There is a lot of interest these days in Continuous Glucose Monitoring (CGM) and how beneficial they are to help manage type 1 diabetes. This post is a compilation of what options are available to you if you would like to get a Continuous Glucose Monitoring (CGM) in Ireland.
I’ve compiled information from the two years that I have been using one of these devices myself, from talking to/emailing representatives from each company and also from the Diabetes Online Community.
It’s worth remembering though that using a CGM can be information overload and lead to more anxiety around managing your diabetes that before. Always remember that everybody’s diabetes is different and what works for you may not work for someone else!
This post is divided into three sections: What is a CGM, Which ones are available in Ireland at the moment and the piece you are probably most interested in, What are my Funding Options if I want one?
Firstly, What does it do?
A continuous glucose monitoring system monitors glucose levels 24 hours per day. It takes a glucose value every 5 minutes and gives the wearer an average blood glucose level and where it’s heading (trend arrow) for that hour.
One very important element of a cgm is to always remember that the glucose measurement is taken from the fluid between skin cells (interstitial) and not from capillary bloods in your fingertips like a traditional glucose meter. The reading from a cgm is approximately 10 minutes behind the reading from a glucose meter.
There are lots and lots of online articles on the benefits and disadvantages of using a cgm, google will provide that list for you. However, I have been using a cgm since November 2015 and I wrote about my experience with it here, here and here. And you can find out more about how they work, the advantages and disadvantages here
The system has three parts:
(If you know this bit already, skip ahead to the How do I get one section).
Sensor: This is the part that goes under the skin. It’s also the part that costs the most because the sensors have to be replaced between 7 to 14 days. A flexible wire is inserted under your skin, held in place with an adhesive patch and has a plastic cradle on top of the skin that the transmitter clips into.
Transmitter: The transmitter sits on top of the skin, collects the glucose information from the sensor and transmits them to a receiver.
Receiver: The receiver receives the information and displays it on a screen along with a trend arrow and often a graph of up to the previous 24 hours. (The Libre displays more than that).
Sometimes the receiver is built into an insulin pump like with the Medtronic Veo & 640G series or the Animas Vibe. And sometimes the information can be sent wirelessly to a compatible smart device.
There are three CGM devices available at the moment:
Dexcom G4 or the G5
Dexcom have a good reputation in this field and have been leading in accuracy. As far as I’m aware Dexcom can be integrated with only one insulin pump: the Animas Vibe meaning that you don’t need a receiver. It’s one less thing to carry around.
The G4 has been around for awhile but Dexcom are now focusing on their G5® Mobile CGM System where the Transmitter sends data wirelessly to your compatible smart device or your receiver where you can “View your glucose trends in vivid colors to know when it’s high, low or within range.”
Medtronic Guardian Connect
The Guardian Connect was launched in Ireland April 2017. It’s not integrated with any insulin pump just yet but I imagine that will happen in time. This CGM also transmits information wirelessly to the Guardian Connect app on your iPhone or iPod Touch only.
However, there is currently a global shortage of Medtronic Enlite sensors. The company has made the decision to maintain existing customer supply and has placed a freeze on any new CGMs being sold until next spring in Ireland.
Flash glucose monitoring- Freestyle Libre
The Freestyle Libre is, Technically, not a cgm but a flash GM. The difference being that the wearer has to scan the sensor to get the glucose value and trend information. Here is a review that co-founder, Rebecca Flanagan wrote on behalf of her daughter who continues to use it.
CGM’s IN THE PIPELINE
Senseonics’ Eversense: a 180-Day CGM which received it’s CE mark approval in Europe in September and is being trialed in many European countries at the moment.
Also in clinical trials is the Nemaura SugarBEAT patch. The first-generation sugarBEAT® received CE approval in early 2016.
What are your options for getting a CGM?
If you are interested in getting a cgm you. Have three options:
Not many people are aware of this but anyone can get a cgm! You don’t need a prescription or permission from your diabetes team. That is if you have the money to pay for it! And they are flippin’ expensive!
It’s as simple as going to one of the three websites above and sending an email to them, or making a phone call to order or order online directly as with the Libre.
Here is Dexcom’s latest pricing information. Here is the libre’s. And Medtronic’s will be available when they relaunch the Guardian in the spring.
If you do self fund you do qualify for a 20% Tax refund through revenue.
You can also request all companies for a trial before purchase. It’s a lot of money to invest and you should be sure before you have to commit financially.
Combined funding is a combination of Part self funded and part HSE funded. This option requires you to work with your team to come up with a plan that works for everyone.
It can involve a suggestion from you to your team that you are willing to fund the transmitter and receiver if your team can submit an application to have the sensors funded through the Long Term Illness Scheme (LTI).
This is where the HSE cover the cost of the CGM 100%. One such Grounds for this funding include hypo unawareness. However, be aware that if you are deemed to be hypo unaware that it has consequences for things like life insurance or mortgage.
Others grounds for HSE funding can be found under the UK’s NICE guidelines.