Diabetes Management Plan incorporating Flash Glucose Monitoring (Flash GM)

Flash GM is used in addition to, but does not completely replace, blood glucose level (BGL) checkFlashing using finger pricks.

The FreeStyle Libre 2 Flash GM System is indicated for measuring interstitial fluid glucose levels in people (age 4 and older) with diabetes mellitus. The indication for children (age 4 - 17) is limited to those who are supervised by a caregiver who is at least 18 years of age.

The caregiver is responsible for managing or assisting the child to manage the FreeStyle Libre 2 FLASH GM system and also for interpreting or assisting the child to interpret sensor readings.

Flash GM reads interstitial or tissue glucose, not blood glucose. It can differ from blood glucose significantly under certain circumstances (e.g. very high or very low BGL) and there is always a time lag between finger prick BGL and the FLASH GM sensor. This lag can be up to 20 minutes. All high (>10 mmol/L) or low glucose readings (< 4 mmol/L) from the FLASH GM sensor must be checked with a finger prick BGL. Accuracy relies on calibrations using BG checks.

A BGL is required during times of rapidly changing glucose levels when interstitial fluid glucose levels may not accurately reflect blood glucose levels, or if hypoglycemia or impending hypoglycemia is reported or the symptoms do not match the system readings.

BGL checking must take place during times of illness and any time you are symptomatic of a hypo or hyperglycaemia, regardless of the sensor data.

For the Libre 2 a confirmatory BG check is recommended when any alarms occur.

For Libre 2 set low alert to 3.8 and ON; turning high alert notifications on is at the discretion of the user

BGL and sensor glucose reflects the effect of insulin doses. The Flash GMcan help by ‘filling in the gaps’ between those blood glucose checks with a trend graph. It can make visible patterns of highs and lows which are not seen at usual BGL check times and if these are a pattern, dose changes can be made. To use FLASH GM effectively you must actively engage in insulin dose adjustment.

The Flash GM is ONLY recommended for insulin dosing if:

• Sensor glucose is 4.0 – 10.0mmol/L.
• The child is not unwell and/or does not have symptoms of hypoglycaemia or hyperglycaemia.  
• The child is aged 4 and above.

An important eligibility criteria for the NDSS subsidy is to actively participate in a diabetes management plan which incorporates FLASH GM.

Information on Libre 2 can be found here;