BREAKING: MAY 31, 2022 – Libre3 finally received U.S. FDA clearance! This will surely give millions of insulin dependent diabetics like our seven year old daughter, Coral, diagnosed with T1d from 15 months old; the accessibility, affordability of a real-time CGM! Learn more on MedTechDive about the updates and scroll down for some infographics I designed to display the comparison between their more expensive rival, Dexcom’s G7 CGM. Pop some champagne or Spindrift [not sponsored] to celebrate!
Update: AUG 13, 2021 – Libre 2 App for the U.S. is finally updated and available for free download on the App store here (click and read). For Parents/Caregviers: Download to no older than iPhone 8 for child’s main use. Check compatibility on Freestyles website and see details in app store. We’ve downloaded the LibreLinkUp app to our iPhones 10 and 12 mini to get alerts from her iPhone to ours overnight. We turn off our alarms during the day so we don’t have three phones going off all at once when she’s low (<80 mg/dL) or high (>200 mg/dL) to prevent burn out.
Update: AUG 2, 2021 – FreeStyle Libre 2 App Receives Clearance from US FDA for Diabetes Management. Read more from the Endocrinology Network here. Please read in full and pay attention to the golden words (hyperlinks are clickable) or sentences in bold. Mahalo!
Disclosure: I have no intentions to convince readers to switch glucose monitoring systems and was not paid to do this honest review. In fact none of my reviews are paid and I’m fine with that. However, I earn a small commission for affiliate links from Sugar Medical – that’s it. As always, I only share products that work best for us after thoroughly trying them.
The FreeStyle Libre 2 Flash Glucose Monitoring System by Abbott is a “integrated glucose monitoring (iGM) device with real-time alarms capability indicated for the management of diabetes in persons age 4 and older.” Due to over 42 Dexcom G6 sensor errors (failed sensors) from October 2018 through Fall of 2020, we switched to the Libre 2 system. It’s been almost nine months since we made that vital switch for Coral’s sake as with anything we’ve ever done to better improve her quality of life with this chronic autoimmune disease known as Type 1 diabetes. Please read in full to learn of our experiences and suggestions for the Libre 2 system in the U.S.
As with any diabetes technology such as insulin pumps and continuous glucose monitors (CGMs), each has its own pros and cons, requiring necessary adjustments to learn how to safely utilize that tech to get the most benefits out of it. For those who don’t know, the Freestyle Libre 2 in the U.S. requires frequent scanning with provided reader to check blood glucose (BG) levels throughout the day and night. For more basic Libre 2 features, I implore everyone to please refer to Abbott FreeStyle Libre here.
Third Party Bluetooth Apps
Unfortunately, the Libre 2 system in the U.S. uses a near field communication (NFC) encryption which does not allow us to use a third-party transmitter device such as Ambrosia BluCon or MiaoMiao 2 for bluetooth sharing to Coral’s iphone 5S (too old, needs chip) and our iphones 10 Pro and 11 Mini. Also, the current LibreLink app is only compatible for Libre 10 and 14-day, not Libre 2, as of this writing. I reached out to @freestylediabetes on Instagram and Twitter in June 2021, but no further updates from any Freestyle Libre representative has been available (this is standard protocol for any technology). They don’t even know estimate release dates of software and hardware yet.
Bottom line: It’s worth waiting what may be only weeks for Freestyle Diabetes to update their app instead of experimenting with yet, another third party app developed in a foreign country. Which will then, likely be outdated as soon as the LibreLink app is updated for the U.S. It all depends on each persons individuals needs, lifestyle, and situation. As mentioned above, the LibreLink app just received FDA clearance on Aug 2, 2021! It’ll be nice to have the option to scan Coral’s sensors with our iphones and/or her “Libby” reader soon. Freestyle is definitely going to pave the way for affordable CGM options for millions of diabetics around the globe!
Therefore, we’ve been coaching Coral to scan her Libre or “Libby” as she calls it, sensor about every 10-15 minutes before, during, and after meals or snacks. The same “check BG” timeframe applies for treating lows. The Libre 2 reader also has the option to set reminders as a Timer with snooze button or exact times. This particular feature is a great option for children with type 1 diabetes. We have also used a basic kitchen timer to help train Coral to get into the habit of checking her BGs more frequently since we now lack the real-time updates with the Dexcom G6 – which isn’t ideal at all for when she finally goes back to school in-person (as in, after she and her little sister are finally able to get fully vaccinated for Covid-19). My husband has preemptively taken the majority of the “overnight shifts” waking to check her BG at 3:30am every night by setting either of our regular phone alarms.
This, of course, has led to severe diabetes burnout for both of us Dparents and also Coral. So, I fuel her BGs up with 2-3 oz Premier Protein shake (not sponsored) if her BGs less than 125 mg/dL before bed, pending if she ate enough dinner and whatever amount of insulin on board (IOB) I’m guessing she has. It’s also important to note that we’ve been on a reluctant pump break and giving her multiple daily injections (MDI) for the past long three challenging exhausting months. Protein keeps BGs steady overnight. See that blog post here.
8/13/2021 – Libre2 App is here in the U.S!
A little redundancy in case you breezed through that update at the very top of this blog post. Libre 2 App for the U.S. is finally updated and available for free download on the App store here (click and read). For Parents/Caregviers: Download to no older than iPhone 8 for child’s main use. Check compatibility on Freestyles website and see details in app store. We’ve downloaded the LibreLinkUp app to our iPhones 10 and 12 mini to get alerts from her iPhone to ours overnight. We turn off our alarms during the day so we don’t have three phones going off all at once when she’s low (<80 mg/dL) or high (>200 mg/dL) to prevent burn out.
10/4/2021 – Libre2 App Update
Please see our IGTV from Instagram here. Again, each Libre2 sensor lasts 14 days. We’re currently on the second Libre2 sensor using the NEW Libre2 app and have brought to attention with Freestyle Corporate: 1) Granted it’s new, the app trends 80-100 mg/dL higher than fingerstick values (pokes) about 30 minutes after a meal. Both the app and reader trend 20-45 mg/dL higher than pokes while fasting for more than 2hrs. Per my husbands expertise as a physicist and artificial intelligence expert, this is likely due to systematic biases and trend prediction forecasting algorithms. See this example of systematic bias in AI from Towards Data Science. We’re still so glad we switched from Dexcom G6 last Summer for all the reasons stated in this blog post. Furthermore, we’re very pleased with how attentive and open to suggestions for improvements Freestyle customer service has been so far. It feels great to finally be taken seriously and considered given our knowledge and skills with diabetes technology and beyond [my husband’s a genius]. They’re well-aware that Dexcom is their biggest competitor in the CGM market.
Per photos below, you can see Coral is capable of unlocking her (my old iPhone 8) with her fingerprint ID, opening the Libre2 app, and scanning her Libre2 sensor to check her BGs. She’s a quick learner and we coach her daily. More on our Instagram posts or Stories @type1diabetic_life!
1/8/22 – Libre2 App Update
We’ve had to set multiple staggered iPhone reminders on vibrate for Coral to scan her Libre2 sensor throughout the day during her first week of in-person learning in first grade at a new school. We’ve strongly emphasized that she needs total care as specified in her endo’s School Orders and on her IEP. More on returning to school in another blog post coming up. Reminder: You must scan the Libre2 sensor to get any readings and trend graphs both on her phone and ours (followers must download and use the LibreLinkUp app as specified at top of this blog post).
Sharing Reports to Providers
Coral’s endo’s office will request her CGM reports the day before her office or telehealth visit. Fortunately, Freestyle has made this easily accessible via their website which allows me to view, save and email her endo’s office a pdf file. It consists of about 68 pages of detailed reports, but her endo usually refers to the first few pages of her LibreView reports to help us make any necessary changes to either her basal and/or insulin to carb (I:C) ratios. He has expressed his confidence in our diabetes management for the past few years in SoCal of which we are very grateful.
Coral’s doing great! You guys are doing a fantastic job despite the constant challenges with diabetes devices. Her HbA1c is still awesome under 6.7% given the Libre trends typically higher than her actual glucose. Keep up the good work! Don’t be so hard on yourselves.– Dr. “G” of CHLA
Libre View software is needed to generate, view, and share reports with healthcare providers. The software must be downloaded onto a compatible computer. Learn more here. Feel free to view the first page of a typical report and comparison of Coral’s “time in range” below (Non-medical personnel: No sharing of her data is permitted without my prior written consent). This is a judgefree platform and I encourage everyone in the diabetes community to be more supportive of each other – never judge a person by one or two pics.
Libre 2 MARD or Accuracy
The Libre 2 system has a mean absolute relative deviation (MARD) of “9.3% (9.2% for adults and 9.7% for pediatrics), making it the only iCGM sensor sustaining a high level of accuracy over 14 days.” More on that here. Given we’ve been self-isolating safe at home for over a year during this real pandemic, we usually only poke to check her actual blood glucose (BG) about 1-3 times a day. However, we are scanning her Libre 2 sensor 40 times daily on average per the logbook on the reader. We have and always poke every single morning before breakfast with fasting BGs for an accurate glucose reading with her regular Freestyle glucose meter. Almost every single time we’ve scanned right after poking, “Libby” is usually 20-25 mg/dL higher than her actual BG. If we were to actually poke her 10 times a day for 30 days, I could plot a graph comparing actual BGs to Libre readings. Yeah, not doing that for her sake and my mental health. Keep reading please.
With that said, we no longer freak out when “Libby” reads 221 [arrow up] if she has IOB and about to go for a walk or swim. We cautiously wait about another 15 minutes to scan again and it usually levels itself out as if to say, “Whoops! I got carried away.” Rule of thumb: When in doubt, poke don’t shout. In contrast, if Libby reads “71 [arrow down],” we’re like, oh sh*t. Juice! 12 sips Cor’! That would equate to about 50 mg/dL if we were to poke her. When her BG’s dropping that fast, no point in poking – just treat the low asap! Scan again in 15 min and wait until her BGs level out again. Yes, this requires chasing her down to drink juice quite often actually, because she and her little sister are very active.
Access and Affordability
Currently, Abbott’s Freestyle Libre system (referring to all generations) are the most accessible and affordable in the CGM market throughout Europe, the U.S. and other parts of the world. If interested, I highly suggest contacting Freestyle for a FREE trial soon as you can here. Be sure to contact your insurance provider regarding coverage (if any) and your co-pay amounts. Be vigilant.
We’ve dealt with countless rude and some kind reps from Dexcom and will never go back to dealing with their BS again. I am however, selling thru our remaining Dex G6 sensors to make back at least half the money (hundreds) we lost on several sensor replacements sent (replacements are not free). Email me at firstname.lastname@example.org or use my contact form if seriously interested only – domestic shipping rates will apply. Sorry, I cannot risk shipping these sensors out of the U.S. Please contact IFLusa.org or Getinsulin.org for further assistance. Please understand that I must put my child with T1d first in addition to caring for my toddler especially during this real pandemic.
Some Libre 2 FAQs
Please visit Abbott Freestyle for their FAQs. I’ll be answering some of ours in this section below:
How accurate is the Libre 2 sensor? Please see above section regarding its MARD. Also, refer to comparison charts below. C’mon, don’t be lazy. It took me forever to write, edit, photograph, document, and design graphics for this single blog post. Thanks 😉
Are we burnt out with diabetes duties? Yes. We’ve been enduring this raging pandemic living in Los Angeles, CA where many people still aren’t taking it seriously and never will. 47% of residents still choose to remain unvaccinated for Covid as of July 2021 but have access to it. All while managing our strong-headed six year old’s T1d since she was 15 months old, distance learning, along with caring for our toddler. Diabetes is never-ending, tantrums, trying to avoid covidiots, etc. Yep, seriously burnt out, but still trucking along and thankful for our new home, true friends and ohana [“family” in Hawaiian].
Was it worth the switch from Dexcom G6 to Libre 2? Yes. Coral will tell you herself, “I hate D*xcom!” Libre 2 is smaller, more affordable, lighter weight than G6 and actually stays on the FULL 14 days as FDA approved and advertised. Their adhesive is much better than even Omnipod and Dexcom’s adhesive. Unlike the G6, which failed about every 2-3 days since the notable decline in hardware and software quality as of April 2020. G6 was failing about every 7-9 days in the months prior to last summer. Keep in mind, we are experienced users of the G5 system too. Also, my husband has a PhD in Physics and was a former medical professor. I take the time to interpret his explanations into terms so that others may be able to understand and benefit from it.
When will Freestyle (Abbott) be releasing a real-time CGM? Libre 3 is a real-time CGM and appears to have concluded its clinical trials in the U.S. as of September 22, 2020. Libre 3 received its CE mark in November 2020. It is still not known when it will be available in the U.S. or for children Coral’s age under 12 years old. Libre 3 has been available in the U.K. as of September 2020. Stay informed and check updates at Abbott.com and DiaTribe.org. Sign up for Libre 2 or 3 updates at Abbott.com.
Would you switch back to Dexcom G6 and/or Loop? Per answers above, not likely IF Libre 3 becomes available before we put her back in school for the Fall/Winter semester. As of this writing, it sadly doesn’t appear to be the case. It’s unrealistic for us to be texting or calling whoever her future nurse or caregiver will be at her new school or for them to be constantly scanning her Libre 2 sensor. Nor do we expect Coral to scan to check her BGs every hour. At the very least she’s able right now, is scanning “upon demand” or before her meals and sometimes snacks. We surely do miss Looping though, but have applied that valuable experience to more intuitively adjust her temp basals on the Omnipod’s PDM.
Are you going to try the Tandem Diabetes Tslim pump? We have and it sadly didn’t work out for her either because we are using Fiasp – which isn’t currently approved for the Tslim pump and it clogs within 20-36 hours from time of site change due to it’s sticky density compared to either Humalog or Novolog. We surely aren’t going to waste her remaining supply of thousands of dollars worth of Fiasp Flextouch pens either to switch to another brand of analog insulin – that simply is not an option for us. We’ve tried the TruSteel and AutoSoft XC sets and neither worked out for her for said reasons and she quickly developed a skin reaction to both infusion set adhesives within a matter of hours upon insertion.
We always research, explore and exhaust all options before resorting to MDI or any other method of managing her T1d. Multiple daily injections are exhausting, time consuming and a constant guessing game of how much IOB does she have remaining since her last shot/bolus? She prefers using syringes for a quick jab rather than insulin pens where you have to hold it into your skin for 8-10 secs. Therefore, the InPen (bought out by Medtronic) is not a solution for us at this time either. We offer her options and sometimes have to be firm with her to keep her alive and thriving. Pushing pens on her is not constructive for her mental health and growth or acceptance of this damn autoimmune disease.
Note: I would prefer others (there’s been a lot) discontinue to offer any suggestions regarding how we manage her diabetes especially on social media. Good intentions as it may be, it is not necessary unless I actually ask for it. Thank you for your understanding and genuine support.
How well does Libre 2 work when swimming? It will alert when there’s a signal loss, I’ll scan her sensor with the reader and we’ll almost always get a BG reading. So far, the only times we’ve had sensor errors is if her BGs less than 60 and/or rising or dropping quickly (ex: more than 3 mg/dL per minute). Per Freestyle, any excessive amounts of vitamin C will cause inaccuracies in readings. Learn more about their list of warnings here. As for longevity of wear, we keep her sensors on with I.V. Prep, and cutting out a custom hole from a roll of 2″ Opsite FlexiFix tape (spammers, yes, that’s how the brand name product is spelled). After every swim session or bath/shower, we blow dry her sensor patch, holding the blow dryer about 12″ away from her arm, cool setting, while gently massaging the sensor’s adhesive on her arm. The actual adhesive Freestyle uses is very durable and retains its stickiness for about 10 out of 14 days pending how often she’s swimming or perspiring during outdoor activities. Again, reinforce with Opsite tape or Tegaderm – both clear adhesives sold on Amazon (not sponsored). Note: Coral has severe allergic reactions to SkinTac and any type of fabric adhesive like Grif Grips, KT tape, pod and Dexcom adhesives, etc. Read my Quick Referrals page for more of our favorite diabetes accessories and supplies.
How long does it take for the Libre 2 sensor to warmup? 60 minutes after scanning it to start the sensor. Readings may be a little wonky the first 12-24 hours as expected, so we always remember to poke if symptoms do not match readings. We’re really impressed and pleased with how quick and easy it is to insert the Libre 2 sensor with the one-push applicator. However, it’s important to be honest about how painful it can be for Coral given she’s very lean. The sensor must be applied to the “back of the upper arm” per Abbott’s recommendations. We find it’s less painful for Coral if we apply to the side of her upper arm instead.
Do you get sensor errors with Libre 2? We have received many sensor errors on the reader when scanning Coral’s Libre 2 sensor during events of quick drops in BGs or low BGs usually less than 60 mg/dL. Reader will say to check in 10-15 minutes and it will often provide a new BG reading then. I always say, “When in doubt, poke!” Always use poke and use the fingerstick value over any CGM especially during any sensor errors and/or when symptoms do not match given readings. This is detailed on every single manufacturers (Freestyle, Medtronic, Dexcom) website. So far, only one (1) sensor in the past nine months has a sensor abruptly ended prematurely before its 14th day. See next question below. Please keep in mind, these are our own individual experiences which may vary for others.
How difficult is it to get sensor replacements? Within the aforementioned previous nine months, we’ve only had to call about three times for two sensor replacements. 1 of 3 times was due to a customer representatives error in sending us a Libre 14-day instead of Libre 2 sensor as requested. Each time I’ve called, the wait times were really long, between 15-35 minutes at around either 10:00am or 3:30pm PST. Unfortunately, FreeStyle does not have a patient ticket request form online like Dexcom does. This would save us all the trouble of wasted time on the phone especially with young children like mines running around and screaming like crazy at each other. Yes, I have suggested this to them many times on Instagram and Twitter, “Update your website to add that online request feature like your biggest competitor, Dexcom, has available. Time to meet market demands FreeStyle.” See and read that Twitter thread below please:
Libre 2 vs. Dexcom G6
I briefly mentioned some comparisons between the Libre 2 flash GM system and Dexcom G6. Keep in mind, we also have prior experience and expertise using the G5 from April 2016 through Oct 2018. My hubs and I are very techy, more so my hubs who again, has a PhD in Physics and is currently a top-level artificial intelligence (AI) software engineer. Please read my Dexcom G6 review here to catch up to speed if you’re not familiar with any of the CGMs covered on my info-blog. Also, why anyone would want to defend Dexcom when and if they aren’t even sponsored is beyond me. You are advertising for them with #TimeinRange on social media for free. Did you know a 30-sec Super Bowl ad costs around $5.5M just for the air time? Read more about that controversy on Escquire by an adult with Type 1 diabetes himself here. Did you know Dexcom’s CEO, Kevin Sayer made over $13.8 MILLION dollars for fiscal year ending 2020, per Salary.com (see below)?
One of the best things about the Libre 2 and 3 system is that it only takes 60 minutes to warm up after scanning to initiate it. Whereas the Dexcom G5 and G6 always took 2 hours to warm up (unless you’re using the Spike app which I have no energy to get into on this post or ever because that requires a high level of tenacity with minor tech know-how).
See Pros and Cons and Libre 2 vs. Dexcom G6 Comparison charts below.
Libre 3 vs. Dexcom G7
Bottom line: Dexcom’s multi-millionaire CEO Kevin Sayer still refuses to acknowledge the many hardware and software issues we’ve all been sharing on social media and has not specified if they were remedied with the G7 yet. So, let’s not hold our breath. Truth is, although Dexcom may have slightly better software, Freestyle makes up for it in the quality of hardware, customer service, accessibility and affordability. Technology is fantastic when it works and yes, truly “life-saving” as so many have said before. It’s even more important that we hold all diabetes companies, pharmaceuticals, legislators accountable for when it is A) hard to attain due to access and/or affordability and B) causes life-threatening incidents due to either malfunctions in hardware or it’s software algorithms.
Read more about Dexcom and Abbotts patent duel here. This indeed affects filing and processing times of either companies patents resulting in further delays of Libre 3 in the U.S. By now, I sincerely hope you’re all second-guessing the integrity and ethics of Dexcom’s CEO Kevin Sayer and his EVPs as running a monopoly on the CGM market.
8/11/21 – Update: A more recent article from Connected in Motion published July 19, 2021, states that the Dexcom G7 will take only 30 minutes to complete sensor warmup, smaller applicator and packaging, and last 10 days (confirmation on 14-day wear TBD). Please check for updates on your own.
I’ve designed another comparison chart for my fellow visual learners below. Please credit any and all of my blog posts and infographics if sharing on Instagram @type1diabetic_life or Twitter @t1disabeach or Facebook @typeonediabeticlife with #t1dlife.
Once Freestyle updates their LibreLink app for iphones or possibly Android phones (the latter still unannounced), I’ll be able to fully recommend the Libre 2 system for caregivers or T1ds themselves in the U.S. As of this moment, it just isn’t entirely practical for insulin dependent diabetics of any type especially adolescent T1ds in school. This current system works great for Type 2 diabetics who don’t need to check their BGs as often as those with T1d which equates to about aforementioned 40 times daily for children like Coral. I am anxiously awaiting the Libre 3 CGM and will continue to keep checking Abbott for updates or sign up for their emails here. The Libre 2 system has worked just fine for us during this pandemic given that we’re always home with Coral. We can easily run to her side to scan her sensor and aforementioned Pros and Cons above. Overall, we have no regrets making this decision to switch and are confident in Freestyle Diabetes as a global company to better serve both type 1 and type 2 diabetics more than its competitors. Again, I’m a realist and nothing I say or do is meant to be taken as medical advice. I implore everyone to speak with their healthcare team to find the best solutions to fit your or your child’s individual needs rather than searching for quick answers on social media or even from me. Thank you for reading and I wish you all good glucose vibes! Be sure to click the subscribe button on my info-blog (informative blog) and follow us on Instagram @type1diabetic_life or on Twitter @t1disabeach.
Shelsea & Coral
Freestyle Libre 2 Safety Warnings – Also viewable on their website hence where I got that link. Please read and further educate yourselves especially regarding proper storage of sensor kits, MRI scans, etc.
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Abbott. “Freestyle Libre 2: Next-Gen CGM is Here” <https://www.abbott.com/corpnewsroom/strategy-and-strength/freestyle-libre-2-next-gen-is-here.html>. Published June 15, 2020. Accessed 21, Jul 2021.
Abbott. “FreeStyle Libre 3: World’s Smallest Sensor is Here” <https://www.abbott.com/corpnewsroom/strategy-and-strength/freeStyle-libre-3-worlds-smallest-sensor-is-here.html>. Published September 28, 2020. Accessed 23, July 2021.
Edelman, Steve, MD. “Dexcom G7: Get Ready for the Next Gen” <https://tcoyd.org/2021/03/the-next-gen-dexcom-g7/>. Published Mar 10, 2021. Accessed 23, Jul 2021.
Garza, Matthew, and Katie Mahoney. <https://diatribe.org/freestyle-libre-3-cleared-europe-smaller-thinner-and-no-more-scanning>. Published September 9, 2020. Accessed 20, Sept 2020.
Holmes, Dave. Esquire. “Nick Jonas’s Super Bowl Ad Raises Important Questions. Some Are Uncomfortable” <https://www.esquire.com/sports/a35441322/nick-jonas-super-bowl-commercial-dexcom-controversy/>. Published Feb 28, 2021. Accessed 26, Jul 2021.
Hacker News. <https://news.ycombinator.com/item?id=25935986>. Published January 28, 2021. Accessed 30 Jan 2021.
Salary.com. Dexcom, Inc. Compensation by Company <https://www1.salary.com/DEXCOM-INC-Executive-Salaries.html>. Updated 2021. Accessed 26, Jul 2021.
Disclaimer: Nothing I say or do on this Blog or my social media accounts @type1diabetic_life on Instagram and @typeonediabeticlife on Facebook is meant to be taken as medical advice. Do not literally follow us. Always seek counsel from your healthcare provider like your endocrinologist or certified diabetes educator. Make educated decisions for your and/or your child’s safety. Call 911 for an emergency. Also, I do not make a profit from this blog. I actually have to pay a subscription to maintain it on WordPress. An average of 15% of royalties I make from my Zazzle shop designs all goes back to maintenance and supporting my family. I am in no way compensated for sharing products and educating others on my platforms unless otherwise specified in that particular post. Mahalo for reading and please subscribe to my blog and share if you care!
Last updated: June 2, 2022