CGM for type 2 diabetes

[FrogFairy]

I am looking into this for my dad. He has had diabetes for more than 20 years and his levels have always been stable, but suddenly he is having hypos (unconscious and unresponsive on one occaision) His insulin dose has been dropped but is still falling to around 3 most evenings. Awaiting an appointment with the diabetes consultant.
My online research shows that a CGM is unlikely to be available on the NHS but he is willing to pay for it himself. Also it seems the Freestyle Libre is not reliable.

If you or someone in your family use a CGM, please would you share any advice or thoughts on it. What brand you use, the cost, any feedback at all really. We really like the idea of an alarm via a smart phone that would warn him of his blood sugar getting low.

many thanks in advance for any advice you can offer.

Depends on the area. If you look at NICE guidance, it advises that if on multi injections for insulin and having hypoglycaemia then it's granted. The Gp can prescribe at their discretion too. You dad needs to reduce his insulin again if still having low levels.

Flash monitoring is available for above.

my type 1 diabetic daughter has had both libre and now dexcom. The dexcom (G6) is definitely the superior product as it tracks constantly rather than having to scan your arm. I believe the newest libre does that but is less accurate than dexcom.
I know NICE guidelines find this for type 1 diabetics, but given your dad's situation, I wonder if they'd fund it?

fund not fine

Dexcom over Libre. You can order a month's trial kit to see if it works for your dad :

https://uk.store.dexcom.com/en-GB/dexcom-g6/g6-starter-kit/GBSTARTERKITG6.html

DH has had both and the Dexcom is loads better. If you can afford it I would just order it and give it a try.

Definitely right for heading off lows and you can get a graph app which I think is called Clarity for free that lets you see trends and change your insulin to avoid highs and lows.

I've had medtronic cgm and Libre2 as a T1. You can't compare the 2 they are so very different.
In the meantime why is the diabetic nurse not monitoring things and suggesting a much reduced dose of insulin?

My son has just been diagnosed with type three c diabetes it's a rare form caused pancreas damage ,he's got A Dexcom on the NHS,hes only had it a few weeks it's very reassuring to me as I can check.his levels without disturbing him
.

Thank you all so much for your replies, they are all very helpful. I didn’t know that the GP was possibly able to prescribe a CGM so will try that rather than waiting for the referral to the consultant.

Regarding the diabetic nurse, dad had a diabetic review that showed his hba1c was only borderline diabetic. She did not change his insulin dose and about 10 days later he became unconscious half way through eating his dinner. Thank goodness it didn’t happen while he was asleep overnight.He ended up spending a night in A&E where a diabetes specialist lowered his insulin dose and has referred him to his diabetes consultant. I am also type 2 diabetic but just take tablets. My gut feeling is that perhaps dad needs to stop insulin and just take tablets, obviously closely monitoring his bs levels (but of course I am not medically trained)

My research online has suggested that the Dexcom was a good choice, not heard of Medtronic but will also look at that.

once again, thank you all very much.

The Dexcom,is really reassuring and easy to use but it is expensive fortunately my son gets it on the NHS,but I was told it was £800/ three month supply .

Yikes, that is expensive. I had expected around £100 per month. No idea how I missed that.

I've had diabetes since aged 1. I've had a pump for over 20 years. The funding for pumps, cgm's is like pulling hens teeth.

So does he have a diabetic consultant ? My Dh is type 2, under a diabetic consultant, can email the team direct. Also can ring the diabetic nurse, who works as part of the team team under said consultant.

Why on earth aren't you contacting diabetic nurse direct. Or telling all this to GP and politely demanding immediate action?

If your Dad is experiencing hypo ,s regularly especially if he's insulin dependent he might be a candidate for CGM,they are expensive so I get why not everyone can have one but May be you should push for one !

my son shares is data with me ( he's only 16 )but it's so reassuring I can check i his levels

Surely he shouldn’t be on injection if he is only just borderline? No wonder his BS is so low. Sp to nurse or someone else ASAP- question them why if they don’t suggest reduction. Does he even need any treatment other than diet at just borderline?

I have type 2 diabetes. My nurse at the gp surgery has prescribed a Freestyle Libre 2 sensors and reader. I was prescribed these because I inject insulin twice a day. You won't be prescribed it on the NHS if you only inject once. I asked the nurse. It warns you of low blood sugar and if you are type 1 it will also warn of high blood sugar. You can set it yourself but I ask the nurse to do mine. I also don't plug mine into my computer just in case I do something wrong. I didn't ask for this so I think it is a new initiative. I am in Worcestershire.

Thank you all for more replies.

I am frustrated, agree with all you have said and trying to get him to be more proactive in sorting this out. He used to see a diabetic consultant but he was so well controlled that they passed him back to the diabetic nurse at our GP practice quite a few years ago. The doctor who saw him at A&E is referring him back to his original consultant. He has no email account so has never had those contact details nor a phone number it would seem. I am due my own diabetic review at the GP practice soon and while she won’t be able to discuss my dad specifically, I will enquire if she could prescribe the CGM and perhaps obtain contact details for the diabetic consultant. He does inject twice a day currently.

We had a chat about the situation earlier and the reason he does not want to be too pushy is the fear of being told to stop driving. My mum is very unwell and has lots of appointments, as well as him needing to go shopping etc. I think this makes it even more urgent to sort this but he is as stubborn as a mule.

You need to chase to get the consultant appointment asap. You also need him seen by diabetic nurse at surgery asap. Phone his GP. All 3 things can be chased today. You are focusing on the cgm too much, whilst ignoring the diabetic basics. If he needs his insulin dose reduced then get the nurse or consultant to action this.

It sounds like your dad might be losing hypo awareness which means he needs to inform the DVLA regardless; if he’s needed help with any of his hypos other than when he lost consciousness he is also required to inform the DVLA.

It sounds like he’s concerned about the impact of temporarily stopping driving, but he might already be breaching the conditions of his driving licence (are the DVLA aware he’s an insulin-treated diabetic?).

If you use insulin your driving licence needs renewing every 3 years. My insurance and DVLA have been informed. I must admit the form to renew is a bit misleading in some of the questions! Hope your Dad gets it sorted soon OK.

I think the requirement re DVLA is basically: A hypo, 'requiring assistance from another person', more than once, ie twice, in the last 12 months.

I use freestyle libre and while I agree there are better CGMs on the market, it's good enough for what you pay for it. You will see trends. Good luck with getting your dad sorted.

Thank you all.

He has only had the one hypo requiring assistance, his insulin dose has been reduced by the hospital and an appointment with the consultant has been requested (but I plan to phone the consultant’s secretary to chase this asap)

The DVLA are aware that he takes insulin and he renews his licence every 3 years.

We hope that a CGM will further help monitor his blood sugar levels for the sake of his health and safety to drive.