Owners of the FreeStyle Libre 3, one of Abbott Laboratories’ flagship glucose monitors, received an email this week warning them to “disable automatic system updates on your iPhone” because the new operating system’s StandBy Mode and Assistive Access Mode “may impact your ability to receive time-sensitive notifications including glucose alarms and notifications indicating that alarms are unavailable.”
“Key Steps to Optimize your FreeStyle Libre System on iOS 17,” the email reads. “While our teams are working quickly to verify and confirm compatibility, we recommend that you disable automatic operating system updates on the smartphone using the mentioned apps. Please check the compatibility guide on myfreestyle.com before the new operating system is installed.”
Abbott is telling customers who have already upgraded to disable StandBy Mode, which activates the iPhone’s Lock Screen while it’s charging and placed on its side. They are also being advised to turn off “Assistive Access” mode, an accessibility mode for people with disabilities. Abbott says that this mode “will impact your ability to activate a sensor, modify your alarm settings, or receive glucose alarm notifications from our apps.”
Abbott writes on its website that failure to take action when users get an alarm, or failure to use the device “as instructed in labeling may result in missing a severe low or high glucose event and/or making a treatment decision, resulting in injury.”
Why didn’t they warn people sooner? iOS 17 has been in beta for months. This seems more like incompetency on their side.
Like so many parts of the health care industry in the US, people like to make money off of diabetes not invest in solutions.
I’ll bet money that no one actually tested this product on the beta at all.
They could’ve let Apple know about this during the beta period. They’re a big enough company and Apple is big on integrating with healthcare tech. They probably could’ve got some changes merged in.
See my other comment. Its been several years since i worked in the industry but Apple has a history of making changes that are not included in the beta
Well, this is the total opposite of the incident you experienced nearly a decade ago. This wasn’t a sudden quick change. These features were announced and were available for almost 5 months.
Incompetence.
That’s literally the only answer. My guess is they can find a fix which even further underscores their incompetence at not having it ready at launch. I’ll give indie devs and small companies a pass on not having day one support for a new OS but large corps and especially medical apps like this have no excuse.
I used to work at a mobile app test automation company and there is an alternative answer: apple is the fucking worst. They used to frequently make additional changes that are not in the beta just before release and other companies have no warning until its live. I remember when ios8 released in between the final beta and general release they ripped out the entire api our platform used to interface with phones. We had to rewrite iOS support from scratch in like a month post release. It was a disaster.
If something critical (lives) life depends on some software working, they probably should’ve always been recommending that people disable major .0 updates. That’s systems administration 101.
I worked for a major (medical) company that would skip .0 releases, precisely to combat stigma and folks skipping it.
We did have one particularly bad release that we ended up telling folks to delay taking.
IMO, the real secret to most critical upgrades, and at the heart of skipping .0 releases, is to test in non-production, talk with super users and peers, and patch intentionally and quickly. If you have the resources.
The named email says Abbott’s teams are working to “verify and confirm compatibility”, so it’s unclear if this is an actual issue or just a precaution over what they think could be an issue.
This wouldn’t be the first time either. We’ve had more success with android and sensor readings than with apple. The Diabetic team at our local hospital have sent out 2 warnings that Libre could stop working with Apple when there has been a major update.
We’ve since moved to a pump which uses a ‘phone’ and this is android and it’s been absolutely life changing for my daughter.
iOS is way worse when it comes to support for things like this. IOS started super restrictive and slowly allowed for slightly more background app support, but anything off the beaten path of “open app, view stuff, leave app” is not well supported on iOS.
Android would historically allow apps to do whatever the fuck they wanted, but in the past like 6 years started adding restrictions, and then started adding some mechanisms for users to allow exceptions.
It’s very unsurprising for Android to support these cases better, but they’re honestly both getting worse, because “battery optimization”, and it really hurts “off the beaten path” applications.
What was it prior to using a phone? Did they have external devices or something that notified you?
Before my daughter was given the libre sensor she would just finger prick at regular intervals to see where her numbers were, there were no warnings or notifications if she was outside her ranges. We’ve been lucky that when she has a hypo she knows about it due to feeling ‘shaky’ but if she was hyper she wouldn’t know unless she did a finger prick.
The Diabetic team we have moved us away from Libre to a Dexcom G6 which has been great but as another poster has said does throw warnings out every now & again about Battery optimisation & Do not disturb settings.
Just over a month ago my daughter was given a pump made by Insulet and with that you are given an Android phone, that is used purely for controlling the pump and getting readings about her current numbers, it’s very locked down. Since she’s been using the pump her numbers have been absolutely fantastic, she’s very rarely outside of her ranges, not only does her new device beep to alert her that something needs attention but so does the actual pump.
Thank you! Super glad that your daughter is doing great and this is working for her!
That’s all fascinating. I’d seen a few videos of people who had pumps talking about how it effectively revolutionized their lives, but I didn’t know exactly how. I didn’t know the finger pricks were still common. I just assumed there was some intermediate device between pricks and phones, but boy was I wrong.
TL; DR for what’s actually happening
- Standby mode is a mode that turns your phone into an Echo show if you plug it in and put it on its side. Like other focus modes in iOS (do not disturb, bedtime, etc) users can disable notifications for this mode. This is bad because it looks like Abbott didn’t ensure their notifications are set to “critical.” Critical alerts ignore settings that hide notifications. Critical alerts was a feature that was introduced 5 years ago.
- Assistive Access is basically a new grandma-mode for phones. It allows a guardian or caregiver to turn an iPhone into a super dumb phone. Abbott has not built support for this yet. You have to go through a complex setup process for Assistive Access, so this is likely another edge case.
- Instead of telling people to keep notifications on, and not to enable a new lockdown mode, Abbott is telling people to disable system updates. This smells like they actually didn’t test iOS 17 over the last 5 months, and now their legal team is worried that there might be other hidden issues.
IMHO, this story makes things seem worse than they are. That said, if you depend on some software for your anything critical, it is a best practice to NOT upgrade to the latest and greatest major point release of any operating system. Windows, MacOS, iOS, Android, etc. Wait at least 3 months until the kinks are ironed out.
My pharmacy can’t even get Libre 3 sensors, so I’m stuck with Libre 2 and the software has been incredibly broken, even on iOS 16. 2-star review on the App Store.
Thankfully, my diabetes is managed well enough the alarms aren’t critical to me. But it’s really surprising how bad the software is for one of the most popular glucose monitors.
This has been the case with every OS update across android and IOS for my constant glucose monitor since they added the first phone app. What a waste of a story
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