FreeStyle Libre: Questions and Answers from #DX2Melbourne

I’m back home today after a whirlwind two days spent at Abbott’s Diabetes Exchange event in Melbourne. The event was filled with such insightful and stimulating conversation, that my mind was still buzzing at 11.20pm last night when I finally crawled into bed at home.

Abbott covered my travel expenses from Perth to be there, but they did not pay for my opinions here or anywhere else. I am really grateful that Abbott are continuing these consumer conversations after last year’s DX2Sydney event, when they clearly didn’t need to. Perhaps my views are biased because I was a part of these conversations, but I am really enthusiastic about the FreeStyle Libre. My experience with it has been largely positive, and it continues to be a part time member of my diabetes toolbox.

It was fantastic to hear the Abbott team acknowledge and even encourage those little tips and tricks that people out there are already doing, even if they couldn’t technically endorse them. Like letting the sensor sit for a day after application before starting it up. Or the Rockadex patches and other adhesives that people are buying from small businesses online. I loved that they were somewhat aware of what people are doing out there in the real world.

Through my blog, through e-mails and through my circles here in Perth, I have received a great deal of feedback on the FreeStyle Libre. People either love it or hate it. Today, I thought i’d start by sharing some of the feedback I received from Abbott over the past two days. While I’m doing my best to relay what I heard and talked about, I can’t guarantee that these words are 100% accurate.

External adhesives.

Hands up if you’ve had a sensor fall off? During the days of warm weather, t-shirts and outdoor activities, that sensor is simply not sticky enough for me. Jessica Shi, Abbott’s QA and RA Manager, tells me that any external adhesive needs to be of medical grade in order for it to be officially endorsed.

Inaccuracy of the sensor when levels are high.

Ever had the Libre tell you that your blood sugar was 18mmol, while a fingerstick gave you a reading of 13mmol? There was definitely a conscensus among the room that some of us had difficulty trusting the sensor at times.

Bruce Passingham, Abbott’s Scientific Affairs Manager, told us he’s interested in hearing about each individual’s circumstances. There might be other conditions or medications that could be affecting results. He also touched on hydration as well, which is a no brainer for me when my levels are a little stubborn.

The biggest takeaway here is to make sure you call customer service. I am so surprised at the number of people who tell me that they haven’t bothered to. All of my issues have been resolved through customer service, and a few bloggers in the room praised the express shipping of replacement sensors.

When will we see the Libre funded by the Australian government?

Earlier this year, the Department of Health was seeking submissions from consumers to potentially get the FreeStyle Libre funded through the National Diabetes Services Scheme. It’s currently a bit of a watch this space…

Are there any plans to add alarms to alert users of dropping blood glucose levels?

In reference to the likes of Dexcom and Medtronic, Abbott have reminded us that their product is not a Continuous Glucose Monitor. It is a replacement for finger sticks.

How many people will an automated insulin delivery system actually reach?

Recent headlines out of the US have surrounded the partnership between Abbott and Bigfoot Biomedical, makers of an automated insulin delivery system. “Next generation” FreeStyle Libre sensors will supply glucose data, which Bigfoot’s system will use to automatically deliver insulin and regulate glucose levels.

My question to the team was around how many people the end product will actually reach. I was told that this next-gen Libre sensor can also be paired with a Bluetooth enabled insulin pen, which will provide smart dosing advice for those on Multiple Daily Injections. Abbott expect that their product will reach a greater number of people through the options for people with type 1 on Multiple Daily Injections, and those with type 2 diabetes.

Obviously, don’t expect to see anything like this to hit Australian shores for a long, long time…

This doesn’t even begin to scratch the surface of a very stimulating two days of diabetes conversation, and I’ll have more to follow in the coming days. You can also keep an eye on these bloggers who were in attendance, for their perspectives on the event.

Further disclosures: Abbott supplied me with a new FreeStyle Libre reader, two sensors, and a lovely goodie bag with some pens, paper and a few other bits of branded stationery. I was put up in a room at the Blackman Hotel in Melbourne for one night. I was also fed and watered across the duration of the event.

Feeding the D-Tech Frenzy

Growing up, many of the appliances in our house had longevity. When an item malfunctioned for the first time, there was a pretty good chance that it could be fixed. When the VCR began spitting tape out of our videos, the handyman came out and put some new parts into it. When our second hand Windows 98 computer got stuck in Safe Mode, my Aunty’s computer guy came over and fixed the belt inside the box.

When a beloved household item came the the end of it’s life, I watched Mum and Dad mourn over how well it had served them and how hard it would be to replace. As those items were eventually replaced, we noticed that they all had one thing in common. They never lasted nearly as long as their predecessors. I can’t begin to count how many kettles, washing machines, printers, televisions and computers we’ve gone through since the originals packed up.

We live in a very consumeristic society. Nothing is designed to last anymore. Today’s innovations will likely become enhanced or obsolete in a few year’s time, and the attitude seems to be to throw it away. Everything has to be brand new. Sure, things are far cheaper than they once were, but we probably spend just as much on replacing defunct items.  It’s hard not to feel that we as consumers, have fed this frenzy to a degree.

It’s hard not to feel that diabetes technology is heading this way, as well.

No sooner than the Dexcom G5 Continuous Glucose Monitor was released, I was already reading about plans for a Dexcom G6. No sooner than the Medtronic MiniMed 640G insulin pump had begun rolling out, I was already hearing about plans for the hybrid closed loop 670G. Tandem recently rolled out an upgrade of their t-slim insulin pump. Bigfoot Biomedical, which have a closed loop system in development, recently announced a partnership with Abbott that will utilise data from a “next gen” FreeStyle Libre system. We even have confirmation of Apple entering the market. 

Technology is the hot topic of the town in the diabetes community – and rightfully so. Who doesn’t get excited about all of the advancements in the pipeline that will improve the treatment of diabetes and the quality of our lives? Who wouldn’t get excited about a shiny new device, just like we do with our smartphones and tablets and cars? Diabetes is monotonous, so I’ll certainly appreciate anything that makes it a little more exciting.

Call me a hypocrite writing this, because I am an enthused user of diabetes technology. I am a privileged person. I get excited over a shiny new gadget, and I am grateful that the tech is an option for me.

But I kind of feel that we, as consumers, have fed this technology-focussed frenzy to a degree.

When looking at the bigger picture, it doesn’t feel like an actual cure for type 1 diabetes is even on the horizon. It’s beginning to feel like these advancements are no longer a solution, but rather a pathway to the next enhancement or product.

If my social media feeds are anything to go by, people are crying out over the skyrocketing prices of insulin, and access to basic healthcare. Then I look at all of these advancements, and I wonder just how many people the end product will actually reach.

Dad showed me an article in the paper yesterday, of promising research on insulin producing cells, or something like it. I dismissed it instantly, citing that I’d likely never hear of it again as I have with many other developments that qualify closer to a “cure” status.

I wonder why we aren’t questioning companies on the feasibility of these advancements. I wonder why we aren’t holding companies to greater accountability for their actions. I wonder if we are throwing enough support behind research into potential diabetes cures. I wonder if we, as the consumers, are taking full advantage of our ability to drive the agenda.

I wonder if we have lost sight of curing diabetes.

Getting the Most Out of a Flash Monitor

I’ve recently started freelancing for Diabetes Daily, which means that from time to time I’ll be linking to some of my columns over there.

The topic I am most frequently asked about is the FreeStyle Libre. While my experience with the device has been an extremely positive one, I definitely didn’t hit my strides after my first sensor. Any shake up to your diabetes management is going to be an adjustment. In my first column, I wanted to share some of my tips and tricks for a smoother transition from finger sticks to flash monitoring.


Like the fact that getting out of the shower, or going from a dark room to a bright one, can cause momentary changes in the readings. 

Or that higher blood sugars can cause greater variances with a traditional blood glucose meter. 

And that I shouldn’t obsess over the small variances, because two blood glucose meters won’t ever produce an identical reading!

You can check out the full column over at Diabetes Daily right here.

(That being said, Your Diabetes May Vary!)

 

Mixing Up Finger Sticks and Flash Monitoring

I don’t cope well with the continuous nature of glucose data. After prolonged periods of using my FreeStyle Libre, I tend to get a little fatigued and overwhelmed. I know that I’m not getting the most out of my flash monitor, which I pay a pretty penny for. Perhaps I might feel differently if I were not an insulin pumper as well, and the Libre was the only technical device I had to deal with.

Over the last couple of months, I’ve settled into a routine of wearing a FreeStyle Libre sensor for the first two weeks of the month, and then imposing a break which sees me going back to fingersticks.

Mixing up flash monitoring with fingersticks helps to keep things fresh and exciting for me. These little breaks help me to clear my head from the constant flow of data that’s just a scan away. It helps me to re-evaluate my glucose monitoring habits, and whether I am checking my blood sugar out of necessity or simply for the sake of it. It also keeps me from becoming too reliant on the Libre, considering it is costly and not currently subsidised here in Australia.

However, I have also found fingersticks challenging after using the Libre. Over the past year or so, I’ve been learning a lot about my blood sugars and applying some of these observations towards my diabetes decision making. I usually apply a new sensor with the intent of, for example, analysing my overnight line or basal testing my work day mornings. But with diabetes being diabetes, two weeks is simply not enough to complete all of those little tasks I’ve set out to achieve.

Coming off the Libre has felt a bit like driving somewhere south of the river without directions. I’ve often found myself feeling lost in those little problem spots, anxiously trying to keep my head above water with finger sticks. By the time my self imposed break is up, I’m ready for a new sensor.

However at the moment, I find myself in somewhat unchartered territory.

I’m currently in my longest stretch on fingersticks since I first began using the FreeStyle Libre last year. There are two unopened boxes of Libre sensors on my shelf, and I haven’t felt any desire to put them to use in some time.

I don’t feel like I am struggling without it. I’ve applied what I’ve learned and observed. The problem spots are slowly but surely smoothing out, and starting to feel less problematic. I feel…comfortable.

I guess I have always perceived the Libre as a tool to evaluate elements of my diabetes management, rather than a tool to directly make my decisions from every day.

At the moment, I feel like I am where I have wanted to be for a long time.

Review: MedAngel Insulin Temperature Sensor

Earlier this year, I was contacted by Amin from a company called MedAngel. Having lived with type 1 diabetes for ten years, he began to tell me about an incident where his refrigerator completely froze his supply of insulin. From there, he created a solution to his problem in the form of the MedAngel temperature sensor.

(Disclosure: I received a MedAngel One to try. There was no expectation that I would blog about the product, and all opinions expressed here are my own).

The MedAngel consists of a small oval shaped temperature sensor, which is stored in the same place as my insulin. The sensor then connects to an app on my smartphone, and transmits the temperature of my insulin via a Bluetooth connection. 

I must admit that I couldn’t muster too much enthusiasm for the MedAngel, initially. It sounded a little…unnecessary. Honestly, I didn’t think that I needed it.

I know that insulin needs to be refrigerated when it’s not in use. It’s good for 28 days once taken out of the fridge, and should then be disposed of. I’ve often stretched out post-holiday supplies beyond that timeframe, feeling guilty to waste something that’s so expensive. However, I guess I’ve never really given too much thought to what that exact storage temperature should be.

I first learned the concept of “spoiled insulin” last year, when my levels became seemingly impossible to tame. I’m also really conscious of temperature every time I go to the beach on a blazing hot day. But do I give a lot of thought towards the safe storage of my insulin day to day? Probably not.

Two weekends ago, I put my MedAngel to the test. I placed my sensor in the bar fridge with my insulin, and connected it via Bluetooth to the MedAngel app on my iPhone. There was a list of medications to choose from, and I was easily able to find both my Novorapid Penfill cartridges and Lantus pens. I told the app that I was “Storing” unopened medication, and I was good to go.


Soon enough, the app began alerting me that the insulin in my fridge was below the safe storage temperature of 2-8 degrees. 


I spent the rest of that weekend cautiously adjusting the temperature in my fridge. When I started out, the temperature dial in my fridge was sitting inbetween “Colder” and “Midpoint.” By the time my fridge had reached a safe storage temperature, the dial was sitting inbeweeen “Midpoint” and “Warmer.”

While I suspected that I might have to make my fridge a bit colder, I was hardly expecting the complete opposite. I couldn’t believe that my insulin had been sitting at borderline freezing point for all this time.

My only negative is that I had to be in the same room as the sensor, in order to receive the temperature via Bluetooth. There was also no ability for me to manually “refresh” to obtain a new reading, but that’s just me being impatient…

The results really did speak for themselves. It was a lower trafficked fridge, and it was a really cold weekend. But still…the results were eye opening.

This is a really, really amazing product.

If you think this issue doesn’t affect you, then you need to try this product.

The MedAngel is available online, and it ships worldwide.

For those of you in Australia, MedAngel is also available through One and 2 Diabetes Accessories.