Reviewing the wireless FreeStyle Libre sensor (usually worn on arm) system from Abbott Diabetes Care after using it for six months as a 25 year old diabetic.
You‘re a diabetic and have heard some rumours of the FreeStyle Libre glucosemeter. Supposedly a glucosemeter that can measure your blood-sugar levels without having to pierce your finger every time. According to Abbott, the company behind this product, it is also fast, easy and painless. That sounds good, right? But what is it and how does it work? Are you supposed to wear it on your body like an insulin pump? Do I feel it all the time? Do I have to wear it all the time? Does it cost five million dollars? Maybe you are considering to try the FreeStyle Libre, but before you proceed you want to dig a little deeper. Let me (I am a 25 year old diabetic, type 1) provide you with some insights by sharing my personal experience with the FreeStyle Libre.
What is the FreeStyle Libre system?
So let me begin with a short explanation of what FreeStyle Libre is. Basically, it’s a different method of measuring blood-glucose levels. Diabetics usually do this by pricking their finger in order to access some blood with a blood-glucose meter. With the FreeStyle Libre system this is no longer necessary. Instead, you attach a small sticky chip (sensor) to your skin (a common known place that works well is the back of the upper arm). One side of this sensor contains a tiny needle that goes inside of your skin. This tiny little needle continually registers your blood-glucose levels, which are saved inside the sensor for up to eight hours. This way, diabetics no longer have to go through the process of finger-pricking each time they want to measure their blood-sugar levels. Sidenote: I have never felt the needle in the slightest way, not even upon insertion, so don’t let that be your main concern.
The blood-glucose levels that are registered by the sensor can be wirelessly transmitted to compatible devices such as the FreeStyle Libre glucose-meter by holding it above the sensor.
The device will then immediately show you your current blood-glucose level, and registers the blood-glucose levels of the past in a graphic. Sounds good, right? But it gets even better. Abbott Diabetes Care has recently finished developing their App for both Android and iOS (for iOS, it requires at least iOS 11.0, often meaning at least an iPhone 7). For me, this was a huge improvement, because I can now measure blood-glucose levels by simply hovering my phone over the sensor upon opening the FreeStyle Librelink app and hitting ‘check blood-sugar’. Yes, my phone. This means I don’t need to carry the blood-glucose meter around anymore, my phone works as a substitute.
I really hated carrying all that diabetic stuff around, so for me this change has serious impact on my quality of life. It makes me feel free again.
Every sensor works for two weeks. After two weeks, the sensor will automatically terminate and you will need to apply a new one. The sensors don’t come cheap, or at least not if you are located in The Netherlands like I am. Single sensors can be ordered for 60 EUR at http://www.freestylelibre.nl/, or you can select your country here in order to be redirected to the right site domain of FreeStyle Libre. Unfortunately, many health insurers do not cover the FreeStyle libre sensors yet, not even partial. The technology is still being investigated for its short, medium and long-term health effects on diabetics. The outcomes of these investigations have to determine if the sensors are eligible for coverage by certain insurers. Some U.S. based diabetics may be well off though, earlier this year Abbott announced that U.S. based health insurer Medicare has already declared they will be covering the FreeStyle Libre sensors (source).
Attaching and using the chip/sensor
Attaching the sensor is a piece of cake and can be done within a minute. The sensor comes in a small yellow carton box and exists out of two components plus instructions and some disinfecting alcohol swabs.
Before applying the sensor to your skin, you pick a spot on your body with preferably not too much fat (the tiny needle needs good access to blood, but people have regularly claimed spots such as their thighs to work just as well) and rub the disinfecting swab over it to make sure the skin is clean. Afterwards, you take the sensor out of its container with the sensor applicator, just follow instructions, it is very simple. You are now ready to inject your sensor. Abbott recommends to put the sensor on your upper arm. I personally wear it on the back of my upper left arm, a little above the reach of my t-shirt sleeves so it is not visible for others. Considering I am right handed, this also makes it easy for me to hold my phone over the sensor. Anyway — now that the sensor is attached to the body you will will be able to scan it with the device you want to use. You can only use one, so choose your glucose-meter or smartphone. After the first scan, it will start and needs 60 minutes to start up. After start up, the sensor will be ready to use and can be scanned as much as you want. Injecting the sensor has never even as far as itched for me personally. It is a smooth and short operation that is completely painless. When wearing it I do not notice its physical presence either. Even if it feels uncomfortable for a few days, that may well pass in a certain period of time.
Also, you shouldn’t be afraid of hurting yourself with your sensor because of physical activity or other energetic behaviour. There is a chance that the sensor falls off during rough contact of course. It happened to me once in a game of squash when I couldn’t stop myself from running into a wall, but the needle on the sensor is so tiny that I didn’t even notice it leaving my body. It’s like a sticker falling of your arm. However, as soon as the sensor is detached it will terminate immediately, meaning you will need to apply a new one. It can therefore get pretty expensive when sensors fall off more often. When this happens, you can try calling Abbott Diabetes Care with a complaint. I did that once, and they sent me a new sensor right away, but I doubt they will keep repeating this if your skin for some reason doesn’t hold well. Sensorsmfalling off is not a common problem for me. It only happened to me once. But if it does happen to you, then luckily there are some solutions to this problem (helps during physical activity as well). One of them is Skin tac, a glue similar to the one applied by the alcohol disinfecting swab that quickly becomes very sticky to ensure that a sensor actually sticks to the skin best.
Another option is a rubber band called the Librefix that holds the sensor in place. I don’t have one myself but I plan to order one for my squashing sessions. This and many other accessories for the sensors and FreeStyle Libre can be found on https://www.freestylesticker.de/en/shop/.
The LibreLink app from FreeStyle Libre
Now lets dive a little deeper into the LibreLink app, since you will be using this the most! The app was recently released for iOS (already out there for Android, but I have no experience there), and although this is obviously fantastic because of its use case, I do feel like the app still holds a lot more potential. The Librelink app currently meets the following features:
- Check your blood-glucose levels (you can also set notes after a check)
- Access a log of your blood-glucose levels
- Set personal alarms and reminders
It also offers reports and insights about:
- Your daily blood-glucose trends on a 7, 14, 30 and 90 day basis
- Your time within target blood-glucose levels on a 7, 14, 30 and 90 day basis
- Your hypo’s throughout the day on a 7, 14, 30 and 90 day basis
- Your average blood-glucose levels during the day on a 7, 14, 30 and 90 day basis
- A daily graphic of your exact blood-glucose levels per day
- Your estimated Hba1c
- Some statistics on your scan uses
I personally feel like there is room for improvement because the graphics are not quite interactive yet (no zoom or scroll functions, no possibility to show various statistics in one graphic etc). This could be a little more playful. Next to this I was thinking that maybe Abbott can implement some form of gamification where local (or global) diabetics can participate in online or offline games or competitions in regard to their blood-glucose levels. Perhaps they could even work towards partnerships rewarding various prizes for diabetics with stable blood-sugars. I figure this could stimulate diabetics, especially children, to maintain good blood-glucose levels and it would simply make it more fun to use the app more frequently. Last but not least: it might be nice if the app would automatically scan for a sensor upon opening, instead of the extra step of ‘check blood-glucose’ being required. But in general, the app is the first of its kind and it works as intended, so thumbs up!
Then apparently, there is also a sequel to this app, called the LibreLinkUp app. I have not used this myself but apparently it allows other people to keep track of your blood-glucose readings (for example your parents or doctor). Could be useful, especially in case of young children and worried parents.
Pros and cons
Before I go on and recommend you to try the FreeStyle Libre (at least if your a diabetic), I put together a small list of pros and cons rather based on facts. So go ahead and check it out below.
Pros:
- Easily and quickly attached to your skin, no complicated instructions
- The chip/sensor is small, easy to hide and holds pretty well
- No further interaction with the sensor required except for scanning it
- Sensor is absolutely waterproof, can be worn in the shower and even while swimming
- In most cases, sensor doesn’t itch or hurt (this varies for some people with specific skin conditions or allergies, but for most people this is not a problem)
- Most important of all: you no longer have to carry around glucose-meters and strips!!
Cons:
- Readings are not always a 100% accurate
- Sensors can come off, and when it does it terminates
- Very expensive and not covered by insurance
- In some countries, very long delivery times and scarcity (not in The Netherlands)
- Only works for two weeks
- Limited global availability
Conclusion
I can generally recommend all diabetics to try the FreeStyle Libre if you have sufficient funds and aren’t already using it. Not only does it make me feel much better in terms of freedom and utility (I can carry insuline and some needles around quite easily, but not a glucose-meter), but it therefore also indirectly drastically improves my Hba1c and average blood-glucose because I tend to check my blood-glucose levels much more often. Also, the ease of access to playful statistics really motivates me to regulate my insulin more often when necessary. You could say it kind of turns into a game.
Last but not least, if you are a diabetic and you are considering the FreeStyle Libre, don’t let the fact that you will need to carry something on your body scare you away because it doesn’t “look cool”. The fact is that it looks very cool. It is cool because it emphasises the fact that you care that much about your physical wellbeing, and therefore reflects that you are a mature person. That is simply something that can’t be argued with. Furthermore, I think this is a really strong step forward as a way to treat diabetes and I hope it will help others as much as it is helping me.
