Review: My first thoughts about FreeStyle Libre?

Welcome to my review of the new Abbott FreeStyle Libre continuous glucose monitor. This page will be my personal account of using the Libre to manage my insulin dependent Type 2 diabetes.

I have officially joined the world of being a cyborg. Part man, part machine, part totally cool! Noting as crazy as Steve Austin and the Million Dollar Man, however its a start. Today, I welcomed FreeStyle Libre into my life (December 2018); which is now available in Canada; to help manage my diabetes. To the words of my nine year old, “Good luck, I hope it doesn’t bother your body” and a big hug for moral support.

What is FreeStyle Libre?

I am positive you have seen the ads on television and social media (that’s why you are here), however let me explain the world of continuous glucose monitoring or CGM.

The Libre is a flash glucose monitoring system that uses a sensor to continuously check your blood sugar levels – the days of routine finger pricks are coming to an end.
The sensor is where the magic lies – a convenient, discrete, easy to use, and user friendly device that you wear for up to 14 days to continuously monitor your glucose levels.

Convenient: The small sensor (About the size of a quarter) continuously measures and stores 8 hours of glucose readings day and night. I may finally understand why my morning blood sugar levels are unmanageable.

Discreet: Glucose readings with a painless, one-second scan even through clothing. No more routine finger pricks.

I wear a suit to the office and it works well through the multiple layers of clothing.

Easy: Swim, shower or exercise — the FreeStyle Libre system is designed to be water-resistant and worn while bathing, showering, swimming or exercising. Once it is “installed”, for lack of any other appropriate label, the one time use sensor can be worn for up to 14 days – literally, it will self destruct after 14 days – which it does to the hour. At the end of 14 day mark the sensor stops storing information and time for a new unit.

User-friendly: With every scan you get your current glucose reading, the last 8 hours of glucose data and an arrow showing the direction your glucose is heading. Up to 8 hours of continuous readings — how did the snack without a small insulin pairing send your globose levels out of target? How well does my bedtime insulin injection bring my overnight sugars down? With knowledge, comes power, right?

What is FreeStyle Libre System

The FreeStyle Libre system comes in two parts: the continuously worn sensor, and a reader.  

The Sensor:

The 8 hours of data should not be an issue, we scan one before meals; once two hours later, and once before bed. 7 scans a day, or for me, as soon as I wake up – so 8. 8 finger pricks, plus botched attempts – so 10 finger pricks saved a day!

The sensor Is about the size of a quarter, and about two quarters deep. The disposable sensor tracks up to 8 hours of continuous data (so be sure to scan at least once every 8 hours), and a 14 day battery life.

The Reader

The Libre Glucose Reader

The cool thing about the Sensor is that it uses the same technology as our debit cards – near field communication (NFC) to speak to the reader. It scan well through multiple layers of clothing.

The Libre has its own glucose monitor that we are all familiar with, or you have the option – and this is even more cool. You can also use the NFC technology built into most modern smartphone devices to simply “tap and go”. Imagine a world where you no longer need to carry around your glucose monitor 24/7?

Note – as of April 2019 we are still waiting for an Android app for the Freestyle Libre here in Canada. However, there are a few unofficial apps that could do the trick for you. As an IOS user I have not tested them myself, so user beware. You can get a list of these Android Apps for the FreeStyle Libre on my Frequently Asked Questions about the Libre System. If anyone has a Android Phone with NFC that I can have, I will be sure to give them a try.

One of the reasons I switched to the Freestyle Libre came down to me having three glucose monitors – one for home, one for the office and one to keep in my laptop bag. Who doesn’t carry their phone around with them? Talk about a win. One device for everywhere.

There is a huge caveat here, that I will touch on later. However, for now — let’s go with 90% of the time, you are finger prick clear and you can leave your traditional monitor tucked away.

Wearing the FreeStyle Libre Sensor

Wearing or better said, “installing” the sensor was generally pretty easy. The Sensor is recommended to be installed on the back of your arm, and came in two pieces – the sensor in a sealed container and the applicator.  

The packaging looked over kill – however, when you consider this as a piece of equipment that needs to be treated as clean as a surgical room to reduce any chance of infection or irritation we can’t hold Abbott at fault.

The steps to wearing your sensor:

1. Disinfect and clean your application area (back of your arm) with the include alcohol wipes. Truthfully, I am overly cautious and use a larger alcohol pad. As diabetics, we know slow circles, starting from the inside working out (lets kill those germs).
2. Open the sensor container and the applicator and assemble — watch out of the little needle sticking out of the sensor. This reminds me of one of those stick fly traps — keep your fingers away as the glue is designed to have the sensor survive two weeks of life, exercise, sleeep, clothes, wrestling with the kids and loved ones. You name it.
3. Press the applicator to your arm and – a painless POP!

Literally that’s it – the pop is more of a jumpscare then a sting and basically painless compared to any other auto injector – i.e. EVIL HUMIRA for my Crohns, this was nothing.

If you would like to see a short video on how easy it is to wear a FreeStyle Libre, check out the Instagram video from Jessie Inchauspe. Click HERE to view the video.

The sensor is designed to last 14 days.

If you find the adhesive edges of the sensor are starting to life up – no worries. There are tones of 3rd party products out there to help you. Here is a small sample of FreeStyle Libre accesssories from my Amazon Store where I recommend KT Tape, Skin Tac, and other products. I have also created a second post with additional suggestions to help ensure your Libre last the full 14 days.

The FreeStyle Libre Reader

As I mentioned earlier, you can either use the FreeStyle Libre Reader to track and monitor your glucose results or a compatible smartphone and the FreeStyle Libre application.

The reader features a touch screen, colour display, trend line with your target range highlighted, and your typical notes section: insulin injection amounts and other information you would like to track.such as grams of food or units of insulin.

The Log Book / history section of the Reader includes:

• Log book
• Daily Graph
• Average Glucose Reading (similar to your A1C)
• Daily Patterns
• Time in target (remember you can potentially be tracking 24 hours of data – this is huge)
• Low glucose events

My only critism – I am use to readers coming with a carrying case and lancer to test your blood traditionally. This reader did not come with either.

IPHONE and ANDROID APP

I have yet to try the iPhone version of the reader as my iPhone isn’t compatible. If anyone can donate a iPhone XS let me know. However, I will be sure to write more on the APP once I have a chance to give it a try.

Looking on the Website: The FreeStyle LibreLink app is an IOS and Android app (April 2019: we are still waiting for the Android app in Caanda) designed to work with FreeStyle Libre Sensors. The app enables you to monitor your glucose using your iPhone or Android phone with a FreeStyle Libre Sensor — there is no need to use a separate blood glucose meter for routine glucose monitoring. When you scan the sensor with a compatible phone that’s running the FreeStyle LibreLink app, your glucose data is displayed directly on that device.

With the app you can:  

• View your current glucose reading, a trend arrow, which indicates how your glucose is changing, and the last 8-hours of glucose history
• See glucose reports, including your Ambulatory Glucose Profile, which reveal trends and patterns
• Add notes to track your food, insulin use, exercise, and other events The FreeStyle LibreLink app is a mobile app designed to work with FreeStyle Libre Sensors. 

The FreeStyle LibreLink app is compatible with NFC enabled phones running Android OS 5.0 or higher and with iPhone 7 (I only have an iPhone 6 – anyone want to hook me up) and higher running OS 11 and higher.

UPDATE DEC 2018: I love the iPhone app. The ability to only have one device to scan, track and monitor my glucose readings is a game changed. I always have my iPhone and as such always have my reader.n the app itself is intuitive and more importantly has some great tools – such as a weekly average which shows your 25-75th and 10-90th percentils. How consistent are you readings? The same data is available for 14, 30 and 90 days. It also has an estimated A1C.

The FreeStyle Libre Software

The Freestyle Libre software for Windows PC and MAC is intended for use by individuals and health care professionals to aid in the review, analysis, and evaluation of information such as sensor glucose readings, blood glucose test results, blood ketone test results, and other data uploaded from the FreeStyle Libre flash glucose monitoring system, in support of an effective diabetes health management program.

• Using FreeStyle Libre Software, you can gain a deeper understanding of glucose patterns and variability.
• The Ambulatory Glucose Profile summarizes glucose data into percentiles11 throughout the day. It’s a snapshot of a typical day revealing hypoglycemia and hyperglycemia trends.
• The stoplight chart is designed to help you quickly and easily focus on potential trouble spots12 (red and yellow stoplights)

Screen Capture from the Libre Software

I have the software a look the other night – it has potential. I was able to read my readings off of my Libre Reader and start generating custom reports. It was great to see the 24 hour trend lines of my sugars. It will be interesting to see, if at all, you can pull the data off of the LibreLink.

Do I still need to finger prick

Ok, so the bad news. Yes you will still need to fall back to traditional finger pricks with the FreeStyle Libre system if:

• Your glucose reading indicates a low or going low message; or a high message
• The trending arrow is rising or falling quickly
• Your sensor cannot provide a reading
• Your readings do not match how you are feeling

For convenience, the reader has a spot for traditional test strips. However, this is an added cost. One positive though, all your readings are built into one system.

Who knows – one day Abbott could use traditional finger prick test to better calibrate the Sensor.

How accurate is the Libre Sensor?

According to the manual, in some situations Libre Sensors may give readings that are more than 20% higher or lower than blood glucose. You can test the accuracy of the Sensor by using a traditional finger glucose test with the strip meter at the front of the Libre reader or on another blood glucose monitoring system.

You will know the system is performing correctly if your blood glucose is within 20% of the sensors glucose reading. For example, when the sensor reads 10.0 mmol/l, the blood glucose result from your finger test should be between 8.0 and 12.0 mmol/L.

If the sensor readings are not within the 20% range, consult the quick reference guide. Treatment based on inaccurate results can lead to low glucose or high glucose.

After using the reader for almost two weeks, I have noticed significant improvement in the accuracy of the reader. It appears that as your body adjusts to the sensor being installed, the reliability of the readings compared to my traditional finger reader have improved significantly.

One reminder about the sensor, instead of taking glucose readings from your blood, CGM sensor glucose readings are taken from the interstitial fluid (ISF), a thin layer of fluid that surrounds the cells of the tissues below your skin. Blood glucose readings tend to be about 5 to 10 minutes ahead of interstitial glucose readings. In simple terms, if you check you blood glucose – the Libre will catch up in about 10 minutes with similar readings. Typically this isn’t an issue – we take our insulin dose before meals – so generally a steady insulin line. As a precaution the system also has a small arrow which reminds you which way your sugars are going – up; down; steady – we treat accordingly.

Questions and Answers about the FreeStyle Libre

I have pulled together some questions and answers about using Abbott’s FreeStyle Libre glucose monitoring system on my Q & A page.

Read more about the system here with my Libre hits, tips, and questions and answers. You can also buy accessories for your Free Style Libre here.

Initial Thoughts (more to come)

Overall, I have been impressed with the Libre System.

The sensor is small, discrete and comfortable. The official Reader is colourful, has a large display, and all the features you would hope for. I look forward to learning to work with the system to better manage my diabetes and will be writing more again soon.

As traditional finger glucose tests are not only recommended but required for safe glucose management, it is unfortunate that Abbott requires us to buy those as well. I will need to see if my insurance covers both the sensors and strips or have I maxed out at the customary monthly limit.

Overall – the integration with my iPhone has been flawless. It’s great to have glucose readings with a simple tap of my phone to my sleeve. I love being able to visualize how my body responds to particular foods – and how well my insulin dosing is brining me back to my baseline. This is important for both Type 1 and Type 2 diabetes as half of our battle is eating well.

Please share your thoughts and experiences you have had with your Libre adventure in the comments below.