Dexcom G5 and Medicare- low alerts on Dexcom monitor

I have come to a major crossroads. After 8 years on a Medtronic pump and Enlite CGM, Medicare now dictates my choice of CGMs. I am leaning toward the t:Slim and Dexcom BUT NO apps allowed (Medicare does not approve the use of apps).

My question: I frequently trigger the “low alert” on my Medtronic pump/cgm. The vibration/beep will wake me or my husband up during the night to resolve the low. I understand t:Slim does not have a “low alert.” Does the Dexcom monitor have an audible or vibrating alert for lows?

u can adjust the “low” alert but not the 55 mg “Urgent Low” alert feature

Thanks, Dave. Is there an audible low alarm on the Dexcom receiver or only a visual alarm?

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audible. wakes us up when we go too high or too low and both are adjustable. also u can turn OFF the alarms (except URGENT LOW) , or make them vibrate only. These things are a lifesaver. Saved me from so many lows and highs, I can’t count! I set my high alarm for 150 most of the time. When active, low set at 75 and at night 65 or less.

@Buchsee

The Tandem t:slim X2 does have a low alert.
The user manual is online so you can read through it. Perhaps this may give you additional information to help you decide what is the best approach for you.

https://www.tandemdiabetes.com/docs/default-source/product-documents/t-slim-x2-insulin-pump/aw-1001943_b_user_guide_pump_tslimx2_wg5_final_web.pdf

EDIT: BTW - There is an update to the Tandem t:slim X2 expected this summer which will involve the cgm integration. Depending on your timeframe to make a decision, you could wait for the update to be released and see if that impacts your thoughts on this.

EDIT2: Both Dexcom and Tandem say that Medicare recipients are not supposed to integrate the Dexcom with the Tandem t:slim X2 pump. Aside from that fact that I don’t think they could easily see whether you do or don’t use the pump in integrated mode, I also do not believe this is actually what Medicare ruled on.
Medicare specifically said no SmartPhone usage - they did not say no pump usage. But you as the Medicare recipient would need to decide what you are comfortable with.

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I want to make a point here about Dexcom terminology since I think it can make our communication clearer.

Dexcom uses many different “alerts,” high, low, rise rate, fall rate, and out-of-range, for example.

But it only uses one “alarm.” The alarm term is only used in reference to falling through the 55 mg/dL line. The 55 alarm may not be disabled. It will only quiet once it is acknowledged by a receiver button push. The 55 alarm starts off as a vibration and will escalate to an audible one if not acknowledged.

I’ve never owned a Dexcom receiver denominated in mmol/L. I suspect that that low alarm is at 3 mmol/L.

@Terry4

It can be a bit more confusing depending on the device.

"CGM Fixed Low Alert " is what the “55” is called on the Tandem.

That’s unfortunate. It’s only a matter of semantics. They can use whatever word they want but using inconsistent terminology makes communicating about it harder. I wonder what term is being used by the G6 for the 55 alarm?

@Terry4
The G6 (from the Dexcom point of view) maintains the distinction as you have described. The wording cut-n-pasted from the Dexcom G6 User Manual:

Alarm or Alert?
While there are a variety of alerts, there’s just one alarm: the Urgent Low Alarm (alarm) at 55 mg/dL. The alarm can’t be changed or turned off with one exception. If you have an Android phone, and you turned on Total Silence or No Exceptions, you won’t get any alerts, including your Urgent Low.
Otherwise, as long as your display device is getting G6 readings and notifications, you’ll get your alarm.

The G6 integration with the Tandem is not expected until later this year. No specific timeframe announced yet (other than very general guidance about “this year”) but possibly Q3 and more likely Q4 (just my guess). Until that happens, we would not know how Tandem would refer to the G6 cgm events.

I wonder if the FDA noticed this cross-platform terminology inconsistency between the pure Dexcom environment and the Dexcom/Tandem application. I suppose it doesn’t matter if you only operate in one platform. It does make a difference in how we communicate here. I guess it’s one of those distinctions without a difference.

Yes it does, but it never wakes me up. You can set your low and high range and dex will also keep alerting you on that. The urgent low alert is at 55 and is automatic. I think the new tslim has everything decom in the pump. I’m not sure what alerts are on that, I have to wait until December to get one.

@Buchsee forgive me for chiming on, but… You could run.a.Tandem.pump.and.XDrip or a similar app on Apple that would give you the alarms you seek and not “violate” Medicare rules (that don’t make sense on so many levels).

yes it does.