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 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:
- 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).
- 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.
- 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.
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I tied the Libre for 2 weeks. The readings are way higher than the Accucheck numbers. First thing this morning before eating the Libre read 14.8. The Accudheck was 8.0.
I am going off the Libre and back onto the Accucheck. I cannot use the system if I cannot trust the numbers.
Hi Laurie – wow, I agree that is a bit of a difference. As I noted in my post, I am not affiliated with Abbott in any way. I am simply a user the system much like you. However, after using the system for over a year and a half, I can attest that difference is NOT normal. Typically my difference is between 0.75 and 1 mmol/L or less than 18 bases on the US standard – between my Libre and my finger glucose test (taking into account the 10-minute delay between the two). As I understand it, any difference over 20% is considered a defective sensor or poor interstitial fluids (CGMs do not read your blood directly) and may fall under warranty and replaced by Abbott.
For myself, I have been able to bring my A1C down from 7.5% to 6.4%. You probably already have a second sensor – even if you double-check every reading — why not give it another two weeks? One reminder when comparing readings – as CGM’s read interstitial fluids, you need to test your glucose and then compart that to your Libre (same applies to Dexcom) about 10 minutes later. This is how long it typically takes for changes in your glucose to be registered in the fluids under your skin.
I have been using the lebri scan for about 2 years and have never questioned the readings. However I decided to do some finger pricks and I cannot believe the difference. I talked to Abbots and they said that they would send me a new reader. Today I received the package which contained a new sensor no reader. I have been tracing my blood sugars. With the new sensor. I couldn’t believe the readings. I did one reading which read LO, so I decided to do a finger prick which read 8.4. I have been insulin dependent for 55 years and of late I have not been doing well as I take insulin according to my readings.
I am extremely upset as Libre are doing nothing to assist me. Please do not have insulin according to your readings as you may find yourself in a dangerous position.
Hopefully I will now get some help.
Kathleen W
Ontario, canada
Hi Kathleen – sorry to hear about your troubles with Libre. As you know, the Libre tests our glucose using interstitial fluids so they will never be the same. Typically the Libre is delayed by about 10 minutes, you test your blood with a finger test, then your Libre 10 minutes later. That being said, the numbers you noted are a extreme as the Libre should not be more than 20% difference.
For me, my Libre is typically 1 mmol/l different than my blood glucose. This,in combination with the trend arrows I have been very successful using the Libre. With every A1C my sugars have steadily declined over the last 18 months.
What are your plans? Are you going back to finger tests alone?
Three weeks into Libre I am encountering habitually HIGH scan readings compared to Accurate-Chek finger tests. The error is frequently 30-40% occurring AFTER MEALS (eg 15 vs 12) with trend arrow pointing right. This is opposite to discrepancies due to interstitial fluid lag.
Bottom line; unsuitable for continued use unless the problem is resolved.
Hey James! I agree, the system isn’t for everyone. However, I have also experienced amazing results.
If I am reading your 15 (Libre) vs 12 (Finger test). How far apart are you testing the two? There should be a 10 minute gap between your finger test and then your Libre.
Thanks for the really helpful review Mark. I activated my Freestyle Libre for the first time today and found it remarkably accurate against the finger prick tests. There was some wandering of the figures as I rapidly repeated the tests using the Libre but it quickly responded from my low of 3.1 when I I had taken two glucose tablets.
I am now showing over 4.0, a figure I am happy with as I am recovering from surgery after losing two toes .Low blood sugars are essential for the healing process. The wound left by that operation in July 2019 is still large and being treated with quite severe debridement to encourage granulation and in two weeks they will apply a skin graft which also requires low blood sugars . I need the continuous information that I can now see quickly and as often as I like. This is a great step forward for all we diabetics who believe we know our condition better than any ‘expert.’ The staff here at my convalescent home (The Bruyere St Louis residence in Ottawa Orleans ON) are all intrigued and delighted by their first experience of the Freestyle Libre and have thanked me for being their Guinea Pig.
Hi Paul! Welcome to the Libre club and glad your first experiences are positive. Where I have found the greatest benefit of using my Libre is being able to visually see how high my sugars climb and more importantly how long my sugars stay hi. It’s interesting with the continuous monitoring to see my insulin kick and and my sugars fall — however with certain foods, this fall is only temporary as my sugars continue to climb. With knowledge, comes power – and in our case much better A1C’s (I went from an A1C of 9 to 6.8).
As for some helpful tips 1) keep hydrated, that appears to help with the accuracy as the Libre relies on the interstitial fluid under your skin over raw blood. Secondly, I firmly believe it takes some personal responsibility to help the Libre last the full 14 days. I have a few tips posted here – https://www.makingyouthink.ca/2019/tips-to-help-keep-your-freestyle-libre-attached/
Keep up with the positive numbers and good luck with the healing, and the reduced number of finger pricks.
Mark
MARK – happened on your site through google -loved your information and your answers – thanks for caring enough to share your ideas and experience – sandy in ontario.
Hi Sandy from Ontario – Thank you for taking the time to write and the kind word. The system has been great for managing my diabetes, so it is always fun to write about something close to us. I have been meaning to write another post about what I have gained from the CGM over my finger picks – just need to find/make the time. However, keep your eyes posted.
Oh and back to Ontario, me too! Just north of Toronto.
just got this new system for hubby
I have to look after it all since he has vascular dementia. Reading the information booklets how do you keep from over dosing on the insulin the meter says you are to take when you told differently by doctors ?
Hi Linda! I am not a medical professional, only a guy with diabetes himself, so I always recommend using the insulin regiment prescribed by your doctor. That being said, the Libre system is generally no different that your finger glucose tests so the process is very similar to what you are currently doing. The only difference is, as the reader is looking at the fluids in your tissue over blood there is a slight delay (about 10 minutes) between what your finger test would read and your husbands Libre. That is where I personally fall to judgement and look at the arrows that go with the reading. Arrow points up, you know the reading may be a bit low, going down – the reading may be a bit high then your actual glucose and treat accordingly. When In doubt, I always treat on the side of caution and correct at my next meal or before bed to reduce the chances of overdosing.
These are all great questions and worth a visit to your physician or local diabetes clinic to confirm what is best for your husband.
Do you need a prescription for the sensor
I have a prescription to be covered under my private health insurance. Unfortunately, I can say if you are paying our of pocket, if a prescription would be required.
I have the monitor but can’t afford the sensors they are far too expensive so I use test strips. Contacted Freestlye to find out if there is case for the monitor and if they could send me a Lancet as mine is broken. Got the worst customer service I have had in awhile. Freestyle had sent me a response email wanting to talk directly to me and to use the customer # given to me. No one knew what i was talking about when I called, am waiting for the 3rd department to call.
Sounds like you have had a bit of an ordeal. Certainly nothing similar to what I have personally experienced from Abbott – which has always been prompt service. That being said, yes, they do seem to prefer calls overs digital correspondence – call them old school customer service.
Cost? Yes – compared to strips, a bit more pricy. Although, significantly less than other options like Dexcom G5. In the grand scheme of medical expenses – my monthly pharmacy bill is in the order of $2600 a month, so it’s a marginal impact.
You are right – the monitor ships relatively basic. No Lancet or case. Having 5 other glucometers around, this wasn’t a big deal – I just simply borrowed from one of them. There are many case alternatives that I have been able to track down and have added to my Amazon Store – https://www.makingyouthink.ca/2019/accessories-for-the-freestyle-libre/
brenda – i made mine very attractive -bought a shiny bag silver with zipper $ 1.50 dollar store
That is totally my bad :-(. You are right – just looked on the Canadian site and there appears to only list iPhone. Apparently I am going to need to update my post.
As of October 2019, the app is available for IOS and Android.
The belly unit is the Dexcom. More accurate than Libre (10-15% off vs 20% Libre) but way more expensive
http://www.dexcom.com
I will I wore about other locations with Libre tech support.
Learn anything surprising using the unit re foods, sleep, exercise, fasting?
Yeah that’s it! Exercise yeah totally … my sugars drop well during a run so been playing it cautious and skipping my insulin does before a run. This will be my first running season on a full insulin regiment so I’m sure that will change as I feel more confident in how my body will respond. Food wise – I love how I can see what foods makes me spike more than other foods or where my sugars didn’t climb as high and explain my low warning post meal. I have really found the system useful in getting my mornings / overnight under control. Just seeing the trends — my evenings seem to climb and climb. However mornings are now lower / in better control than they have been ever.
Very helpful thank you. Re accuracy, from the lines FAQ:
“Interstitial fluid glucose measurements are taken from the fluid within tissue while blood glucose measurements are taken directly from the blood. Sensor glucose values, which are based on interstitial fluid glucose levels, can be different from blood glucose levels (fingersticks), particularly during times when your blood glucose is changing quickly. For example after eating, taking insulin, or exercising. When glucose levels are falling quickly, glucose readings from the Sensor may be higher than blood glucose levels. On the other hand, when glucose levels are rising quickly, glucose readings from the Sensor may be lower than blood glucose levels.”
Accuracy is still important for tracking glucose lowering interventions and area under the curve analysis. I assume one can export the raw data in excel? If so one can take finger prick readings and then apply a correction factor to the entire data to smooth it out and improve accuracy.
Last question. It recommends applying behind bicep correct? I do a lot of resistance training so that muscle is in very high flex. Concern about its stability in this dynamic? What other places can it be applied?
Looks like you have done your research and yes the info about ISF is consistent with what I have read. Both the phone app and the Libre monitor make suggestions for when a traditional finger test is recommended. I still (usually) have my old tester available; although not used as often as I first thought I would need to.
Funny – I had the same concerns about any upper body work. Although sadly my chicken arms are far from having to be concerned with a very high flex. I have since move back to my usual routine of body weight exercises and presses. That being said – the quick start guide literature only seems to suggest the back of the arm. I may be worth giving the Libre help desk a call to see if they have alternate locations. Coincidentally I am putting in a new sensor tomorrow. I will check the detailed guide in the box and see if any other options are mentioned.
Honestly – I would say give a unit a test drive. See how it performs in the recommended location (if no other options are available) and see how it performs. I have also seen another Brand popping up on my social media (have to love focussed advertisements) that is similar to the Libre however is shown in the belly. I have never looked into that system so all I really know is that I have seen it. LOL
Will the app on an iphone capture the data even when screened off? Like say at night, my phone is on my end table, but the screen has gone off, but the phone is still on of course?
And do you take the raw data and recalibrate with actual pin prick glucose readings…when the unit is in a stable glucose period, not during dynamic changes? I’ve read it can be up to 20% off, although I am really more interested in diet/lifestyle trends (not diabetic) vs. true accurate readings. I don’t dismiss the true reading, as I am implementing general lowered glucose interventions, so would like to quantify also absolute lowering of glucose.
Hi Mac! Yes absolutely, the sensor captures data 24 hours a day independent of your phone. Look at the sensor as an independent device – your phone or the Libre glucose meter only needs to be around once every 8 hours to download your stored data. Otherwise they are two independent devices. That being said you can scan the sensor as frequently as you want.
I have found every glucose meter I have owned has had a level of fluctuations in the readings. Yes, the manual says the reader can be off by up to 20% however I have not found that to be the case. Now you have me interested – over the next week I am going to try to remember to scan and finger test each time. However, I would say that I have observed that the readings are more accurate after a day (you body has adjusted to the needle). That being said if we are talking worse case 20% of a 5 is 4. So on the low end where I am most concerned not an issue. In your case for trend analysis — that’s what I love most about the system. I misbehaved the other day and grabbed a Dairy Queen Milkshake — wowsers, looking at my spike I felt totally guilty.