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Flash glucose monitors (Freestyle Libre) and continuous glucose monitors (CGM)

How does a flash glucose monitor and CGM work?

Flash glucose monitors and continuous glucose monitors let you check your blood sugar levels without you having to prick your fingers.

You wear a small sensor on your body day and night that reads your blood sugar levels so you can see the information on your mobile, or other device. If someone helps you look after your diabetes, their mobile can be linked up too.

With a CGM and the latest flash glucose monitor (Freestyle Libre 2), you can also set an alarm to sound if your blood sugar levels go too low or too high. 

This can also be set up to sound on someone else’s mobile, for example, a parent or carer’s.

One of the other main benefits of a flash glucose monitor and CGM is being able to review what your blood sugar levels do every minute of the day and night. With the charts and graphs, you can start to see and understand how food, activity, and other things affect your blood sugar levels. 

"It's a real mental health break knowing what your blood sugar levels are doing at any one time." Matt

Time in range

As you can share your data online with your healthcare team, they can adjust your treatment. They can also suggest things to help increase  time in range – which is shown every day on your device. 

How finger prick checks differ to CGM/Flash readings

 

Watch Matt's video about his experience of using a Freestyle Libre 2

A description of what happens on screen in the video can be downloaded (Word, 12KB)

Videos on how to use a Freestyle Libre 

Help and tutorials from the Freestyle Libre manufacturer Abbott.

Difference between a flash glucose monitor and a CGM

With a CGM your latest sugar levels show up on device or mobile automatically, transmitted by Bluetooth. With a flash glucose monitor, it’s only when you wave (scan) your device over your sensor that you get your blood sugar readings.

Some people prefer to use Flash (Freestyle Libre) over CGM. Reasons can include not liking the alarms. But unlike Flash, a CGM can ‘talk’ to an insulin pump, if you want to use a closed loop system.

Your diabetes healthcare team should be able to support you to make the decision on which device will be best for you.

How do I get a flash glucose monitor or CGM? 

If you’re in England, Wales or Scotland, check the latest guidelines on who should be offered a flash glucose monitor or CGM on the NHS. If you’re in Northern Ireland, you’ll need to check with your healthcare team.

Generally people with type 1 diabetes should be offered a CGM or flash glucose monitor and some people with type 2 diabetes may be offered a flash glucose monitor to help manage daibetes.

Getting free Flash sensors and CGM sensors 

If you get a Freestyle Libre or a CGM on the NHS, you should also get the other things you need like sensors and replacement parts.

It’s also worth knowing that sensors only work for individual products, so sensors for a Freestyle Libre won’t work for a Freestyle Libre 2 or a CGM.  

“Using a Freestyle Libre helps me prevent hypos and it’s much more sociable because when I'm out, I don’t have to find somewhere convenient and clean to do a finger prick check. I’m lucky I can afford to self-fund.” 

Margaret, 73, who has type 2 diabetes and uses insulin.  

Buying a CGM or flash glucose monitor

If you don’t qualify for a flash glucose monitor or CGM, your main option is to self-fund a device. It’s expensive so if it’s something you’re thinking of doing, it’s worth speaking to your healthcare team first to see if they think it’s something that would suit you.

There is only one flash glucose monitor manufactured at the moment. This is called the Freestyle Libre (the Freestyle Libre2, the newest model has alarms for predicted high or low blood sugar, but the alarm only sounds when you scan the sensor to check your readings). Both are offered on the NHS to people who qualify and are available to buy.

Cost of buying a Freestyle Libre

The cost of Freestyle Libre or Freestyle Libre 2 sensors are around £50 every 2 weeks. If you have a compatible smartphone you can just download the app and use your phone to scan the sensor to see the readings. But if you don’t, you can buy a small device called a reader, for around £50 and this is a one-off purchase. Speak to your healthcare professional about where you can buy a reader from – they can be available direct from the manufacturer (Abbot), from a pharmacy or online but this can change. 

Cost of buying a CGM 

As well as the sensors which cost between £40 to £70 each and usually last for 10 to 14 days. Sometimes you’ll also need to buy a transmitter and a reader, sometimes known as a receiver, which is a one-off cost. They are often sold in ‘starter pack’ bundles along with some sensors which cost around £200. You can usually buy these directly from the manufacturer's website.  

CGMS used by the NHS or to buy

The Freestyle Libre 3 is a CGM which is available on the NHS but not yet available to buy. 

These are some of the CGMs available:

Dexcom G6 licensed for those aged two and over

Dexcom G5 licensed for those aged two and over

Glucomenday licensed for those aged six and over

Guardiam Connect (Medtronic) no age restriction

GlucoRx Aidex (licensed for those aged 14 and over)
 

Some CGMs work with insulin pumps - see information on these integrated systems.

How finger prick checks differ to CGM/Flash readings 

A finger prick check tells you what your blood sugar level is at that moment.   

With a flash glucose monitor or CGM, what’s being measured is the amount of sugar in the fluid surrounding your cells. This is called interstitial fluid. It’s not quite as accurate as a finger prick test as it lags behind blood sugar levels by up to 15 minutes. And the difference between the blood sugar and CGM or flash reading is more likely to be greater  when you’re eating or exercising. 

So even if you’re offered a flash glucose monitor or CGM by your healthcare team, it’s important that you still get your diabetes kit on prescription including your blood glucose meter to let you do finger prick checks. "

"I found that pricking my finger up to ten times a day was challenging and sometimes painful so I got the freestyle libre 2 sensor which has helped a huge tonne. Alfie, 15

Why you still need some finger prick checks

You may need to do a finger prick check, for example, if what you’re feeling doesn’t match what your blood sugar reading says. Or if you’re treating a hypo, you may want to do one to get the most accurate result.  

With some CGMs, you may also need the result of a finger prick check every day to reset your device. 

Flash sensors and CGM sensors

With a flash glucose monitor, sensors (small white discs) should be worn on the arms only. And we recommend that they aren’t placed over areas with tattoos as this could impact your results. With a CGM, you can wear the sensor on different parts of the body, such as your abdomen.

The sensors don’t normally need to be taken off. You can usually wear them in the bath, shower and during sports. But some people do have problems with them falling off. There are adhesives you can buy to keep them in place.

You cannot remove a sensor for a while – once it has come off you need to replace it with a new one.

How often you have to change the sensor will depend on the type of model you’re using and the manufacturer’s instructions. You’ll usually need to change it at least once every 14 days.

It’s quick and painless to put on a sensor. You insert them just under the skin using an applicator

Pros and cons of using a flash glucose monitor or CGM

Diabetes technology is a wonderful thing, but it certainly isn’t for everyone. 

Some people feel uneasy about getting lots of data, and for some people it gives them more confidence. We’ve got more information to help you work through these different feelings about using diabetes tech. And you can always call our helpline to ask questions or just to talk it through.

Advantages of Flash and CGM

Disadvantages of Flash and CGM

You don’t need to do so many finger-prick checks and you can set alarms if your blood sugar goes too low or too high (unless you’re using a Freestyle Libre 1).

It’s not always as accurate as doing a finger prick check and it can take a while to get used to using the technology

You can see trends, like when your sugar levels are starting to rise or drop, so you can take action earlier.

You can get overloaded with data, which can confuse or worry some people.

You can get your sugar levels in your target range more often as you have more information about when you’re high and low.

You may find wearing the sensor irritating, you might not like the look of it, or showing people that you have diabetes.

You can see what your levels are like at times when you don’t normally test, like during the night (either by looking back at your own data or scanning someone else’s sensor while they’re asleep).

 

Your glucose levels can be shared with your diabetes team, so they can review and adjust your diabetes management. It also means that the information can be shared easily during virtual appointments.

 

  

Learning to use your CGM or Freestyle Libre

Your diabetes healthcare team will set you up with your CGM or Freestyle Libre if it’s free on the NHS and show you how to use it. Sometimes manufacturers will help you set up the technology – this is fine and can help your healthcare team get more people on to the technology more quickly. 

Abbott, which supply the FreeStyle Libre, also provide free online learning for people with diabetes using the technology to help them get the most from it. 

You may also benefit from going on a diabetes education course if you use Flash (Freestyle Libre) or CGM. Ask your GP or other diabetes healthcare professional to refer you. 

If you want to share your experiences about using tech or find out information by asking others using it, go to our forum

Faulty flash and CGM sensors and devices

If your sensors, reader or CGM transmitter are faulty, you can send them back to the manufacturer and request replacements. It may help to send example readings, compared with finger prick checks.

You can also report any concerns to the MHRA yellow card scheme.

Getting insurance for your CGM or Freestyle Libre

Like all types of tech, looking after it and things like making sure the batteries are charged is important. Because electronic devices are expensive, you may wonder whether to get insurance to cover it in case you lose or break it. Before taking our separate insurance, it’s worth seeing if you can have it as a named item on your household insurance. This might be a cheaper and simpler option.

Driving and checking your blood sugars using a CGM or Flash

You can use a flash glucose monitor or CGM to check your sugar levels when driving, but you must confirm your levels with a finger-prick test if:

  • your blood sugar level is 4 mmol/l or below
  • you have symptoms of a hypo
  • your monitor gives a reading that’s not consistent with the symptoms you’re getting – for example, if you feel like you’re having a hypo but the reading doesn’t show this.

Troubleshooting information for Freestyle Libre2 users

We know that lots of people have been reporting issues they've been having with the Freestyle Libre 2.

We previously collated some of these issues and fed this back to Abbott who have provided us with some 'Top Tips' for issues with Libre 2 alarms.

If you have any concerns or specific issues with your Freestyle Libre2, please contact Abbott directly via their Libre2 support pages. Or use the Abbott guides we're sharing below.

Top Tips for Freestyle Libre2 Android (1MB)

Top Tips for Freestyle Libre2 iOS (1MB)

 

Still have more questions or things you're not sure about on CGMs or flash glucose monitors after reading this page? Let us know by emailing mytech@diabetes.org.uk

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