Senzor FreeStyle Libre

Jelikož se množí dotazy, jak ve FB skupinách tak na mě osobně, napsal jsem tento článek o tom, co je FreeStyle Libre, jeho použití, o principu měření pomocí senzoru, přesnosti měření, kde Libre koupit a možnosti reklamace.

Ne, toto není fotka autora článku :) Fotka vystihuje použití senzoru. FreeStyle Libre
Ne, toto není fotka autora článku 🙂 Fotka vystihuje použití senzoru.
Je možné mít senzor a vypadat sexy? Ano :)
Je možné mít senzor a vypadat sexy? Ano 🙂

 

Abbott FreeStyle Libre používám intenzivně už druhým rokem a také díky tomu si držím hodnotu glykovaného hemoglobinu dlouhodobě kolem 45 mmol/mol a snažím se o co nejméně výkyvů glykémie.

Něco na úvod

Senzor Libre je podle mého názoru v současnosti nejefektivnější, při samofinancování nejdostupnější a nejpříjemnější možnost jak kontinuálně sledovat svoje glykémie. Někteří mohou argumentovat, že to není plnohodnotné CGM. Ano, není. Data ze senzoru do telefonu či originální čtečky se musí manuálně načíst přiložením čtečky k senzoru. Následně pomocí NFC protokolu se načtou data ze senzoru za posledních 8 hodin. Libre čtečka zobrazuje zprůměrované a algoritmem upravené hodnoty po 15ti minutách, přičemž se berou v úvahu i data z integrovaného teplotního senzoru. Libre senzory jsou továrně kalibrované a tudíž při použití pouze originální čtečky není možnost jak hodnoty ze senzoru zkalibrovat. V naprosté většině případů to nevadí, protože odchylka od glukometrů je velmi malá, MARD hodnota je kolem 11%, viz odkaz o přesnosti měření, což je lepší než systém Dexcom G5, který se navíc musí kalibrovat.

Princip měření glykémie

Oproti glukometru všechny dosud běžné senzorové techologie měří z mezibuněčné tekutiny (ISF – interstitial fluid) ne z krve. Pod kůží je zavedena tenká kovová sonda tenká asi jako lidský vlas (zhruba). Biosonda obsahuje několik vrstev, eletrodu, enzymy sestavené tak aby bylo možno měřit elektrický odpor tkáně ovlivněný koncentrací glukózy, více viz anatomie senzoru a technologie senzoru. Z tohoto principu také vyplývá určité zpoždění změřené glykémie – vždy se jedná o historickou hodnotu starou zhruba 5-10 minut oproti hodnotě změřené z krve glukometrem. Glukóza se totiž musí osmoticky „propasírovat“ z cév do mezibuněčné tekutiny, viz studie „Time Delay of CGM Sensors„.

Kde Libre objednat

Systém FreeStyle Libre stále není dostupný přímo na území Česka (a Slovenska). Ačkoliv má Abbott evropskou certifikaci, která opravňuje Libre prodávat kdekoliv, naráží to na lokální omezení a byrokratické překážky ohledně schvalování úhrad za zdravotnické pomůcky. V CZ je v tomto ohledu asi nejbyrokratičtější process tohoto typu v celé Evropě. Česká pobočka fy Abbott není schopna sdělit konkrétní datum dostupnosti, resp. je stále slibováno a odkládáno. Čekám na vyjádření SÚKLu, České pobočky Abbottu a Kategorizační  komise MZ.

Update: České zastoupení Abbott mi oficiálně sdělilo, že termín uvedení na český trh je říjen 2018. Dále dle neoficiální informace by Libre mohlo být v CZ levnější než jinde v Evropě. Uvidíme.

Osobně, z několika důvodů – angličtina, cenová dostupnost a asi i sympatie k UK, objednávám z britského eshopu fy Abbott. Problém je, že z eshopu nelze odeslat zboží přímo k nám. Toto lze obejít založením anglické adresy – virtuální schránky (něco jako POBox). Já využívám firmu Nákupy v Anglii.

V eshopu si založíte svůj účet, vyplníte svou anglickou adresu a můžete objednávat. Při objednání doporučuji vyplnit „VAT exception form„, který diabetiky 1 typu opravňuje nákup bez VAT (DPH). Neřešil jsem zdali to je jen pro UK rezidenty. Pokud navíc necháte objednané zboží pár dní v košíku, přijde vám do mailu voucher na dopravu v UK zdarma. Na dopravě ušetříte £5. Na VAT ušetříte £10 za jeden sensor.

Zboží doručené na vaši anglickou adresu si velmi jednoduše přepošlete do CZ za poštovné zhruba 450,-. Cena je variabilní a závisí podle váhy, množstevní slevy atd. Cena senzoru poslední dobou (leden 2018) vychází na 1450,- což je levnější než při objednání v Polsku nebo Německu.

Jak aplikovat senzor

Aplikace senzoru je v současnosti absolutně nejjednodušší ze všech senzorových technologií na měření glukózy. Krabička se senzorem obsahuje velmi podrobný a jednoduchý návod. Dále je na Youtube oficiální a spousta neoficiálních instruktážních videí. Pokud to velmi zjednoduším tak po sestavení z jednotlivých dílů (3 kusy) vznikne jakési razítko, kterým si na zadní část ruky narazítkujete senzor. Jediné co může být na poprvé děsivé (jak pro koho) je aplikační jehla, která zasune pod kůži zmíněné vlákno – bio sondu. Ale je to jen pocit, aplikace je téměř nebolestivá a velmi rychlá. Občas se může stát, že se jehlou trefí jemná žilka a pak dojde ke krátkodobému krvácení. O nic nejde a činnost senzoru to neovlivní.

Jak měřit

Po nasazení senzoru je nutné jej aktivovat. Já doporučuji používat oficiální čtečku. Nepřipravíte se tak o možnost zpracovávat reporty na počítači pro sebe nebo lékaře a o možnost reklamace senzoru. Aktivace probíhá zvolením volby „Start new sensor“ na čtečce a přiložením čtečky k senzoru. První data dotanete po jedné hodině od aktivace. Prvních zhruba 24 hodin se senzor „usazuje“ ve tkáni a hodnoty glykémií tudiž nejsou tolik přesné. Doporučuji senzor před jeho aktivací nasadit 12 – 24 hodin předem. Pak už bude po aktivaci měřit rovnou přesně. Senzor funguje přesně 14 dní pomocí čtečky. Případně při použití alternativy telefon s Androidem a aplikací Glimp můžete ještě využít dalších cca 12 hodin. Pak už senzor dodává nesmyslná data, pozor na to!

Jak stahovat data z Libre Reader a vytvářet přehledy

FreeStyle Libre Data Flow
FreeStyle Libre Data Flow

FreeStyle Libre Software pro PC a MAC ke stahování dat ze čtečky Libre Reader je dostupný na stránkách výrobce, třeba v UK. Přímý link pro PC zde. Problém je, že SW lze stahovat jen z UK IP adres, museli byste se tedy pomocí VPN služby maskovat jako UK resident. Alternativně, pro zjednodušení jsem SW uložil na Ulož.to, kde je volně ke stažení. Pomocí tohoto SW tedy můžete z dat ze čtečky vytvářet různé přehledy o glykémiích nejen pro sebe ale i pro lékaře.

 

LibreView Cloud
LibreView Cloud

Alternativou pro předešlý SW, který se musí instalovat je cloudové řešení LibreView. Na PC nebo MAC se instaluje jen ovladač čtečky. Všechna data se nahrají do cloud úložiště a zpracovávají tam. Svému lékaři můžete umožnit přístup pro nahlížení, ale tato služba je dostupná jen v zemích, kde se Libre distribuuje. U nás doufejme na podzim 2018.

Jak na reklamaci

Z různých důvodů se může stát, že budete potřebovat senzor vyreklamovat. Někdo má reakci na lepidlo pro používané pro přilepení senzor na kůži. Prý je to důvod pro reklamaci, ale osobní zkušenost naštěstí nemám.

Pro mě hlavním důvodem reklamací je z nějakých důvodů nepřesné měření – velké odchylky 2-3 mmol od měření glukometrem. U sebe jsem vysledoval, že to je pravděpodobně správným umístěním na zadní části paže. Nejvíce mi aktuálně vyhovuje umístění co nejvýše (nejblíže k podpaží) – asi nejlépe prokrvené. Správné umístění si každý asi musí najít sám podle sebe. Pokud mi tedy senzor neměří přesně nepoužívám oficiální čtečku (neumožňuje kalibraci) a používám mobil s aplikací Glimp (umožnuje kalibraci).

Abbott uznává reklamaci senzorů oproti měření pomocí glukometru. Pokud senzor měří s větší odchylkou než deklarují můžete senzor reklamovat a pošlou náhradní.  Abbott pro uznání reklamací požaduje měřit glukometrem 5-10 minut před odečtením hodnoty ze čtečky a dodat data pro porovnání. Musíte tedy dodat export dat z glukometru i z jejich oficiální čtečky. Abbott zašle náhradní senzor za vadný a požaduje zaslání vadného senzoru zpět. Vyplatí se možnost reklamace využít i když musíte platit poštovné z UK.

Libre a CGM

Jak již jsem psal v předchozí části samotné Libre není plnohodnotné CGM, tím je myšleno, že samostatně a aktivně senzor nikam data neposílá, tudíš vás automaticky neupozorní na rizikové výkyvy glykémie. Je tu ale možnost toto obejít s využitím zařízení jiného výrobce. Jde o systém BluCon Trans Am a Nightrider od kalifornské firmy Ambrossia Systems. Jedná se o dva typy zařízení, jedno je vodě odolné na jednorázové použití a druhé s vyměnitelnou baterií, ale není vodě odolné. Obě zařízení fungují stejně, nasadí se na senzor Libre a fungují jako NFC čtečka. Kontinuálně čtou data ze senzoru a pomocí Bluetooth posílají data do telefonu. Osobně s tím zkušenosti nemám. Odradily mne negativní zkušenosti zákazníků na FB profilu firmy a z jiných FB skupin. Výrobce velmi laksně reaguje na objednávky, čekání na objednané a zaplacené zboží může trvat i měsíce, i po urgencích.

Alternativně se dá BluCon Nightrider objednat v Polsku v eshopu sugarcubes, kde kromě toho mají spoustu dalších vychytávek k Libre.

Eshopy s doplňky pro Libre

Zde uvádím několik tipů na eshopy s doplňky a vychytávky pro Libre případně jiné senzory.

 

Zde jsou tedy odpovědi na nejčastější otázky z FB skupin. Pokud bude zájem o další informace, zkušenosti rady napište mi do komentáře a rád doplním.

Autor: Petr Čvančar.

Děkujeme za skvělý článek Petrovi Čvančarovi o FreeStyleLibre, které už klepá na dveře v ČR.

https://blog.gandalf.cz/t1d-cs/senzor-freestyle-libre

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