This falls into the category of “It happened to me and it could happen to you!” So what is this “happening?”
The last time I applied a new Libre 3 sender to the underside of my upper arm, it bleed like a stuck pig, however stuck pigs bleed. It WAS somewhat profusely and went through my sweatshirt and elicited from my wife “What is that?” in an alarming fashion. I knew I was in trouble – again, but NOT WHAT FOR. Keep in mind I have been using the Libre 3 without any such occurrence for months and months.
We cleaned up my underarm area with alcohol swabs but left the expensive new sensor in place. I did not bleed anymore and it has been in place and operating normally ever since.
If it happened to me, it can happen to you also…… Be forewarned.
As I have documented in this blog numerous times, I am paying out-of-pocket for Abbott’s Libre Freestyle 3 Continuous glucose Monitor. It offers enough value to my life to make it well worth the expense. Turns out my brother-in-law Jerry is in the same boat.
Up to now, for about nine months, I have been paying $192.00 per month for two Libre 3s. I purchase them from HealthWarehouse.com out of Florence, KY under prescription from my GP. On 7/20/2023 my most recent shipment arrived with a billing of $154.12, a $37.88 reduction in price. No reason was provided but let’s surmise.
Why would Abbott drop the price of the Libre 3? They are already less expensive than the Dexcom G7 and also last longer. Dexcom is their nearest competitor I posit. I postulate further that their separate reading device which is required to gather Medicare coverage is about to be approved. They are using penetration pricing to be very attractive to insurance companies for coverage and thus increase the numbers game down their experience curve.
Have any readers of this blog experienced a drop in their Libre 3 prices?
I am using the Abbott Libre Freestyle 3 as I have often noted herein, and paying for the same out-of-pocket. Recently I had a bad sensor, called Abbott’s customer service, and they replaced it and requested I send the defunct one back which I immediately did. Today I received a formal letter from Abbott which stated they had not received the return and requested the same. The letter went on to state if it had already been returned to disregard their request. Before the letter went in the bin I read the small print.
On the back of the letter under Warnings/limitations, it states: ” The FreeStyle Libre Pro System does not provide real-time results and patients should adhere to their blood glucose monitoring routine while using the system….Patients with high levels of ascorbic acid (Vitamin C) or salicylic acid (used in Aspirin) or severe dehydration or excessive water loss may experience inaccurate results with this system. The FreeStyle Libre Pro System is not approved for pregnant women, persons on dialysis, or recommended for critically ill population….” All emphasis is mine.
The first sentence, “patients should adhere to their blood glucose monitoring routine while using the system” directly states to keep doing old fashion finger pricks while using the Libre system. Doesn’t this totally beg the issue of why even use it then?
The second group excludes Orange Juice which I am drinking for breakfast since my dialysis dietician took me off tomato juice because of potassium, and I have also been taking glasses of orange juice to stave off low glucose readings. I take a baby aspirin every day to appease my cardiologist. I have noted that I have been receiving lots of low glucose readings from my Libre 3 while at the same time having no physical presence of being low. Having been at this game for about 40 years I know what a low feels like.
The last statement precludes persons on dialysis from using their CGM in no uncertain terms, no ifs ands, or buts.
I turned to my ChatGPT AI with the following prompt and response in an attempt to dig deeper into this subject with the following results:
Prompt: I just received a letter from Abbott concerning the use of the Libre 3 CGM system. It states in Warnings/Limitations that the Freestyle Pro system is not approved for persons on dialysis or with high levels of ascorbic acid (Vitamin C). Why is this?
ChatGPT provided the following response:
The Freestyle Libre 3 Continuous Glucose Monitoring (CGM) system, like many glucose monitors, works by measuring the level of glucose in your interstitial fluid. This is the fluid that surrounds the cells of your tissues, and it generally mirrors the glucose levels in your blood.
For people on dialysis, there could be a few reasons why the device isn’t approved. The body’s fluid levels can fluctuate significantly during dialysis, and this might affect the accuracy of the CGM system. Additionally, dialysis patients often have other health complications that might affect the system’s performance. However, without more specific information from the manufacturer, it’s difficult to say for sure.
As for high levels of ascorbic acid (Vitamin C), this is likely due to the fact that ascorbic acid can interfere with glucose monitoring systems. Many glucose monitors, including the Freestyle Libre, use a method called glucose oxidase to measure glucose levels. However, ascorbic acid can react with glucose oxidase, leading to falsely high glucose readings. This is a known issue with many glucose monitors, and it’s likely the reason why the Freestyle Libre 3 isn’t approved for use in people with high ascorbic acid levels.
At this point, I am flummoxed and speechless. No MD I have interfaced with has brought this up. No RN I have interfaced with has brought this up. No medical professional of ANY ilk has brought this up. I am going to continue underway as before and keep gathering data, such as it is. Stand by for another itshay!
On May 26, 2023, in CNBC Tech Erin Black ran a story “How Dexcom and Abbott are moving beyond diabetes with blood sugar monitoring.” Since I am also a Type 2 diabetic and paying out of pocket for an Abbott Freestyle Libre 3 Continuous Glucose Monitoring system, this blurb was of interest to me. Watch the embedded video below for more insights into this growing market for CGMs.
It’s been an interesting week from many perspectives. (Graphic above from Designs.AI’s Illustrator. It reminds me of my Dialysis nurse for some reason.)
Our Granddaughter, who lives in the Seattle area, visited
I got tangled up in ExpressScripts bureaucratic nightmare.
My Fresenius Liberty Cycler continues, on a random basis, to illicit drain alarms and, this week, one fill alarm. For the past 15 nights, seven have had no alarms (47%), and eight have had alarms (53%). Disregarding the fourth and last drain, when I am always up and moving about, 15X3=45 possible drain alarms, of which I have experienced 10, or 10/45=22%. So more than half of the time I go to bed, my sleep is interrupted by Cycler alarms. Remember that Fresenius’ tech support is oblivious to this fact, telling me to shut off the alarms as a “fix.” What BS!
I can’t seem to articulate to my GP’s script person that I want all scripts written for a 90-day supply. Why is this so difficult to understand?
At one point, our Fresenius stock was up $5.00 per share from our by-in price. Not too shabby.
My GP script person sent a prescription to CVS for a Libre 3. But it was sent in for three, not six, covering 90 days, more or less. My CVS app shows they have been working on it since 4/13/2023. Why is it that I can buy direct from HealthWarehouse.com, which I am, and receive Libre 3s like clockwork, but the large government-contracted agencies cannot? What’s wrong with this picture?
I have a normal monthly meeting next Thursday with my Dialysis Team. I’ll share my going-in discussion points with you next week.
Our goose eggs hatched with six little ones that have been seen paddling around in our local ponds. Life does go on, even on Dialysis!
I used AI to generate the feeser.me ad is shown below, which I then posted to Facebook and Linkedin. Enjoy what AI can do for you if you can 🙂
Bright and early this morning, almost at 0800, I received a direct real person phone call from a pharmacist at ExpressScripts. He attempted to explain why the script for a Libre 3 Continuous Glucose Monitor from my GP was not being filled by them. The reason he stated, was that ExpressScripts does not yet carry the Libre 3; they could however fill a script for a Libre2. Hummmm?
I attempted to relate that I received a letter from ExpressScripts stating that the reason they refused to fill the order was that my GP was just that, a GP and not a diabetic specialist. He apologized and stated that was not correct. When I told him I was buying Libre 3s directly from an online supplier, not a problem but at an out-of-pocket cost of over $200 per month he essentially wished me luck.
Keep what’s going on here in perspective. ExpressScripts’ contract with the government started in January 2023 and runs through 2029. It has value in the billions of dollars and serves over 9.6 million active-duty service members, their family members, and retirees.
As Walter Winchell used to say, “Good evening, Mr. and Mrs. America from border to border and coast to coast and all the ships at sea. Let’s go to press.” First up today is great news for diabetics who are priced out of using a Continuous Glucose Monitor (CGM) to aid in their control of diabetes – and by association implications for dialysis patients since so many are also diabetics.
Yesterday in the financial news I read that both Abbott and Dexcom stock took a rather big bump up after it was announced that Medicare will cover CGMs for a broader group of patients starting in April. The policy change includes broader language that appears to include people with non-insulin-treated diabetes and a history of hypoglycemic event(s) as well as who take daily insulin – not the previous requirement for multiple insulin shots. Since this is breaking news and I’m certain not yet been promulgated down the chain to prescribing physicians, it is still a breakthrough worthy of following up on. I certainly intend to as I am currently spending over $200 per month out of pocket for the Libre 3 CGM.
As previously mentioned, on March 1 2023 I visited Fresenius Granbury, TX for my monthly visit with my Team Nurse Cindy and labs. The results were indeed available the next day. Herein I present the results limited to those not meeting the established parameters. There are five in total given below. My short comments are at lab footers.
Trending Down – talk to the team about
t
This is one of those so what readings?Improving – but what is the impact of this reading?Close but trending down. Take Calcium tabs as is – need more?Corresponds to an eGFR of 8 which is holding steady.
