe myself like a piece of fruit at the grocery store and listen to the scanner loudly beep at me, made me feel like a sick person taking a moment to tag in with diabetes. Glancing at my pump makes me feel like a normal person tagging in with technology to live my life.

So 10 days later I was back on my Dexcom and actually welcoming the little vibration to let me know I was north of my anticipated post prandial range. The Freestyle Libre is a great tool! But I find this marketing attempt to get people to switch form Dexcom to the Libre a bit laughable. It really feels like a step back for me.

However, since using the Libre I have been reaching out to a LOT of people in my life, previous patients, and patient care environments to recommend the Libre!

So who is a great fit for the Freestyle Libre Flash Glucose Monitor?

• Anyone in an assisted care environment who is currently using a traditional glucometer.

Compliance, errors in testing, reduced dexterity, and improved relationship between a person with diabetes and their care giver all make the Libre ideal for these persons! Just after the Libre was approved by medicare I immediately reached out to every care giver I knew of a person with diabetes since this could benefit their relationships by no longer forcing the person to associate caregiver interactions with pain and frustration of fingersticks. I can not over emphasize this benefit.

• Less tech savvy patients

Dexcom use does take a few steps to insert, putting the transmitter in the sensor, getting the transmitter back out of the sensor after removal, and interacting with a receiver or app that takes some amount of technical acumen. This is not ideal for everyone. However the Libre is extremely simple to insert and even simpler to use after that. The user does not have to be bothered with setting lots of possible alerts and repeats and tones. They get the on the spot data they want without the threat of being overwhelmed by info or options, meanwhile providers can still download the full 24 hour data they look for to improve treatment.

• Those suffering from tech/data overload & alert fatigue

There is such a thing as too much of a good thing. Getting too much data on our blood sugar can lead some users to become overly fixated on their data, their trends, their numbers, endlessly seeking the “good” numbers, or troubled by “bad numbers”. This can be a significant variable adding to diabetes self management burn out. The great thing about the Libre is that it only gives you as much information as you want, it’s not pushy, it doesn’t beep at you at all! No calibration beeps, no alert beeps, not even a sensor out of range beep. But you still get the full 24 hours of data to look back on for analysis as you like.

• Persons with diabetes and sensory disorders

Technology can raise some particular difficulties for persons with sensory disorders (such as autism spectrum disorders) and their caregivers. The sudden interruption of a beep, a vibration, or even a suddenly lighting up screen can be very disruptive. The great thing about the Libre is there is no risk of any sudden startling noises or flashes. The transmitter sits quietly, unobtrusively on the skin and the only interaction with noise or light is when it is scanned.

• Persons with type 2 diabetes or other glycemic control needs without the need for alerts

Many prescribers have persons with type 2 diabetes test their blood sugar once daily, some rotating this time to try to get a more accurate picture. But the fact of the matter is that this is like trying to see Wonderland by peering through the keyhole. Other persons with type 2 diabetes are ordered to check their blood sugar more often but are not getting the data needed to see the cause and effect relationships that drive more effective treatment decisions both by the patient and their provider. These persons have a far lower risk of hypoglycemia or DKA that would indicate benefits of real time alerts, but wold greatly benefit from more comprehensive monitoring.

• Finger stick resistant or phobic patients

Anyone who has a barrier to achieving the number of finger stick blood sugar checks they need in a day, even to calibrate their Dexcom, could clearly benefit from the Libre as it requires no finger sticks after the initial warmup period, and if one were able to overlap the devices as mentioned above fingers sticks can be minimized further.

The bottom Line…

I love giving different treatment options a try. I don’t often find one that makes me want to jump ship from my current methods, but I am always excited to see more options.  More options mean that more people living with diabetes will get the care they need, that fits their life! More options also means more competition which drives further innovation and development and that benefits everyone!