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.”
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.
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.
Well I mean you can disable battery optimizations easily on Pixel. Not really Google’s fault for what other OEMs do.
In fact, apps that require running in the background will ask if they can disable battery optimization on first launch, and all you have to do is tap “yes”.
Yeah, that’s kind of my point.
On the other hand, as mentioned above, including that request is regulated by Google Play and it will trigger a manual review process. It’s possible, yes. And Google is upfront about it.
But it’s still just removing app specific battery policies. It doesn’t stop the device from sleeping itself etc. Disabling these battery optimizations drastically expands where, when, and how often you can run. But it’s not as open ended as Android was 10 years ago. Many of the APIs and system behaviors have changed since then. This gets you like halfway back though. But still only halfway.
On the other hand, iOS is super restrictive and a massive pain in the ass. It’s not surprising the OP mentions Android supporting these cases better.
Google are pretty strict about background operating these days… you don’t get on the play store with that permission without a manual review and they want a evidence that it’s necessary. OTOH they’re upfront about it - you can get the review during the open testing stage, and it’s valid for all versions.
Apple wait until you try to release, reject the app then ask for justification, which delays release and is a general PITA (although I find the apple system pretty much a test of patience anyway… it all depends who you get, and whether they actually read any of the notes you give them).
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.
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
Freestyle libre still works on Android 14 beta, but funny enough bluetooth syncing for One Touch meters is broken.
You’d think the amount of money these companies get for the most common disease in the world, they’d be more competent.
I’d expect the phone manufacturers to create stable APIs for these use cases, instead of sabotaging the developes. I’m not even a diabetic, but the way android is fighting against the background processes makes the phone less and less usable with every update.
To be fair, the underlying phone operating systems, are moving target.
And as a critical medical device, they have to make sure it works in all circumstances for all patients, so somebody doesn’t miss a hypo or hyper alert. Even if they’re running ancient Android
I think you’re mistaken, because the app that’s broken, is One Touch, which just syncs your results to your phone, to allow your doctor to view them. It doesn’t notify you of highs or lows.
The freestyle libre 2/3 do, and they aren’t broken on Android 14.
So it’s just straight up incompetence.
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.
Why didn’t they warn people sooner? iOS 17 has been in beta for months. This seems more like incompetency on their side.
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.
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.
Like so many parts of the health care industry in the US, people like to make money off of diabetes not invest in solutions.
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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.
True but it’s also on the doctor, pharmacist, and especially the vendor to communicate it to patients. Patients aren’t sysadmins and can’t be expected to know what sysadmins do.
That said, it’s also on the app developer to make sure their app works on release day. And that’s especially true for critical apps.
Looking into this a bit more, it looks like both of the use cases they’re concerned about are pretty edgecase-y.
They’re worried about users not getting glucose notifications. And the user has to intentionally turn off notifications in a settings panel for one use case, and for the other use case, a caregiver must intentionally opt into a hidden accessibility mode that is literally designed to turn a smart phone into a dumb phone.
This smells like the Abbott legal team is being overly cautious.
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.
Good thing they are on it so quickly. It’s not like they had several months of betas to test on or anything.
Right? That’s like exactly what the betas are for.
Leave it to big pharma to not do that though because it would have cost more money, and they’ll just pass the blame.
Damn really goes against their latest apple event commercial saying “buy Apple or die” with their safety stuff.
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