Terahertz (THz) metamaterial-based reflection spectroscopy is proposed for label-free sensing of living cells by a self-referenced method. When sensing the living Madin-Darby canine kidney cell monolayer and phosphate buffered saline solution, self-referenced signals showed significant differences in peak intensity because of inherent discrepancy in the imaginary part of their complex refractive indices, as confirmed by 3D-FDTD simulations. The resonance peak intensity was unaffected by cell monolayer thickness variation, demonstrating feasibility for sensing various cells. Simulations and experiments showed that saponin-induced changes in cell permeability could be monitored in real-time. The self-referenced signal was linearly dependent on the adherent cell density, illustrating a label-free in situ THz metamaterial-based cell sensor.