The non-diabetic’s guide to getting a continuous glucose monitor

[UPDATE: Less than a year after I wrote this, at two new retail price options for getting a CGM in the USA came online: Levels Health and AgelessRx (and possibly others that I don’t know of!). I don’t know much about the two businesses overall, but they both hooked me up with inexpensive Freestyle 2 meters with almost no hassle. They’re definitely cheaper and easier than the Canadian reshipping option I describe below!]

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I’ll get right to the point: This post is about how you can get a continuous glucose monitor if you, like me:

• Live in the USA or another country in which continuous glucose monitors require a prescription
• Want a window into your long-term metabolic health, data on how blood sugar affects your mood and appetite, or help dialing in your diet (or if you just like measuring things!)
• Don’t have a geek-friendly doctor who will write you a prescription for a CGM anyway
• Are willing to spend ~$120 for two weeks of data (that’s 1,344 data points!)

If you’re just learning about CGMs, check out some great Quantified Self posts about how tracking your blood glucose can help you fine-tune your nutrition and keep yourself healthy long-term. But they don’t have step-by-step instructions on how to actually get one. That’s what I’ll provide here.

Part 0: Not so scary

Quick digression: I imagined that a CGM would be like an IV, where there’s a long rigid needle stuck into me that hurts every time something touches it. I almost passed out a few times just thinking about it. In reality, the insertion device uses a needle, but the needle pulls out and leaves behind a tiny, painless metal filament attached with adhesive. It’s a lovely piece of design.

Part 1: Legal in Canada

It’s legal to sell CGMs in Canada without a prescription, so that’s where we’ll order from. As far as I know, there are no tricks or discounts; just go to the manufacturer’s official source and pay retail (CAD 100, which is about $80 US).

You’ll order the “FreeStyle Libre Sensor”. The “reader” is a NFC device for downloading sensor data, but you don’t need one. Any phone made in the last 5 years can do it using the official app.

Notice that they’ll only ship to Canadian addresses, and they require a credit card with a Canadian billing address. If you have a friend in Canada who’s willing to pay for it and send it on to you, you’re golden. If not, here’s how I got one using a reshipping service:

1. Go to https://www.shipbymail.com/ and create an account. (There are other services you can use too; this is just the one that worked for me. I’m not affiliated with them and don’t get a referral bonus.)
2. Go to this page and confirm that this is still the page to order the Libre 2 sensor. Make sure you’re looking at the “sensor” and not a “reader”. You can also order the older model, which doesn’t have real-time glucose alarms but which might be more hackable by third-party apps. I’ve only tried the Libre 2, myself.
3. Go back to Shipbymail and select the “buy for me” option. This means they’ll make the purchase, so that it’s coming from a Canadian address. At this point you’ll need to pay them for the device plus shipping to their mail drop center.
4. Wait up to a week while the package is shipped to them. When you get an email saying it was received, go to their site and enter the info to have it shipped to you.

The whole thing took 12 days from starting the order to getting it at my door, and the total fees from the reshipper came to ~$27USD.

Part 3: Your Canadian Alter Ego

The libre you ordered from Canada will only work with a Canadian version of the LibreLink app (I think — I didn’t try it with the US app because I was afraid of bricking it). Here’s how I got the app on my iPhone:

1. Sign out of your iCloud account. The phone gives some scary-sounding warnings about losing your data, but you’ll get all your iCloud data back when you sign back in.
2. Create a new iCloud account located in Canada. Some people report being asked for a Canadian billing address, but this didn’t happen to me.
3. Go to the app store and get the app Freestyle LibreLink 2 — CA
4. Sign out of your new account and back into your old one. The CA app will remain on your phone for you to use!

I haven’t tried this on Android, but there are lots of articles about it (example), mostly based on using a free VPN so that you’re coming from a Canadian IP address.

Part 4: Embellishments

If you read about the Libre, you might see people talking about third-party readers or apps that can automatically calibrate it or improve its resolution. Feel free to explore those, but you don’t need to — the vanilla app works just fine. Third party apps also used to be able to extend the sensor’s lifespan, but Abbott locked that out on the latest models.

Alternatives:

There are subscription services that provide CGMs along with nutrition coaching. I can’t endorse any of them, but they’re easy to find with a Google search. You need to pay for a monthly subscription, which costs 3x or more the price of a single monitor — you get two monitors for that price, plus the coaching, but if you just want to try out a monitor once this is a very expensive way to do it.

Conclusion:

You’ve done it! Now it’s just a matter of following the instructions for implanting the sensor (I found this video helpful) and activating it using your Canadian app. If these instructions helped you, please leave a comment and let me know what you plan to do with your continuous glucose monitor!

Bonus tip: The Canadian app shows blood glucose in mmol/l. To convert to mg/dl, like we use in the US, multiply by 18 (mental trick: multiply by 20, then subtract 10% of the result). But really, it only takes a few days to recalibrate yourself to think in Canadian units.

h/t to redditor ensembio for answering my questions when I was figuring this all out!