I posted my initial thoughts about the Libre a few weeks ago here; so how has it been after two weeks using everyone’s second-favourite flash glucose monitoring system?
In summary, when it’s good it’s very, very good. When it’s bad it’s just annoying. First of all, let’s cover off the good.
The snaking worm of results
Seeing what you’re doing in almost real time is utterly fabulous. In fact, it becomes addictive. On my first full day with the Libre I scanned my arm 48 times, which is bordering on some sort of compulsion.
I know that interstitial blood glucose lags behind finger-pricking capillaries by 10-15 minutes or so, but when you’re looking at a trend over a few hours, this just doesn’t matter.
Yes, if you want accuracy – when you’re driving a car, operating heavy machinery, starting your blindfold circus knife-throwing act – then get out the finger pricker and do it the old fashioned way. But for just a wee peek at what’s going on then the Libre is wonderful.
Seeing the snaking worm of results has its benefits.
As I’m essentially a very dull person, I have the same breakfast every morning at roughly the same time. A toasted seeded bagel with a bit of Lurpak on top. Yum! It’s exactly 43g of carbs.
My usual practice was to shove in the appropriate amount of insulin in via the pump as soon as my bagel popped up from the toaster. Drooling with anticipation at my tasty, toasty breakfast I didn’t really think about insulin and how quickly (or not) it worked.
With the Libre I saw a rapid peak and then rapid crash – it looked like the profile of a dangerous Alpine mountain. However, after a bit of experimentation, I found that shoving in my insulin 15 minutes before breakfast – just after I got dressed and headed downstairs – I found that I could change my mountain into a rounded, more pleasant hill.
Cleverer diabetics than me will be saying “well, yeah, duh!” as I say this. Indeed, the specialist nurse up at the Royal Infirmary told me to do this about 12 years ago. But did I listen?
There’s something about seeing the little black (or red) line snake along the graph in real(ish) time each time you scan that makes you slap your forehead and say aloud “ahh, they were right. Some of this stuff works”.
The temptation, of course, is then to try and use all this data to correct every error – perceived or otherwise – in your daily diabetes routine immediately. The day I got my Libre I was warned on twitter to resist “chasing the sugars”. And as with everything that’s posted on twitter – with NO exceptions – this was genuine, helpful, useful advice.
I’ve looked at the trends over the course of a few days and started to make some small tweaks. My blood glucose was clearly and regularly dropping down during the night. Nothing serious but a very small reduction in my overnight basal rate means I now have a nice flat(ish) line during the night, rather than gradual slope down. Useful.
One of the hidden problems of type one is carrying around tonnes of guff. This means I carry a rather manly man-bag with me wherever I go, resulting in my wife always asking me to carry her crap too. Another horrifying burden of diabetes.
Anyway, the Libre also allows you to check your results using your fancy smart phone via its Near Field Communication (NFC) gizmo. While the reader that comes with the Libre is absolutely fine, it’s great being able to leave it at home and use your phone instead and so carry less detritus about. I always have my phone with me as I get withdrawal symptoms if I don’t see at least three YouTube funny cat videos or send at least a dozen abusive tweets every hour of every day.
This means that if I’m out and about and I want to see what’s happening with my blood glucose, I can whip out my phone and press it to my arm. This is remarkably convenient. A few week’s ago I was in a crowded Murrayfield stadium watching Scotland firmly kick England’s behind in the Calcutta Cup.
In the olden days, I wouldn’t have bothered checking my blood glucose – it was far too much of a faff to get out the meter and finger-prick while two hairy, kilted Scotsmen on either side bellow Flower of Scotland. But this time, I quickly checked with the Libre via my phone, saw that all was well and carried on celebrating Scotland’s glorious and well-deserved win.
The Libre app works well, looks nice and seems reliable so far. I use the Android version on a reasonably decent Sony Xperia; I don’t know (or indeed care) how the iPhone version works. It also automatically uploads your results to the LibreView online platform, which saves the bother of plugging it in and uploading your data to the website. A small but handy feature.
If my finger-tips had mouths (which they don’t, sadly) then the Libre would have been greeted with the hallelujah chorus from Handel’s Messiah. I was diagnosed with type one in December 2005. Since that fateful wintery day I’ve finger-pricked at least 150 times a day, 8 days a week. Over the last 12 years that means I’ve shoved a bit of steel into my finger-tips over 14.8 billion billion times.
As a result my finger-tips are rough, calloused and blackened (rather like my soul). Since Libre-day I’ve been finger pricking only when I tie on the knife-throwing blindfold (and when driving). I don’t know about you, but I don’t like shoving a bit of steel into myself; so not doing that is wonderful. Sometimes it’s the ickle things that make a difference.
Back in the day when I used to review blood glucose meters (oh, those halcyon days!) I never used to bother looking at the graphing software that inevitably came with each meter. This was because they were almost always universally crap. The LibreView reporting tools are actually quite good. Abbott have really tried to take the morass of data you generate and display it in a way that makes sense and helps you identify patterns. So, by way of example, here’s my results for the last few weeks on the LibreView home page:
Using the shades of blue and a median line through your results is insightful. You can really quickly see that I’m rubbish at carb-counting at lunchtime. You don’t have to be a statistics geek to see what’s going on. I know some people just love spreadsheets of stats, but lazy people like me prefer easy-to-read graphs like this instead. So hurrah!
That said LibreView does allow you to dig down in to daily detail if you want to get down and dirty with your data (there’s alliteration!) and there is a benefit to seeing your data on the big screen, especially when your phone uploads everything automatically.
Conclusion about the good stuff
While there are always exciting things ten year’s in the future, diabetes technology that makes an actual, real difference to everyday life has been gradually moving forward. And the little things do make a difference, for example Bayer’s better designed test strips and more accurate meters made a small but significant difference. It made life a wee bit easier.
However, occasionally from time-to-time, you get a step change which makes a huge difference. The first of these for me was changing from Multiple Daily Injections to a pump. My control continues to be so much better, life is more flexible and so much easier. The pump made a big difference to my quality of life.
Is flash glucose testing such a big step? Perhaps not. But it is certainly a definite step change. I can see what’s going on in almost real-time, I can forgo sticking bits of metal into my fingers and using my phone to check my BG is just so convenient.
With all this good stuff I have a feeling I will grow to love the Libre.
But every love has a dark side and the Libre is not perfect; so I will cover that off in a separate article soon.