My First Freestyle Libre: Making Adjustments to T2D Care
When you speak with John Ramos, you hear a person who is self-assured about what methods of diabetes care and self-management work for him, and which ones simply don’t. John, who’s been living with Type 2 diabetes for over 15 years and is a member of the Beyond Type 2 community, shares his story with Type 2 diabetes, his experiences with trying different kinds of medications, and how his introduction to the Freestyle Libre 14 day system has helped him manage diabetes more effectively.
BT2: Hi, John! Thank you for joining us. When were you diagnosed with Type 2 diabetes?
John: I was diagnosed probably right around 2004 or 2005 with Type 2 diabetes. My A1C was probably right around 11, so it was very high. I was, of course, given the normal Metformin and the general advice of “you just need to eat better” by the doctor. That worked for a while and my A1C was getting better and went down to about 8 or maybe the high 7s. During all of those years, I went into denial. I was still taking my meds, but just didn’t diet and ended up gaining weight, which made things worse for me.
How did your experiences lead you to obtain a Freestyle Libre? Did you research CGM technology yourself?
I was researching it and thought I wanted the Dexcom simply because I was having severe lows, but my insurance wouldn’t cover it because they said I wasn’t a Type 1. Fortunately, I was able to get the Freestyle Libre 14 day system. I like that I get my data directly to my phone.
Through all of that denial, my A1C was going up and down like a yo-yo. It would go up and down but stay right around the nines. I later started having severe reactions to metformin and had an issue with pancreatitis. My doctor switched me to Victoza, but that didn’t work so well. So, I was introduced to insulin in 2008. I’ve used mixed insulins such as 75/30, 70/20, and 75/25 mixes, NPH, and Humulin R. I’ve also used analog insulin but they’ve gotten too expensive, so I went back to regular insulin.
When the pandemic started, diabetes got a little harder to manage. My diabetes nurse suggested I start Humulin R U-500 insulin, which required me to get approved for medical financial assistance for low-income individuals. Sometime last year, I started on Jardiance, which didn’t do much for my A1C, even with insulin. Then, I moved back to Victoza, which made a difference in lowering my blood sugar. I was making a lot of progress and later had to be taken off U-500 insulin because I was having severe lows and needed to check my blood sugar anywhere between 15 to 20 times a day. I’m disabled and on Medicare, so I asked if I’d be able to get a CGM and qualified because I was injecting insulin and checking my glucose more than several times per day. This allowed me to get the Freestyle Libre.
What were some of the first things that you noticed after you started wearing your Freestyle Libre? What changes did you make after wearing it?
After wearing it for the first few weeks my glucose levels were significantly dropping. I was still having those severe lows now and then, especially around dawn, with the lowest sugars dipping into the 2.8-3.3 mmol/L50-59.4 mg/dL. I had to eat late at night sometimes to keep it up. But, I could see when my glucose would start rising before I woke up, which is just the kidneys releasing glucagon. It’s been a cool learning experience. I’d have to give credit to people on YouTube who shared their experiences. Those videos helped me learn how to adjust to highs and lows, including tweaking my insulin, learning about my insulin sensitivity factor, and learning how to calculate my carb ratios. I could see my blood sugar drop a lot sooner than I thought after a meal with those calculations. I thought it would take about four hours to see any effects on my glucose, but it turned out to be an hour-and-a-half to two hours. The other great part is being able to see my readings in the LibreLink App and on LibreView on the web.
What foods did you learn had a big impact on your blood sugar? Were there any surprises there when it came to learning about food in your diabetes journey?
Not in general, for example, I knew some of the big things like frappuccinos would set me off. But I learned my glucose levels vary with some other things like pizza, something I have about once a month, depending on where I get it. It’s all about calculating my dosages correctly and remembering that fat makes carbs digest slower, so I have to time my doses well, too. For example, I had ice cream and calculated enough carbs for that, and my glucose was fine; it rose a bit but came right back down. A friend of mine had me bake a German chocolate cake and the icing has egg, sugar, condensed milk coconut, and pecans – all of which are delicious. But still, I have to take into account the actual cake, the icing, and their carbs and fat content when taking insulin.
What results have you seen in terms of your A1C and overall glucose since you’ve been wearing the Freestyle Libre?
My A1C was right around 9.7 in probably around February of 2020. By August, I think it was just before I started the Libre it was down to like a 7.4, most likely due to the severe lows. When I started wearing the Libre in November, it was around 6.0, when I was still having lows. This past April, it was around 6.3. It’s a bit higher because I’ve learned to address my low blood sugars.
Why is CGM an important tool for people with Type 2 diabetes to have access to?
It’s a big eye-opener on you can see what food you eat each day and how high your glucose is going to reach. You’ll be much more informed to make changes to portion sizes and medications if you need to. Let’s say you had a large portion of rice or potatoes, the Libre can help you learn how much will work for you and your glucose. It’s a safe and virtually painless tool to have.
This content was made possible with support from Abbott, the makers of FreeStyle Libre 2, a Founding Partner of Beyond Type 2.