Glucose Monitoring

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.

Diabetes at 3.14am

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I stirred in my sleep, registering the blaring red 3.14 on the clock radio beside my bed. Pulling my left arm out from under the covers, I fumbled around for the switch at the base of my bedside lamp. When my desk was finally illuminated in cosy warm white light, I heaved the remainder of my body up from the bed, reaching for my meter and test strips.

This certainly wasn’t the number that I was expecting to see, considering the full 2 unit correction that I had given prior to bedtime for a 10.7. (And in case you’re wondering, I’m only using the OneTouch Verio to deplete my final box of strips…)

I immediately ripped my pump away from it’s resting place inside my inner left pocket, and gave another full correction of 3.3 units for that very uncomfortable number. My frustration was only further fuelling my actions, as I set a 50% basal rate increase for the next two hours on my pump to ensure that this correction insulin did its job.

As I flicked off the lamp and rested my body back onto my bed, I couldn’t get back to sleep. I could feel the heat emulating from my pillow, and flipped it over to the cool side. My whole body felt stuffy, presumably a consequence of the higher blood sugar.

As I lay there, tossing and turning, my mind was quickly consumed with guilt.

I wasn’t happy that it had taken me this long into the night to finally stir in my sleep and check my damn blood sugar. I felt terrible for the fact that I had been sitting there, at that very uncomfortable level, for the better part of five hours. I felt frustration, because a mere two weeks ago I was super insulin sensitive and today I feel like I’m not getting enough.

Second guessing my prior decision in the darkness, I reached for my pump and lowered that 50% temporary basal rate to 30% before clipping it back inside my pants pocket.

Trying to purge those thoughts from my mind, I began thinking about all of the positive things that I am doing in managing my diabetes, reminding myself that numbers like those are isolated occurences nowadays.

If this had happened in the middle of the day, I’d have corrected the high without giving it a second thought. But laying there in the middle of the night with nothing else on my mind to worry about, was a completely different story.

By the time I woke up on a grey Sunday morning, last night’s occurrences felt like nothing more than a dream.

Curse of the One Touch Verio IQ

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I first received a One Touch Verio IQ glucose meter when I started on my insulin pump in May 2016. As most diabetes sales reps do, I received a rave review about how it was one of the most accurate blood glucose meters on the market.

I was using the FreeStyle Insulinx at the time, which I absolutely loved for it’s ‘Lite’ test strips that only required a tiny sample of blood and weren’t wrapped in that annoying foil. Although I had no intention of switching from the Insulinx, I decided to place this meter in my travel case and use it as my spare.

To give it credit, the Verio is actually quite an attractive meter. It has a colour screen and a backlight that automatically comes on when inserting a test strip. The meter is a refreshing white colour, rather than the dull greys and blacks that I’m accustomed to. By far, my favourite thing about this meter was the plastic shell that holds the meter, test strips and lancing device, which makes it super easy to carry.

Unlike any other meter I’ve used, its also rechargeable. This is good in the sense that you don’t need to keep on buying batteries (which are expensive, mind you!), but also not so good in the sense that you need to remember to keep your meter charged up before leaving the house. As a travel meter, the battery life held up well and would typically last me a month.

Testing with this meter was tricky to get my head around. Unlike FreeStyle and AccuChek meters, the test strip port was situated at the top of the meter. Additionally, blood had to be placed on the side of the strip, rather than at the bottom.

My pet hate was getting strip fill errors if I didn’t get sufficient blood on the strip in one go. I had a lot of these in the beginning as I was getting used to placing blood on the side of the strip. This was extremely wasteful compared to FreeStyle meters, which would give me ample time to apply additional blood.

I also didn’t like the fact that the capped test strip vials only stored 25 strips rather than 50, and that boxes came with 50 strips instead of the usual 100. This was an unnecessary waste of packaging materials, and meant that I needed to buy double the number of boxes to get the same amount of test strips. Although the price was comparable to other brands, Pharmacies didn’t necessarily stock more boxes of Verio strips on their shelves.

However, the biggest dealbreaker for me was the accuracy of this meter. I have consistently found that the Verio reads 0.5 to 1mmol higher than each of my other blood glucose meters.

Of course when I raised this issue with Aussie distributor AMSL diabetes at the ADS-ADEA conference last year, I was basically told that it was the other meters that were wrong. The accuracy of this meter fell within the acceptable Mean Average Relative Distance (MARD) from laboratory glucose readings. It had also been recommended for calibrating readings with Dexcom, which is the golden child of Continuous Glucose Monitoring.

I’ve done a little experiment with some of my leftover test strips, comparing the Verio with my FreeStyle Insulinx, Accu Chek Guide and FreeStyle Libre. I washed and dried my hands prior to each test, as I’m well aware that any moisture or dirt on my hands can impact glucose readings.

To be fair, all meter readings are only accurate to the nearest 1mmol of a laboratory result. Two simultaneous blood glucose readings will likely produce different results. So how do I know which of these readings I can trust?

I’ve found myself feeling hypo on several occasions, only to test with the Verio and receive a reading in the 4s. Patterns as exhibited above are a regular occurrence.

I’m exercising my own judgement here, in saying that I simply cannot trust this meter.