There is a far better wearable system ready to go but not in production, a combined sensor and automated insulin dispenser, that has passed human trials, but no one wants to go into production with it because of liability issues. Given that people are riding in self-driving cars and landing in aircraft on autopilot, each of which are also potentially fatal and involve a larger set of variables, I wonder if and how long it will take to progress in this regard.
If you're interested in using a closed loop, take a look into AndroidAPS or Loop, how to build one by yourself. It's all open source and works really well. Been a user for some years now. You just need to compile it by yourself and own the right hardware.
Then it gets to be an issue with cost and convenience, as hauling around both systems with lancet device and strips and insulin and syringes and glucose tablets is a nuisance for anyone who does not carry a purse. Test strips cost around a dollar each (if one eschews the likes of Walmart), and it is very difficult to get Medicare to pay for more than 3 per day. I do not know if they will pay for any now that they are paying the higher monthly cost of the libre sensors.
The delays make the comparison difficult. Also if it gets too high or low then people react and quickly change the slope of the graph, then the sugar level in the extracellular fluid would not reach the same extremum as the sugar in the blood.
i have the same experience, the Libre was very inaccurate for me as well.
> There is a far better wearable system ready to go but not in production, a combined sensor and automated insulin dispenser, that has passed human trials, but no one wants to go into production with it because of liability issues.
Well there's this, even if it's not a "100% pancreas replacement" yet: https://www.medtronicdiabetes.com/products/minimed-670g-insu...
"Automatically adjusts your basal (background) insulin every five minutes based on your CGM readings."
Blog post: https://richardsprague.com/notes/cgm/cgm_analysis/
Slides from presentation last week: https://www.slideshare.net/richardsprague/quantified-self-se...
He also tweets about it: https://twitter.com/sprague
> The sensor is applied to the back of the upper arm with a simple, disposable device called an applicator. When the sensor is applied, a small (5mm) filament is inserted just under the skin, and held in place with a small adhesive pad.
'Inserted just under the skin' means it's still invasive, but that sounds nicer than regular needle-sticks so perhaps 'less-invasive' would be a more accurate description.
For clarity: the measurement you pasted is the length of the filament. The width/thickness is ridiculously tiny. Basically, this product has the same UX as a nicotine patch.
The adhesive tape which is needed to attach it to your skin is actually more uncomfortable than the sensor.
Combined with a 670G pump it has been a huge benefit for me. My A1C of 9.0 is now down in the 6's. My pump broke while I was on vacation for a week, and my control was clearly worse with pens and finger sticks than the pump and sensor.
I prefer "minimally invasive"... You can't just remove the device and stick it back on, but it's good enough that a truly non-invasive device would be a marginal improvement for me.
It's reliable enough - the biggest downfall is that it's around 15 minutes behind real-time, ie, what you can measure with blood. Sometimes it can feel 'stuck' too, and change rapidly between a short amount of time.
The second model, which I am waiting to try, includes Bluetooth alerts if a trend high or low is detected. This may make it even more useful.
I just got my first CGM, FreeStyle Libre 14 day, 2 days ago :) The relief I've already experienced from not having anxiety about where my blood sugar is at has been incredible. That said, being able to set alerts for lows/highs and not having to manually scan the sensor would be huge improvements.
The way I was checking blood sugar before (finger pricks) it seemed like I'd gain relatively little by using a pump, but now I'm thinking a pump may be indispensable if used in combination with a CGM: Since I can now see how my blood sugar is changing in near real-time, if I have errors in dose size, I'm going to want to be able to make small correction...
I really like the real time data aspect which means I can access it easily on other devices.
I also still regularly use the official phone app to get a reading via NFC which suits certain circumstances for me and I find pretty accurate most of the time.
That’s what I’d be most interested in. Folks conjecture that it’s your insulin response that causes weight gain rather than the blood sugar increase. They’re not as correlated as you’d expect!
The Freestyle Libre and regular continuous glucose monitors measure glucose in the interstitial fluid under the skin - not blood. This is why the numbers can be wildly different to a blood glucose test done via finger-prick.
From what I've seen while researching very low carb diets, insulin levels are incredibly important and influence a lot of body chemistry. For example, someone without type 1 diabetes can have a normal blood glucose but only because they're producing an enormous amount of insulin. A large amount of insulin in the blood will cause fat to be stored, so the patient puts on weight.
I personally use a keto mojo to measure blood glucose and blood ketone bodies. I’m not diabetic so I don’t need to use it, but I’m a fan of being able to tell how far into ketosis I am.
I believe the thinking is that people need a professional to discuss results with. I understand that perspective, but I don’t agree with it, and I definitely don’t agree that having someone to discuss results with should outweigh the increased access/adoption of over-the-counter sales. This is the first product that makes it practical - even easy - and completely painless for non-diabetics like me to track blood glucose informationally, so perhaps this will change. That said, the FDA has made other overly-conservative decisions, like disallowing fingerstick A1c tests (which don’t require fasting or a full venous blood draw) for first-pass screening of diabetes: http://www.onsitehealthdiagnostics.com/blog/a1c/, https://twitter.com/troyd/status/1018150306125758465.
As a side note, I think this requirement is completely bogus. You should be able to get any "read-only" medical device you want, anytime you want, especially in a country where there is no universal healthcare. I see a contradiction where on one hand the authorities say: we have to protect you so that you don't harm yourself and on the other the same authorities say: your health is your responsibility and we want nothing to do with it.
The problem with Dexcom is the price. A sensor should be replaced every week and costs 80€, the transmitter turns off after three months and costs between 300-400€. If you understand what you're doing, you can easily extend the sensor lifetime to 3-5 weeks and transmitter to 6-8 months.
My take to this is, every T1 deserves a Dexcom system from the insurance. It easily saves your life and makes the control much easier.
Some sensors get noisy sooner than the others. I noticed they work longer during the winter when its cooler. Last one worked for 4 weeks quite good, but in the summer they stopped working in less than two weeks.
I found some pictures of someone replacing the battery on the transmitter of a G6. This is.... not really practical. 
What would be interesting is if you could pull out the internals and 3D print a new enclosure that had an actual user serviceable battery.
 - https://seemycgm.com/2018/07/12/g6-transmitter-battery-repla...
It does seem like a helpful tool to screen.
Here in the UK, I don't have a prescription (despite being type 1 diabetic) but occasionally self-fund the devices directly from Abbott. I get a VAT excemption so it costs ~£45 per unit, which lasts 2 weeks.
Tracking Blood Pressure
Tracking Blood Sugar
I mean... yes. They're a prescription medical device used by Type 1 diabetics to stay alive.
And more unfortunately, it has been my experience that information about managing blood sugar given to diabetics by doctors is almost uniformly quite bad (I've received the same sort of overly simplistic, misguided instructions from 4 or 5 different doctors myself; now I just nod and let them finish speaking). As a result, nearly every other (non-engineer/scientist) diabetic I've been met has very bad numbers (A1C: three month average blood glucose)—as I would have too were I to follow my doctors' advice. Instead I have very good numbers which are a result of research and reasoning I had to do myself.
Edit! High fives, not threes. See my comment below.
The one I was seeing before her once started yelling at me for having such a bad control, so I seriously started looking for a better practice.
I could see why you have a pretty high threshold for the quality of advice you want. Not sure it's a typical experience, though.
Wait, really? Your average bg is in the low 60s? I've never heard of that before.
I just checked my last score which was 5.8. IIRC I’ve always been between 5 and 6 since I started directing my own treatment.
If you're wondering if you may be pre-diabetic then wouldn't an A1C test (home tests available and are very accurate) be a better diagnostic test?
But HBA1C can sometimes still be good, even for people who have high & low glucose peaks.
Maybe because the average value will still be good if you have equal peaks "up" as "down"? i don't know..
They are opaque on pricing, do not answer questions about where to buy, do not clearly state what kind of prescription they need.
Before you must do some reading and understand the concepts. OpenAPS and AndroidAPS are state of the art systems and you can do even better than the basal setup using the oref1 SMB algorithm. I know countless of diabetics using it and we all have much better and easier control in our therapy.
The result is not considered as accurate compared to finger sticks but it's an option for people that can't really stick their fingers I guess.
They're mostly the more modern ones that don't need much blood. Also the ones I've purchased have a special attachment for the lancet device to accommodate the different location.
The ads do seem to imply that you don't need to use a lancet but that's just marketing and advertising. You still need to use a lancet to get a drop of blood.
No. This is well understood science. The fatigue you feel soon after eating is caused by postprandial hyperglycemia, or a “spike” in blood sugar soon after eating. You can, and I have tested this after overeating carb heavy meals and that's exactly what's going on.
I'm prediabetic, so I watch this carefully as I have a family history of diabetes.
Make sure to get the 14-day version: https://www.freestylelibre.us/system-overview/freestyle-14-d.... It’s about $80 (cash to a pharmacy, not through insurance) and includes 2 14-day patches.
Over the next year or two, performing at least a few weeks of real-time monitoring per year will become standard practice among those who consciously monitor their health. With the Libre, doing a few weeks per year is no harder, and not much more expensive than a home blood pressure cuff. It’s not even all that expensive to do year-round.
(I don’t think this should require a prescription, but in the US it currently does.)
It works the same way. It's 2x more expensive but it's a watch.
It's hard to take the author's concern seriously when he is at low risk. A better take is that he's just curious.