Hi there! I have two kids who were both diagnosed with T1D in the past two years. My kids are fairly young - 7 and 10 - and we have so far been getting by with a glucose meter and insulin pens (Humalog and Lantus). We have just ordered our first CGM for our son (our daughter does not want one right now) from Dexcom - we’re getting the G5 - and it should arrive any day! We are so excited because I think this will really help manage his sugar better - his last two HA1cs were in the 9 range so we definitely need to improve!
I had expected that there would be some type of training provided by Dexcom, but apparently they just ship the CGM and then send info on video tutorials and a number to their help line if needed. What has your experience been with getting started with a CGM? Any advice for first timers? Although I am generally fairly handy with all things medical, I do have some concerns about trying to apply the sensor for the first time without any training or assistance. Do you recommend that I seek assistance from our diabetes educator the first time around?
Youtube has some good videos. I’d get skintac or some kind of adhesive to help it stay on. I don’t think you need an educator, but if it makes you feel more comfortable you can go that route. Hope it works out well for you!
There may be a local rep or trainer in your area to whom your doctor can refer you. I had the option of doing a Skype session to do the first insertion but didn’t want to wait to schedule it. I was advised by the pharmacy rep I worked with (who uses one) to stand up to place it on my abdomen, be sure to inspect for any tiny blood vessels on the spot I selected, and to depress the plunger swiftly to minimize pain. Otherwise I read the instructions, manual, and tutorials and proceeded with a bit of anxiety and a lot of excitement!
The abdomen is the prescribed location for the device but many of us use back of arms, “love handles”, and even inner thigh and calf. I really like the side/back of my arms. Whatever location your son prefers needs to have enough fat in which to insert the sensor. Also, there are a variety of other tapes to place over and beyond the edges of the Dexcom tape to keep it in place, also adhesives and adhesive removers and members have discussed pros-and-cons a lot on this site.
I watched Dexcom’s online training videos even before my first one arrived. As it turned out, my insurance made me do a 1-week trial with my endo before approving the Dexcom, so my actual first insertion was done by a technician in my endo’s office. Funny thing, though, was – I actually had to help the trainer get things right!! Those videos and other documentation from Dexcom are great.
I hope it works out well for you. For me, it’s the most useful tool in my diabetes arsenal!
Some parents use a numbing cream for the Dex insertion on young children and that is not a bad idea IMO. I have used Dexcom since 2011 or early 2012. I have never had to remove a sensor due to pain. However every insertion hurts when the needle goes in. I know it is quick and it’s not traumatic for me, but if I were a kid I’d be afraid of it.
It won’t be long until there is a new Dexcom inserter. It should be less complicated and less painful.
I did not do training with Dexcom, but I had been using a Medtronic CGM for several years. If you mess up an insertion, Dexcom will usually replace the sensor for you. Even now I have to pay attention to what I am doing.
We asked the Dexcom tech in our area to do the first insertion with us. We looked at the training videos before the first time, the the first couple of times after that. You often pick up more tips from the videos after several times viewing them.
My suggestions based on our experience so far:
view the videos several times, every time you insert for the first month or so.
always clean with alcohol, then wait till the alcohol is dry
always use Skin-Tac. What I learned on the forums here was that (a) you should wait until the Skin-Tac has slightly dried before applying the Dexcom patch (it should be rather tacky), and (b) several layers of Skin-Tac are better than one. I found both assertions to be true in our case. It takes us about 5 minutes to apply 3 layers of Skin-Tac, each time letting it dry some.
Before you take off the patch’s backing, straighten it out as well as you can so that the patch is nice and flat. It makes it easier to apply. Once the backing is off, everything is harder:-)
after you have applied the Dexcom patch, rub on it strongly with your fingers for about 2 minutes after applying, to make it stick better. The heat of the rubbing makes for better adhesion. Use alcohol pads to clean your fingers (they quickly get sticky).
It helps with the pain if you pinch the skin and flesh layer over the muscles before inserting the sensor, so that there is more thickness under the sensor. My son is really skinny, so it is actually hard to find flesh to pinch:-)
Finally, we found the abdomen not to be a good place for us: my son participates in many sports, and the abdomen did not work well for him. We use the thighs, and carefully rotate insertion sites (we use about 10 sites to rotate through). FYI, my son is 12, and inserts his CGM himself: he has had a CGM for about 3 months, and has done it from day 1 - I am really pleased with that because it makes him more independant. He does need some help in being meticulous about the procedure though.
When you remove it, it really helps to use adhesive remover wipes.
Yep I agree with many of the others, watch videos and read the info dexcom provides and you will be fine. I didn’t have any training. Just remember 2 clicks down, 2 clicks up! I also like the back of the arms best, less chance of pain going in (usually don’t feel it), better accuracy, and less skin irritation for me anyway. Skin tac gives me a rash so I use opsite flexifix cut into a donut shape. There’s lots of great info here about dexcom, good luck:)
Suzanne, forgot to mention: my son’s CGM made a huge difference in his control. Thanks to his Dexcom (also a G5), he is maintaining a 5.xx% A1C, and stays in his control range about 85-90% of the time. I am looking at his Clarity records right now, and his last two days look like a normal’s BG (although he had to wake up both days in the middle of the night - the curve does not show the effort…). Of course, that is not true every day.
We got him an iPhone SE so he can use it as a receiver.
I watched Diabetic Danica videos to learn to insert mine. I found her videos most informative.
I hope you find the Dexcom to be as beneficial for your child, as I have found it for me. As for ways to hold it on, you might want to look into GifsGrips. They have fun designs that kids love. I am wearing a wonderful dinosaur. Of course, I have puppy paws in the closet. And yes I am 59, my grandchildren love the style. lol
Wow, thank you all so much for your input and encouragement! I have looked at the links you’ve shared and have also stumbled across some others - what a tremendous help! I feel better already after watching the videos and will also watch them with my son, Jacob. I think he’ll be interested to see them. He is a trooper and never complains, and does all his own shots (with us double-checking the dose to make sure it’s dialed properly). Having seen the videos and read your advice, I’m sure we can handle this without help from the diabetes educator.
I have also looked at your suggestions for adhesives. For now I have ordered some Flexifilm and Dextape and we’ll see how those work. I will also keep in mind the SkinTac and GifsGrips, as those sound like good solutions as well. His skin is fairly sensitive so we might have to try a few things to find the right option. Jacob is fairly rough with everything and I expect we’ll need something to help hold on the sensor if we want it to last a week or longer! I’ll let him choose the site, although I’m thinking the arm works best. We certainly don’t have to worry about finding a spot with enough fat as he is fairly “squeezable”! Having said that, I think his arm would work best - his tummy might hurt the least (and is where he likes to do his shots) but might also get in the way. West of Pecos - the thighs are an interesting option, and something to keep in mind. I hope we get the same kind of HA1c improvement that your son has seen - I’d be thrilled to be even in the 7 range!! 5.xx% is amazing!
I feel much better having heard your suggestions and cannot thank you all enough for your help! I’ll let you know how it goes - I just checked the tracking for our Dexcom package (and have been doing so a little bit obsessively!) and it should arrive by Saturday. Can’t wait to get started! Thanks again!
You should also ask your provider if they or their Certified Diabetes Educator can give you a lesson, and help with your first insertion. I know the clinics in our area do this as a free service to their patients.
One of the most important things if you want to optimize the accuracy of your Dexcom CGM is to calibrate wisely. I will post a copy of my calibration tips once I get back to my computer.
I will look forward to this, @rgcainmd. We use some of our own rules for calibrating (such as no more than 3x per day unless big drift, etc.) but we are not always successful.
I look forward to this too, @rgcainmd - being new to this, I obviously have no experience with calibrating. My only understanding right now (having not researched this at all) is that we will do the first calibration 2 hours after inserting the sensor, and then every 12 hours after that. However, I’m sure there are nuances when it comes to calibration that I don’t yet appreciate. There’s alot to learn I’m sure!
Any additional information you could provide would be wonderful - thanks!
There are “good” and “not-so-good” ways to calibrate. The following is what has worked well for my daughter:
1. After starting a new sensor (or re-starting one that’s still working at the 7-day mark), wait at least 10 minutes between the first two calibrations. Calibrate at least two hours after a meal or after treating a low BG.
2. Although it can be very tempting, do not calibrate more than twice daily and only when requested to do so. *Exception: I throw in one to two extra calibrations during the first 12 hours of a new sensor if the numbers are a little wonky.
**Sometimes I get a little calibration-happy when my daughter’s sensor is getting a little “ripe”, i.e. over 15 plus days old, if the Dexcom readings seem significantly wonky (at which point, she’d be better off if I just bit the bullet and put in a new sensor.)
3. CALIBRATE ONLY WHEN THE DIRECTIONAL ARROW IS HORIZONTAL. I repeat: CALIBRATE ONLY WHEN THE DIRECTIONAL ARROW IS HORIZONTAL. Trust me on this! Your sensor continues to function after the big red blood drop screams at you to calibrate right now. Tell it to hold its horses and you’ll calibrate when you’re good and ready (when the directional arrow mellows out and becomes horizontal.) No ones Dexcom has stopped working or imploded, creating a black hole that engulfed the universe, because they didn’t calibrate the instant the Red Drop of Dexcom appeared.
4. Try to avoid calibrating when BG is below 80 or over 200. Correct and get your BG within this range (80 - 200) and then calibrate ONCE THE DIRECTIONAL ARROW IS HORIZONTAL.
5. Learn to question the accuracy of your BG meter as much as, if not more than, your Dexcom. Personally, I trust the Dexcom more often than I trust the BG meter. But my daughter’s Type 1 vibes seem to resonate exceptionally well with those of her Dexcom. I often think that my daughter and her Dexcom are as one.
6. Stay well hydrated. I believe this helps produce more interstitial fluid that more accurately reflects BG levels.
7. Learn to accept the fact that the lag time after treating a low BG is going to be longer than you’d like. Keep this in mind so you don’t over-treat lows.
Good luck! In short order, you will wonder how you lived without this miracle of diabetes technology.
