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The Diabetes Forum - find support, ask questions and share your experiences with 209,001 people. The Abbott FreeStyle Libre has come as an entirely new concept in glucose monitoring by providing much greater data than blood glucose testing whilst being more affordable than continuous glucose monitors (CGM). The sensor is a round disc, 5mm high and 35mm diameter, making it roughly the size of a A?2 coin.
Within the 14 days of usage, the sensor allows you to scan the sensor with the handset which sends data of your sugar levels over the previous 8 hours to the Libre system’s handset. When you scan, you therefore get not just a glucose reading, as you would with a blood glucose meter, but can also see whether your sugar levels are starting to go up, down or are stable.
The data provided by the FreeStyle Libre is the largely same as the data provided by a CGM, just so long as you ensure you take a scan at least once every 8 hours.
The one feature that CGMs have that the FreeStyle Libre most notably lacks is that it cannot alert you when glucose levels are going too low.
In terms of hypos, particularly over night ones, the fact that the Libre allows you to review graphs of your sugar levels whilst you’ve been asleep means that you can see that if your sugar levels have been trending low over night and can make changes to minimise the risk of future nocturnal hypos.
Note that the sensor provides a glucose level reading not by measuring the level of glucose in the blood but the level of glucose in interstitial fluid, fluid in the body which acts as a reservoir of nutrients, including glucose, for your body’s cells. Whilst the sugar levels provided by readings from interstitial fluid are largely a close match for blood sugar readings, there will sometimes be differences.
Find support, ask questions and share your experiences with 209,001 members of the diabetes community. 10 week (free) low-carb education program developed with the help of 20,000 people with T2D and based on the latest research. The first comprehensive, free and open to all online step-by-step guide to improving hypo awareness. In this update to my initial review of the Abbott Freestyle Libre I wanted to share my experience of what it was like to use and also to provide the promised comparison with results from my regular fingerstick meter (the Contour Next Link USB).
It is probably worth pointing out at the outset that the Libre WILL NOT give you identical readings to your BG meter all the time.
I found the Libre to be extremely comfortable and unobtrusive to wear and both sensors stayed firmly stuck for the full 14 days. In my previous post I mentioned how amazing it was to suddenly be able to see what had happened overnight every morning. After I had been living with the Libre for around 7 days I noticed that I had added a whole new technique to my management armoury. As I suggested earlier the Libre is reading glucose levels in interstitial fluid (via factory calibrated sensors) and then interpreting those through an algorithm to present values intended to reflect plasma glucose levels. What matters more to me is not whether results are identical all the time - it is more whether the results I get are useful. In order to understand what I was getting from the Libre I tested both sensors against my standard BG fingerstick testing routine.
What I think this means for me in practical terms is that if I was running off results from the Libre more or less full time, with only a few cross-checked results where BG was moving rapidly or if things 'didn't feel right' I would most likely run a little higher most of the time.
After several days of 'waiting to see' I contacted the lovely folks at the Abbott helpline who ran through a few checks to make sure I had the sensor in the right place and generally could tell my Libre from my elbow. A couple of days later I had a call from Fiona who I'd met at the Libre pre-launch meeting called to say that a software glitch had been discovered (and fixed) in some of the very early sensors which was causing some interruptions in data and other concerns. In the meantime, and certainly into the second week, the second sensor seemed to be settling down considerably and behaving much more like the first. I would have expected that a relatively consistent error would have still yielded useful 'trend' data - but in reality I found it very difficult to detach myself from the uneasy feeling that 'red' (hypo) results gave. So in the end I am left with one spare sensor yet to use (which I plan to put into action around Christmas time) and just a very slight sense of unease as to what future sensor(s) might bring. If other sensors only perform to the accuracy of the first 5 days of Sensor 2 then it's a whole different ball game. All in all I love the Libre and I am really hoping that future sensors live up to overall positive experience I have had so far.
Now that the online shop has opened I'd be interested to hear your experiences if you have used the Libre yourself. I currently use ?110.00 (apprx) in test strips every 6 weeks, I want to apply this, or some of this, to libre. Very interestingly though Robert, look how long that overdose of Novorapid affected you for. I seem to have been very insulin resistant since devouring so much glucose, which put me on a roller coaster. I found this on a French forum, there is of course no way to check it's accuracy and it may be a bit Chinese whispers!. I found it an interesting opinion , particularly in view of the mixed results people are having. It is certainly true that all the current long term trials in France (and the UK) are on insulin using T2s. Having read the french topic, it is quite an interesting point of view, especially as that isn't the way that it is being portrayed in the literature on the website.
My question relating to that French quote is why would they include the ability for a health care professional to set up the insulin calculator and allow you to enter insulin details if it wasn't designed to work on all types? I had mine a couple of weeks back - but I did hassle them quite a bit to get it sorted out. The Mobile was within 0.3 mmol of the built-in Libre meter whenever I checked it (only checked it 6 times though due to lack of strips).
There were excited murmerings on Facebook last week and on Friday I received a phone call that confirmed what many, many people have been waiting for over the last few months. I think it is probably fair to say that Abbott were a little taken aback by the level of demand for their new toy immediately after launch (the Libre 'flash' glucose not-quite-CGM monitor). Some people have got quite cross about this, but I'm more inclined to give them the benefit of the doubt.


Of course they will have to weed out a bunch of dead results from those expressions of interest.
I've just used one sensor, it was fairly close to my meter readings after the first day and certainly was excellent at telling me the direction glucose was moving and how quickly.
I have a question re-my sensor readings - they're fine during the days and go inaccurate overnight for some reason. My second sensor is on the back of my arm and my readouts don't seem to drop during the night.
Over the next few days you may see a pattern and be able to work out a correction factor to use for the higher readings without having to double check the reading with a finger prick. I know that Er3 373 means that the sensor couldn't be read - this is the code I got when I tried to scan the sensor that had been removed by a door frame. Most people that were used in patient trials of the Libre rated the application of the sensor as being painless. However, the much lower price tag for the Libre means that some people will not be put off buying the Libre despite lacking the alerts. If you have been living in a cave and have no idea what I'm on about you can get an introduction to the Libre here. I was almost never aware of the sensor being there, with the exception of one or two times when I leant on it or absent mindedly scratched near it (having forgotten it was there). Since I started attempting to *actively* manage my blood glucose levels four or five years ago I spend quite a lot of time wondering what is going on between my BG checks. They might be a bit simplistic for some, but by dividing the day into four chunks and averaging 7, 14, 30 and 90 days of results in those sections I found it very easy to spot patterns and filter out the ebb and flow of 'diabetes randomness'.
Whether any variation is modest enough that the readings, trends and analysis help me manage my diabetes better. This is usually between 6 and 10 fingerstick tests a day, including premeal and post-meal tests as well as those around driving, exercise and activity. This would probably do wonders for my avoidance of hypos, but I suppose it may also have a small knock-on effect on my HbA1c.
I had been given a handful of Freestyle Optium Neo strips with my pack of goodies and the helpline person suggested I tried cross-checking against the Libre's inbuilt BG meter rather than some other technology (interestingly these strips also read a smidge lower than my ususal meter).
I related the issues I'd been having with the second sensor and while they didn't seem to exactly fit with the software glitch described, Fiona offered to replace the second sensor.
When it worked at the 10% MARD that Abbott promise in the marketing literature I found it an incredibly powerful tool. It may not display this or other websites correctly.You should upgrade or use an alternative browser. So when I was giving him my figures clearly showing that the libre was frequently running higher, he couldn't understand why that would be.
I found it great but I probably have LADA and those of us who have a little insulin of our own may have fewer fluctuations .
I have called and am emailing to garner further information relating to the test pattern that they have used. It wasn't long before they realised that consumer enthusiasm was going to outstrip their production capabilites and they took a tough decision to stop taking on new customers in order to protect supply to those who had signed up first. This was a completely new piece of technology in a relatively small market place (certainly in the UK).
People who have changed their minds and so on - so if you recive an email you will need to act on it pretty promptly.
The touch insensitive screen isn't too good either, I thought the Neo screen was poor but at least that was free.
As you can see in my attachment it got very accurate during Friday daytime already which I was very happy about.
I initially ordered the libre to sort out my overnight levels but if I can't trust it overnight then I can obviously not make any basal adjustments based on its readings so I am really not sure. It was attached between the side and back of my arm and I felt that it was reading lo during the night because I was lying on it. For this reason, it is advisable to carry out some blood glucose tests during the day to check for accuracy and to do a blood test if you think you may be hypo. I did deliberately try to remember it when towelling off after showering to make sure I didn't accidentally dislodge it, but apart from that I barely gave it a second thought. I have never really known how often this happened until now - but the Libre released me from any monitoring constraints. Waking every couple of hours to check blood glucose via fingerstick is a very effective management technique - but it's no fun. I've regularly used them since I started with Artoo to cover activity and other things, but this was slightly different. I particularly liked the 'Daily Patterns' graph which only appears after 5 days of results are stored and offers an average of daily results along with a 90th and 10th centile shaded area (it's a simplified version of the Ambulatory Glucose Profile graph - see image).
But if the results the Libre is providing are complete garbage, then it doesn't matter a hoot how nifty the downloaded PDF reports might be.
And much as I realise a lot of work will have gone into ensuring that those results will be mostly OK for most people most of the time - clearly it is likely or at least possible that some variation will occur. Whenever I took a BG fingerstick test on my 'normal' meter (the Contour Next Link USB that works with my pump) I cross-checked with the Libre.
If the first sensor had tended to read a little lower, this sensor was taking that to new levels. I had a few overnight traces that looked as it I'd been on the verge of a hypoglycaemic coma all night - when in reality I'd just been bobbling along in the low 5's (I know because I panicked and checked). As it turns out the reading on that occasion was pretty close (typical!) so I left it at that and wished I'd called them earlier. And if I'd been stumping up hard-earned cash for that sensor I suspect I might have been quite miffed that data from 36% of the life of the sensor was fairly useless to me. If it were available on prescription and performed consistently like that I would be banging the table and asking to swap my (fairly generous) fingerstick allowance for Libre sensors - topping up with as many strips as I needed on top of that out of my own pocket.


From a user's perspective I have already seen several posts from people who would find it very useful to have a 'manual override' setting where you could offset Libre readings which are consistently out to bring them more in line with our own fingersticks. In fact, the DAFNE teaching is largely based on this premise - hence if your last bolus was 5 hours before you got to sleep, anything that happens to your BG overnight is to do with your basal. Even if it were, you would still need to test your blood using the traditional BG meter, so you wouldn't be able to stop the funding of lancets and test strips. A nice lady there took responsibility for chasing it through in the end and I got it within two days of her dealing with it, so I can only assume it would never have arrived had she not got involved.
Probably the right thing to do, but pretty frustrating for many people - myself included, who hadn't quite got around to registering with their e-shop early on. They had to anticipate what sort of level of early take-up there might be, but it's not entirely surprising that they didn't get it spot-on. If that's what you want the Libre to do, you can pretty much stop looking, because it's not going to happen - not with the Libre and not with *any* technology that measures glucose in interstitial fluid and then converts that into an estimate of plasma glucose values (so all current CGM options).
But look at what happened when I had 28 consecutive basal tests - the result is at the very top of this post.
Because of the constant availability of data and the trend arrow that accompanies each check, I found myself setting short sharp TBRs - perhaps 50% for 30 minutes or an hour - to head off an impending dip in glucose levels.
Not least because the glucose values in interstitial fluid will 'lag' behind blood glucose values (typically 10-15 minutes, though the Libre aims for 5). At the end of each sensor I then downloaded all the data and compared it on a spreadsheet to see what (if any) differences there had been.
There were also results where the Libre read hypo, but my BG meter confirmed I was in the 5's. Now Abbott do suggest that the Libre sensors may not read quite so accurately on day 1, but that days 2-14 should be relatively steady. On several occasions the Libre just reported 'LO' - with (allegedly) a level too low for it to record. Finally, I don't think the NHS allows for partial funding or allowances, although I might be wrong about that. And deciding to limit supply so that fewer people got better service rather than many people getting rubbish service seems to have quite a consumer-focussed feel to it. I phoned them last week (okay, and this week too!) and they said they are hoping to have contacted everyone within the first quarter of this year - so by the end of March. I couldn't help but tinker with my overnight basal profile gradually moving it from a bit wobbly, to ridiculously level (at least for a short while!).
I was slightly surprised to realise that the 'level' trend arrow on the Libre doesn't actually mean level as such.
You get a similar view (but with many more options, and helpful traffic lights) when you connect the Libre to your PC (or Mac - hooorah!).
I do not for a minute pretend that this is a scrupulously scientific test - or that the results here might apply to anyone else. They didn't just take everyone's money and not deliver, they concentrated on ensuring that those who signed up early could get full-time sensor coverage if they wanted it.
Seeing the patterns every day meant it was easy to spot the general trends and ignore the one-offs. The Libre software niftily allows you to create smart PDF reports recording all sorts of averages, graphs, low glucose events and mealtime patterns which can really help to understand what has been going on.
I took these comparisons purely for my own interest, and share them here in case others find them useful. I have seen some comment online where people have found that sensors came loose after just a few days, but that certainly didn't happen to me. I had expected that my frequency would drop off after the initial excitement, but I remained fairly consistent through the full life of the sensors - checking more frequently when levels were changing more rapidly and leaving hours between checks at times in the day where things are generally more stable.
And I made alterations to the 'shape' of my overnight pattern that I would *not* have made without those data.
Given that they are still being a little cautious about maintaining stock for new customers you might have to be patient for a little while yet, but at least new customers are now being taken in the initial launch countries - and their production capability certainly seems to be increasing. With infusion sets I have found that the adhesive seems to need 12-24 hours to get up to full strength.
The inconvenience and discomfort of 'traditional' punctured-finger-and-strip-fiddling monitoring means I would never check this often via a BG meter, but for 28 days whenever I wondered what my levels were, I found out.
By using preventative TBRs for flat or more accurately reading-flat-but-slightly-falling readings that were just 'a bit near the edge' I managed to avoid several low level hypos and without bouncing up into double figures. If you have a particular penchant for number crunching you can also download up to 90 days results and details as a 'tab separated' txt file ideal for import into your spreadsheet package of choice. Similarly, micro-boluses of small fractions of units when levels were high-ish (but not yet out of range) allowed me to be bolder in preventing BG drift.
If it gets loosened early on you may need to over-tape it with Opsite Flexifix, Tegaderm or something similar. There's not a lot of 'edge' on the sensors and I can see the possibility of the sensor getting 'levered off' if knocked in just slightly the wrong direction. I did hear a rumour from Abbott that they were launching a new, larger, production facility in the very near future. No 'avoiding' the numbers (whatever they might be!) in between my 'normal' testing routine. Hopefully they will be able to roll-out to other EU countries then.I have heard some very unfortunate expereices of people buying off eBay etc, so I think that is best avoided. From Italy I have registered at the end of September but still no email, and no update what so ever from abbott.



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