NHS-funded Freestyle Libre

This leaflet contains some key information for getting started with the FreeStyle Libre flash glucose monitoring system. 

To get the most from your FreeStyle Libre, we recommend that you spend some time looking through this leaflet and the additional recommended resources. 

How will I get my prescription for the NHS-Funded Freestyle Libre? 

  • Your diabetes team will assess your clinical situation and confirm you meet the eligibility criteria, as defined in the NHS England guidelines.
  • Once your eligibility has been confirmed, you will be invited to an online education webinar where initial  information will be provided to get you started with using the FreeStyle Libre safely and effectively. 
  • As part of the registration process for the webinar, you will be invited to order your first sensor (and reader device if not using compatible LibreLINK app on your mobile device). 
  • If it is not possible to attend the online webinar, we can direct you to online resources to work through in your own time (‘self-starter’). We will require you to send over the certificate to confirm that you have completed the education. In exceptional circumstances, your diabetes team can provide the initial education in a face-to-face appointment.
  • Once we have confirmation that you have completed the initial education, we will notify your GP and ask them to kindly add the sensors to your repeat prescription (2 sensors per month).
  • NHS England guidelines advise that further prescriptions for the Libre sensors will only be provided after the initial six month period providing there is evidence that the individual has fulfilled all of the below criteria:
    • Engaged with education on how to get the most from their Libre sensors.
    • Using a sensor a minimum of 70% of the time.
    • Scanning a minimum of eight times per day.
    • There is evidence of clinical improvement such as: 
      • An improvement in HbA1c or ‘Time in Range’.
      • An improvement in symptoms such as DKA or hypoglycaemia.
      • An improvement in psycho-social wellbeing.

What resources are available to support me to use the FreeStyle Libre effectively?

There are a number of online resources available to support you to get the most from the Freestyle Libre. We would encourage that you start by looking at:

1. Nine short modules created by the FreeStyle Libre manufacturers to teach you the basics. 

2. Short videos created by expert diabetes clinicians and patients. 

Do I still need to finger prick?

It is important to do a finger prick glucose test at any point if:

1. The Libre reports your glucose to be less than 4.0mmol/L.

2. You experience hypo symptoms.

3. If the trend arrow is pointing vertically downwards.

4. The Libre gives a reading that is not consistent with the symptoms you are experiencing e.g. you feel hypo but the Libre reading suggests you are not hypo.

Can I use the FreeStyle Libre to test for driving?

From 14 February 2019, the DVLA updated their guidelines to allow Group 1 Licence Holders (those who drive a car or motorbike) to use the FreeStyle Libre to take glucose readings before they drive, or during breaks in driving. 

As with finger-pricking, it is against the law to do a glucose test whilst driving.
It is important to carry out a finger prick test in any of the situations specified in the finger prick section.

Who should I contact if I have any issues with my Libre equipment (sensor or reader)?

If you have any Libre equipment issues, please see the FAQ section or contact the customer care team or telephone 0800 170 1177.

There are a number of mobile apps available to support with calculating insulin bolus doses:

Carbs & Cals 
1.Bolus advice available only with Android version of app at a cost of £3.99.

MySugr Pro
1. Bluetooth compatible with AccuChek Mobile meter via wireless adapter device – device available from Accu-Chek Customer Care Line (Tel: 0800 701 000).
2. App is free of charge with wireless adapter device serial number.

Ypsomed MyLife
1. Manual entry of glucose level required if not using  corresponding Ypsomed glucose meter.
2. App is free of charge and accessible to all.

Diabetes:M 
1. Bluetooth compatible with 4Sure meters.
2. App is free of charge with Nipro Account ID code from Nipro Diagnostics Customer Service (Tel: 0800 08 588 08).

Are there any initial tips for getting the most out of my FreeStyle Libre?

  • We would encourage setting your glucose target range at 4-10mmol/L. It is important to have realistic  expectations - evidence suggests that achieving 70% of time in target range 4-10mmol/L indicates excellent control.
  • Some people find that their sensor is not as accurate during the first 24 hours. However, they found they can improve the accuracy of the sensor glucose readings on day one by inserting the Libre sensor when blood glucose levels are at their most stable e.g. first thing in the morning (and not eating for a couple of hours), or at least four hours since eating (and not eating for another a couple of hours). 
  • Ensuring you are adequately hydrated is also important for accurate sensor glucose readings at any point when using the Libre sensors.
  • Calibration with a finger prick test is not essential unless under specific circumstances (please see section on ‘Do I still need to finger prick?’). However, we would encourage doing some finger prick tests on a daily basis for comparison and to confirm accuracy (particularly in the first 24 hours). 
  • It is important to recognise that the sensor glucose and finger prick blood glucose readings are unlikely to be exactly the same due to the ‘lag effect’ of changes in interstitial glucose. Please see the module ‘How the FreeStyle Libre System Works’.
  • Initially it can be quite overwhelming to receive so much information about your glucose control. In some circumstances, this can lead to individuals becoming quite ‘reactive’ with their management which can have a negative impact on control.
  • When you first start to use the Libre, try not to act on trend arrows unless there is a definite immediate need for action, such as having a hypo. Also be aware of the ‘lag effect’ e.g. a change will happen to the blood glucose level before it changes in the interstitial fluid.
  • Try to put the arrows into perspective e.g. ‘have I just eaten and therefore should I expect to see a diagonal upwards arrow on the Libre?’
  • Review trends in glucose control after 48 - 72 hours and consider where action may have helped and what you could do differently next time. 
  • Try to refrain from correcting any high glucose readings within 3 hours of a previous bolus dose to reduce the risk of ‘insulin stacking’ and increasing your risk of hypo.
  • To avoid spikes soon after eating, try to give your bolus insulin twenty minutes before meals. 

How can I share my Libre data with my healthcare team?

So that your healthcare team can provide individualised advice, particularly if being reviewed remotely (via telephone), please upload your Libre data to LibreView ahead of all appointments.

Information on how to do this will be provided during your initial education. If you need further advice, please contact your healthcare professional. 

The Southmead Hospital Clinic ID is: 50-41343.

References

Abbott Diabetes Care Inc. FreeStyle Libre 

NHS England. Flash Glucose Monitoring: National arrangements for funding of relevant diabetes patients

Association of British Clinical Diabetologists. DTN-UK Flash Glucose Monitoring Education Programme 

Driver & Vehicle Licensing Agency. A guide to insulin treated diabetes and driving 
 

This edition published October 2020. Review due October 2022. NBT003239

NHS-funded Freestyle Libre