Libre 2 Changeover Time Trick

 The Libre 2 should last 2 weeks, at changeover time there is always the 'will it start, won't it start' question which could mean you're not getting readings for at least an hour, possibly longer if the sensors fail.

I had once bad day when 2 Libre's failed one after the other, which meant 3 hours without readings, and really impacted my DIY looping - here is how to get wound that problem.

Use a miaomiao 2 reader with xDrip - I have a couple of these from before xDrip fully supported the Libre 2, and there was a good period of time when I couldn't get anything working properly.

1. Put the miaomiao on the old sensor and change the 'Hardware Data Source' in xDrip to 'Libre Bluetooth' and connect to the the miaomiao in Bluetooth devices, without stopping the sensor
2. Once that's done the miaomiao will continue to use this sensor after its expiry time (it only expires in the LibreLink app rather than actually stopping working) and you're ok to carry on using the Libre 2 for a good few more hours (though accuracy starts to decline, its still ball-park ok)
3. Then start the new Libre 2 using the Librelink App (or patched Librelink app in my case) and wait for it to start. Once its starts ok, you can stop the sensor in xDrip and start the new sensor as normal, if it fails to start, carry on using the old Libre 2 and miaomiao until you have one started

Its a work-around but keeps your loop running until you get a good sensor signal with the new Libre 2

I'm currently looking at switching to Dexcom One - not sure if there is a similar way to avoid dead time with a Dexcom yet.

Insulin Pump Renewal Time (again)

 Since being put on pump therapy I've had 3 changes.

The first pump I chose was an Animas 2020, followed by and Animas Vibe - then when Animas withdrew from the pump market the only option at the time was to go for a Medtronic 640g

The Medtronic works more or less exactly the same way as the Animas pumps did - i.e. it was a long way behind the other pump companies developments and was 'old tech' before I got it - 4 years on its a bit like watching Star Wars on VHS - ok at the time but looks like you need an eye test now

Advances in pump therapy mean we can now use pumps integrated with CGM to create a 'Hybrid Closed Loop' system - the pump works as an artificial pancreas as long as we tell it a few basic things (like how much we've just eaten) and it does the rest based on our current BG readings, IOB, etc.

I'm under Derby CCG for my Diabetes Care, and in Nottingham for everything else (prescriptions etc)

At pump renewal time I've been offered the following pumps:

• Medtronic 780g
• Omnipod Dash
• Tandem t:slim (possibly later in 2022)
• DanaRS or maybe Dana i (possibly later in 2022)

The big hit here is looping - Imagine how life changing it would be to be able to have my pump altering insulin in the background if I go high or low? Now that's attractive - so how to achieve that given there are only 2 pumps available?

Self fund sensors on the Medtronic - that's a minimum of £1820 per year - taking into account Derby are usually 12 months ahead of Nottingham in approving things - that could be £3640 before I get the kit to use Medtronic looping and wouldn't give me the tech for BG on a watch etc. - as it's not available directly (though there may be some fudge loading data into xDrip+ I guess)

I'll admit I'm not a fan of Medtronic - the pumps are 'ok' but suffer from cases cracking, there customer service has been terrible (improved over the last 18 months, but things like Christmas come as a complete surprise every year and you cant get consumables for your pump) etc. They also tie you entirely to their equipment and sensors - no open API or freedom to integrate kit that they don't make so I prefer not to use them

So the options are the Artificial pancreas open source apps on the internet - More on those shortly as they drive pump choice for me, to integrate with my existing Libre2 sensors

NHS approval for CGM

 It looks like this week NICE will approve CGM (continuous glucose monitors) for addition to Health Authorities formularies so can be put on individuals repeat prescription in a more general manner.

Currently they have only been available for qualifying children who need the support of these specific devices.

That means that closed loop systems are within reach ok UK diabetics - for some time Medtronic have been trialing closed loop in some LHAs (local health authorities), recently some other pump manufacturers have announced the same capabilities tied to their own CGM censors.

Taking into account the time it takes for LHAs to gain funding and approve products for prescription, and the current funding crisis caused by Covid, it may be some time before we see those products available in Nottingham (for example) and it may be triaged on a case by case basis until the LHAs can see benefit from cost savings and life quality to those taking up the opportunity for CGM and the Closed looping.

I have a pump renewal coming up in May 2022 - I'll take advice from the Derby Diabetes specialists to see what its likely to happen, however I'm currently planning on using my Libre2s linked to xDrip and Nightscout, a new DANA RS pump (open API) and AndroidAPS to perform the looping. That should buy me 4 years for it all to settle down, and I can review what's happened next time when its all sorted out.

Interestingly there is a new 'Libre 3' device that seems to be CGM rather than flash - more on that when I work out what that might mean

Its not easy being a Diabetic - you need one foot in the medical camp (I have spent most of my life being 'an organ' - in this case a pancreas) and one foot in the technology camp - I have no idea how this will work out when I hit 70 and still need to be switched on to compiling Android apps and whatever the new version of Bluetooth protocol stack is doing.....