The first Robo-Diabetic in Singapore

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Me wearing my new kit

Ever since I was diagnosed with diabetes nearly ten years ago, I have relied on my trusty blood sugar meter to give me an understanding of my blood sugar and to help me manage Type 1 diabetes.

Blood sugar meters were a great invention and have been in use as a primary tool for diabetes since the early to mid-1990’s. Before then diabetics would have to rely on urine tests – which gave often inaccurate results and always a delayed view of blood sugar.   Urine tests were like viewing your diabetes in the rear view mirror.

Modern blood glucose meters offered a real time way of judging blood sugar and the first patient to adopt their use was Dr. Richard Bernstein, a Type 1 diabetic who has gone on to be the pioneering author of ‘The Complete Diabetes Solution’; in my view the most important book available on the subject of diabetes self-management.

Blood glucose meters have been incredibly important is providing much needed data to diabetics in control their condition; helping to make decisions on diet and medication and helping to avoid hypoglycemic episodes.

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My reliable but sizeable One Touch kit

A large range of different meters is available – in the region of around 30, but I have always relied on my One Touch Ultra from Lifescan, which has served me well for ten years! I take as many as 8 tests a day, and this is not only expensive – at more than $1 a test – but hugely inconvenient.  There is just no way to be discrete about pricking your finger with a lancet and drawing a pea sized amount of blood into an electronic meter.  Try doing that at a dinner table, in the class room or in a meeting.  So, whilst I am hugely grateful for blood glucose meters, they aren’t the most user-friendly of devices.  Also the user interfaces look like something from the 1980s, I guess we have been spoiled by our smart phones to expect something better! I have followed the development of alternative types of glucose checking over the last few years to see if any offered a real alternative. Until now I have not been convinced.  The existing CGMs (Continuous Glucose Meters) seem so unwieldy and difficult to wear and I have read repeatedly that their results can be unreliable.  For this reason, I have given them a wide berth; I recognize others feel differently on this.  For me accuracy is the number one concern; especially as I am making insulin dosing decisions based on the results.  A mistake can prove costly with insulin.

Very recently though, I came across glowing reviews for the new device from Abbott, ‘The Freestyle Libre’.  I read reviews from people in the UK, where the device has been available in limited quantities for over a year or so.  This offered a different solution to blood glucose monitoring. (Technically it is not actually reading the blood glucose but the interstitial fluid and uses clever algorithms to approximate the blood glucose).

The device comes with two main pieces. The first is a reader – This is a glucose meter, but a modern take on it, with good graphics, a simple user interface and a USB rechargeable 7 day battery.   It is small and light and feels like it belongs in the 21st century.

The second part is a sensor – this is a small device, like a patch a bit larger than a 50c piece, worn on the upper arm that has a very fine short needle in the middle. The sensor is attached using an applicator and is intended to be worn for 14 days.  The sensor has a sticky substance to hold it in place which is also waterproof.

The clever part is that the device only needs to be waived over the sensor to read your blood glucose level. You can do this as often as you like for 14 days.  If you do not scan for a while, for instance when you are asleep, the senor remembers the readings for the last 8 hours – so when you do your first can in the morning, you get a full record!abbott libre

So I wanted to try this device based on the excellent feedback. I quickly went onto the UK site of Abbott to find that only residents of European countries could buy the device now and that a long waiting list had developed.  As I am based in Singapore, I was very disappointed.  Not to be put off though I searched around on eBay and found a device and some sensors.  I had to pay well over the usual price in the UK, but I was determined to acquire one.  My thinking was that if people can pay $1000 for a smart phone, buying a device that might just keep me healthy for a lot less than that makes sense!  It seemed more important than playing ‘Angry Bird’.  I don’t like the fact that people are profiting from selling these devices on eBay, but I was willing to overlook that.  I also wanted to be the first to provide a review of this in Asia!

When the device turned up I was excited. I un-wrapped the box quickly and was instantly impressed by the size and weight of the reader.  It is so much smaller than my blood glucose meter.  The other boxes contained the sensors and I was able to work out within 5 minutes how to apply the first sensor.  The senor is placed into on the applicator and you place it on your arm where you want to the senor to be located.  You then push down on a button and the sensor clicks on.  It was painless and easy; not any more painful than a finger blood test, and the best part is that you only need to do this once a fortnight!

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The accuracy of my first test was very encouraging

Next you run the reader over the sensor and a 60 minute countdown begins. This is the activation process for the new sensor.  The reader displays the countdown on the screen, so you can excitedly await your first result.  I had heard that the device gets most accurate after 12-24 hours – after its initial warm up phase. When the 60 minues was up, my first result appeared.  The new machine read 7.0mmol/l – I quickly performed a blood test using my One Touch, and it showed 7.0mmol/l.  I was astonished. Over the next few hours, I performed a few tests every 10 minutes or so. There were differences sometimes as much as 2 mmol/l.  This was disheartening, but I had read on a lot of blogs in the UK that this was to be expected.  I carried on using my old blood glucose meter for the rest of the day to be sure that I was not making decisions based on bad information.

The following day, day two of the sensor, and the differences between my old meter and new Libre were so minimal – around 0.1-0.2 mmol/l that I could stop the finger tests completely. Testing is just so easy.  For instance, I went out to lunch that day with friends and could discretely check my blood glucose by simply bringing this small device to my arm.  To be honest, this was so exciting and thrilling, that I kept showing people.  Someone called me Robo-Diabetic, which I quite liked.  It also allowed me to take insulin exactly as was needed for the situation.  I could see the trend of my blood sugar, displayed by up or down arrows on the screen and make fine adjustments.  This is just not possible with blood glucose meters, which only give a single point in time reading.

It is easy to imagine how much this device will help people with diabetes, or those caring for them, and in particular parents of those with young diabetic children (note: the device does not yet have approval for use with children).  I imagine this is what the users of the first blood glucose meters in the 1990s felt after having relied on urine tests for so many years; it’s the same magnitude of step forwards.  I cannot emphasise how much I believe this will help diabetics manage their condition and keep their blood sugars normal.

I have noticed some things that I would never have been able to understand with my finger stick tests. For instance the other day I had a dish that I normally eat and which two hours after eating has always given me normal blood sugar.  With this device I could see my blood sugar climbing quite high before it fell back again.  I was previously unaware of this spike.  Also I was able to use the device easily during exercise which is another massive benefit.

There have been reported teething problems with some of the sensors in the UK and some readings being way off. By all accounts, Abbott will replace the defective sensors.  I believe that with any new technology, that this should be expected.  Abbott has a long waiting list and the device is not approved for sale in many countries outside Europe yet including the US, as well as most of Asia, including Singapore

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You see I don’t need this anymore to test my blood sugar

As far as price is concerned, for people who test frequently, this should work out cheaper than buying test strips. In the UK the sensors cost GBP 48.29 or about $100.  Considering that a single sensor will last 14 days, you will need 26 sensors a year; that will cost – SG 2,600.  I use around 8 test strips and the cost of each strip is around $1.    Therefore I spend close to SGD 2,848 on testing a year.  The cost of the reader is around $100, which is similar to the cost of a regular blood glucose meter. Currently, the device is not covered on insurance, but that will surely change. The device is such a breakthrough and so effective at giving accurate readings that its use should significantly help to prevent complications and therefore reduce the long term costs of diabetic care.  The device is also cheaper for people who test frequently; that is a strong argument for its quick introduction and for insurance companies to cover it.  I also hope that this is available as soon as possible in Asia.