I currently have a Medtronic Minimed CGMS purchased in October, 2008. At best I have found it to be erratic, always painful, and basically not a good fit for me. I tried to get a Navigator in 2009 and was denied because of my good A1c, no ER visits, and the fact that I had the Medtronic system. Because the Navigator went in the tank shortly after that, I consider myself lucky that I didn’t get the system.
I have decided to try to get a Dexcom now and know that I will initially be denied and will have to appeal. ( My Medtronic system was purchased under a previous, more generous insurance plan and I have my work cut out for me under my current plan.) I’d love to hear some of the things that you have used to justify the purchase of CGMS, especially the Dexcom system. I’d had a few frightening lows lately that remind me that I am safer using CGMS than I am without it. But I can’t see trying to get a new Medtronic transmitter because the sensors result in huge bruises and the BG readings are no better than rolling a dice.
I’d appreciate any help you could give me. I know all the message boards show a lot more customer satisfaction with Dexcom. Are there any studies proving this or showing more accuracy with Dexcom? Any good jargon for justifying CGM?
I know nothing about the Dexcom, other than what I read today or last night - (sorry, can’t remember where), which is that the sensors are being sent to China for production.
However, I started the Guardian a month ago this past Saturday. So far, I’ve not had any issues with pain, except for one time. I had to pull that sensor, the area was getting red on me, after about 7 hours. This issue was my error. I wasn’t paying any attention to how I inserted, and I believe it was less than 45*, I did have a small amount of bleeding with this one.
After your other thread, I started putting mine in the same area as you did yours. What I changed was the angle of insertion. I’m going in at 60* - 65*, and I don’t feel anything but a slight pinch, no bleeding at this angle. Far fewer weak signals as well.
Mine has been pretty accurate, except for 6 times, when it was like 53% difference from SG and BG once, and 40 something% another time. They were able to see how many times in Carelink. We tested the transmitter today, and it was fine. They are shipping overnight, a new receiver, though. Another thing, I had a lag time of 58 minutes for a couple of times. I’m having some minor (?) heart issues, with my electrolytes being out of whack, so I don’t know if this had a bearing on it or not. Medtronic doesn’t think that would affect the lag time or other, though.
Maybe if you went in at 60* to 65* angle, it might work better for you? You know with the navi, I went in at 90*. So I figured the deeper the angle of insertion, the better it would work.
I’m sorry you are having so many difficulties with yours, especially with those lows.
Oh, one more thing, where I’m inserting, is about 2 inches below the breast line, but in mid center of upper abdomen. I also stand up for insertion, during exhalation.
Trisha–I’ve been using this for several years and believe me, I’ve tried every trick in the book. I am way too thin to go in consistently at a steeper angle and I could never insert a sensor above the waistline. I don’t have as much fat there as the sensor is long. I have tried the steeper angle (that suggestion has been around for years) and I don’t get better results–just more bruising and pain.
This morning is going to help my argument, I think. I woke up at 5:00 feeling slightly off and tested BG at 40. I figured I should start using CGMS again because it’s just getting too dangerous to have these lows. I inserted a sensor on my belly and immediately had a blood gusher. I grabbed my camera and took photos with the bloody tissue and sensor. Medtronic says not to continue to use a sensor when you have this much bleeding. My trainer is of the opinion that sometime the bloodiest sensors work the best. Whatever. I’ve kept the sensor in and will watch and record closely how it goes.
One of the biggest problems I’ve had through the years is in the early days of a sensor, especially the first day calibrating. I will be at a stable, good BG of say 100. I calibrate and within 30 minutes the sensor starts reading in the high 200’s. Having not eaten or anything, I check my BG on my meter and it is still at about 100, so obviously stable. I try to wait it out and sometimes the sensor finally comes back down after waiting 3-4 hours. By then it’s time to calibrate. The next calibration will send it soaring again. I usually restart the sensor and sometimes then it works okay and sometimes it doesn’t. I usually insert my sensor the night before starting it in the morning so that it has had at least 10 hours to “get wet”.
Medtronic has really had no solutions for this problem although it’s documented several times with them. My transmitter tests out fine although the last time I spoke with them, they indicated it might be worth a try replacing it. I just can’t see putting any more money into this system, especially because of the pain and bleeding I get. That’s why I’ve decided to pursue Dexcom. There is no doubt that the Dexcom sensors are smaller and more comfortable. Most people moving to Dexcom from Medtronic seem to find it to be much more accurate. So I’m going for it.
I’m glad the Guardian is working well for you and hope it continues to do so.
Hi Lathump, I think that you will be very happy with Dexcom. You know how much we loved the Navigator, but the Dex is actually more accurate for Melissa and less intrusive in our daily lives. We knew it within a few days of the trial. We don’t trust it completely the first day, but after that it is usually very accurate. When I download it I can see just how accurate it has been on the charts. The bg’s are red dots and they almost always line right up with the cgm lines. Any that don’t are easily fixed and the line follows the red dots after that. We get at least 10 days out of each sensor and to restart them you only have to press a couple of buttons, no disturbing the site.
Emphasize the lows that go undetected at night, and that you no longer feel your lows and how dangerous that could be.
I know you’ve been happy with Dexcom and I’m glad it’s still going well for Melissa. I’m really going to work on my documentation to get the Dexcom approved. Right now with my insurance, they continue to pay for my Minimed sensors although they still consider me ineligible to get a CGMS. I would actually pay out of pocket for the starter kit for Dexcom if I knew they would pay for sensors. But that’s too risky to do because I suspect they wouldn’t because I changed brands.
I ended up taking out this morning’s bloody sensor. Too painful and after more gushing, I’m left with a hard lump under the skin. This disease is not for the faint of heart…
No gushers ever here with Dexcom, we had plenty of them with Navigator. I think that if I were you I would try to see if the supply company would send you the Dex sensors in place of the Minimed with your script first. Get the doc to write two different scripts and try to have the sensor one filled first. These insurance companies really don’t seem to pay attention to brands, they don’t even really know what it is! You could also call Dexcom and tell them the story and see what they can do. Tell them that you don’t want to buy the system until you are sure that they will pay for the sensors. Tell them that you would send it back within the 30 days otherwise, so they should want to work with you to avoid that happening.
I know that you have been trying it for a long time, but was sure hoping it would work. That’s a great idea, using the camera! If I remember correctly, Kelly used her camera for the same purpose. I wonder if Medtronic, would give you something in writing, to help the cause?
If the insurance gives you a hassle, fight it tooth and nail. It took me 9 months to get the navi. I didn’t have to fight it this time - given the situation with Abbott, and it was out of warranty.
I wouldn’t put any more money into it either then. I had gushers with the navi, so I know how you feel. It seems to be like everything else with 'betes, it is all different for each of us.
Do try Mary’s suggestion for the sensors. The product NDC code is the same as for all the other sensors, so maybe the insurance would pay for them. There is not that much difference, in the price of Dexcom and MM sensors. ( I did check out the Dex first, but my supplier wouldn’t do it, even though insurance would. My then supplier, was dropping insurances right and left.)
I do hope this gets worked out for you, and very quickly. One other thought…I think you mentioned, that you had to have help, with some of the last hypos. Make note of that, even if it was not outside assist. Any help needed, seems to count.
Please let us know how this turns out for you. Keeping fingers and toes crossed. (((( HUGS ))))
I would get a copy of your full insurance policy…usually it will tell you exactly when cgms is determined to be medically necessary. I have seen/heard of several policies where they want to see multiple lows under 50 as the standard and possibly hypoglycemic unawareness.
We were on MM cgms for 3 years, so I understand totally the problems you describe. We love our Dex. No pain, no lost signals, no erratic readings. For us it’s like night and day - no kidding.
I like my Dexcom a lot better than the Navigator also - I am crossing my fingers that I get more sensors and it is going to be a fight this time. My lows & gastroparesis are my reasons. Sue posted in the Dexcom group & maybe you can get some tips here.
I think your best bet might actually be to start with the Dexcom people? I’ve always had a lot of assistance from the MiniMed people during my pump and CGM experiences and it seems like they’ve done most of the work w/ the insurance people, coordinating forms between the doc and the insurer, etc.?
When I was denied the Navigator, I was given a list of the qualifications for getting CGMS under my insurance plan. The first two criteria are easy: Patient has Type 1 diabetes and uses an insulin pump. It’s the 3rd criteria where I struggle: Adequate control is not achieved despite frequent blood sugar checks. This is shown in the medical records by at least one of the following: a) hypoglycemic unawareness as shown by seizures or loss of consciousness, b) nocturnal hypoglycemia, c) unexplained wide ranges in blood sugar over time, or d) hemoglobin A1C is above goal and not consistent with fingerstick patterns.
I have almost total hypo unawareness, but I have not lost consciousness or had to go to the ER ever since starting the pump many years ago. I think the nocturnal hypoglycemia will be my best bet, having woken up this morning at BG of 40. I have a great A1C and my fingersticks probably match my A1C. I’m extremely insulin sensitive and like most people with Type 1, I live on a tightrope where minuscule changes in insulin, exercise, or who knows what result in BG’s in the 40’s and 50’s or well above 200.
I am really excited at the prospect of using the Dex. If I thought that the new Minimed Enlite sensors would hit the USA soon, I’d maybe try to wait for them. But I can’t wait anymore.
I called my insurance late this afternoon and the representative I spoke with was very helpful. Rather than put in a claim and have it denied, he is going to have someone from the Appeals department call me tomorrow or Friday and discuss ahead of time what I will need to prove to be covered.
I downloaded my pump today and from May 15 to May 25, I had 18 readings in the 50’s and 6 readings in the 40’s. I had only 1 day that I did not have a reading under 60. I’ve been reducing my basals and boluses like crazy, but I’m so insulin sensitive that I’m still going low a lot. So hopefully I can get this to justify the Dexcom.
The only problem I anticipate with the Dexcom is where to put another controller. Right now my pockets are full with a Revel pump, a phone, glucose tabs, and car keys. I hate things around my waist, so don’t think I could stand a spibelt. But I hope that I have the chance to be creative to find a solution. Obviously if I get the Dexcom, it is likely that my next pump will be an Animas assuming that the combination will finally come to market. My pump warranty runs out in 10/2012.
Kelly-Thanks for the link. It looks as though Sue still hasn’t gotten a decision. I just hate the idea of technology being out there that can help us, but then being denied the ability to use it. Hope she gets approved.
It sounds as though Dexcom hasn’t been very helpful for some people. I think that they just don’t have enough staff. I have actually been a very happy Medtronic pumper and would happily stay with them if I could get access to the new Enlite sensor. I think it will be the cure for my current problems (less painful and better accuracy), but unfortunately I think it will be a long time before we see it in the USA. I think the Revel is the best pump out there, but I know that if I end up with Dexcom, I’ll probably end up leaving Medtronic with my next pump. Do you hear that, Medtronic? Come on, FDA, let us get the Enlite sensors here!
I think you have a strong case, especially if many of your lows happened in the night - or heck you could be napping during the day too when those lows occurred
I hope you don’t have to jump through too many hoops.
I have only once had a kidney test out of range and that was an isolated test over 10 years ago.
I’ve often wondered if I’m one of those Type 1’s who produces insulin. I’ve never had a c-peptide test because they weren’t around when I was diagnosed in 1976. On the other hand, if I have a bad infusion set, I have ketones and am sick within 3-4 hours. I think I’m just incredibly insulin and carb sensitive.
It is possible, that you could still be producing a little bit. Both Richard and Joan, were in that 50 year Joslin study, and Joan still does produce a tiny bit, sometimes. Not sure about Richard though. I don’t remember the last part of his name -it has three numbers. They didn’t have the C-Peptide when I was DX’d either. Darn, we didn’t even have meters, till a couple years later.
I’m glad to know that your kidneys are probably ok.
Either way, the whole kit and kaboodle stinks, doesn’t it?!
I wish you all the best, Lathump. You certainly deserve it.
The studies I have seen have found no significant difference in accuracy so I wouldn’t try that argument. I think the big difference with Dexcom is comfort and not accuracy - the Medtronic has a larger needle and more intimidating insertion. BUT since you already own a Medtronic, you would be better waiting for the new Medtronic Enlite which has been released in Europe. LINK HERE It should be similar in comfort to the Dexcom. I don’t know when it will be released in the US, but since you’ve been waiting for two years it won’t hurt to wait a bit longer. You should call Medtronic to ask when it will be available in the US - I couldn’t get a date when I asked last summer but maybe they know more since it is now available in Europe.
