• Angad Chandhok

Miaomiao: The perfect CGM upgrade for Freestyle Libre (Pro)

Updated: Aug 1

There’s no second thought about the fact that continuous glucose monitoring (CGM) has made managing Type 1 Diabetes so much more convenient. However, good things do come at their own cost and more so quite a high one for a CGM like Dexcom. In a country like India, where there are no insurance plans for Type 1 Diabetes that covers the cost of CGM device, Dexcom remains highly unaffordable for a common man. Abbott’s Libre Pro is the closest thing to a CGM that people in India have been using for the past couple of years as a proxy for the patient version Libre which finally got released in Nov 2020 after a long wait. While the Libre Pro has relatively been a lot more affordable it still cannot compete with the edge that a CGM provides; UNLESS you pair it with MiaoMiao!



MiaoMiao is a smart reader that sits on top of the Libre sensor and turns it into a continuous glucose monitor, sending your blood sugars to your phone or watch every 5 minutes. It comes with a charging cable, a few strips of adhesive stickers, a smart band (works as an alternative to the adhesive).


Setup


Setting up the Miaomiao is pretty straight forward. The most popular apps to use with it are Tomato (iOS and Android), xDrip+(Android) and xDrip4iOS. For fellow Indians, Libre Pro + Miaomiao combination works ONLY with the Tomato app.


Before setting it up, ensure you plug it in charging and charge it fully the first time until the blinking blue light turns a constant green. The following are the steps to get started with the Tomato app:

  1. Place the Miaomiao reader on your activated Libre/Libre Pro sensor (using adhesive sticker or the band)

  2. Ensure that your mobile bluetooth is enabled

  3. Open the Tomato app and go to My Devices in the menu

  4. Click on Bind Miaomiao, then ‘Next’ twice

  5. It’ll scan for your reader and once it shows up in the list, click on it. You’re done!




User Experience


Having used the Miaomiao for almost an year, my experience overall has been a pleasant one apart from a few pain points that I’ll point out. Being very active, I often do crossfit workouts, long runs and cycle rides and these are the times where the USP of Miaomiao shines: avoiding the need to take a pause from my activities to scan my sensor for reading my blood glucose levels. A simple glance at my watch tells me how my levels are doing and if I should be taking any action. For many people with type 1 diabetes, the concern of having yet another device on their body is one of the major factors that hold them back from opting for it. If you’re one of those, then you have nothing to worry. MM is literally weightless in the sense that you won’t be able to tell without looking whether you are wearing it or not! Tomato app lets you calibrate your sensor with glucometer readings which ensures that the MM readings stay fairly accurate with minimal deviation. The occasional connection drops that happens when you get outside the bluetooth range of the phone takes no time to mend once you’re back in range. However after a while like any electronic device the battery of the reader starts deteriorating. This brings me to the first pain point: After a few months, the reader’s battery won’t last the whole 14 days that it ideally should on a single charge. However it can still be charged while applied on the sensor with the help of a power bank so it’s bearable I guess? There were a few times where updating the android version caused unnecessary troubles of app crashes since the developers of Tomato take a while to release app updates. So it’s highly advised to not update your smartphone’s OS unless you’re sure the newer version supports a stable version of the app.


CGM in the Cloud: Nightscout


While Miaomiao works well with just the Tomato app if you need to get the readings on your phone, connecting it to Nightscout makes life even more convenient.

Nightscout (CGM in the Cloud) is an open source, DIY project that allows real time access to a CGM data via personal website, smartwatch viewers, or apps and widgets available for smartphones.


Setting it up can be a bit too much for not-so-tech-savvy people but there are quite a few videos on Youtube like this (22:00 onwards) that you can refer to and follow the instructions.



Having a Nightscout account makes it very easy to get the blood glucose data accessible on your wrist. Garmin, Apple and Android watches have Nightscout integration capabilities. For Garmin you can search for Nightscout in the Connect IQ app to go through the various watchfaces, datafields and apps. My personal favourite watchfaces are Gearmin 2 ($4.99) and NightscoutWatch2 (Free). Once you install these watchfaces, you’ll need to open the watchface settings in the Connect IQ app and update your Nightscout URL in the concerned field.




Apart from this, another advantage of using Nightscout is that with it now you can analyse your glucose level patterns during various activities. There are various Nightscout datafields available in the ConnectIQ store that not only display the glucose levels during the activity but also export the blood sugar trend to the activity file alongwith the usual activity data (HR trend,etc). This enables you to observe and understand patterns in the blood glucose levels during exercises and workout of different intensities, allowing you to make better decisions w.r.t. to your diabetes management.



Another great app that I mention to people using Nightscout is Sugarmate. It is available on macOS, iOS and iPadOS and has one of the cleanest and the most aesthetic UI for any CGM app. It is a great tool to analyse your data and get the most out of the CGM. It has a really cool option that let’s you create your own customised Siri shortcut. You can then basically ask Siri using the designated keyphrase for your blood sugar readings and it tells you the last updated reading!




While Nightscout helps make data available on the go, Miaomiao does a fantastic job getting the data to Nightscout with minimum interruption. For anyone using Libre or Libre Pro sensors, I’ll highly recommend getting this amazing piece of technology that makes a huge difference in your diabetes management.


Price: €149 (~ ₹13500) + custom duties

Link to buy: Here ($10 discount)

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