Glucose Monitoring

Red Light.

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I glance at the watch on my wrist. I know that it will only take me a minute, but it’s 4 o’clock and I really want to get out of here already.

I make the trek outside, where my car is conveniently parked in its usual spot at the end closest to the centre door. It’s a longer walk in the morning, when I have to come in through the back entrance, but completely worth it at the end of the day.

I hop inside my car, and place my belongings on the vacant seat beside me. I know that it will only take me a minute, but I really just want to start making my way home where afternoon coffee is calling my name.

I place my keys in the ignition, lock my doors and wind down my windows. I reverse out of my spot and make my way out of the carpark, cutting through some of the quieter residential areas in order to avoid the pile up of traffic on my way out of the centre. I make one final right, which takes me back out onto the main road and in a far better position traffic wise.

Finally, I have what I’ve been waiting for as I begin to apply my brakes, slide my gears back into neutral and cars begin to bank up in front of me. A red light.

I only have a minute, but I know I can do it.

I dive into my bag, pull out my travel case and grab my meter, strips and lancing device. I quickly pop open the cap on my test strip vial and slide out a fresh strip, sticking it into my blood glucose meter. I prick my finger with the lancing device, and squeeze my fingertip. A little drop of blood appears on my fingertip, but I know its not enough. I squeeze again, harder, like I’m holding on tightly for dear life.

Part of me knows I don’t have enough blood, but the other hasty part of my brain watching the traffic light tells me I can do this. I bring the meter closer to my fingertip, and let the blood slide onto the end of the test strip.

A shrill BEEEEEEP! Sounds from my meter as a strip fill error appears on the screen. My absolute pet hate when it comes to living with diabetes.

I furiously rip out the useless test strip, pop open the cap on my vial of strips and slide out a new one. I stick it onto the end of my meter, shove my lancing device right up against the tip of my finger and prick again. This time, blood flows more freely. Satisfied, the test strip laps it up and decides to give me a blood glucose reading.

I quickly wipe the excess blood on my fingertip against the side of the test strip as the light changes to green and traffic begins to move. I fling everything on the passenger seat beside me, which I’ll clean up during the next red light.

Hypo in the Diabetes Clinic.

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“Are you still using the Animas?”

“Actually, I have the new YpsoPump.” I replied to the nurse, pulling it out of my pocket.

“Would you like to use your own lancet?”

“Good idea,” I replied, pulling it out of my pencil case and avoiding a bloodbath on my fingers.

“Oh, you’re 3.8,” the nurse said to me after I had applied some blood onto the test strip. “Have you got some hypo treatment on you?”

Before I was even given any time to answer, she had poured me a glass of sugary fluid to drink and handed it to me. Encouragingly, it was an appropriate sized amount that wouldn’t send me rebounding.

“Are you able to feel your hypos?”

“If it’s a steady 3.8, like this one, I feel fine. But if it were a 3.8 and dropping rapidly, I would.” She was lovely, and I didn’t feel that I was being judged.

Another nurse walked in, also wanting to have a look at my new YpsoPump. “Of course, you should treat your hypo first!” She exclaimed to me in a motherly way, after being reminded by nurse one that I was hypo.

“Are you sure I can’t get you some biscuits or anything?” the nurse asked me, as I made my way towards the door.

“No, I’ll be fine. The tea will probably bring me up as well,” I said as I grabbed the Styrofoam cup that I had been given in the hallway earlier.

I made my way back toward the end of the corridor, took a seat and buried my head into my iPhone, grateful for the warm drink on my sore throat. I wasn’t worried.

Some time later, the nurse returned. She hovered for a moment, but I didn’t really notice until she spoke.

“Frank, would you like to check your blood sugar again?”

Knowing it had been sufficiently treated, I had completely forgotten about my hypo. I pulled out my FreeStyle Libre, registering the 3.7. I wasn’t convinced that I needed anything further, and pulled out my meter.

“I’m happy to leave it,” I said, holding up my meter that was displaying a 4.4. “I don’t want to overtreat it, and the tea will probably bring me up a bit more as well.”

“Are you sure I can’t get you any biscuits or something?”

“No, I’m fine. Thank you.”

I get that this comes from a good place. A really good place.

Perhaps if hypos hadn’t interrupted many of my work days, bed times, socialising, housework, walks and errands over the years, I might just treat them with the same response as that nurse.

Hypos are not a scary thing, provided I know how to manage them. They are a part of living with diabetes, just like checking my blood sugar or injecting some insulin. Last year at the Roche Educator’s Day, I made a big point of stating that two hypos per week was an unrealistic expectation from my healthcare professionals. Moreso as my skills in managing blood sugars improved and I was spending more time in range.

I get that hypos are not good for me in the long run. I get that hypos can impair my cognitive function. I also get that hypos can be life threatening – and maybe I’m just lucky that I’ve never had one where I’ve needed help. Believe me, I don’t like having hypos anymore than a healthcare professional likes seeing them appear on a blood glucose meter.

However I feel it’s more important that I’m dosing insulin responsibly, checking my blood sugar often enough, travelling with glucose tabs on hand and am able to sufficiently treat a low.

Some healthcare professionals condemn people with diabetes for having too many lows, and this is where we need to reshape our attitudes toward hypos.

Making me feel any lesser for the number of hypos I have will only make it more difficult for me to share openly in front of a healthcare professional, ultimately jeopardising the provision of any support I may need.

FreeStyle LibreLink: First Impressions!

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I must admit that I couldn’t get too excited at the news of FreeStyle LibreLink hitting our shoes Down Under. However I was really blown away by the response to my vlog last week, which suggests that perhaps I am in the minority on this new smartphone app.

FreeStyle LibreLink is a smartphone app that can either complement or replace the fundamental role of a FreeStyle Libre reader. So if you are thinking about trialling or getting started with a FreeStyle Libre system, you will no longer need to invest in a $95 reader. I also thought that LibreLink may be advantageous to parents or loved ones, who could have their own access to the data provided they scan the sensor with their respective devices (devices don’t share data).

Abbott told us that while LibreLink was originally due in August, they have fast tracked the launch as a show of their commitment to get their technology into the hands of as many people as possible.

The FreeStyle Libre system utilises Near Field Communication (NFC) technology in order to scan the sensor and obtain a blood glucose reading. In order to use the FreeStyle LibreLink app, your phone must have these same NFC capabilities as the FreeStyle Libre system, and this is the reason for limitations on compatible phone models.

So, blame Apple. Or Samsung. Or whoever else you feel like blaming.

Apple users will need an iPhone 7 or higher, running on iOS 11 or higher. Android users will need a phone with NFC, running on Android 5.0 (Lollipop) or higher.

If you wish to use your reader in conjunction with the LibreLink app, you must activate a new FreeStyle Libre sensor with your reader, followed by the LibreLink app during the 60 minute warmup period. If you do not activate with both devices during the warmup period, then you will only be able to read data with the one device you activated with.

Why can LibreLink only be used with a new sensor, and not an existing one? I am told this is purely for security reasons, otherwise I could theoretically approach anyone wearing a sensor and scan it.

My loaner iPhone seemed to scan my FreeStyle Libre sensor just as well as my reader did. A reading is best taken by pointing the top end of your iPhone, where your ear rests, over the sensor.

One noteworthy feature is the text to voice, which will voice your blood glucose level and trend following a scan. This may prove useful when you’re in bed and don’t want to open your eyes, or if you’re wanting to interrupt someone else’s presentation and show off your reading of 6.6 and steady to the rest of the group (sorry, Kim!).

I also think that the app will be really valuable for accessing blood glucose reports without the need to upload to a computer. I must admit I can’t remember the last time I uploaded my pump or my meters to the computer. In the whole scope of managing diabetes, little tasks like these often slip and features like this really do make a big difference.

LibreLink does not have the capability to transmit blood glucose data to another device. Nor can data be shared between a phone and a reader. You know how you can click on that little forward button when browsing your iPhone to share a link or a photo? That’s basically how you can share things like screenshots or reports from inside the LibreLink app with others.

Everything else that you’re used to seeing in the reader is there, with a bit of an expanded view.

      

Also on the horizon is Libreview, a cloud based software designed as a companion to LibreLink that provides a way to share data with healthcare professionals.

I don’t have any plans to upgrade my old iPhone 6 anytime soon to use the LibreLink at home. I’m also not sure that I view carrying my Libre reader around as a hassle. Having my iPhone on me all the time can be equally distracting. Another reservation I have is the increased demand placed on my iPhone’s resources from the introduction of two new mobile apps in the space of a week (YpsoPump app and LibreLink).

That being said, I have definitely underestimated LibreLink. It’s fantastic that FreeStyle Libre users will have more ways to access and engage with their blood glucose data. More choice for people with diabetes is always a good thing.

The FreeStyle LibreLink app launches in Australia tomorrow, and is available as a free download from your Apple or Google Play store on a compatible device.

Disclosures: Abbott Diabetes Care covered my travel and accommodation costs to attend DX2Sydney. I was fed and watered across the duration of the event. I was also provided with a FreeStyle Libre sensor and a loaner phone if I wished to trial the FreeStyle LibreLink app during the event. There was no expectation that I would blog about anything covered at the event. My opinions and my time, including the annual leave I took from work to be there, are my own.

FreeStyle LibreLink App Launches in Australia!

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I’m in Sydney over the next two days attending Abbott’s third annual DX event, which brings together a group of Aussie diabetes bloggers.

Abbott are launching the FreeStyle LibreLink app in Australia on June 5, and this can either complement or replace the fundamental role of a FreeStyle Libre reader. Abbott are letting me road test the LibreLink app for 24 hours, so hit the play button below to see how it all works.

I’ll be sharing further insights on LibreLink and the Ypsopump on Instagram, so send me a follow request if you’re not following me already!

Disclosure: Abbott have covered my travel and accommodation costs to be here. There was no expectation that I would try or blog about the LibreLink. As always, my time (including the annual leave I had to take to be here) and my opinions are my own.

Review: AccuChek Guide Blood Glucose Meter

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The AccuChek Guide has by far become my new favourite blood glucose meter in recent months.

I first received this meter from my friend Tammy of Diabetes: Forever and Always, before also picking up another one from the trade hall at the ADS-ADEA conference last year. There was, of course, no expectation that I would write or even use the meter itself.

The Guide has been around for a fair while, with it’s first claim to fame being the “spill proof” capped test strip vials.

Strips can also be easily accessed by simply sliding them out of their place, without having to stick your fingers in there and fumble around for one.

While this meter does use a slightly larger blood sample (0.6uL) compared to my FreeStyle Insulinx (0.3uL) and OneTouch Verio IQ (0.4uL), the accuracy more than makes up for it. Past meters have shown big variances from two consecutive readings, aren’t consistent with other meters, or the readings simply don’t match up with my feelings,. Even on grubby working hands, I have found the Guide’s accuracy to be the most consistent and superior.

I also like that I can see the blood go onto the strip, compared to my previous FreeStyle Lite strips which had me guessing whether it was blood or sweat had gone onto the strips.

My biggest gripe, as with other meters, is the strip fill errors. If I don’t get enough blood on the test strip on the first go, which often happens when I’m quickly trying to check during a red light on my way home, I have no choice but to start over with a fresh strip. Alternatively, both my Optium Xceed (does that meter still exist?) and the FreeStyle Insulinx gave me an additional 60 seconds to apply more blood.

One thing that disappoints me most is that every meter in the AccuChek family uses a different line of test strips. In comparison, the FreeStyle family only has two kinds of strips (to my knowledge). This definitely limits my enthusiasm to trial other meters, and does prove inconvenient when trying to stockpile test strips for spare or travel meters.

The guide comes with AccuChek’s FastClix lancing device, which is pretty damn amazing. Each cartridge change contains six lancets, meaning that I can change my lancet six times by simply sliding the little white knob. Unfortunately, this still does not motivate me to change my lancet any more often! There are also 11 depth settings, making the finger pricking experience pretty comfortable.

By far, my favourite feature of this meter is its Bluetooth connectivity to the AccuChek Connect smartphone app. Every time I check my blood sugar, the reading is wirelessly transferred to the app on my smartphone. The app makes it so convenient for me to review my blood glucose data, without the hassle of having to force myself to sit and upload each meter to my computer with its corresponding USB cable.

When you test your blood sugar as often as I do, you’ll get a nice graph of patterns and time in range, which has been really helpful to me while I’ve been adjusting to my pump break.

The app also has a built in bolus calculator that can be accessed with a single use code from a healthcare professional, however this feature has been recalled in Australia for some time. I’m currently using RapidCalc for bolus calculations on my iPhone while I’m on my pump break, but I would love to integrate my insulin dosing into the Connect app as well.

The biggest tradeoff to the additional features is a faster drain on the meter’s standard coin cell battery. I might get 2 months of battery life from checking my blood sugar 10 times per day on my main meter, alternating between a spare and a FreeStyle Libre as well.

The AccuChek Guide is an amazing, amazing meter that has all the bells and whistles for 21st century diabetes management. It definitely helps keep me feeling excited and motivated in managing my diabetes.

Bells and whistles aside, however, the biggest sell for me is that it’s a meter that I can trust.

It’s definitely worth asking your diabetes educator for one on your next visit.