Type 1 diabetics have recently got a dose of good news: the Freestyle Libre blood glucose meter is being made available on the NHS. With the Libre you can wear a small sensor on your arm (about the size of a two pound coin) for two weeks at a time, scan it, and the reader tells you what your blood sugar has been doing for the last 8 hours, and also the trend. That information can then be downloaded and sent to a clinician to analyse if necessary.
When my Type 1 colleague saw me recently she said she almost cried when she heard the news. It is undoubtedly a very useful tool and potentially life-changing. For years diabetics have made do with finger pricking to measure their glucose. This is quite painful, and in some respects it can feel like you’re being penalised every time you take a reading – not a healthy attitude to instil when you have to measure four or more times a day! On top of this, repeated pricking is not exactly good for the sensitivity of your fingers (especially when feeling in the extremities is one of the first things to be affected by diabetic complications). In addition, the old method only tells you what your blood sugar is at that point in time.
The Libre removes all those downsides of measuring, allowing you to spot your patterns more easily. If old glucose monitoring was snorkelling, new monitoring is like scuba diving: you can understand things at a much deeper level. My own glucose control has improved markedly as a result, which has helped to reverse the first signs of complications.
Some in the diabetes community have greeted the news of NHS funding the meter warily, worried that the healthcare system simply won’t be ready for the demand, or that CCGs will attempt to weasel out of paying for them. Personally, I’m willing to wait and see what happens. CCGs had the ability to fund it from the start of November but, although I'd like to see it being funded sooner rather than later, I know these things always seem to take longer than you'd think.
For me though, the signal sent by the NHS agreeing to fund the sensor goes beyond the practical benefits or concerns. I am profoundly grateful; having the NHS fund the sensor will enable me to have a higher quality of living without the financial burden of £1200 per year. I feel re-connected to the founding principles of the NHS, and to my fellow citizens who will pay for my treatment.
Beyond that sense of gratitude and solidarity, I am hopeful, though my reasoning sounds contradictory. The Freestyle Libre is not the best glucose meter the service could have funded: it is not the most accurate meter, nor does it have the functionality of ‘true’ continuous glucose meters (CGM), which measure every five minutes, report the results in real-time, and are usually interoperable with insulin pumps. But it is relatively cheap (approximately half the price at retail of a normal CGM), and it is good enough to satisfy the needs of patients to be able to spot patterns in their glucose levels, and (with the right education) adjust their insulin dosage.
‘Good enough’ is not usually something to celebrate. But good enough is real, and reveals a shift in thinking. For as long as I can remember, the general attitude of clinicians was that the best way for a diabetic to live was in a perfect routine. The management of glucose levels was the number one priority at any given time; then regular time for injections to cut down on variables (regardless of activities); injections administered fifteen minutes in advance of eating to allow optimal absorption (ignoring the fact that you probably didn’t not know how much to inject at that time), and finger pricking for the most accurate measuring possible (even though less accurate but useful measurements could be taken from less sensitive parts of the body). Real life was relegated: ‘good enough’ was not worth bothering with when textbook control was at stake. A more orthodox, clinical view would have dismissed the Libre as inaccurate, a second-rate option for funding.
Something has changed. Maybe clinicians are listening more, perhaps person-centred care is really beginning to percolate, or is co-production with people who have lived experience starting to bear fruit? Whatever it is, funding the Freestyle Libre is an emblem of hope for diabetics and for the NHS itself.