Inserting Sensors

I was just wondering how you all felt about the insertion process. I’m still trying to decide to go with a cgm. I had a lot of problems inserting my minimed infusion sets. I’m currently using the omnipod wich the insertion process is way easy. So I was just wanting to know how you would scale the Dexcom’s insertion. Thanks for any insight!

I don’t have any issues with Dex’s insertion but I will admit that it takes some getting used to just like anything.
Its a pretty simple process - slap on skin, remove guard, push down, pull up and unhook! :slight_smile:
I never had issues with the insertion it was more the attaching the transmitter that was difficult for me in the beginning.

Actually, I think it was just last week that we finally figured out “the trick” for removing the piece that helps snap the transmitter into place.

Honestly though, this wasn’t even a thought when deciding on a CGMS. It was all about accuracy and convenience and for me Dex is much more accurate than MM and I like that it has a receiver separate from my pump :slight_smile:

Ditto to Stacey’s comments. Insertion of the Dexcom is easy after you’ve done it a couple times. My Dexcom has definitely helped my diabetes and I love having a separate receiver for the data (especially when I’m on the bike).

I have to disagree with the others who have responded to this. Folks, please keep in mind that Jess said she had problems inserting minimed infusion sets. You have to admit that inserting the Dex sensors is WAY worse than inserting a MM infusion set (assuming you’re using one of the the MM serter devices to help with infusion set insertion). I have no problem at all with my MM infusion sets, even when I do them by hand. The Dexcom thing, however, is much harder for me. I’ve been doing it for over 6 months, so have plenty of practice and I still have a hard time. There’s no button you can push or anything to help it go quickly. You have to manually push the needle into your skin and for some reason, this one is, for me at least, much more painful than infusion set or other needly things I’ve had to poke myself with. I do agree with the others that I would be hesitant to choose a CGM based on the sensor insertion. There are so many other more important things to consider.

Kerri Sparling did a really good video showing herself (with help of her new hubby) inserting a Dexcom sensor (due to putting sensor in back of body).

Here is the link…
http://www.youtube.com/watch?v=nb-3TeVS5MQ

I have yet to put a sensor above my butt or in the arm, haven’t had the right moment to borrow my Hubby to put a sensor in one of those spots and I’m afraid of messing up a sensor being put in. After the first time putting a sensor in, I got it down pat. The first time I felt really unsure of myself but then after the one time during training it went smoothly.

Another thing about the Dexcom sensor is that the needle is known for being smaller than the other brands and Dexcom’s needle is between 1/4" and 1/2" (sorry I need to go measure again). The needle reminds me of a skinny skinny frail bendable wire (the website says it is the width of 3 hairstrands).

Thanks so much for all of your replies!! The video definitly helped after watching it I feel like I could handle that. There is another one done by 1happydiabetic too. Thanks again!

Does anyone know what kind of adhesive Kerri Sparling is referring to on her video? It sure was helpful to see that clip. Thanks for supplying the link.

I’m not sure but I’m guessing that Kerri used I.V. Prep by “smith&nephew” - in an orange packaging. If you get monthly supplies directly from Minimed Medtronic for an insulin pump, it’s the box of I.V. Preps they give you. I’m just guessing this as Kerri also wears a Medtronic insulin pump (I wear a Medtronic Paradigm insulin pump). Kerri Sparling has a website www.sixuntilme.com

I haven’t used the I.V. Prep yet but I notice that if I put a sensor far enough away from where the waistband of skirts and pants normally land on me, the sensor stays stuck pretty well. It’s only when the edges of a sensor sticky part hits my waistband that I start to get the rippling or stickiness becoming unstuck (I hope that makes sense! LOL!).

Almost certainly NOT I.V. Prep.

Or, if Kerri is still using that product, (even though I’ve suggested something else, and I may have done that in a personal message), then she should switch. The same company makes another kind of wiping pad, far better for Sensors, in almost identical packaging. It’s called “Skin Prep”, and THAT’S the one you want.

The formula for “Skin Prep” seems pretty similar (a bit less alcohol; more Butyl Ester of PVM/MA Copolymer; Acetyl Tributlyl Citrate more or less replacing Triclosan; no water at all.) But after you put it on the effects are dramatically different.

I.V. Prep is labeled as an “Antisepctic Wipe”, while Skin Prep is labeled as a “Protective Wipe” for attaching taped appliances. Label Bullet items as follows:

  • Effective protection between tape and skin
  • Reduces risk of tape stripping
  • Helps tape, film, and appliance adhesion
  • Non-irritating
  • Reduces Friction

While "I.V. Prep: has:

  • For preparation of the skin prior to injection or venipuncture
  • contains 70% IPA.

My Dexcom Sensors stay put for almost two weeks, and I’m a VERY active person. Before I found this product, I’d be resorting to Mastisol to re-glue the failing edges after only 5-6 days… and I’d have do re-do the mastisol glue treatment every 2-3 days afterwards, building up nasty gunk, and getting high from the fumes. :((

Now I can use mastisol just once, usually around day 13, and it lasts for the entire remaining life of the Sensor (usually about 5, 6 days more.)

THIS is the one you want. For Dexcom Sensors, just wipe the entire area of where the Sensor pad will be attached; use a hair drayer on “low” to blow it completely dry; REPEAT; and then, after the second wiping is dry, put down the Sensor.

It’s a kind of good idea to fold the log sides of the Sensor pad upwards, so that the Sensor hits the skin before the edges of the pad do. Then, you roll your finger pressing towards the edges of the pad to keep it flat and un-kinked; and pressed in well. In order to get long Sensor life, with any brand of Sensor, you need to keep the wire motionless on your skin. When the pad fails and starts curling up at the long-side top or bottom edges, the stability of the wire position becomes compromised very fast.

Even though you see that there’s still considerable area of tight pad-to-skin contact between the Sensor mounting and the failing edge portion of the pad, the position of the mounting becomes microscopically much less stable. It slides around, dragging the wire in and out as it goes. That’s really bad for Sensor lifespan, especially Minimed: Minimed users who keep the wire motionless, and keep their BG’s low, can get more than a month of excellent results from a single Sensor. (If they’re “compatible” with Minimed, which I’m not, all my results sucked.) Dex and Abbott are less BG-dependent; Even though you control bGs well, the “background” consumption of reagent is pretty high in these Sensors, and they’ll run out of reagent in much less time. (No more than about 15 days Abbott, and no more than about 25 with Dex. They just “run out of gas”.)

WARNING: Although Dexcom’s wire has no sensitivity to the products, Minimed documentation tells people to avoid putting such stuff in the spot where the wire will puncture through. (They want you to leave a small, untreated “donut hole” for the wire to shoot through.) I imagine that proper use, letting it dry completely before even attaching the adhesive pad, would minimize any ill effects. But I don’t know-- my own little Minimed trial lasted only a few days, and ended long before I tried either one of these products.

Both boxes and foil pad wrappers are orange. But, on the pad wrappers, “Skin-Prep” has a green square above the orange rectangle on the left, while “I.V. Prep” has a blue square.

The Dexcom inserter LOOKS like a torture device from the Spanish Inquisition, but it works really great. None of the “weak spring did me wrong” problems which MM infusion set shooters often have.

On the other hand, the wire is VASTLY thinner and weaker than any infusion set (Teflon with insertion needle stil present, or steel.) About 1/20 times, even I somehow end up with a bent wire. Easily recognized when you take it out, and you WILL take it out early: a bent wire is uncomfortable and gives usually gives really bad readings. (If it didn’t last at least 4 days, bent wire = bent wire; almost anything else = blood poisoning.)

How nice? Well, I used to use a lidocaine cream for 40 minutes before shooting in my infusion sets. (And they’re high end ones, I’m just a whimpy whiner.) With Dexcom, I’ve never used anything. If you CONCENTRATE on the pain at your skin, instead of gigantic insertion device, you’ll realize with delight that it’s about as tough as a mosquito bite.

Except that mosquito bites itch afterwards, puff up and get all nasty. And did you ever notice how, once in a while, a mosquito bite actually DOES hurt?


I remove the guard first, you really need to PUSH the plunger down quite a ways before it springs. In both directions, you’ll want to push pretty firm; not ‘lunging’ at it, but moving with moderately high speed all the way through.

Now hints about the pull-up of the retract/disconnect ring: FIRST, remember to keep your thumb" down on the plunger, after shooting in, and don’t move it AT ALL until the pull-up is complete. This helps to keep the whole assembly motionless during the retraction of the needle and various locking steps which occur in the pull up. Remember: any motion by the Sensor within the skin, any any direction, after insertion, is bad for it.)

SECOND, be aware that the pull-up will have a two places where episodes of drag occur, each followed by a sudden “POP” after that work step is done. (The big one is the needle getting locked into it’s safety-retracted, never-coming-out-again position, the second is the ring itself locking in conjunction with the “Release from Sensor Housing” step, when only the two spring clips are left holding it in.) These “bumps” will cause unwanted motion, unless you pull up firm and even, fairly quickly.

The pull-up was designed to be a one-handed operation. (If you use two hands, you’ll end up tripping over yourself.) The final removal, though is best done two handed: use the “other” hand to actually hold and then take away the inserter assembly, while using thunb and index finger of your original hand to use move back down to the “spring” clips and squeeze them both open (press ridged parts at one end together, and it should spring opens the clips at the other end).

If something’s a bit stuck, go ahead and move your “second” hand down from the assembly to actually pull each side of the clip open-- while your fist hand doing the squeeze of the ridged clip ends.

THIRD, Now put in the transmitter, and rotate the Transmitter “Depressor-Thingy” to press it in under the clips. Be absolutely positive that both of the clipped corners are under the clips, you can use your other hand for “help” if one clip didn’t quite get it done using the depressor.

And FOURTH, proper removal of the “Depressor-Thingy”. (Stacey mentioned it earlier, but didn’t say exactly what to do.) Firmly hold the spring clips together with the thumb and a finger of one hand. But not the ridged ends, which OPENS the clips, but the actual CLIPPING ends holding them extra tight on the transmitter. With the other hand, you twist the “Depressor-Thingy” off from the Sensor housing. But, at the same time, you use your grip on the side clips, just below the “Depressor-Thingy”, to keep the housing and tape flat on your skin-- twist the clips and Sensor back towards direction, while twisting to break off the “Depressor-Thingy” in the opposite direction.

Use your grip on the Transmitter clips to create a balanced twisting force OPPOSITE of the twist you’re creating to break the clip, and the Sensor/Adhesive pad assembly doesn’t move at all. (Well, OK, just a tiny bit when the “Depressor-Thingy” breaks off.)

Complicated procedure. But after you’ve done it two or three times, it’s all obvious and automatic. The bottom line, from your original question goes like this:

“Rick, How do you rate Dexcom Sensor insertion?”
“Well, it’s a lot more difficult to floss my teeth. When I pull the floss back up and out, most of those pairs of teeth have a bit of pull, and my floss-wrapped fingers end up hurting A LOT more than more than the Dexcom insertions do!”

(Yes, I use waxed floss, it isn’t bad at all. But Dexcom hurts even LESS!)

My niece has used both. Just inserted one Dexcom sensor yesterday so we are not experts, but I can tell you there is no comparison. Dexcom was easy to insert and painless. (We did use EMLA just in case; however we had to insert Dex before EMLA took effect. We inserted Dex half hour after EMLA. I don’t believe the area was completely numb because skin was not white and it is supposed to take 45 minutes to take effect. It may have been partially numb). No problems. Piece of cake compared to Minimed. Dex Rep showed us the sensor wire and it is so fine, like a few hairs stuck together. Introducer needle is 26 guage, smallest insertion needle on the market. But it is still 26 gauge; not as fine as an insulin needle. I would numb area first just in case.

The key, which I maybe didn’t emphasize enough in the long post above: You want one FIRM, moderately quick motion through the entire process. Don’t shoot in first, then stop, then retract, then stop again at the needle lock, then start pulling up again, and then stop when the ring hits the top…

No. The push down, with your fingers already braced to pull the ring up, needs to follow right through into the pull-up steps, and you don’t stop until the very end. Smooth, FIRM.

Jan-- it’s not actually “EMLA”, is it? FDA hates those “witches brew” multi-active-ingredient concoctions. If she’s using EMLA, she should be switched to a lidocaine-only alternative.

FDA’s announcements focused on the lower “headroom”, before dangerous overdose, of the combined products (versus higher-concentration, MORE effective, single-ingredient products.) But we all use only tiny, nickel-sized spots-- not entire legs, as the laser hair removal death incidents did. So overdose isn’t the issue; the issue is allergy risk.

If she becomes allergic to both lidocaine AND prilocaine from the “constant, every 2nd or 3rd day” usage, then there’s no easy alternative for ER Docs (who can’t let you get all loopy on Nitrous during emergency treatment. Those few dentists who are willing to use NO2, all by itself, will charge and arm and a leg for doing so. So try to stick with just one active ingredient (lidocaine), don’t use both in a “chronic” way. Leave that Prilocaine in reserve, in case an allergy develops.

Your Endo never told you about this?

Rick, yes it is EMLA. So we should get the LMX-4 or 5, then? We initially used EMLA first nine months after she went on the pump when she was 8, and she had no problems with it. She stopped using EMLA after a few months and we no longer numb the area for site changes. We just put EMLA on for the Dexcom site change. I think we will want to continue to numb the area, although this kid had a chest tube put in without anesthesia (some problems after surgery) and the docs were amazed she did not even flinch, as they have seen grown men cry when this is done. Just until she gets used to Dex, we will numb.

Yes, that’s a good switch. LMX-4, LMX-5, and Topicaine all have formulas with higher safety. There may be lots of others, too , whose names I don’t know.