In the years after I was diagnosed at 24 with Type 1 diabetes, I would sometimes cry when I stopped to study my hands. Back then, the skin of my fingertips was pockmarked by tiny craters, traces of the blood tests I performed seven or more times a day. Though they would heal in time, others would immediately take their place. Merely knowing they were there was dispiriting, a reminder that my disease would always leave its mark on my body in one way or another.
Successfully managing Type 1 diabetes requires almost relentless biomedical self-surveillance. You learn to count carbs, measure insulin doses, and track your glucose levels. It’s the last of those that’s the most frustrating for many who live with the disease, as the process has traditionally involved pricking your finger with a lancing device and then checking the capillary blood that springs forth. Typically, the process isn’t that painful, but it can be messy, and the disposable single-use test strips it requires are often expensive, sometimes costing more than $1 each without insurance. (That may not sound like much, but it adds up if you’re using them the recommended 4–8 times a day.) Perhaps more importantly, the information it reveals is limited, showing you where you stand in the moment but telling you nothing about whether your levels are rising, falling, or holding steady. That can be frustrating when you need it most, since it makes it hard to detect potentially dangerous rapid changes.
More recently, continuous glucose monitors (or CGMs) have begun to smooth that process over somewhat. Mine, the Dexcom G5, communicates information to my phone from a temporary sensor and transmitter that I attach to my stomach via a formidable-looking plunger device. (Those sensors technically last a week, but most users wear them for two.) The readings, which update every five minutes, provide me with a more holistic sense of my body’s trends, and the system aggressively warns me if the numbers are too high or low. It still requires twice daily calibration via finger-stick testing, however, and it occasionally drifts out of sync with my body chemistry, especially when my glucose levels have dropped steeply, which demands further testing. While those qualities can sometimes be frustrating, the system is central to the way I live today.
Comfortable as I was with this approach, I was initially skeptical when I learned that a competing system, Abbott’s FreeStyle Libre, had received FDA approval. Known as flash glucose monitoring, Abbott’s approach promises to almost completely free users of finger-stick testing (though it’s still recommended under rare circumstances, like a high blood sugar episode). Instead, it relies on near-field communication to pull blood sugar data from a factory-calibrated sensor, one a little smaller than the Dexcom unit, that sits on the user’s body for 10 days. (In Europe, where the FreeStyle Libre has been available for much longer, the sensors remain active for two full weeks.) Though the prospect of a system that didn’t require blood work appealed, I was still leery about the more irregular flow of data.
As I found when Abbott sent me a FreeStyle Libre starter kit for review purposes, however, it was that very intermittence that convinced me of the system’s merits, though it has plenty of other selling points as well. For many diabetics, the most important of them may be that it’s relatively inexpensive, with the sensors costing between $4 and $5 a day. That’s not cheap, of course, but without factoring in insurance or other reimbursements, it’s still less than it costs to keep a Dexcom CGM going, which typically comes in around $5–$7 a day. It may even be more affordable than some test strip–based regimens.
That might not make a difference if the FreeStyle Libre system itself weren’t so pleasant to use. The sensor in particular is surprisingly slim, especially relative to other diabetes technology. Designed to be worn on the upper arm, it is, as Abbott promises, “approximately the size of two stacked U.S. quarters.” Attaching the sensor in the first place was similarly simple. Each kit comes complete with a pair of interlocking pods.
Once you’ve snapped them into one another and pulled them apart again, you push one against your arm and pull it away. The process automatically attaches the plastic sensor to your skin while painlessly inserting a 5-millimeter long electrochemically-sensitive filament into the tissue beneath. I found that it effectively disappeared against my body, freeing me of the unsightly protrusions of some of the other technology I employ to manage my disease. You then activate it with the separate reader and leave it to warm up for 12 hours. That wait felt onerous at first, and may have been more so if I didn’t have my normal CGM running in the background.
When the FreeStyle Libre is up and running, however, its true pleasures—a word one rarely attaches to diabetes technology—are clear. Pressing a large physical button on the device primes it to take a reading. Hold it to the sensor and it almost immediately beeps, presenting you with a blood glucose reading and showing a graph of the last few hours, along with indications with other information such as sharply rising or falling levels. The interface isn’t perfect, but it’s hard to overstate how engaging the system is to use, most of all because it left me feeling involved in what was happening to my body.
Even when you dose insulin with care and precision, blood sugar fluctuations are almost inevitable under ordinary circumstances. When the numbers are coming in autonomously through my CGM, the effect is sometimes almost alienating, never more so than when the device is sending regular alerts about a high or low reading that I can’t quite seem to correct. The results can set me emotionally adrift, the very work of self-care undermining my sense of self. By contrast, the FreeStyle Libre drew me into the process, letting me evaluate where I stood on my own terms and schedule. Perhaps because the numbers weren’t just there, I found myself taking even greater than usual care in my insulin regimen during the time I was using the system, and my average blood sugars fell into my ideal range considerably more frequently for the duration.
Diabetes technologists will sometimes tell you that they want to help patients forget they have the disease. Short of some truly revolutionary solution, that’s unlikely to happen any time soon, partly because most of the currently available devices encourage us to pay more attention to the disease, the better to care for ourselves. So long as we’re obliged to pay constant attention to it, however, the FreeStyle Libre presents an elegant solution, one that encourages that encourages those of us who are ill to live as if we weren’t. At the very least, it promises to make my fingerprints my own again.