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One of the striking discoveries for many people using a Libre is how oZen their

glucose level dips low overnight

–

diﬃcult to detect when using only ﬁnger-prick

tests. This is a problem as, if it occurs oZen, it reduces your ability to detect hypos.
Low glucose overnight can also make it diﬃcult to control the glucose level aZer

breakfast.

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Summary of Contents for Libre

Page 1: ...1...

Page 2: ...this front and back it s double sided and then hand it in to us before you leave tonight This is the form we will be using to generate leBers to GPs and if we don t get a form we won t be able to send...

Page 3: ...3...

Page 4: ...he DCCT Diabetes Control and ComplicaEons Trial was performed in the United States to answer this quesEon People with T1 were randomised to usual care and maintained an HbA1c of around 9 75 mmol mol o...

Page 5: ...The DCCT was a real landmark study in diabetes The early results showed huge reducEons in diabetes complicaEons such as eye and kidney disease 5...

Page 6: ...paEents sEll have much lower rates of eye and kidney complicaEons Importantly the risk of cardiovascular disease is reduced by 42 and the risk of death by 33 Tight glucose control makes a big di eren...

Page 7: ...e the recommend glucose targets for adults with T1 diabetes in Scotland Targets do need to be individualised as in some circumstances they may not be appropriate this is something to discuss with your...

Page 8: ...of glucose stuck to haemoglobin in red blood cells The higher the glucose level the more sEcks to blood cells Over the last few years the unit for HbA1c has changed from to mmol mol Good control is t...

Page 9: ...some other centres in the Europe parEcularly in the Netherlands and Scandinavia closer to 50 of people achieve this target One of the major di erences between these centres and our is that there is a...

Page 10: ...It is not easy to achieve Eght glucose control Many people with on target HbA1c are checking nger prick blood glucose over 7 Emes per day 10...

Page 11: ...course This has been proven to improve well being and diabetes control including fewer hypos and is o ered at all 3 major hospitals in NHS Lothian Please speak to your diabetes specialist team to res...

Page 12: ...informaEon on signing up to the Scoish Diabetes Research Register which gives us permission to contact you regarding studies which may be of interest and also permission to use spare blood from rouEn...

Page 13: ...o using the Libre have been included in your Libre packs We would recommend having a look over both of them as they summarise a lot of what will be discussed here If you use an insulin pump there is a...

Page 14: ...There are also speci c video guides to help keep your blood glucose in target in relaEon to exercise and a video guide to carbohydrate counEng 14...

Page 15: ...15...

Page 16: ...al uid under your skin The sensor lasts for 2 weeks aZer which it is simply peeled o like a plaster We are not going to dwell too much on the pracEcaliEes of puing the sensor on as the videos on the A...

Page 17: ...When the Libre sensor is applied a very small lament remains just under the skin to measure glucose you cannot feels this and it is not a needle 17...

Page 18: ...e LibreView system without you having to plug anything in to a computer If you use the reader and a phone always be sure to acEvate the sensor on the Reader rst The screen on the reader shows the curr...

Page 19: ...ose will have changed by 1 7 in 15 minutes Eme and by over 3 in half an hour If it is a slanted up or slanted down arrow the glucose will have changed by 1 in 15 minutes and just under 2 in 30 minutes...

Page 20: ...ose which is the uid between cells under the skin This means there is a lag of around 10 minutes blood glucose will rise rst and fall rst aZer food and the intersiEal glucose then catches up When the...

Page 21: ...And this graph shows that across the two weeks of usage the Libre result is typically within 10 of the nger prick test However 21...

Page 22: ...king a morning nger prick glucose before breakfast when the glucose should be relaEvely steady to assess how accurate your current sensor is Given that many people drive in the morning DVLA regulaEons...

Page 23: ...e rst 24 hours As you will see in this example many of the episodes which seems like hypos on the Libre are not actually hypos on nger prick tesEng Some people insert a new sensor and leave it in plac...

Page 24: ...orted by the biggest study of Libre in type 1 diabetes where people with on target HbA1c were randomly assigned Libre or conEnued with nger prick tesEng The Libre group dropped to tesEng nger prick gl...

Page 25: ...e at least 6 scans per day which should generate enough informaEon to help with meal Emes and prior to bed Remember you can always look back at the trace so you don t need to scan mulEple Emes aZer a...

Page 26: ...Over treaEng hypos and then giving too much insulin or stacking insulin doses on top of each other can result in swinging between highs and lows SomeEmes it pays to wait 26...

Page 27: ...nough to make it too uncomfortable to conEnue Here are potenEal approaches to minimize the reacEon where it has developed There have also been changes made to the sensor to prevent it becoming too moi...

Page 28: ...w accurate a glucose measurement is you basically want to see all the results form along the diagonal line in the middle and just around it Zone A The further out into zones B to E the less accurate t...

Page 29: ...ng longer drives Libre results would not be regarded as acceptable and would leave you open to prosecuEon or invalidate your insurance in the context of an accident This situaEon may change in the fut...

Page 30: ...t had the opportunity to sign up and complete the free Libre Academy course we would highly recommend it ParEcularly in relaEon to the use of LibreView LibreLink and making sense of the summary glucos...

Page 31: ...Similarly watching this series of introductory videos should leave you in no doubt about the basics and pracEcaliEes of geing started with the Libre 31...

Page 32: ...32...

Page 33: ...to show how many factors people with diabetes oZen need to consider when working out the correct insulin dose Although it can someEmes seem overwhelming oZen picking one factor at a Eme can help you...

Page 34: ...34...

Page 35: ...f insulin injecEon site rotaEon or in pump users the importance of replacing the giving set at least every 3 days InjecEng in to lipohypertrophy caused by repeated insulin injecEon leads to massive va...

Page 36: ...ng glucose traces like the one on this slide The black line represents the glucose level over Eme Ideally we want to see this in the green band 65 of the Eme or greater The traces on these slides are...

Page 37: ...oZen their glucose level dips low overnight di cult to detect when using only nger prick tests This is a problem as if it occurs oZen it reduces your ability to detect hypos Low glucose overnight can...

Page 38: ...nsulin too high overnight basal for pump users Is it related to exercise the previous day in which case a 10 20 reducEon in dose of overnight insulin could be considered with future exercise or was it...

Page 39: ...f all the glucose results have fallen over that period The lighter blue shading is where 80 of all results in the past 2 weeks have fallen LibreView provides a tra c light style guide to the risk of h...

Page 40: ...ut this is oZen not the case but despite this background insulin doses are increased A much commoner cause for high glucose in the morning is that the bolus dose of insulin with the previous night s e...

Page 41: ...r having a carb free meal The ideal trace is the black line nice and steady The red line shows what might happen to someone with too much background insulin and the blue line shows what might happen w...

Page 42: ...These examples of carb free meals are also listed in the 10 steps guide in your Libre pack 42...

Page 43: ...y assess the amount of carb in your meal ideally less than 50g to test ICR no other QA insulin in previous 4 hours Ideally not much more than 2 higher at 2 hours than before meal and roughly back to b...

Page 44: ...Are your raEos roughly in keeping with this 44...

Page 45: ...This quick guide to ICR is at the back of the 10 steps guide 45...

Page 46: ...46...

Page 47: ...second change would mean a meal with 60 grams of carb would be covered with 5 units of insulin rather than 6 units previously The maths for 1 10 tend to be fairly easy but harder for other raEons cons...

Page 48: ...48...

Page 49: ...high in people who don t bolus 15 to 20 minutes before meals and peaks extremely high in people who bolus aZer meals Whilst the new quicker acEng insulin FiAsp may be a liBle beBer dosing before meals...

Page 50: ...in bolus starts to work So long as you re not close to hypoglycaemia you can wait for the bend as blood glucose starts to fall and start your meal This strategy will help avoid big peaks in the 2 hour...

Page 51: ...fat may require an addiEonal bolus dose of quick acEng insulin an hour or two aZer the pre meal bolus around 1 3 the dose of the pre meal bolus or in pump users an increased bolus dose an extra 1 3 g...

Page 52: ...he insulin to cover carbs in your next meal it is likely you will remain high over the next few hours You can give a correcEon dose even if you don t plan to eat but it is important to avoid insulin s...

Page 53: ...In the example here the correcEon factor at lunchEme has been too much and resulted in a hypo if this is a consistent nding the correcEon factor would need adjusted 53...

Page 54: ...ose is high rst thing in the morning and you take only a correcEon but skip breakfast then how much your glucose drops in the next few hours will be your correcEon factor For example if you took 2 uni...

Page 55: ...55...

Page 56: ...You can use the direcEon arrows to help guide how much more less insulin to use with a meal in addiEon to your normal carb counEng and correcEon factor 56...

Page 57: ...Novorapid and Apidra are preBy much the same that almost no insulin reaches the bloodstream in the rst 15 minutes aZer an injecEon emphasizing the importance of pre meal dosing Insulin peaks at around...

Page 58: ...to develop the con dence to take just enough carb to correct a hypo and not over correct Previous hypos are the biggest risk for a further hypo and you should scan regularly to idenEfy prevent recurr...

Page 59: ...If this is too much for you you can modify your approach 59...

Page 60: ...re is a lot to say about exercise and most of it is covered in our website video guide Overnight hypos are one of the biggest risks and reducEon in overnight basal insulin aZer exercise is oZen needed...

Page 61: ...food exercise etc LibreView or Diasend are both ways to do this If you link your LibreView or Diasend accounts to our clinic we can have a look and try and provide some useful advice If you use your...

Page 62: ...We want to provide exible support when you need it One of the best ways to do this is through sharing data remotely and as technology develops this may become a central part of the diabetes service re...

Page 63: ...Phone us Email us We will keep working with you unEl you re happy with how things are 63...

Page 64: ...im to use your pump bolus wizard or smart meter dose calculator if you nd you are over riding it consider why is the ICR wrong Is the CF wrong Could you do with a carb counEng refresher Using bolus ca...

Page 65: ...ing it will save the NHS money This is important as we need to be able to show that Libre is not just an addiEonal cost but is saving money elsewhere i e test strips Of course if you need more test st...

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