November 27, 2017

I'm Testing the FreeStyle Libre Flash Glucose Monitoring System

Last week I received a FreeStyle Libre Flash Glucose Monitoring System #FreeStyleLibre from Abbott to try out. I have been very interested in this product for quite a while as if it does what is claimed for it, it could be a huge help to people who are trying to learn how food affects their blood sugar. So today, having gotten through most of the Thanksgiving goodies, (which I did not want to track with a glucose monitor, thank you!) I got up my courage and inserted the sensor into the back of my arm. I had read all the instructions a few times and am hoping I did it correctly.
The sensor comes with a spring loaded applicator that shoots it into your arm. It stung for about half a minute, as the sensor samples blood through a small needle. A bit of blood appeared on the outside of the sensor when I was done, which I wasn't sure about, so I called the 800 support number the company provides and spoke with a customer support person who assured me this was normal unless it hurt and/or there was "an excessive amount of blood." She was unable to define "excessive" but it seems like the thing isn't bleeding any more.
I then waved a little phone-looking device over the sensor and it beeped and told me it was started and to come back in 12 hours. It takes 12 hours for the sensor to be able to report accurate readings. I will be very interested to see what the results look like.
The booklet that comes with the Freestyle Libre System states that the accuracy is plus or minus 15-30%, which is broad enough to make you wonder. But this thing is measuring interstitial fluid, not the fingertip blood that can be a bit more accurate. I am mostly interested in the graphs it will produce to see where exactly peaks and valleys occur, and to learn what is happening late at night when I sleep, as I see higher fasting blood sugars than I like this past year, no matter what I eat. I don't know if it is dawn phenomenon or a raised fasting blood sugar. This should help, even if the actual readings don't match a good meter.
The device which analzyes the sensor's data and graphs it also works as a blood sugar meter with FreeStyle Precision Neo test strips, which do not come with the system. So I will be checking against my trusty Ultra Mini and my old FreeStyle Lite meter which I still have some strips for. The FreeStyleLite meter usually reads about 10 mg/dl below the Mini.

Here's a picture of the sensor, installed.
I'll update my progress as it happens. There is an active discussion going on at my Facebook page. You can join in at https://www.facebook.com/bloodsugar101. Commenting is so flakey on the blog and the trolling it was receiving so ugly that I have had to turn it off.

After 24 Hours


So here are my impressions after a full day of wearing the #FreeStyleLibreglucose monitoring system that Abbott Global Solutions gave me. I love it. It has its flaws, yes, but after almost 20 years of testing my blood sugar with strips, it is downright amazing to be able to check my blood sugar any time I want to and to finally be able to see what has been happening during all those many hours when I haven't been able to test.

The accuracy I'm seeing is close enough that I can definitely see where it could be a huge help in getting better control for anyone who isn't getting very flat sugars eating an extremely low carb ketogenic diet--which is probably 99% of all people with diabetes in the world. I have 3 meters, none of which, it turns out, agree with the others, so this is just another meter that doesn't agree, but it is falling in the same general range as my other three. Sometimes it is higher, sometimes lower, but the magnitude is within 10 mg/dl and often closer. I'm not quibbling about whether a high of 164 mg/dl is really 155 mg/dl. It isn't 135, and that is what I'm concerned about.
At this level of accuracy, I'm seeing very clearly how long my highs last and how they effect the low I see at the next meal. Some findings are a bit surprising. For example, the pizza slice I ate for lunch wasn't nearly as hard on my blood sugar as a slim slice of Thanksgiving pie I had for dinner later. The carbs were probably the same, but the high from the pie lingered forever. So what I learned is that as the day goes on, my tolerance for carbs seems to drop significantly. This is good to know, and since I usually eat my big meal at lunch, not a big problem.
I'm eating a lot of stuff that will push my blood sugar up, while I have this device, in order to get a good idea of exactly how my blood sugar response is performing now. If I wore one of these for 10 days every month, once I had figured things out I would probably be more likely NOT to eat things that might make for a long, visible spike.
I'm also seeing some things that I didn't know were going on at times when it wouldn't have occurred to me to test, including a several hours of what was for me a low blood sugar after eating a breakfast that met my target. This wasn't a hypo, but it wasn't a number I had ever seen on a meter for a long time. With my limited access to strips I can't test very often, and mostly just look for highs. This explained the 85 mg/dl reading I got when the doctor sent me to the lab which I had found baffling as my fbgs are usually 108 mg/dl or higher.
I'm also thinking that with this device showing me minute by minute readings I will, at long last, be able to get the repaglinide I take to work properly. I never felt safe using it with only the 50 strips a month I get from my insurance. Now I will be able to see exactly when it kicks in and how long it lasts. They tell you not to rely on it for dosing insulin, but so far it is pretty solid on when blood sugar is rising, falling or stabilizing. With repaglinide, which can cause severe hypos, any downward motion at a reading anywhere near 80 would be a warning that would get me testing with a meter.
As far as comfort goes, I got used to it after the first night, and am now to where I don't even notice it. I was able to sleep rolling over on that arm with no issues last night. I even remembered to test when I woke up at 2 am so that I didn't lose any readings.
The reader works great through my clothing and ski jacket. You can turn off all noises or set it to vibrate, so you can use it in public without anyone noticing it. Ditto late at night. It is also very easy to set alarms for 1 and 2 hours after eating and you can enter in the grams you ate when you enter a food.
There are some negatives and I will list them here:
1. The reader doesn't come with a case so for a woman like me who carries everything in a purse and wants to carry the reader everywhere, it's possible the reader could get scratched up.
2. The reader screen is not hard like cellphone screens but soft--which is understandable for the price. But you sometimes have to really press on it for it to know you have made a selection.
3. Though it keeps a log of your entries, only the last 3 show up on the screen at once and paging through is a pain since you may make dozens of readings a day. You can't see the details of how many grams were in a meal unless you find the original entry for the meal. With how often I am scanning the meter, this means I can't find what I ate without a lot of slogging.
4. The blood sugar graph is tiny and the scale goes up to 350, so for those of us in good control, it's hard to know exactly how large an excursion is unless we test during it. This is mainly a problem at night time. I saw several drops graphed during the night, but can't tell from the graph how steep they were. I.e. were they to 85, 90, or 100 mg/dl since I woke up again around 108.
Supposedly you can upload your information to a web site so you can see your data better and share it with your doctor. I tried it and couldn't get it to work, but the company rep explained it won't be live until Friday. I will report on how useful it is when I can get it working.
I am still waiting to hear what the price will be. Supposedly someone will get back to me. If they do, I will update the info in a comment on this thread. They did tell me that the Freestyle Libre system will be available for retail customers to purchase next Monday. However, you will need a prescription.
If this is priced like the Canadian version, which would be $70/sensor, it would be well worth the money for anyone who isn't currently getting an A1c of 5.4% or better. Look at it this way. You are going to pay deductibles of $500 or more for a single MRI caused by the damage you end up with from high blood sugars. I'd rather spend the money learning what I need to know to avoid them.
I am liking this thing so much, right now, that if the second sensor they sent me performs at the same degree of accuracy, I'm thinking that if I can get my doctor to give me the needed prescriptions, I will use one sensor each month to keep myself motivated and in range. My insurer won't be covering me for any device with that 5.7% A1c, and it will be a struggle to get the doctor to write the prescriptions, as he thinks it is hilarious that I am not happy with that 5.7% A1c. But seeing those 160s and 170s on the FreeStyle Libre (and strips) and the many night hours I am spending at 110-113 (no dawn phenomenon, it turns out) is motivating me to do better. FWIW, the average blood sugar I am seeing on the FreeStyle Libre so far is 117 which matches my 5.7% A1c.

Two Days In 

I did see more discrepencies between the meter and the FreeStyle Libre system when I tested some repaglinide (which can cause lows) last night and ended up in the 70s. But I'm thinking it may also have been a bad strip or meter--because my two minis turned out not to agree. Basically, the whole meter thing is BS half the time, too. 

But still, all very useful, as I could see how long the effect of the repaglinide lasted, and when it kicked in, which were not when I expected, and explained why I was having so much trouble making it work. I have been moved to a generic instead of the brand name I used to use, and it definitely is NOT the same in terms of how long it takes to become active. 

I also, for the very first time, caught a low turning into a rebound high at night. I woke up saw a 72 on my FreeStyle Libre system and then about 25 minutes later, I surfaced from sleep and saw 118 mg/dl. I KNEW this was something that happens to me sometimes but never could document it it, and of course doctors told me it couldn't possibly happen. I also knew that when it happens I get a surge of high blood pressure, and a pounding pulse at times, too. The cardiologist insisted this, too, was impossible. So there doctors who told me I was FOS!


Pricing Information from the Company

Many of you have asked me what the price is going to be of the #FreeStyleLibre system. This just came to my email box directly from @abbbottglobal: "The list price for the FreeStyle Libre system is $36 per sensor and $70 for the reader (one time purchase). However, prices may vary depending on the retailer or an individual’s insurance carrier. We are still in negotiations with commercial payers."
Close concerns has reported "Walgreens has the 10-day sensor priced at $43, compared to $53 at CVS; readers are $97 and $85, respectively."
My guess is that Walmart will be cheaper, as is usually the case. Walmart, RiteAid and Kroger are also listed as participating pharmacies on the FreeStyle Libre official website.
This makes this device highly affordable. And just in time for Christmas. Instead of having your relatives give you all those stupid "gifts under $10" which you will stick in a closet and eventually regift, you could ask them to pool together and get you a reader and a couple sensors.
Some of you may wonder why I am suddenly so enthusiastic about a product from Big Pharma, knowing as you do that I am usually so UNenthusiastic about anything Big Pharma that I have been excluded from every single Big Pharma-sponsored diabetes blogger get together ever held. Well, the answer is what I care about is people understanding their blood sugar and learning how to lower it without all those toxic, ineffective drugs doctors prescribe because they are the easiest way to get diabetics out of the office.
This device is mind-bogglingly informative. The only thing missing, sadly, is some hint in the company's manual, that if you see a high you can lower it by cutting back on your carbs. But we can get that message out a lot easier if people are seeing those real time spikes after eating.
So Big Pharma this time has hit a home run and I honor them for it. For the price of a fancy cup of coffee you can get 24 hour real time monitoring of your blood sugar that is good enough to help you make the changes that will drop your blood sugar into the range that will keep you from every developing complications.
You just have to be willing to cut the carbs when you see those long, ugly spikes.
And at this price, it is very possible insurers will cover it, though my guess is, only for people on insulin. The only downside I can see, is that knowing how insurers think, it is possible they will try to force people on insulin to use these instead of the much more expensive Dexcom CGMS which is more accurate and reports continually without scanning and which issues alarms when a low occurs which can keep sleeping people alive. This is NOT a replacement for a Dexcom. It is an upgrade from 25 to 100 strips a month. It's like getting 1000 strips every ten days. And no finger pricks!
BTW, the thing is still completely painless even though I keep rolling over and sleeping on it.

Graphs Show The Kinds of Information the Libre Provides that I Missed when Testing with a Meter


You can read a discussion here on my Facebook Page where I show how tesing at 1 and 2 hours misses very different patterns of response to foods. The graphs are posted, too. 

Facebook Post Showing and Discussing FreeStyle Libre System Graphs








May 8, 2017

Jenny Ruhl Just Published a Brand New Diabetes Book

For those of you who don't read my Facebook page, I wanted to let you know that my brand new diabetes book has finally launched.  This is the first completely new health book I've written since 2012. It's 240 pages long in print and packed full of stuff I didn't have room for in Blood Sugar 101.

It's called Your Diabetes Questions Answered: Practical Solutions That Work and Keep On Working.



This book is a problem solver. It uses an easy-to-read, informal Q&A format to answer over 200 questions of the sort people have been emailing me over the years since I first published Blood Sugar 101.

If you've read Blood Sugar 101, some of this material you'll find here will review what you already know, but quite a bit of what you'll find here is new.

You can download a sample or go to your favorite eBookstore to buy the paperback or eBook versions.

Your Diabetes Questions Answered: Practical Solutions That Work and Keep on Working is now available at these links:

Amazon Paperback

Amazon Kindle

Barnes & Noble Paperback

Nook eBook

Apple, Kobo, and more ...

If you find it helpful, do consider posting a review on the bookstore website where you bought it. That's the best way to raise the visibility of a new book nowadays so that other people who need it can discover it.