Continuous Glucose Monitors CGM Funding Options

I believed for a long time that they only way I could get a Continuous Glucose Monitor or CGM was through my diabetes team in my clinic. However, I have since discovered that there is more than one option to get your hands on one of these and more than one funding option. 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. You can read more about what this device does here.

What are your options for getting a CGM?

If you are interested in getting a cgm you. Have three options:

100% SELF FUND

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!

All of the companies offer a trial before purchase. It’s a lot of money to invest and you should be sure before you have to commit financially.

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.

UPDATED 21/4/2018

If you do self fund your device you can claim a VAT refund AND an Income Tax Refund for your CGM.

CLAIMING A VAT REFUND

Claim your VAT refund of 23% back from the cost of your Flash/Continuous Glucose Monitor through the "reclaim VAT on aids and appliances for disabled persons" scheme, as diabetes is legally recognised as a disability in order to be included on the Long Term Illness scheme.

This is the link to find out how to claim.

AND

CLAIMING AN INCOME TAX REFUND

You can claim relief on the cost of health expenses. These can be your own health expenses, those of a family member or any individual’s, as long as you paid for them.

You generally receive tax relief for health expenses at your standard rate of tax (20%). Find out more here.

Note - The Med 1 is no longer available. Health expenses are claimed through your tax return form.

COMBINED FUNDING

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).

HSE FUNDED

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.

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.

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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.

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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

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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.

The Freestyle Libre; why we need it

I write quite a bit on BloodSugarTrampoline.com about how fortunate I am to have a Continuous Glucose Monitoring System CGM courtesy of our health service. It was something I had to fight for and I will never give it up or switch to a Freestyle Libre. So why am I, a die hard CGM user, pushing for more people to be included in the Freestyle Libre reimbursement scheme here in Ireland?  

We should all be included in the Freestyle Libre reimbursement because:

 

THE INFORMATION ON GLUCOSE LEVELS

Firstly, the information that both a CGM and the Libre provide about your blood glucose levels are similar, even though they are different types of technology. I wrote more about the Freestyle Libre here when it was launched in Ireland in November 2016. https://bloodsugartrampoline.com/blog/index.php/2016/11/01/funding-the-freestyle-libre

Having more information beyond a finger prick means you are better informed to make insulin dosing decisions. You can take action to avoid hypos and hypers before they happen. Within the first six months, that I used my CGM I brought my HbA1c down by one whole percent!!! I hadn’t been able to budge that number for years.

For decades, we have been using finger prick devices which don’t provide enough information about our glucose levels. The Freestyle Libre does provide this information and empowers us in our life with diabetes more and be less reliant on our diabetes health care team.

The Freestyle Libre also give our consultants more information to help us manage better.

I feel that having this information is priceless! Worth a lot more than €62.60 per year.

 

 

REASONABLE COST TO THE HEALTH SERVICE

CGMs are way more expensive, therefore more difficult to get funding for though the health service. And so if we can’t give everyone CGM’s why not give everyone, who want it, a Libre at a much more reasonable cost. The HSE estimates that it would only cost an additional €62.60 per person, per year for the Libre when you account for the reduction in test strips.

Device name Libre Dexcom G5 Medtronic Guardian Connect (Pay as you go Plan)
Start up cost €169.90 €397.72 €660.1
Sensor cost €59.90 €79.95 €66.125
Sensor cost per month €119.80 €319.80 €316.25
Annual cost of replacing Transmitter N/A 1254.6
annual cost of consumables €1,437.60 €5,092.20 €3,795.00

 

EASY TO USE

  • Minimum training, if any, required for people to insert and use. I was able to insert it using the photo instructions. Plug and go!
  • It doesn't hurt like a finger prick check can sometimes hurt. So you’re more like to use it more. The once every 14 days doesn’t even hurt.
  • It takes less time to get a glucose result, about 10-30 seconds versus 2 minutes using a traditional finger check monitor.
  • It doesn’t cost more if you scan more often. And many studies show that increased glucose checks lead to better glucose management.
  • It’s so discreet. No-one can tell that you are checking your glucose.
  • It gives more information to aid in insulin dose calculations.

 

  • AND, AND, you don’t need access to hand washing facilities like you would to get an accurate finger prick check.

 

“Continuous glucose monitors, or CGMs, have been around for over a decade, but poor quality and high costs have been barriers to use, says Irl Hirsch, who holds the Diabetes Treatment and Teaching Chair at the University of Washington School of Medicine.

But improvements on both fronts lead him to believe that CGMs will soon become the standard of care. At his own clinic, 60 percent of patients use one.”

 

It is a huge step forward for people with diabetes who were using finger prick devices only.  I think that Dr Irl Hirsch is very insightful when he suggests that CGM’s, including the Libre will be the standard of care soon. I don’t think Ireland should be left behind again.

Here are some of my blog posts from Blood Sugar Trampoline on my experience with my CGM.

 

All people with diabetes need to be included in the Freestyle Libre reimbursement scheme. We should get to choose if we want this device or not.

Please join me outside Leinster House, Dublin 2 on Wednesday 18th April to present the Libre Petition to members of the Dáil.

100 Extreme Challenges with Diabetes

Thriveabetes 2016 Speaker, Gavin Griffiths, also known as the DiAthlete, comes to Dublin and Belfast on the 26/27 April as part of his challenge to take on 100 Extreme Challenges with Diabetes. He intends to run 25 marathons in one month. If successful in completing all 25 marathons he will have completed a total of 100 endurance challenges with type 1 diabetes in the 10 years! Gavin lives was diagnosed with type 1 diabetes at age 8 in 2000 and hopes that by doing this he will inspire others living with type 1 diabetes that they too can achieve their dreams but also to raise awareness in the wider public about the challenges living with type 1 diabetes.

He is also fundraising for T1International and The League of DiAthletes: a group of dedicated ambassadors living with type 1 from around the world who run educational workshops to support their local diabetes communities in low-income countries. People can donate to support these projects here.

Gavin plans to take on Dublin on Thursday 26th April and Belfast on Friday 27th April, more information about starting and finishing points, where he will welcome local T1D Heroes to run with Gavin’s Olympic Torch from the 2012 London Olympics, can be found on the DiAthlete’s Facebook Event page.

Gavin’s Previous Extreme Challenges with Diabetes include:

GBR 30/30 Challenge: running 30 mile routes every day for 30 days from John O’Groats to Land’s End in the UK;

the Manhattan Marathons: running 7 marathons in 7 days around Long Island, NY, for the type 1 charity Marjorie’s Fund;

mHealth Grand Tour: cycling 1500km in 9 days from Brussels to Geneva, including pedalling over a few Alp mountains;

World Diabetes Tour T1D Challenge 100km hike around an active volcanic mountain called Hekla in Iceland…

 

Even though Gavin takes on these crazy challenges, he feels it's important for people to know that while growing up with type 1 diabetes he wondered what this condition actually was, hated it for much of my childhood and in some regards feels he learned his lessons the hard way.

He says, “I’m not superhuman, but if there is a part of me which is, well, it stems from having the right attitude when it comes to living with type 1 diabetes.”

Gavin wrote a blog post for Thriveabetes in October 2016 where you can read more about his type 1 diabetes journey which you can read here. Don't forget to follow the 100 Extreme Challenges with Diabetes Adventure on Facebook.