Diabetes is an intimate condition that forces us (and the parents and carers of) T1D’s to develop an understanding of our biology and the influences of internal and external factors like few other conditions. We tend to have an encyclopedic understanding of the influence of a bowl of pasta or 5 km jog on our blood sugar levels. If we’re looking on the bright side, this capability derived from misfortune gives us a weird kind of advantage.
I was diagnosed with Type One Diabetes as a 30-year-old, while living in London, training for the London marathon and working in Fleet St. I tested my blood sugar with finger pricks for 13 years before stumbling on a solution that meant no more annoying finger pricks — the Freestyle Libre CGM (Continuous Glucose Monitor). I wish we’d had CGM’s when I was first diagnosed, this way the first 13 years would have been just that little bit easier and healthier.
Those getting newly diagnosed T1D in today’s world should know how lucky they are. I occasionally reflect on what it would have been like prior to my generation, with even more rudimentary technology. We really do a lot to the advances in medical technology that make our T1D lives easier. I mean, if we really want we can cast our minds back to 1921, where things for T1D’s were particularly inconvenient, because there wasn’t any synthesized insulin to treat “sugar sickness” back then. The best that could be done was a severely restricted diet which only prolonged the inevitable.
In this regard, the Freestyle Libre has been a complete game changer helping to bring my HbA1C down from 7.9% to 6.5%. And it all comes down to the power of ‘informatics’. They say knowledge is power and nowhere is that more evident than in the power to make minor adjustments due to the availability of information about blood sugar levels.
I’m a relaxed diabetic, so a HbA1c of 7.9% is pretty good, while 6.5% is a dream. And shows that even the most poorly behaving T1D with the right information delivered in the right way can find a way to achieve levels that a CDE (credentialed diabetes educator) or endocrinologist would be satisfied with.
Now… I can scarcely recall my life pre-diabetes, soon, I’ll scarcely recall my life pre wearing a Freestyle Libre CGM.
A CGM (continuous glucose monitor) is a device that continuously monitors glucose levels throughout the day. While there are 7 types of CGMs (see down below), they are basically doing the same thing – giving you readings with indication of which direction your blood sugar is going in (up or down), showing how the levels change over time and what happens to your blood sugars overnight, and displaying the patterns that occur after specific meals or during exercise.
|Dexcom||Medtrum A6||Medtronic||Accu-Check Eversense XL||Freestyle Libre||Freestyle Libre 2||MiaoMiao 1 & 2|
|Pros||no need to calibrate the G6;
proven to lower HbA1c
|CGM data can be integrated to the pump, providing a semi-closed loop system of diabetes management||The sensor is now 80% smaller in size compared to a former version||The sensor can last up to 180 days.||more affordable than a CGM||despite better functionality, it remains at the cheapest price-point.||You just need to buy 1 MiaoMiao – it can last for years.|
|Cons||Can be prohibitively expensive;
adhesive on the sensor is poor
|Anecdotal concerns that the accuracy is poor compared to other CGM systems||Sensors only last up to 6 days.||The implant requires a medical professional.||no hypo or hyper warning alarms||not widely available across the world.||Anecdotal reports of people having skin reactions to the adhesive.|
However, as my journey revolves around the Freestyle Libre sensor, I will further discuss specifically about it. You can read more about every type of CGM on our blog post (here).
FreeStyle Libre is a product created by Abbott, an American multinational medical devices and health care company. Within its range of products you can find the FreeStyle Libre Sensor, the FreeStyle Libre Reader, and three apps – FreeStyle LibreLink App, LibreLinkUp App, and LibreView. We must keep in mind that rarely are new devices and compounds discovered that further science and improve lives without a lot of public good and public investment. Whilst Abbott are benefiting from the profits there will be many parts of the science behind the Libre that is owed to scientists and students upon whose shoulders companies like nwo stand.
All the apps are working both on Android and IOS. While the FreeStyle LibreLink enables users to get the readings and the data using a smartphone, The LibreLinkUp was created for parents, partners and other caregivers. It will allow the loved ones to receive the glucose readings on their smartphone. In order for the LibreLinkUp app to work, one must be invited by a FreeStyle LibreLink user. Last, but not least LibreView offers a secure cloud to keep all the data from your apps that you can access online anytime, anywhere from any compatible internet.
Discrete, with a small size of 35 mm x 5 mm, the sensor is applied on the body with a special device called “applicator”. When it is applied, a thin sterile fibre is inserted under the skin. That fibre will be able to absorb the blood and measure how much sugar is in the interstitial fluid. The sensor is designed to stay on the body up to 14 days.
In order for you to obtain the readings all you have to do is to do a 1-second scan of the reader over the sensor. Every scan of the sensor will give you a current reading of the glucose, the history of the last 8-hours of glucose, and a trend arrow showing if glucose is going up, down, or changing slowly.
The reader can go through clothes, and stores up to 90 days of glucose data. It costs $95.00 and it comes in a pack of one. On the website you can buy 2 packs at once.
The features of the reader
The sensor is set up and ready to be used when you put it on. The activation is made by the first scan, and after a 1-hour warm up period it starts to record glucose readings automatically.
As far as who CGMs are recommended for…the list is long and somewhat subjective. I hear about koala’s, German Shepherds, Type 2 Diabetics, even those just those interested in bio-hacking. However, for human beings, it is indicated for anyone ages +4 who wants to measure his interstitial fluid glucose levels. For children age 4 – 17 the indication is limited to those who are supervised by a caregiver who is at least 18 years of age.
Depending on where you live will have an influence on your ability to access a CGM. In reality the internet makes them accessible regardless of your healthcare framework. In Australia, I order mine online. In the USA a prescription is required and your insurance determines if you are eligible. I believe the NHS in the UK requires a prescription and funds CGM’s for certain groups of T1D’s.
The FreeStyle Libre sensors are sold in specific markets and are compatible with readers sold, compatible apps, and software downloaded only in that specific market. Therefore, if you are planning on traveling a longer period of time make sure to purchase sufficient sensors from the same country to be able to purchase and use the sensors available in that country.
A sensor costs $92.50 and it comes in a pack of one. On the website you can buy up to 12 packs at once. It is important to mention that the sensor has a 5- to 6-month expiration date.
It is a small automatic device which measures and continuously stores glucose readings day and night, without any harm.
At the time I was testing my blood glucose using the pricking test, I would have on average 4 to 7 pricks per day. With the Freestyle Libre, I average 35 scans per day. I take my Libre into yoga with me, on a jog with me or at the end of the pool while I’m swimming. I scan before, during and after meals. The thought of going without my Libre is mildly angst-ridden. When COVID-19 was incoming I jumped on and purchased 6 months’ worth, for fear of any supply chain or distribution issues.
As for my personal use, why did I choose a Freestyle Libre? The day I started work at Abbott as a consultant in Clinical Decision Support, the guy that showed me around the office had T1D and wore a Libre and the team that was responsible for Libre across Asia and Pacific sat right behind me! Therefore, I used to get the quite cheaply.
Select an area of skin which stays flat during normal daily activities, and avoid moles, scarring or tattoos.
Even though the sensor is supposed to stay on 14 days, usually by about day 10, I’d have a low level of anxiety from the moment I woke up, from the thought that the Libre was getting loose. Even though it is water-resistant, with all the swimming and doing hot yoga, there was just no way that the Libre was going the full 14 days.
And here’s where Not Just a Patch comes in. Since wearing the libre patches I have not lost a single Freestyle Libre before the end of the 14 days. The CGM adhesives give me confidence that my CGM will last and that I don’t’ have to be feeling anxious at the thought of one being bumped off. There is also a certain level of pride and self-expression that I feel when wearing one of the colourful patches. You can call this type of patch an “over patch”. NJaP also designs Dexcom overlay patches and Medtronic CGM patches.
Moreover, taking into consideration the amount spent on the sensor, and the fact that wearing a patch over it allows me to keep the sensor on without problems for the full 14 days, it basically means that Not Just a Patch it is working its magic and is increasing the lifespan of the sensor for less than a $1/ week.
For how to apply your patch over the sensor checkout our video on how to apply Freestyle Libre adhesive patches.
Previews from the reader