What diabetic supplies do you carry with you?

[MissMarplesNiece]

I'm an insulin dependent diabetic. I need to inject a bolus dose before I eat anything containing carbohydrates. I occasionally get hypos - usually if if misjudged how much insulin to take or if I do something energetic - a long walk or even vigorous hoovering - so I carry a carton of orange juice with me. I'm a driver so the DVLA says I must carry finger prick device & monitor with me on car journeys, not rely on my Libre 2.

What do you use to carry all your stuff around with you? I feel like I have a bag full of stuff with me before I even start to put shopping, book, umbrella etc in my bag.

@photofan get in the right decade! You are talking to people who have been T1 for 30+ years. Don't lecture.

The DVLA specifically say you must carry a fingerprick meter at all times when driving

I've just double checked this and the DVLA information leaflet INF 294 specifically states "You should always carry your glucose meter and blood glucose strips with you, even if you use a continuous blood glucose monitoring system (RT-CGM) or flash glucose monitoring system (FGM)". I assume that if you were involved in an accident and you didn't have this with you, your insurance company could refuse to pay out.

This! I think there is a big difference between someone that has been doing this for years and a newly diagnosed T1D. I wouldn’t say I’m complacent now, I just manage my condition well enough to not have to carry the kitchen sink everywhere I go.

My last serious hypo was 4 years ago and a rare high for me now is 13mmol (I start to feel rough around 11.5-12) so normally correct myself then.

Sorry, is that right?
what date was that dvla update?

• Appropriate glucose monitoring systemsGroup 1 drivers may now use finger prick glucose testing and continuous glucose monitoring systems for driving.
• Group 2 drivers MUST continue to use finger prick testing for driving. CGM and FreeStyle Libre are NOT legally permitted for Group 2 driving.

so as most of us aren't group 2, Lorry, surely there he group 1, cgm is fine?

My understanding is that you can now use a CGM or FGM to check your BG levels before and whilst driving. If you register at 4mmol or below at any point you need to confirm using a finger prick test which must read above 5mmol before you can return to driving. Hence why I have a glucometer in my car, just in case.

The law has always said you must carry a fingerprick meter at all times when driving a car. It still says you must carry one, that hasn’t changed. All that’s changed is that in some specific scenarios you can use CGM too. If you’re driving without a fingerprick kit you are driving illegally.

https://www.gov.uk/guidance/diabetes-mellitus-assessing-fitness-to-drive#:~:text=RT%2DCGM).-,Group%201,blood%20glucose%20level%20is%20required.

I think the fact that you would need to check a below 4mmol reading with a finger prick means that you would need to have a finger prick meter with you when driving. I think it's something an insurance company could look at if an insulin dependent diabetic was in an accident, and they could get difficult about paying out if it turned out the driver wasn't carrying the kit & relying just on a CGM.

CGMs are less reliable - they do fail, and I've also seen a lot of people reporting that for the 1st 24 hours of a new sensor they get unreliable readings compared to a finger prick.

You are wrong.

Read the above.

I've had surgery using a cgm FFS. Even the anesthesiologist was happy to use it! The libre USED (as in about 5 years ago) be classed as not reliable/accurate enough. It is fine now. DVLA accept it. As stated above on the stated links by PP. The dexcom is even 'better' but I think now they are probably the same regards accuracy.

The only legislation from DVLA that I signed recently was regarding BS before driving etc.

You carry on carrying all the crap around whilst the rest of us actually live our lives as close to normal as possible.

As IF you still finger prick when you have a cgm 🤣.

And of course you wouldn't drive below 4. If the cgm reads below 4, you don't drive. So therefore don't need to finger prick???

Honestly. I despair. If you're doing this you are wasting you time. 30+ years as a type 1. Excellent control. Doesn't mean I don't assess risk. But fingers pricks are old hat and unnecessary now.

Have you actually read the DVLA link I posted? Here is a quote directly from it for group 1 car drivers

“Users of these systems [cgm] MUST carry finger prick capillary glucose testing equipment for driving purposes as there are times when a confirmatory finger prick blood glucose level is required”

Regardless of the driving rules the need to finger prick to confirm a hypo and again to confirm you are out of a hypo is very outdated. When using a closed loop system you are relying on the CGM data to determine all decisions your pump makes. If it’s good enough for that then why bother finger pricking? (Unless symptoms don’t match readings etc.)
(Disclaimer, not type 1 but husband has been for 45 years and have been managing 5 year old son’s diabetes for 4.5 years now)

It doesn’t matter if you think it’s outdated. It’s the law. Carry your fingerprick monitor whilst driving or you’re breaking the law.

Anyone ever drive over the speed limit?... Nah, me neither 😁

This is the most up to date information from the DVLA - from 2024, it hasn't been amended since then. As I read it, it's OK to test with CGM before /while driving but when it shows blood glucose of 4.0mmol or below, the driver has to use a finger prick until BG returns to 5.0mmol and above. So, a driver must have a finger prick kit with them in the car.

You’ve misunderstood my comment, I mean in general finger pricking is outdated and unnecessary. I’m assuming you don’t only have hypos when driving. In which case I would deem the majority of those none driving related hypo-confirming finger pricks completely unnecessary.

Finger pricking isn’t outdated and unnecessary. It’s essential around highs and lows when CGMs lag behind. CGMs don’t read your blood, they read interstitial fluid and have an algorithm that estimates your blood sugar based on it, which takes time to catch up in changing trends.

So if your cgm says your hypo and you treat it, the cgm will initially continue predicting your blood sugar falling more, even though the sugar has kicked in, making you overtreat. A few minutes after your blood sugar has increased the cgm will realise the trend has changed and correct itself. That’s why hypos you have on the cgm may not always show on the daily graph.

A similar thing happens with highs that you’ve corrected too. Fingerpricking is essential still for highs and lows as well as for sensors getting knocked off, the warmup period, sensors that are inaccurate, fast changing blood sugars (eg when falling fast which will show as sensor error wait 10 minutes on libre) etc.

@PotatoFan
Of course everything you say is correct, but surely on a day to day, run of the mill basis you have factored in the approx. 10 minute delay. Therefore you treat and wait as you would without a CGM.

We use Dexcom here so don’t have the issues with errors with fast changing blood sugars and hypos of less than 10/15 mins not appearing on graphs. We have used Libre though so I am aware of these issues.

As closed loop pump users it would be pointless to be finger pricking for every hypo/hyper in our opinion. If we are trusting the CGM data to determine all insulin deliveries then surely we have to trust it to accurately notify us of hypos/hypers? We use a CGM as a tool to make life easier and take away the need to finger prick constantly (outside of all of the many reasons why you must finger prick, dodgy sensors, warm ups, symptoms not matching readings etc. etc. etc.) Our 5 year olds life is certainly enhanced by not having multiple finger pricks a day.

Out of curiosity do you finger prick before bolusing too? I’ve seen quite a lot of people routinely doing that and have wondered what the logic is behind it? A hangover from when CGMs were new and perhaps a little less accurate?

@PotatoFanFinger pricking is shit. I don’t know anyone that would choose to regularly revert back when technology has put us in a much better place.

Realistically how often are you having to manually check for a high/low?!? My Libre app shows that over the last 90 days I have spent 92% in range (4-10 mmol) I like to sit between 6-7 so have a little tolerance on either side. My last major spike was at a wedding last summer when I seriously underestimated the sticky toffee pudding, couldn’t tell you the time before that. I haven’t officially hypo’ed in the last 4 years. DP still tells the story of when he saved my life. Spoiler alert - he woke me up and got me a carton of apple juice from the kitchen when I tanked during the night. My libre did its job, he was alerted by the alarm on my phone.

I know if my BG is changing rapidly because my vision starts to blur, if I drop below 4.5 ish I start to feel a bit shaky and above 13 ish just ‘meh’. I’m not ‘relying’ on a CGM to tell me something is wrong - I feel it in my body.

I really resent the dvla being so behind the times.
I've been on a cgm for years, I can't remember how long. More than 10 years, I guess a pump for over 22. Why finger prick, I only do in emergencies.
Like Walker I can predict my own blood sugars reasonably accurately by how I feel. I can tell you /guess if I'm 6.8, 8.7, 4.6. I'm not often wrong.

I am well aware that cgm's measure inter fluid thanks! And yes I don't struggle with the time delay. My simplera doesn't lag much, I don't get errors for rapid changing.

"If you register at below 4, at any point"?
errr, like errr no. That doesn't happen to me, I don't go low when driving. I just don't. The moment I can feel myself going below say 5, I correct.

If I was ever below 4, I wouldn't be anywhere near a car! , so name a time I'd need to finger prick, whilst driving these days ?

When you knock the sensor off getting in, when you go to drive and sensor says sensor error, when it’s hot or cold so the cgm doesn’t function (libre has to be at least 10c), when you’ve taken paracetamol or vitamin c which can interfere with readings on some CGMs, when you have a sensor reading too low and saying you’re in the 4s so you have to test before driving for whether you need a snack

Well, I've never had any of that, in my 50 years of diabetes, 25 years of pumps, 15+ years of cgm's, 30+ years of driving.

Originally my libre2, my Medtronic cgm, now simplera, doesn't have any problems with temperatures, I've only knocked one off in 15 years. So no, none of those things affect me.

You seem to be making a lot of assumptions. Why do you think we all experience what you do. Diabetics are mostly unique. I've never seen one patients graphs/data exactly match another's!

Not sure why you’re so argumentative. It’s literally the law to carry a fingerprick meter when driving, and the manufacturers advise to carry one at all times for many reasons.

I carry monitor (I use the finger prick method, and use it when I wake up, before eating and if I feel ‘off’), insulin pen and a snack. If I’m going out for less than two hours I test my blood and leave my monitor and pen at home, but I always have a snack (the need for this reinforced when I had to eat dog biscuits when on a long walk with my dog). I can tell if I’m about to go low. Those marshmallow Rice Krispie treats are good.