Saying Goodbye to GERTI
This article was originally published by Ken Tait on his website, where he blogs about his life with type 2 diabetes in the UK.
I recently had to say goodbye to GERTI. I felt quite sad and a little anxious.
What is GERTI and What Does It Stand For?
GERTI was a continuous glucose monitor (CGM), in this case, it was a Freestyle Libre 2. GERTI stands for Getting Educated, Ready to Inform.
In February, I decided that I needed to understand what all this fuss was about with CGMs. Things like time-in-range (TIR) were quite alien to me a person with type 2 diabetes.
As someone who advocates for diabetes, I thought that I needed to understand for myself so that I could help other people with diabetes. So, for 16 weeks I self-funded with the FreeStyle Libre 2 which is a flash glucose monitor. People with type 2 diabetes, and some with type 1 do not get a CGM or a flash glucose monitor by the NHS. So why the FreeStyle Libre 2? This is the one that NHS gives out with a prescription.
For over the past 22 years, I have fingered pricked to test my blood sugar levels. Because that is what we did, it would tell me a figure and if the reading were high, I would inject insulin to try and reduce the level, and if it were too low, I would have to eat or drink some carbs (carbohydrates) to bring it back to a satisfactory level. The trouble with this is that I did not know if the reading was going up or down or staying the same. So, it was pure guesswork. Mostly this was ok but other times it was not.
When I first wore GERTI it was a complete revelation to me. For the first time in my diabetes life, I could see what was happening in my body. How the food I ate affected my blood glucose levels, how various exercises would affect the levels, and various other information that was now available to me to help me manage my diabetes 24/7, 365 days a year.
So, What Did I Learn?
- How various foods would spike the levels; some high, others not so high, or others foods that had little impact.
- When the best time is to take my fast-acting insulin. Which I found out, didn’t work very fast, but usually about 2/3 hours after I had taken it.
- The best time appeared to be after I had eaten as it seemed to flatten the spike to a more respectable level.
- I learned that if I had tested my blood glucose level by finger pricking, two hours after I had eaten, then I would have had high blood glucose, which would be starting to come down quite quickly. This would have been quite bad for me to inject insulin then as it would lead me into a possible hypoglycemic episode.
- Having the alarms set to go off when the level was high and low was an absolute boon. Especially at night while sleeping, as I did not need to worry about not waking if I was going into a hypo.
- I was also able to go to bed with a reading of 106 mg/dL6 mmol/L or 126 mg/dL7 mmol/L and know that GERTI would wake me if I went too low. Whereas previously I would have eaten carbs to raise my blood glucose levels so that hopefully I would not have a hypo while I was sleeping. Having GERTI meant that I had a better sleep pattern, even though my sleep quality is not great due to other complications.
- I also understood which type of exercise works best for me when I have a high reading, thanks to my Personal Trainer. We recorded both types of measurement finger pricking and technology, to see how they differ. Before exercise finger pricking would be higher, but in the end, they would both be remarkably similar.
- How difficult it was to be within range, my TIR varied from the 20s to the 80s percent.
What Did GERTI Give Me?
- Peace of mind
- Allowing me to manage my diabetes better
- Putting me back in control
- Fewer worries about hypos
- Better QoL (Quality of Life)
- Finally understanding what TIR means and how to get there.
The thing I really liked about the Libre 2 was the ability of Health Care Professionals (HCP) can access my data at any time. This allows them to make recommendations to the person with diabetes to help them manage their diabetes. This information is available 24/7, 365 days and does not just rely on the HbA1c (blood test for glucose levels over a 2/3-month period) which may only be done once a year. The HCP has no idea what is happening the other 9-10 months of the year.
My problem however was that my HCP, my GP who is looking after my diabetes was unable to get this information due to the fact that they are not allowed to monitor people with type 2 diabetes until they have been trained. This is unlikely to happen in the near future until people with type 2 diabetes can get access to the technology via the NHS.
Why do people with type 2 diabetes need a CGM or a sensor-based glucose monitor?
I read a great analogy about CGM or a sensor-based glucose monitor.
If you are on oral medications, then it is like driving through London with a blindfold. If you are lucky enough to finger prick then it is like driving through London with a blindfold but occasionally being able to see for a brief moment of where you are, but not knowing which direction you are going in. However, if you have a CGM or a glucose monitor it is like driving through London without a blindfold and with a SATNAV (satellite navigation).
Having a sensor-based glucose monitor or any type of CGM needs to be available to everyone who has diabetes and not just the few [who can afford it]. If we have the technology, then we can manage our diabetes and have a better QoL.
What Others are Saying about T2D and CGM Access:
Diabetes Technology UK Recommendations For Flash Glucose Monitoring Access
CGM Benefits People with Type 2 Diabetes
Although this interview discusses Abbott Freestyle Libre, a Founding Partner of Beyond Type 2, it was not conducted as a part of that partnership. Beyond Type 2 maintains full editorial control on our platforms.