Home Glucose Monitoring

NHSL Medicines Guidance
NHS Lanarkshire

General Notes

Due to the regular introduction of new products to the market, whether new technology and / or cost-effective systems, clinical staff involved routinely with teaching home blood glucose monitoring e.g. Diabetes Specialist Nurses, may assess meters which are not currently on the formulary. As such, there will be occasional requests for blood glucose strips that do not appear on this list. It is the responsibility of the requesting health care professional to highlight reasons for such requests.

GlucoRx Nexus Voice® (using GlucoRx Nexus® strips) is the preferred talking meter in NHS Lanarkshire.

Blood glucose monitoring gives a direct measure of the glucose concentration at the time of the test and can detect hypoglycaemia as well as hyperglycaemia. Patients should be properly educated in the use of blood glucose monitoring systems and to take appropriate action on the results obtained if, for example, there has been a change in medication or lifestyle. Inadequate understanding of the normal fluctuations in blood glucose may lead to confusion and inappropriate action.

Blood glucose monitoring should be reviewed as part of an individual’s diabetes annual review to determine whether or not it provides a useful adjunct to therapy/education.

In patients with Type 1 diabetes, it is important to test for blood (or urinary) ketones where there is a significant risk of ketoacidosis, such as may occur with significant intercurrent illness e.g. infections. More frequent testing of ketones may be required during pregnancy. Test strips deteriorate rapidly if exposed to the atmosphere and have a limited shelf life.

All monitoring equipment should be subject to regular quality control testing to ensure accuracy and reproducibility of results.

Patients can register with diasend to download their blood glucose meters and obtain a profile of their results. The technology required to do this is available from the meter companies on request by the patient. If they also register with My Diabetes My Way (MDMW), their blood glucose profile can be viewed by their health care professional to help inform their consultation with them.

Basic Blood Monitoring

Contour Plus® test strip

  • Indication: Type 1 diabetes. Type 2 diabetes, where monitoring is appropriate as per NHSL guideline.
  • Meter: Contour Plus Blue or Contour Plus
  • Manufacturer: Ascensia

TEE2® test strip 

  • Indication: Type 1 diabetes. Type 2 diabetes, where monitoring is appropriate as per NHSL guideline.
  • Meter: TEE2+
  • Manufacturer: Spirit

Performa® test strip

  • Indication: For patients who received a Performa meter before December 2021. Type 1 diabetes. Type 2 diabetes, where monitoring is appropriate as per NHSL guideline.
  • Meter: Performa. This meter has been discontinued (December 2021), test strips remain available.
  • Manufacturer: Roche

Blood Monitoring for Paediatric Patients, or for Patients Who Require FastClix Lancing Device

Instant® test strip 

  • Indication: where use of the FastClix lancing device is required, as per Specialist Diabetes Team advice, for Type 1 and Type 2 diabetes. Type 2 diabetes monitoring as per NHSL guideline. Also used by paediatric diabetes service.
  • Meter: Instant
  • Manufacturer: Roche

Complex Blood Monitoring

Accu-Chek Mobile® colorimetric cassette 

  • Indication: Type 1 and Type 2 diabetes. 
  • Has built-in strip cassette plus attached finger pricker therefore recommended for patients with visual problems i.e. ease of use.
  • Meter: Accu-Chek Mobile
  • Manufacturer: Roche

Accu-Chek Aviva® test strip

  • Indication: For limited use in Type 1 patients who are carbohydrate counting; specialist staff recommendation only. 
  • Previously preferred meter for NHSL’s Type 1 group education programme.
  • Meter: Accu-Chek Aviva Expert
  • Manufacturer: Roche

The Aviva® Expert meter has been discontinued. Aviva® test strips remain available.

For NEW paediatric patients or paediatric patients requiring a replacement meter, the option is the Instant® meter. Please refer to information above.

 

Patients Who May Require to Ketone Test

GlucoMen® Areo Sensor for blood glucose

  • Indication: Type 1 and in pregnancy and on insulin
  • Both blood glucose and ketone strips are used with the same meter
  • Meter: GlucoMen Areo 2K/GlucoMen Areo GK
  • Manufacturer: Menarini

GlucoMen® Areo β-Ketone Sensor for ketones

  • Indication: Type 1 and in pregnancy and on insulin
  • Both blood glucose and ketone strips are used with the same meter
  • Meter: GlucoMen Areo 2K/GlucoMen Areo GK
  • Manufacturer: Menarini

The GlucoMen Areo 2K meter is being discontinued. Any new patients will be commenced on the GlucoMen Areo GK meter. The blood glucose and ketone strips remain the same for both meters.

CareSens PRO®for blood glucose

  • Indication: Type 1 and in pregnancy and on insulin
  • Both blood glucose and ketone strips are used with the same meter
  • Meter: CareSens Dual
  • Manufacturer: Spirit

KetoSens for ketones

  • Indication: Type 1 and in pregnancy and on insulin
  • Both blood glucose and ketone strips are used with the same meter
  • Meter: CareSens Dual
  • Manufacturer: Spirit

Patients on Insulin Pump Therapy

Contour Next® strips

  • Indication: Type 1 patients on insulin pumps
  • Meter: Contour Next Link
  • Manufacturer: Ascensia

Accu-Chek Guide® strips

  • Indication: Type 1 patients on insulin pumps
  • Meter: Accu-Check Guide Link
  • Manufacturer: Roche

Continuous Glucose Monitoring

Specialist initiation (S1): 

FreeStyle Libre 2® Plus 

  • FreeStyle Libre 2® Plus is the formulary preferred option for eligible individuals with diabetes who require continuous glucose monitoring.
  • Use should be for those who agree to attend a locally provided education session or complete online certified training modules (part of Freestyle Libre Academy) and satisfy their clinical team that they (or carer) have the required knowledge / skills to self-manage diabetes.
  • Glucose measurements can be displayed using the FreeStyle LibreLink app (if the patient has a compatible smart-phone) or the FreeStyle Libre® 2 Reader. 
  • A maximum of 25 sensors will be prescribed per patient per year.
  • The FreeStyle Libre® 2 Plus can be worn for up to 15 days, which differs to the 14-day sensor wear time of the previous FreeStyle Libre® 2.
  • If sensors are defective or fall off, patients should contact the manufacturer on the same day to obtain a replacement by calling the Abbott Customer Careline on 0800 170 1177 Online request portal at www.freestylelibre.co.uk/replacement). Specialists and GPs cannot issue prescriptions to replace defective sensors or those that have fallen off. 
  • All patients who using FreeStyle Libre 2® Plus or other continuous glucose monitoring sensors will require to test capillary blood glucose using finger prick testing on occasion, for example to check the accuracy of their CGM device or as a back-up (e.g. if blood glucose levels are changing quickly or if the device stops working).
  • Short video tutorials can be found here.
  • MHRA Safety update - FreeStyle Libre flash glucose sensor - Use of barrier methods to reduce skin reactions to the sensor adhesive. The adhesive within the FreeStyle Libre 2® Plus and FreeStyle Libre 3® sensor remains the same as the adhesive within the FreeStyle Libre 2® sensor.

Dexcom ONE®+ 

  • Dexcom ONE®+ is an alternative option for eligible individuals with diabetes who require continuous glucose monitoring as recommended by their diabetes specialist clinician.
  • Dexcom ONE®+ sensor can be worn for up to 10 days. Unlike the previous Dexcom ONE® there is no need to prescribe a separate transmitter. Dexcom ONE®+ sensor consists of an all in one sensor/transmitter.
  • Glucose measurements can be displayed on the Dexcom ONE+ app (if the patient has a compatible smart-phone) or there is an optional receiver that may be used as an alternative option. Previous Dexcom ONE® receivers do not work with the new Dexcom ONE®+ sensor. Patients using a receiver should be advised to contact their local hospital Diabetes Team to access a new compatible Dexcom ONE®+ receiver.
  • Short video tutorials on how to set up the Dexcom ONE®+ device and apply the sensor can be found here, as well as in the app.
  • Any patients who are experiencing issues with their sensor, transmitter or receiver should contact the Dexcom Technical Support Team using the Support Request Form via the Dexcom website (here) or by telephone on 0800 031 5763. Specialists and GPs cannot issue prescriptions to replace defective sensors.

Prescribing notes:

  • Any adverse incidents or safety concerns with continuous glucose monitors (CGM) or insulin pumps should be reported through the Yellow Card scheme. The Medicines and Healthcare products Regulatory Agency (MHRA) has introduced new step-by-step guidance on reporting suspected adverse incidents and safety concerns. See MHRA Drug Safety Update October 2024 for advice for healthcare professionals. 

Continuous Glucose Monitoring with Hybrid Closed Loop Insulin Pumps

Specialist initiation (S1): 

Continuous Glucose Monitors Restricted for use with Hybrid Closed Loop Systems (HCL) 

  • Patients using hybrid closed loop systems must be attending specialist Diabetes services for training and monitoring.
  • For information regarding faulty sensors see above section (FreeStyle Libre® 2 Plus).

FreeStyle Libre 2® Plus 

  • The Omnipod® 5 insulin pump links with the Freestyle Libre 2® Plus sensor as part of a hybrid closed loop (HCL) system.
  • The FreeStyle Libre 2® Plus glucose measurements are displayed through Bluetooth technology on the Omnipod® 5 Personal Diabetes Manager Device (PDM) which in turn adjusts the insulin delivery by the Omnipod® 5 pump.
  • Diabetes Specialist teams are responsible for providing patient training and support for the use of FreeStyle Libre 2® Plus as part of an HCL system such as Omnipod® 5.
  • Freestyle Libre 2® Plus sensors can be worn for 15 days and a maximum of 25 sensors will be prescribed per patient per year.
  • When FreeStyle Libre 2® sensors are used in an HCL system, the Freestyle LinkApp and the Freestyle Libre® 2 reader are NOT used.

FreeStyle Libre 3®

  • FreeStyle Libre 3® sensors are restricted within NHS Lanarkshire for use ONLY with a compatible Hybrid Closed Loop (HCL) insulin pump systems.
  • The mylife Loop HCL system uses a Ypsomed® insulin pump, linked to a compatible Smartphone with CAMAPS FX App and a CGM sensor such as FreeStyle Libre 3®. The FreeStyle Libre 3® glucose measurements are displayed within the CAMAPS FX phone App and can be shared with carers.
  • Diabetes Specialist teams are responsible for providing patient training and support for the use of FreeStyle Libre 3® as part of a HCL system.
  • Freestyle Libre 3® sensor can be worn for up to 14 days and a maximum of 26 sensors will be prescribed per patient per year.
  • When FreeStyle Libre 3® sensors are used in an HCL system, the Freestyle Libre 3 App and the Freestyle Libre 3 reader are NOT used.

Prescribing notes:

  • Any adverse incidents or safety concerns with continuous glucose monitors (CGM) or insulin pumps should be reported through the Yellow Card scheme. The Medicines and Healthcare products Regulatory Agency (MHRA) has introduced new step-by-step guidance on reporting suspected adverse incidents and safety concerns. See MHRA Drug Safety Update October 2024 for advice for healthcare professionals. 

Up-to-Date Costs/Sizes

For up to date costs/sizes please see Scottish Drug Tariff (SDT).

NHSL Joint Adult Formulary Key

To indicate the category of a formulary medicine, updated sections adopt the following key:

Preferred list (P): First-line formulary choices.

Total list (T): Alternative choices when preferred list options not effective/not tolerated, or not indicated.

Specialist initiation (S1): Specialist initiation, or on the advice of a Consultant or Specialist Practitioner in this therapeutic area. Continuation in primary care is acceptable.

Specialist use only (S2): Supply via hospital, Homecare Service or a hospital based prescription (HBP) for dispensing by community pharmacy. Not prescribed in primary care setting.

Editorial Information

Last reviewed: 31/01/2022

Next review date: 31/01/2025

Author(s): NHSL.

Version: Please refer to the introduction section for an explanation of the review dates above.

Approved By: ADTC

Reviewer name(s): ADTC.