A question for those using a CGM or Freestyle Libre: how often do you check your BG with a fingerstick? The reason I’m asking is because here in the Netherlands, the number of test strips covered for Freestyle Libre users is 200 a year, compared to 1600-1800 for those who don’t qualify for a FSL. I couldn’t find out whether the same rule applies to CGM users. CGM and FSL coverage is quite limited. Only those who fulfil certain conditions, e.g. hypo unawareness, persistently high HbAc, qualify for a CGM or FSL. Particularly for those groups of patients, but also in general, it seems unreasonable and perhaps even irresponsible to go without fingersticks for days on end. On the other hand, that might just be because I have never used a CGM.
That’s pretty tricky and certainly difficult to navigate…200 a year is less than one a day… I’m not sure if we have anyone else from the Netherlands who can speak on their experience? There are options (I would guess in the Netherlands too (but this is a total guess)?) of buying testing strips online.
I’ve used a couple different systems, but not the Libre. My # of finger sticks a day roughly correlate to how accurate the system is:
Dexcom g4 and medtronic guardian sensors: 3-4 times/day
Dexcom g6: 1-2 times/day
The numbers of times also would depend on how well each individual sensor is performing (worse performance = less accurate = less reliable for me = more fingersticks)
Yes, you can buy them online, but people aren’t used to paying medical supplies out of pocket. So they probably won’t do that.
I might average out to this much, but I have a number of situations where I think testing is required, even if the G6 is pretty accurate overall.
I often test before/after working out, depending on a number of factors.
I need strips for the 2 hour warm-up period. I’ve had a couple bad sensors (bleeders), and so I end up with a 4 hour+ warm up period.
The first couple of days with a sensor are less accurate too, so I might test more.
I think I request 200/90 days. My doctor wanted to give me 100/90 days.
200 a year isn’t enough for us. We still probably test 6-10 times a week. Yes, we have gone a couple of days without a finger stick, but anytime feelings don’t match the readings we test, also during sport my son tests regularly to ensure he understands where his blood is at, because the CGM is at least 15 minutes behind.
I still do fingersticks quite a bit even with my G5.
My CGM is always off right after I work out and it takes a bit of time for it to catch up.
When I am trending up I often test before correcting because I want to make sure that I am giving myself the right amount of insulin.
When I am low I treat, wait, and then do a fingerstick to see if my BG is going up, as it takes forever to register in interstitial fluid.
Usually before bed if my CGM is showing less than 5 mmol (90 mg/dl) I will have a glucose tab, but if it’s 5 mmol I won’t. I do a fingerstick to make sure that it’s really under 5 mmol before eating.
These are only some examples of when I do fingersticks, but there are more situations than this. Check out this article which also talks about fingersticks and CGMs:
At a minimum we do TWO per day to just CALIBRATE our CGM (G5)! The number of strips you get wouldn’t even cover that bare minimum amount. That’s very unfortunate. For us, at a mimumum probably 6 per day and maximum anywhere from 10 to 20, just depending on the kind of day Liam is having and how his sugars are behaving. Some people swear by the CGM numbers, though, and never finger prick…the G6 doesn’t need calibrated to my understanding, so you may get by (if you REALLY ration) with 200/year.
200 strips a year is not enough. For all the reasons listed in others’ responses, including during exercise and sensor warmup and when suspicious of a bad CGM reading, I can test as often as 20 times a day. From time to time I won’t test at all, and then I can do anything in between, but I need those finger sticks to confirm before making decisions. That’s an interesting recommendation anyway as most CGMs emphasize the importance of checking with a finger stick anytime you have symptoms that don’t match your sensor reading. For people of variable activity levels and of fluctuating blood sugar, this could easily be a couple of times a day.
Thanks for that very interesting article! It expresses exactly my concerns with arguments people use when arguing for expanding CGM or FSL coverage to all diabetics. I hear the “replace fingersticks” language quite frequently in the debate. Although I would really appreciate using a CGM, I’m not willing to give up my fingersticks. So if in the future the criteria for CGM use are relaxed, I will only switch to CGM if I don’t have to give up fingersticks or can afford to buy extra test strips.
Right and I thought everyone agreed on that. But I’ve read people arguing against such recommendations from manufacturers.
I think if you averaged it out, it might be two finger sticks a day, so about 60 strips per month. BUT that’s a misleading statistic. It’s more like we do 6 or 8 sometimes in the space of several hours when the sensor is either inaccurate or fell off, and then none on many days.
Maybe 400~500 per year?
Sure. I would consider my child as being hypo unaware. While sleeping.
They’ve never worn a CGM that persists in reading a low value…when the finger sticks and one’s body feelings say otherwise!
My insurance is like that. If I qualified for their FreeStyle Libre coverage then they limit test strips to 100 a year. I don’t qualify for their Libre coverage (A1c too low…and it it needs re-approval each year, so I’d have to run a continuously high A1c to qualify), and they don’t cover the Dexcom at all, so I’m stuck paying for Dexcom out of pocket.
I’d say I test 6-8 times a day even with the G5. If I’m having a good day where I’ staying mostly in range, then I may only test once or twice. But most days are not like that, and if I’m having out-of-range readings, I tend to test every time I make a diabetes-related treatment decision.
I’m sure if our provincial governments start covering CGM test strip limitations will come with it. As it is now, I believe they cover 200 strips a year for people with diabetes who do not take insulin, and 3,000 strips a year for people who take insulin, unless their doctor writes a letter asking for more strip coverage, in which case they will cover more.
I still think a CGM is way more valuable than a glucometer (love that word, don’t care if it was antiquated even at the time I was diagnosed!) even if sensors can be off sometimes. I use the Libre and used the Dexcom before that. I’ve found both accurate enough that I really don’t test at all anymore. I guess everyone is different though, and it depends how precisely you need to dose and hypo awareness. I don’t find carb counting or correcting a precise enough science to need to know the exact number I am in mmol/L to dose without error personally, but I know it’s different for everyone.
I have a Dexcom G6 and I average a few fingersticks per month, usually when the G6 is giving me crazy results (which is rare) or when I really really need to know my BG during the two hour warmup period (also rare).
I still carry a glucose monitor with me everywhere (the smallest one I can find, the True Metrix Go) just in case but I rarely need it. I accidentally left it at home when I went to work (the first time I’ve done that in 20+ years) and I wasn’t concerned enough to go home to get it. Before the G6 I would have immediately gone home to get it.
My experience is like Ned’s. I have a G6 and when I first got it, I was checking with a finger-stick two times a day. Now, I only finger stick when the way I feel doesn’t match my glucose reading. Even then, my G6 usually agrees with my finger stick.
When I travel, I always carry enough test-strips to get me through the trip in case my G6 fails. It hasn’t happened yet.
I have a Libre and agree that 200 strips a year isn’t enough. The sensor is mostly accurate for me but has a tendency to report false lows, and this gets worse when combined with a delay. For example, I’m not about to ignore a reported low before driving to work, unless I can check it with a fingerstick. In my part of Sweden, the regional government covers the Libre for anyone with T1, and I haven’t heard anything about a limit on test strips, though I suppose they might question it if I started using a truly ridiculous amount.
We have a Dexcom G5, and we use, on top of the G5, about 10 strips per day.
Some days we only use 1-2, but other days with large peaks and long periods of hypoglycemia we use 20.
I have a Dex G5 and use 6-7 a day (about 200 per month). The (Canadian province of Alberta) Pump Program pays for 200 strips every 3 months, so I self-fund 2/3’s of the strips. I look at it as the cost of staying alive.
I love the CGM but it’s been off in any number of situations where a dosing error based on CGM would have been catastrophic.