NICE now recommends Hybrid Closed Loop (HCL) systems for selected people with type 1 diabetes2

The new NICE technology appraisal recommendation means more people with type 1 diabetes qualify for HCL systems. Choose the FreeStyle Libre 3 sensor which is authorized to work with the mylife Loop1 AID system. Find out more.

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An alternative to finger
pricks - your views

I have diabetes;
diabetes doesn't have me

Not an Athlete - A Cyclist Riding for Health and to Manage Type 2

By Stephen Walker, a cycling enthusiast

Disclaimer: The information provided is not intended to be used for medical diagnosis or treatment. Please consult your healthcare professional about your diabetes management. Individual symptoms, situations and circumstances may vary.

Approved on 16/02/2023

I am (just) 70 years old and was diagnosed with Type 2 diabetes in 2008. I wasn’t overweight, my diet was reasonable, and I was a strong cyclist. I’m not entirely clear why I developed diabetes; perhaps an earlier illness may have had something to do with it.

Adapting to the diagnosis

The consequences of being diagnosed with diabetes weren’t really explained; I was given a leaflet, told to take Metformin and watch my diet.  Unfortunately, I reacted badly to all the medications my GP tried (except an old preparation that’s rarely used these days), and ultimately, I’ve had to use insulin.

For quite a while I monitored my blood sugar only with an early morning finger prick, but when I heard about the FreeStyle Libre system I bought the sensors for about three years – trying an alternative CGM for a while but returning to the FreeStyle Libre system pretty quickly. 

Cycling for health

In May 2019 I had two heart attacks.  This made me redouble my efforts to monitor and manage my health with a particular emphasis on exercise in an attempt to avoid increasing levels of medication.

I am a cyclist – not an athlete, but someone who has been riding regularly for 40 years.  I ride to manage sugar levels and to avoid falling into the trap of my only exercise being a walk to the shops.  And because I like riding my bike.

For the last 3 years I’ve averaged over 100 miles every week, completing the Cycling Weekly 5,000 mile challenge in 2021 and 2022 and having just 20 days off the bike last year.  When it is cold and/or wet, I ride indoors as I’m still susceptible to infections and steroids are now only a weapon of last resort given their effect on my diabetes. 

Using data to improve my health

After a career in health research and technology, I have a tendency to be attracted to data.  I have detailed records of every ride since 1986 down to every heartbeat, pedal stroke, and ounce of effort.

The FreeStyle Libre 2 system – along with other devices that I wear - help me to take a data-driven approach to my health challenges.  I know my levels before, during and after rides.  I manage insulin, diet and effort based on my readings.  I can reduce my glucose levels from 11.5 to 5.0 mmol/L in about 40 minutes on the indoor trainer. 

And I can set alarms on the FreeStyle LibreLink app* to warn if levels are going down too fast or getting too low; when I’m riding for 3 or 4 hours without a break, this can be lifesaving.  The period from feeling fine to being potentially unsafe is very short when you’re burning calories quickly.

Why seeing the direction of travel matters

A few years ago, I was hit by a car.  I flew over the roof and landed on the road unconscious.  The paramedic saw from my wristband that I was diabetic and did a finger prick in the ambulance – 6.9 mmol/L “absolutely fine”.  But I couldn’t work out why I hadn’t at least tried to take avoiding action when the car suddenly drove at me.

I think it may have been because of low blood sugar.  A few minutes before the crash, I ate a fruit bar but when the accident happened my blood glucose was probably about 4.0 – it had risen by the time the test was done.  This was before CGM’s - if I’d had a FreeStyle Libre 2 sensor on the back of my arm, the alarm would probably have sounded, I would have eaten earlier and possibly been more alert.        

A window into what's going on in our bodies

As an older person who employs regular, serious exercise to improve physical and mental health – and a sense of self-worth – it is important that the apps and devices that I use take account of my conditions rather than simply seeking to increase strength or improve personal bests.  After all, in cycling power and speed terms, I think most of my “bests” are behind me now; but my determination, focus and ability to ride are stronger than ever.

The biggest gains for patients and populations will come from helping people with long-term, chronic conditions to understand what is happening in their bodies, especially cause and effect – “if I do/eat/take this, what does it to do my sugar levels/weight/resting pulse/heart rate variability?”.  The FreeStyle Libre 2 system is a big step towards one element of this understanding.

My dream is that I could bring the rich dataset that the system provides together with my detailed exercise data so that I could really start to see, for example, how different types and durations of effort affect my long-term diabetes control.  Then I would just need to see my sugar levels on my bike computer, so I don’t have to stop riding to find out if it is time to eat.

An alternative to finger
pricks - your views

I have diabetes;
diabetes doesn't have me

References and Disclaimers

* The FreeStyle LibreLink app is only compatible with certain mobile devices and operating systems. Please check the website for more information about device compatibility before using the app. Use of FreeStyle LibreLink requires registration with LibreView.

◊ Alarms notifications will only be received when alarms are turned on and the sensor is within 6 metres (20 ft) unobstructed of the reading device.