Finding Independence from Continuous Glucose Data

In my latest column over at Diabetes Daily, I’m talking about how I’ve arrived at a place where I don’t feel dependent on continuous glucose data to manage my diabetes.

“The FreeStyle Libre was my first foray into the world of continuous glucose data. After knowing nothing other than pricking my finger up to 15 times per day for six years, it was amazing to be able to check my blood sugar levels so conveniently. The small round sensor that sat on my upper arm provided me with a blood glucose reading, a trend arrow, and an 8-hour history graph each time I swiped my reader over it.

However, the data was addictive. Within the space of a few months, I felt heavily reliant on this device. When the life of my sensor came to an end, I really missed it. I felt lost, and even a little anxious about how I would cope without it. I had lost a great deal of confidence in my diabetes decision making.”

Check out the full column over at Diabetes Daily here.

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.

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.

Mystery of the Varying Overnight Basals

Last week was an exhausting week for many reasons that had absolutely nothing to do with diabetes.

Yet surprisingly, my blood sugars have been cruising along at the best they’ve been in weeks.

I’ve been struggling with my overnight basal rates in recent weeks. There have been some uncomfortable overnight lows, and then there have been other mornings where I’ve woken up frustratingly high. Alarms have been going off 2 or 3 times each night, instead of the usual one.

Things have felt rather inconsistent of late, so I decided to slap on a new FreeStyle Libre sensor last week to try and nut things out. I think I have finally cracked the mystery of the varying overnight basal needs.

If I go to bed sitting in the 7s or 8s, my overnights look something like this.


Looking at the gradual rise from around 4am, I’d be ready to make a basal change.

But when I go to bed sitting in the 5s or 6s on the same basal rate, my nights end up looking like this.

So it seems that my insulin sensitivity is far better when I go to bed in the 5s and 6s. I cruise along much more smoothly during the night, and my blood sugars get off to a much better start when my day begins in range.

So I’m now trying to be a little more bolder with my corrections at bedtime, in the hopes that I can replicate these levels and a decent night’s sleep more often.

Diabetes has so many little intricacies. It always keeps me on my toes, and I’m still learning new things about it after seven years.

Review: My Dario Smartphone Glucose Meter

I was recently given a Dario Smartphone Glucose Meter and some test strips to try from my friends at Perth Diabetes Care. I squealed with excitement at the prospect of taking that little orange device home with me, because I tend to get pretty excited about integrating my diabetes tasks with my screentime. There was no expectation that I would blog about the Dario, and all opinions expressed here are my own.

The Dario is a really nifty little device. I was surprised at Dario’s relatively low key launch into Australia, considering that many bloggers in the UK were given meters to try some time ago. If it weren’t for the odd sponsored post on Facebook or my perusing the Diabetes WA online shop, I wouldn’t have known it had hit our shores.

So, it’s an all in one glucose meter. Lancing device at one end, test strip vials stored on the opposite end.

For some crazy reason, I thought the whole device clipped onto the bottom of my smartphone. So there I was on the first night I brought it home, trying to attach the whole damn thing to my phone! Until I realised that only the little test strip port connects via the headphone jack.

You also need to download the Dario app to your phone, and register to get started. I was able to register with my Facebook account, which is a big plus in my book – one less password to remember! Once you’ve opened the app and connected the little test strip port, you can insert a strip and receive a glucose reading on your phone screen.

The Dario app also had features like a bolus calculator, food databases, data sharing and an estimated hba1c. The data entry screen shown below gave me plenty of time after testing to input carbs and calculate an insulin dose, so long as I didn’t press the tick to exit.

I didn’t really make too much use of the app because I use my insulin pump for calculations, but I imagine that if I were on injections this would be really useful.

How accurate are the strips? Although I felt extremely wasteful doing unnecessary tests for the purposes of answering this question, the Dario quickly proved to me that it was a reliable competitor. It held up extremely well against my FreeStyle Libre, my FreeStyle Insulinx, high blood sugar levels and in target blood sugar levels. From memory, most of my comparisons were within 0.5mmol – with the exception of my One Touch Verio, which tends to read slightly higher than my other meters.

I really wanted to like this device.

Unfortunately I just found it really tiresome to have to pull out my phone, open the app, eject the test strip port from the Dario, connect it to my phone, pull out a test strip and prick my finger for a result.

After a week I still felt kind of clunky using it. I couldn’t remember how to eject the little test strip port from the Dario, or which end was for lancing and which end was for test strips.

Although I had a box of test strips to play with, I didn’t use it as much as I thought I would. While I was out and about, using my meter was simply more convenient.

While I loved the idea of an all in one glucose meter, the reality is that I have to be prepared for my diabetes every time I leave the house. I already carry skittles, insulin and spare supplies to deal with a pump failure, that carrying a meter, test strips and a lancing device isn’t exactly a big deal.

That being said, I have only used this device for a week. It is a big change from using a traditional glucose meter for the last seven years, and perhaps I just needed some more time with it.

The Dario Smartphone Glucose Meter can be purchased online at mydario.net.au, and is also available through selected Pharmacies. The test strips are subsidised through the NDSS, and are sold through the Diabetes WA Shop here in Perth.