No Trend Arrows? And Dexcom is ok with that?

Diabetes Technology Glucose Monitoring
1

Hi folks. Yesterday I spent all day fighting with my dex... It started in the morning with ??? and I tried to wait it out. Of course, I've only been using a cgm for a short time so am no expert. After 3 hours of ???, I called Dexcom. As I began talking to the CSR a value popped up on my dex so I thought problem solved right? Wrong.

The dex plotted several data points then went back to ???. After another hour I began to get values again but no trend arrows. Another call to Dexcom to see if there was something I could try or if it was best to just replace the sensor. This CSR told me there were no trend arrows because the dex could not caluculate it at that time but that was not a reason to remove the sensor. At the end of my work day, I called Dexcom one last time to tell them that I had wasted an entire day with no data from my dexcom. The person who answered the phone told me they would look into it and call me back in 10 minutes....no return phone call.

When I got home from work I just gave up and changed the sensor. Everything seems to be working fine now with the new sensor other than the values being slightly off. This morning I called Dexcom to let them know that nobody ever called me back and that I had wasted a sensor.

The CSR I talked to this time told me that sometimes there won't be trend arrows because the dex can't calculate it at that time. I said "this is normal for it to happen for hours??" and her response was yes. She went on to say that they normally will not replace a sensor for lack of trend arrows because "it happens". She did replace my sensor because she said the reason for the lack of trend arrows in my case probably had something to do with the ???.

This makes no sense to me that the documentation calls the dexcom a "trending tool" but if there are no trend arrows, they don't consider that a reason to change the sensor?? Do you follow that logic because I sure can't? Without the trend arrows, the dex is not fulfilling what it is designed to do is it?

When I said as much to the CSR, all she could say was "I know".

Anybody else have this happen?

2

Yes. It does happen. There is a glitch with the software package that is supposed to be fixed with the newer one (when that gets approved). I use my graph to tell if I'm going up or down. I teach how to graph to high school students so maybe it is easier for me to just "eyeball". I rarely get trend arrows on mine. When I do, it's the double ups or double downs.

3

This is an excellent report.

First off, I have seen both of these issues. The worst is the ???.

After months fighting some of the idiot crap; my sense has been that:

a) sometimes ones body and its liver can so bang the BG around so that Dexcom cannot follow. It gives up and assumes sensor bad. Sometimes that may be a bad sensor but lately I get many sensors back up.

My latest approach is to stop sensor and use fingerstick machine to watch BG and ensure it is moving slowly and stable - rising or failing.

If that is so, restart same sensor and wait for the damm 2 hours. Usually my sensor comes back up and works unless sensor has really gone bad. I have never had a sensor rrecover by just waiting. Their software really gets stuffed.

I find it best to stop sensor and check BG and then if reasonably stable - restart. I assume your sensor was under 12 days in age and better if in the 7 day first window.

I have seen when starting/restarting a sensor and if there is liver tubulence in the BG release, the startup routine of the dexcom chokes on that and flings out ???. I stop sensor and when it seems some stability returns; I restart sensor and wait the 2 hours. I have had great success in getting old/sensor in place back up without incidence and working well asuuming not at end of actual life - 7 days plus the extra - usually 5 days.

I would not worry about the arrows thing as I have seen that sometimes when the receiver due to interference from other sources, the arrows disappear and then return in a couple of minutes.

4

Thanks Emily. It makes me feel better to know I'm not alone with this. I appreciate the tip about watching the graph. That was the only thing keeping me sane for that time period. My only fear was wondering if the graph was ball park accurate but it did seem to track not too far off from my finger sticks. I think I tend to panic when something happens because this technology is still so new to me. Starting with a saline pump loaner this afternoon so more technology to fret about...I'm excited though.

5

Thanks jims for the great tips. I will definitely try the restart if it happens again. You guys are great. Being new to the dex it helps so much to have others with more experience to bounce things off of. I was talking with my CDE yesterday about the dex and she said "you know more than most diabetes professionals".... but I learned it all here, thanks to ya'll. Priceless.

6

To smileandnod:

Many special thanks for kind comments. When one starts out with this technology; it can honestly be harrowing and frightning.

If ones body is still relatively stable and not getting heart stopping swings in glucose from a nasty liver, generally things run reasonably.

Otherwise, keep the $20 cave man finger stick machine hotted up and ready to move in when things look sticky.

For me I need to keep my stinking liver caged out so I am always watching the BG as it heads down. I do not want my BP under 100 and as a big person, glucose can disappear fast. SO I am always watching when under 140.
When my liver kicks in, it rams my BG to 511 and then slides down to 278 and then I have to work it down from there. I could sure use a low level setting that I can alarm at 130 to 140 that would give me time to catch and stop a fast dropping BG. But no, some three degreed dumb bastard knew better.

Software upgrades - hell no. drop dead. Now thats a real stupid approach. WIth a proper regression testing group and strategy , doing that is safe and straighforward. Nope, some hero's have decided - nope.

Lastly, the user manual which to me looks like written by lawyers with socks in their mouth's or is that white house lawyers ( a whitehouse lawyer is a lawyer who can parse fly crap with boxing gloves on.)

For new people there really needs to be a guide for using the dexcom and how to cope with nasty situations and provide guidance on the best techniques to manage and interpret its results and operation.

I have been on this since January 2011 and it took me at leat 3 months to sort out the nonsense till I was reasonably comfortable with its operation and results.

Let me say before I wade into customer service, bless them for doing that but repeating back FDA bafflegab and excuses and apologies is no excuse for customer service. Their best help was getting me a a replacement sensor.

I worked for a high tech microprocessor high performance emulator test tools. Any time any engineer/customer called up our customer service, the customer's immediate response was - good grief - get us to an engineer fast - especially the guy who worked on/designed said emulator - they did not have time to answer 64,00 questions to solve problem.

No offense to customer service folks who honestly want to do their best and help, it is not possible to provide sufficient training and debug sheets to those folks on a new technology product where they can really help. Sloughing this off to the doctors/endos is even worse. They do not do that job, do not have the time and probably have less information on what I am doing and struggling with on a 24/7 day basis on my body and Dexcom.

Coupling a poorly communicating high tech company strangled with FDA red tape with the worlds worst case flat earth - non communicative "hold on target" professional associations( and humble appologies and thanks to all individual doctors and endo's working this technology as best they can.)
really makes it tough.

The idiots who limited the low level alarm at 100 max should be fired and that includes that other pack of heros at the FDA.

In fairness, today looking back, the technology of Dexcom really does help and meaureably improves the situation. Unfortunately it seems detailed training of suggested operating tactics - ie fighter pillot school seems necessary to get this technology settled in and working smoothly. It is not like buying a watch at your local shopp and strapping on and proceeding full tilt unhindered with your life.

7

I completely agree with you on the need for the low setting to adjust higher. I had a really scary low at work for the first time last week. Sitting at my desk concentrating and dex beeped because it hit the 80 setting and was still dropping. Confirmed with fingerstick then I immediately treated but it was continuing to drop fast. I drank an entire coke and tested again. Finger stick was 43 and dex was LOW. I was so scared I drank more coke and it finally stabilized. I've also had a couple of lows in the 40s one hour after a meal so I'm thinking my digestion has slowed or maybe it is something with my liver. I'm supposed to be going to a pump to help deal with those problems.

After that scare, I reset my low alarm to 100 but really wanted to set it to 120 only the dex wouldn't let me. At first I thought something was wrong with the dex because surely they would let you set it higher if you wanted right? Apparently not. The lows really scare me so I'm like you in that I really watch when it gets near 100.

I do like having the dex though because without it I feel even more vulnerable. Without that alarm I don't think I would have realized what was happening in time to help myself.

8

thank you for sharing details on your low and steps it took you to stop it.

My experience tracks nicely. I find that if BG sneaks down to 120, I am adding glucose tablets fast. Usually takes 8 tablets to get cut off ( assuming not too much free insulin floating around in blood)
I count em out in stacks of 4. I try to work 4 tablets over 15 minutes unless numbers dropping fast.
Also try and sneak in some caveman meter tests just to cross check dexcom in middle of firefight.

Caveman machine tests right after munching glucose tablets can see some super rich glucose packets in blood whiz by and caveman machine will snag. Body does not nicely evenly mix glucose from gut or liver and body just dumps out there and expects your heart to mix it all by bashing it around your body.

The arrows - usually my gut will only make a single vertical arrow. Usually if I see 2 arrows vertical - that is liver hammering me and does. Very rare to see gut glucose source wham 2 arrows vertical.

Once at 8, then I end up adding a single tablet every couple of minutes. One also have to be aware of the lag in the Dexcom that has been snuck in and means one is already late adding glucose.

At 130 - easier to arrest, at 120 and less , munch tablets fast.

I have same feeling you do when I have dexcom shutoff. Knowing how hard things can jump in my body;
I do not like times when unit out. That is why I usually pick mornings after liver body up - one to 2 hours after wakeup and breakfast to do probe change - shutdown startup and keeps stress low due to extreme stability in am.

I am absolutely against installing/starting 2 hour sensor change startup late at night. guaranteed fun.

9

Smileandnod:

Regarding your lows; I missed whether you are T1 or T2 and if on metformin.

When BG goes sub 70, liver should dump in more glucose.

I am not Doctor but:

It seems that your liver is not dumping in glucose and if T2 maybe on met which can shut down liver glucose add.

So, you are stopping a problem due to liver.You need to keep BG above 100; 120 to 140 safer point.

As my liver only works in full pail loads, I am stopping my liver from dumping as well. I also have to watch out for when metformin on duty in my body and where BG is

10

Hi jims,

Sounds like we are in pretty much the same boat though I am type I for over 25 years now and not on metformin - I'm on Lantus and Humalog. I've never had these problems until the last 6 months, much worse the past 2 months. I think part of my problem is hormone fluctuations due to my body trying to transition to menopause.

Had a scary night last night. I am instinctively operating in the same way that you are, trying to keep levels above 140 for now and watching dex like a hawk. I started to drop at 9:30p.m., caught it at 130 and dropping two arrows down. Liquid glucose seems to work better for me - I tried juice with little success and switched to coke. Seemed to stabilize so went to bed. Woke up at 1:30am at 395 and took a correction dose but less than my sliding scale would normally tell me to do. At 3:30am started to crash with double arrows down and even had husband drive me to E.R. because I was 120 and dropping faster than I could take glucose in. Coke and glucose gel in car. When we pulled in parking lot at E.R. the fall stopped and started crawling up thankfully so returned home. I'm steady around 250 now and am leaving it there for awhile just to try to stop the bouncing.

Got the saline omnipod trial today but am worried that the pump won't be of much help with these random fast falling drops. So frustrated. Scared to sleep. Planniing to call endo when they open but don't know what they can do about it.

11

Some thoughts:

1. I realize in heat of battle, telling someone to take some caveman readings seems counter intuitive. I take some glucose and then hit a few readings to see if Dexcom is really agreeing with bloodstream fingertip. If initial numbers on cavemanmachine confirm Dexcom "fire in theatre " alarm, keep stuffing the glucose. But if they don't; slow down on the glucose add and add updates to dexcom from fingerstick machine. Smetimes, thinks go awry on Dexcom and it is critical to get caveman machine on job confirming thevalidity of the alarm status. The filter and interstial delay sometimes expand an event to full high defense status when if fact it was a blip. Sometines a intemittent sensor can cause this mess. Last night I had this on a brand new sensor - first time ever whereby some silicon lubricant used in the sensor base leaked all over the sensor platform inside and covered the key electrical pads causing high farce.

Be carefully protective and suspicious of any super fast moving BG values on Dexcom. The body and liver can zip fast but not that fast.

On your insulin doses, carefully check on the $ 20 caveman fingerstick carefully prior to ading a dose. The large interstitial delays can really get you cycling. I inject NO insulin on Dexcom readings alone but after confirmation on two readings - one each hand within 10 points of each other and averaged, I then do insulin dose. This has saved me many times.

At 1 am, I stopped sensor; pulled off , found silicon lubricant leak and cleaned the back of teh trasmitter to remove all smeared lubricant and carefully installed a new sensor.
At 3:00 am ; it was finally up and was stable and continued till now.

I am shocked over how we both are pursuing similar control stratagies; yet for you as a T1 - you have a liver on strike not adding glucose when called to duty and I am a T2 with the opposite issue of my liver only adding full pail loads when called to add glucose.

It sounds as if your liver is no longer storing glucose and always locked in fast mode.

ANyways - good luck and best wishes and for sharing your riots.