Our experience with the Freestyle Libre continuous glucose monitoring system in diabetic dogs
The limitations of glucose curves and fructosamine assays in managing diabetic pets are well established. For example:
FRUCTOSAMINE LEVELS DO NOT AGREE WITH CLINICAL CLASSIFICATION REGARDING DIABETIC COMPENSATION IN DIABETIC DOGS UNDER TREATMENT.
P. Claus, A.M. Gimenes, J.R. Castro, D.S. Schwartz. 2014 ACVIM Abstract
and
Evaluation of day-to-day variability of serial blood glucose concentration curves in diabetic dogs
Linda M. Fleeman, BVSc, and Jacquie S. Rand, BVSc, DVSc, DACVIM
JAVMA, Vol 222, No. 3, February 1, 2003
Bottom line: ‘In this subset of 20 paired curves, an opposite recommendation for dosage adjustment was made on 40% of occasions. Conclusions and Clinical Relevance—There is large day-to-day variation in parameters of serial blood glucose concentration curves in diabetic dogs.’
But now, not before time, we have a reasonable alternative. The Freestyle Libre continuous glucose monitoring system (CGMS). Its use in dogs is supported by at least preliminary reports:
J Vet Intern Med. 2016 Jul-Aug; 30(4): 983–988.
Accuracy of a Flash Glucose Monitoring System in Diabetic Dogs
S. Corradini, 1 B. Pilosio, 1 F. Dondi, 1 G. Linari, 1 S. Testa, 1 F. Brugnoli, 2 P. Gianella, 3 M. Pietra, 1 and F. Fracassicorresponding author
http://onlinelibrary.wiley.com/doi/10.1111/jvim.14355/pdf
‘Conclusion and clinical importance: The FGMS is easy to use and is accurate for IG glucose measurement in diabetic dogs.’
We’ve now used this in a few dogs and our experience is that it’s reasonably-priced, easy to apply, easy to extract data and, on the whole, reliable in the euglycaemic to hyperglycaemic range. Just one patient of ours showed a clear discrepancy between CGMS data and glucometer readings after a few days of initially believable data.
Application:
We haven’t generally covered or bandaged the sensor although I believe that some clinicians do. A little dab of tissue glue helps.
The sampling catheter is extremely fine:
The site after sensor removal 2 weeks later:
You can read data from the sensor wirelessly using either an NFC-enabled smartphone or the reader which can be purchased along with each sensor. The sensor stores 8 hours of data. In order to avoid some data loss the sensor must be read with the reader/phone at least every 8 hours. We’ve not had an problems with owners managing this themselves.
And this is what you get:
5 consecutive days glucose readings from one of our patients with DM and a history of pancreatitis. 27th Feb was the first day of feeding a prescription diabetic diet as opposed to a low-fat rice-based diet.
*Thanks to Jonathan at Bentley Road Vets, Doncaster for forwarding the data and to Wendy and Molly at Chesterfield Companion Care for filming and modelling respectively.
Hi Roger, do you need to purchase the reader if you use the app or is the app + sensor enough?
App + sensor is enough Andy, so long as your pet owner is happy with a bit of gadget faffing. Reader is just a simplified device. App actually makes it easier to transfer data. and phone needs to be NFC enabled I think.
Read article with interest. Total disaster for me sensor stopped working after 3 days. Out over $100. three trips to CVS 2 trips to vet cat is still walking around with sensor. My phone is too old to pick up data so had to buy the reader after sensor broke no one not even the CEO would talk to me because not approved by FDA for pets I wasted my money and time
that’s frustrating 🙁 trouble is it’s the best we’ve got because the alternatives are either 1) lots of blood samples and unreliable results or 2) guess what’s happening. Usually they work ok
I have been using this for my pet recently. This last one was applied yesterday, but even after 12 hours, it says it may not be adhering correctly. Upon closer look, it appears that the skin glue my vet used may have gotten caught under the sensor and may be causing a difficulty in reading the interstitial BG. As long as the area is shaved, do you think it can adhere without the glue? Thanks.
Hi Lauren, Yes people certainly do use them on dogs without additional glue. Even without glue you get the odd sensor where, for whatever reason, it seems to give dodgy readings. Maybe a bit of infection or bleeding around the catheter. Just got to keep an eye out for that and swap to a new one if so.
Is this something I can order and do myself or does a vet have to do it?
Hi Whitney, I think you would be well-advised to get a vet to help you with this. In practice there is nothing to stop you ordering the gadget and sticking it on but you’ll need vet input deciding treatment anyway. You might as well get them involved before you start.
Hi, Roger
Have been trying to find a vet locally ( Israel) who is willing to experiment with this – with no success.
Even the local Abbot rep has never heard of a Vet use of the sensor, and claimed that Abbot themselves had nothing in their files
With Israel’s reputation for being a Start Up nation, one would expect them to be at the forefront.
One question that came up was what glue are you using to adhere the sensor to the dog’s skin?
Hello Mike,
just normal tissue glue
Bill cochran.
Where can I purchase the freestyle libre glucose
monitor? I live in Denver. I also have access to Internet.
Email: billonthenet@hotmail.com
Hi Bill, they’re made by Abbott and (at least in UK) available direct from them.
https://www.freestylelibre.co.uk/libre/products/starter-pack.html?gclid=CjwKCAjwpeXeBRA6EiwAyoJPKl3HtA1SG6QVNLh0QOpxI4OdFAXVm-uS9LOd_33ORXPsP9fH24mnBxoCBdEQAvD_BwE
I really want to try this …Has the” looseness” of skin on the dog’s neck caused anyone issues dislodging the sensor?
Hi Fran, Never seen one dislodge (yet), all the best, Roger
Is the freestyle monitor the same for dogs as for humans
Hi There. Vet here from South Africa. We’re about to test drive this in a cat. Have you tried in a cat before? Do you think putting some Tegaderm over would be ok? Really scared of it being scratched out… Also, how hard do you have to press it in? Looks like quite a bit of force? Thanks!
Hello Rowena, I haven’t tried it in a cat myself but, anecdotally, plenty of other people have. It needs a firm push but not quite as dramatic as it looks in our little video! I think a cat will tolerate it OK. I think many people do put a dressing of some kind over the device in both cats and dogs to give a little protection. Although I’ve always found it stays on very well in dogs and I thought a bigger dressing might stimulate more scratching.
We love the Freestyle Libre on our newly-diagnosed diabetic Siberian cat. So much data, and so easy to upload by phone and share with the vet! I think that without this, it would have taken much longer and required way more trips to the vet and paw-pricks to find the correct insulin dose.
The first couple of sensors loosened within the first day and sometimes didn’t give readings, but even 12 hours’ readings out of 24 was incredibly helpful. The tissue glue really helps, as does a feline t-shirt or such to cover it. We tried one type of adhesive bandage but it didn’t stick to our cat’s fur. (Tip: the first few hours the sensor is under the skin may not yield accurate data, but the count-down only begins when you activate. So once you have the attachment worked out, you’ll get the most valid data if you wait and activate a few hours after placing the Libre. That means that if you’re trying for continuous coverage, you’d put a new Libre on a few hours to a day before the old one stops working, let the new Libre slowly acclimate / calibrate, and then activate the new one and switch over.)
Our vet recommended this and we love it. Our senior dog has numerous issues besides the diabetes and permenant use of this monitor would be awesome. I know it needs replacement ever 10 days, but as long as we do that is there a contraindication of maintaining a sensor over a long period of time?
No problem that I know of. So long as the skin is not looking inflamed in the area you are using then no bother otherwise.
Is there a way to remove the sensor from the dog so the skin doesn’t come off with it??
yeah they just peel off. the problem is usually stopping them peeling off too soon!
Hi, I am able to order this system for myself through my work benefits as I myself am diabetic. My mini schnauzer is also diabetic and soon to be tested for the Somogyi effect as she is having what we believe to have so many peeks and valleys that we have having issues controlling it. This would be a God send to use. Any difference between the one I would use for myself and what I would use for her and she wouldn’t be too small would she as I noticed the dog in the video was a larger breed. Thank you so much.
hello Sandy, sorry slow replying. It’s the very self same device as used in people…we just appropriated it for doggy use. It’ll go on a mini Schnauzer just fine. It would have to be a very very small dog for it not to fit. These devices have completely revolutionised somogyi-hunting in my experience. The most difficult cases have overswings only intermittently: can easily miss them with glucose curve. And glucose curves are often affected by the change of routine involved in doing the blinking thing. best wishes, Roger
Hi there, I am a vet trying this device out on a diabetic dog. The owner is using it with the app and the implantation has been no problem at all. However, we keep just getting readings of ‘HI’. Occassionally they have been read in the 20’s but when I took a BG to see if this was a true reading it was 4.5mmol/L. Do you have any ideas on why this may be happening? Anything to do with the data inputted into the app since its for humans? I’m pretty sure we have done everything else right and the sensor is still nicely in place,
Charlie
Hi Charlie, that’s a bit unusual. I can only suggest put a fresh sensor on and try again…verify it with glucometer. You do get a proportion of sensors which misbehave for some random reason….clot in the cannula, local inflammation or whatever. It’s a pain when they do that. 90% of the time they’re great.
In the states here with a 14-day sensor for our small dog that stopped working after 4 days, with an error message to remove and replace. It had been super convenient, but occasionally iffy readings when compared to test strips, with a 30-125 points difference! I’m being told by the FreeStyle help line no reimbursement or replacement though since it’s “not tested in this environment” (animals). Any advice on moving forward?
hmmm obviously we have no official link to Abbott. I guess they’re not setting out to provide it for animal use so hard to blame them for not being especially helpful. You do get the odd one which stops working well a bit prematurely.
Oh my goodness, the exact same thing just happened to us. We started initially with the 10-day sensor and it worked so great on our little 8lb Min Pin. She did so well with it compared trying to stick her paw a few times a day. She is a newly diagnosed diabetic and cushings disease. Unfortunately when I called the company they will not reimburse because its used on a dog. See what being honest gets you??? So moving forward I am going back to the 10-day monitor because it is about 20 dollars cheaper. We get good data from that 10 days and do not plan on using it continuously. Good luck to your fur baby.
I have been using Freestyle Libre on my dog continuously for around 6 months now (I install myself). For the most part I have had pretty accurate readings. I can’t imagine controlling his diabetes without it.
His past two 14 day sensors have been acting really strange. The sensor he has on now reads “LO” (<40 mg/dL) but his blood glucose taken with an AlphaTrac 2 consistently reads around 140 mg/dL. The sensor prior read 50-100 mg/dL higher than the blood glucose meter. Seems like I must have a bad batch.
hi my twila (dog) is trying out the the libre. The first time the sensor fell out as soon as we got home, her vet is going to put another one on Wednesday. Any tips to get the sensor to stay? I’m concerned with placement since she is pudgy and has a roll on the back of her neck.
thanks
try a bit of tissue glue around the edge of the sticky bit on the underside of the sensor to make it a bit stickier. That usually does the job. You can use any site that is flat but obvs better if somewhere more difficult for her to scratch at. good luck!
My vet has installed the Freestyle Libre sensor 3 times and it never stays on my dog. We have tried surgical glue, wrapping it, etc… newly diagnosed and just trying to get a curve and the exact dose. She rolls a lot and we can’t watch her 24-7. Any Ideas, options before I spend more money?
hmmm maybe it’s not for her if she’s really determined to get it off
Looking to use this for my dog that currently has a very high BG. It was recommended to us by our vet but I have a few questions that she could not answer. She mentioned something about having to scan at least every 8 hours, what happens if you don’t scan in an eight hour period? Will it mess up the monitor? I have a commute to work and would scan in the morning before I left and as soon as I got back home but, it would be very close to eight hours until I able to scan again.
if you don’t scan every 8hr there will be a gap in the curve but nothing else happens.
nice written article, thanks for sharing.
Has anyone ever seen myoclonus in either their dog or cat, seemingly having origin in the area of application of a FreeLibre glucose sensor?
not that I’ve come across…maybe someone out there has?
Using with my 9 year old dog who has been diabetic for several years. I find the range of readings can be as high as over 400 and as low as 100 over the course of a day even though his food in consistently measured and shots given about 12 hours apart. We knew he ran very high but didn’t know he went so low some nights. My question is, would the reading vary depending on where (i.e., how close to the disc) his insulin shot is given? I’d say we are at least 8″ away (30 pound dog). In all the online material, I haven’t seen instruction as to where to give the shot.
Thank you for your time.
Hi Suzette, short answer is no, it won’t affect the reading were you give the injection
Yes. Literature says place at least 1” from insulin injection site. You state the placement on your dog as 8” from injection site so I wouldn’t think it is being affected in your case.
I have the same time issue: very high at night then sometimes goes below 50 in the morning. Still trying to why “normal” glucose spikes, sometimes near 400. One thing that helped was switching from Vetsulin (quick-acting) to degludec, with the super-cool Ozempic-like injection ‘pen,’ that is actually a insulin vial & ‘syringe’ in one. Degludec is longer acting (but takes a little longer to kick in gear). One thing to note is glucose in dogs & cats is in red blood cells, but humans’ glucose is in serum. Because CGMs are calibrated to measurement human glucose, human CGM sensors and a sensor measurement on a dog / cat is from interstitial fluid. Thus a high human glucose metric is not directly dog’s measurement, i.e., a high glucose CGM value for people would be 200, half what my dog’s readings (but readings higher than 350 is not shown (but my high glucose are sometimes displayed, 400±). Usually by morning my dog’s readings are 275±. I’m getting frustrated with Freestyle Libre sensors and going to try the (new) Dexcom 7 sensors, which are supposed to have a longer (linking) range. I’m lucky if I can maintain a sensor connection beyond 5-6 feet away. The other _major_ issue is Abbott support is unimpressive and does not support v14 Android (phone) OS, so I got “their” sensor reader, which does not have iPhone or Samsung phone compatibility issues. Also their readers charge rarely lasts more than 30± hours AND the charge (and compter connection) port is the pre-USB (a micro C or the mini A — instead using a USB C (or thunderbolt); jeesh! And the tiny touch screen not very sensitive and the ‘battery’ charging icon small and hard to see. The bigger problem for me is figuring out how to use the damn reader. A reader manual was provided; it is about 3″ x 3″ and 245 pages long, READ: very hard to read and hold. I want a ‘real’ user manual where I can read more easily. Their online User Manual has been unavailable; I want to download a 8½x11 User Manual that I can print and read and figure out how to download data “stored” in reader onto my computer to send to my vet.
, too, have had issues
Does anyone have any experience with using this to monitor for hypoglycemia. My 11.5 yr old German Shepherd Dog was just diagnosed with insulinoma (biopsy result). I am considering using this monitor, but would like to know if there is a preferred spot to place due to the skin that is thicker than human skin, and is the accuracy for low blood sugar good. I can double check reading with a regular glucose meter if needed. Thank you.
Not so reliable at low end of glucose scale to the best of my knowledge Kaz
Is the starter kit includes the installation device ? the reader, the sensor (how many) the installation thing, the computer cord/charger? im in doubts thanks
Hi Carmen, sorry I’ve been slow replying. Both the starter pack and sensors on their own come with an applicator. You get a reader with the starter pack. However, if the owners of the pet are technologically capable then a smartphone with NFC is a better way of reading the sensor because then you can export the data direct from the phone by email to the vet. If you use the reader which comes with the starter pack then you have to connect via cable (that comes in the pack) to laptop/PC to extract the data. Hope that helps, Roger
The emergency vet suggested the 14 day Freestyle libre. It was applied by the emergency hospital on December 8 2020. The sensor is saying to replace it. I called Abbot customer service, they don’t give a warranty because it is being used by a dog. So I applied another new sensor and the new sensor fell off within 2 hours! Now I have to get another. Maybe I will go back to the emergency hospital for them to put the 3rd one and I’ll ask for them to use the glue!
yes, doesn’t always work out…technology, sigh. I always use tissue glue. Hope you’re all sorted now.
HI Roger – new to this blog. Thank you so much! Do you know if there are any discussions around developing a continuous tracker specifically for pets? We just started using the FreeStyle on our 13 year old pup. I’m not sure how accurate a “human” device is on a canine. Thought?
Hi Belinda, yes it’s developed for people but has been validated reasonably well for dogs (there’s a link to the paper in the blog). In real life the readings don’t always correlate exactly with glucose as measured on blood samples in a lab -but they generally give a reliable indication of whether levels are too high, much too high etc. Generally-speaking it has to be said that the picture we get from Freestyle Libre readings is just waaaaay better than the hopelessly inconsistent results we get from taking a series of blood samples to create a glucose curve. As soon as we start stressing them by sticking needles in them then the glucose starts getting affected. And glucose levels vary quite a lot from day to day due to randomness. It’s just not practical or nice to be stabbing the poor loves hour after hour for days on end.
Hi,
I just recently started using the freestyle libre 2 on my dog. Dermabond has worked wonderfully to keep it in place. I am a registered nurse and certified diabetes educator, so I’m very familiar with all things human diabetes. One thing that may help others here is that savings cards work for pets too. I just filled a months supply of the sensors using a savings card called singlecare. At Walmart, the price was $72.80. I’ve heard cheaper prices, but not sure which pharmacy would be cheapest. The libre 2 also has a feature where as long as the sensor and reader are within 20 feet of each other with no barriers between, the sensor can communicate out of range readings. This is great, since your pet can’t tell you when they’re too low. In the US, there is no app approved for phones, though (Canada does have an app, so it’s probably coming eventually). Sensors do require a prescription to get them, though.
When using on a dog does the owner need to set up the ranges differently ? We have a client who’s pet is always registering high? Which means its greater than 400mg/dL? This is our first time using this system on a client’s pet! Is there a way to set the ranges that we actually get an actual number?
My first use of the FreeStyleLibre sensor was not good. The sensor worked for 7 days when it is supposed to work for 14 days. The help line was not helpful. After 2 calls where I had to describe info on the reader, I was told the Libre system was for people, not dogs. No refund, no NOTHING! I would not recommend this company’s products due to terrible customer service.
yes, it’s a human product….but it’s the best we’ve got for pets. No, Abbott not obliged to help out. And yes they don’t always work. Having said that they great!
How often can you the freestyle to test in a day, I keep getting out of range and high, thanks
it records glucose continuously! sensor itself stores up to 8hrs data…to get a continous set of readings you just need to read it with phone or reader every 8 hrs or more often
New user for my Westie.
“Said replace sensor”after only two readings.. not even 24 hours.
Abbott said no warranty for use with animals.
Can’t afford this if no other alternative.
Please advise.
Am awaiting call from my vet.
Thanks so much.
Gwen
Hi Gwen, usually means some technical issue with the sensor catheter…it just happens sometimes that they bend or get blocked
I’m a nurse at a veterinary hospital. We’ve been using the 14 day sensors in patients for the last couple years. Recently, my practice is considering keeping some sensors and a reader in hospital for hospitalized patients who need regular glucose monitoring. Do you know if one reader can be used for multiple sensors?
Hi Rena, don’t think you can use multiple sensors at the same time. You have to delete the previous one when registering a new sensor on the reader. Best wishes, Roger
You set up a couple accounts (free) and download AP onto your smart phones. You can then log into that animals account and use the phone over and over to monitor. When that animal leaves. Put a new sensor on new animal and use same phone to start monitor. Just know old data belongs to previous animal.
For instance my husband uses his smart phone Libre AP everyday I have AP on my smart phone, too for emergency. If I log into his account it does throw him off of his AP. But I know if something happens to his phone I can log into his account and monitor his Libre sensor. Smart phone is EASIER than reader.
I am here because my dog was just diagnosed with diabetes. We are going to try the Libre with our sweet dog.
thanks Lynn, all useful to know
New here and very excited to have other folks using the Libre. I am working with a vet that our dog is part of a trial for the use of the Libre. I first had the FreeStyle I purchased and the reader stopped working after 8 days constantly giving the error message to try again in 10 minutes, When I call Abbott as with others was told warranty invalid if used on an animal. I found a free voucher online and now have a FreeStyle Libre 2 that is giving the same error could not read senor. This happens often an usually only get two reading a day instead of three. Has anyone else had this problem and if so has any thing worked to resolve this issue. I would love for this to work on our dog.
We’ve been using the freestyle libre system since my dog was first diagnosed with diabetes, 15 OCT 2020, with few issues. We do not use surgical glue, hence less skin irritation. Our protocol involves clipping the area with close clipper setting, then going over the area with a Flawless face trimmer. Clean off “fuzz” with a lint roller. The we put a ring of SkinTac where the edge of the sensor will go. This provides additional adherence without the use of any glue. Upon expiration, we remove the sensor with Goo Gone for Skin, using a cotton swab to gently “ring” the sensor till it almost literally falls off. No skin issues, no discomfort for the animal. We do this at home, no need for biweekly in clinic vet visits. We do have two rectangles, on on each side of the dog, providing four placement areas. Thus, we return to a similar spot only every eight weeks.
Yesterday was my first real problem: the applicator obviously is defective; the sensor remained in the applicator. Abbott is not only not supportive, they won’t even admit that the applicator could be defective! I keep hoping that with more and more veterinary practices finding that the CGM is a good thing for animals, that some day they may become more reasonable.
Thanks, that’s really useful info
Hi,
I have been using the 14 day Freestyle Libre for 2, two week periods. When the first sensor was removed after the first 14 days use, it left a bleeding, painful soar in its place that required antibiotic cream daily to heal. I think it is a shame, painful and harmful to the animal to have to replace the sensor for no reason after 14 days. I would be happy to pay for the next 14 days if I didnt have to take off the existing, perfectly fine sensor and harm my dog in this way, so I wish this option was possible somehow from Abbott.
Please can you suggest which tissue glue is best for a cat? I’m in my third sensor – first fell off within hours & had no glue. Second took 1 day & vet added glue around the edge only. Think I’d like to try a third time with glue on the actual papery bit in dots around as seen on you tube videos. Just not sure what glue to use in UK? Many Tks. Great article & help, Lynnette
Any tissue glue. As far as I’m aware they’re all cyanoacrylate and pretty much the same thing
Thank you. So something like VetBond is ok?
Does it have to be an I phone? I have a Samsung Galaxy could I use that? Thanks Judy
Will be fine
I have been using the FreeStyle Libre 14 day for about 6 months. The ability to constantly monitor glucose has been a life changer as my dog was so traumatized by a curve at the vet, I had to begin doing them myself at home. We learned about the use of the FreeStyle following a hospital stay with internal medicine specialist. I have had very few problems with the system but recently had several sensors go bad. When calling the first time I also was told no replacement was available because I was using them on my dog. I then had one go out early and the replacement never started working… $125 down the drain. I called Abbot and gave my name and neglected to say I was using them on my dog. Today I received two free replacements in the mail. While They recommend that you save the box for 14days incase there is a problem with the sensor. They like for you to return the malfunctioning sensor. I pealed off the sticky part to remove the dog hair!!! Hope others can get some reimbursement for faulty sensors. I pay $63 each when using a Walgreens discount pharmacy card. Good luck!!!
Thanks, that’s really useful. Appreciate you posting