The FreeStyle Libre became available to the NHS in Scotland in the summer of 2018. Neither a traditional blood glucose meter nor a continuous glucose monitor, the Libre was seen as a cheaper and more convenient alternative to people wanting more information about what their glucose between finger-prick tests. Sometimes called a "Flash Glucose Monitoring System," the FreeStyle Libre is the first of its kind, though other makes may arrive on the market soon.
The FreeStyle Libre consists of two parts - a sensor and a scanner.
A sensor is inserted under the skin using an applicator that comes in the box. This can remain in place for up to two weeks. Unlike a blood glucose meter, the Libre sensor does not measure the glucose in the blood; rather, it measures it in the tissue that surrounds the blood vessels (what doctors call the "interstitial fluid"). The user then swipes their scanner (either the one that comes in the starter pack or a compatible mobile phone) and to read this tissue glucose.
If the tissue glucose is different to blood glucose, and finger-prick tests are still required, what's the point of the Libre? When you scan, the Libre immediately provides three pieces of information. It shows the tissue glucose, an arrow showing whether the glucose is going up or down (and how quickly), and a graph showing what the glucose has been doing for the last 8 hours.
Together these can provide you with information about your glucose that you never knew. You may think that your glucose is on target most of the time, but in fact it regularly jumps up after you eat. Or it may show you're often hypo overnight. Or perhaps it tells you that when you go swimming every Wednesday you are high when you're in the pool but hypo by 10pm.
It doesn't really matter what problem the Libre shows; what matters is that it gives you the information you need to make a change to smooth things out. High after breakfast? Try changing the Carb Ratio, or the timing of the injection, or maybe what you have to eat. Then see what happens for the next few days. Problem still there? Try again.
The Libre is not just a glucose meter. It's there to be used alongside blood glucose tests to really get your glucose into target more often, without swinging up and down as much of the time.
Tissue glucose measurements can be different to blood glucose. If you tested both at the same time you would almost certainly find the results to be different. This is because tissue glucose levels change more slowly than the blood glucose. Eating a meal, for example, will cause the blood glucose to rise quite quickly, but the tissue glucose may be slower to rise. It may take around 15 minutes before you see the tissue glucose go up.
Likewise, you may feel that you are hypo but the Libre says you are not. Beware! The tissue glucose might be lagging behind what is happening in the blood. A finger-prick test could well show that you are actually low.
For this reason, we recommend regular finger-prick blood glucose tests throughout the day, particularly when you are making a decision about how much insulin to take (e.g. before meals), if you are unwell or if you think you are hypo.*
Although an agreement was made in 2018 for the Libre to be made available on prescription, this doesn't mean that anyone who wants one can get it. In Greater Glasgow and Clyde, the Health Board have set conditions for use which we must adhere to, and you will be asked to sign a contract agreeing to these criteria before getting the Libre:
If funding is agreed but then the criteria are not met (e.g. by not scanning often enough or by not sharing data), funding for the Libre may be withdrawn.
When we first began using the Libre in earnest, we arranged two large group teaching sessions to inform the majority of families who would be using the device in those first months. Dr Vaiva Kuehne's original presentation, with notes, can be found here and it is recommended that anyone wishing to use the Libre should read it.
To access Libre Academy, go to this website: https://progress.freestylediabetes.co.uk/.
Set up an account. Libre Academy consists of 9 individual modules that must all be completed. You can do them all at once or over a period of days or weeks - it's up to you.
Libre Academy is an online course provided by Abbott Diabetes Care, the makers of the Libre, to help people understand the differences between Libre and conventional glucose testing. We consider it a prerequisite to getting a Libre on the NHS.
LibreView is how you can review and examine the glucose results at home and also allows us in the diabetes team to see the data too. This is important because we want to be able to help you in managing your glucose and we cannot do so unless we have the same information as you do.
Now you will receive your training when you are called to an appointment to pick up your starter pack. This training is normally provided by Donalda and Mags, our excellent support staff.
When all of the modules are complete you can download a certificate, in pdf form, that you can send to the team by e-mail to email@example.com. We can only add someone's name to the waiting list when we have a copy of this certificate.
Once we receive a certificate by e-mail, we will send a reply acknowledging this. If you don't receive a reply within a few working days, please re-send the e-mail.
It's worth knowing as well that there is always a waiting list to receive the Libre. People don't usually have to wait more than a month or two, however, so if you think your name is on the waiting list and you haven't heard anything, please contact us.
In order to both set up a LibreView account for yourself (whether you use the scanner or a mobile phone to read your glucose) and to share it with the diabetes team, you must visit this website to create an account: https://www2.libreview.com/.
Now that you have LibreView account, go to the "Settings" section (that's the three lines in the top right corner of the webpage) and click on "Account Settings". Now click on "My Practices" and enter this number in the box that says "Practice ID":
You should now see our clinic name appear on the list.
Alternatively you can ask us to send you an e-mail invitation to share the data.
You will need to upload your Libre scanner to LibreView regularly, but if you use a mobile phone and have completed the above steps your results will go automatically to LibreView.
Finally, we only look at your results when you come to clinic or if you wish advice. It is still your responsibility to look at your own results and consider what changes, if any, may be required to improve your glucose levels.
You can also share data from other devices - blood glucose meters, insulin pumps, and continuous glucose monitors - with the diabetes team. Click here to learn more.
*If you ever need to be admitted to hospital for any reason, results from the FreeStyle Libre will not be used to make decisions about your treatment. Ward nursing staff will carry out finger-prick blood glucose tests and use these results to decide on things like insulin doses, etc.
If you have a Libre scanner and are looking for some tips on getting started, or just want to see more about how the Libre works, Abbott have provided some videos on their website. These are a great starting point.