Question about DexCom G6 and fingersticks

Hoping to pick some brains. I’m writing a note to the Medicare DME medical directors about the use of “therapeutic” continuous glucose sensors and fingersticks. Because the G6 doesn’t require fingersticks to calibrate the device, Medicare seems to be under the impression that people using one will never need to do another fingerstick and I have had an occasional problem with getting Medicare to pay for the test strips in the you’re on a G6. This problem occurring more frequently.
While it does cut down on frequency of testing, it doesn’t necessarily exclude the need for fingersticks.

For example, one issue I’ve run into is with Medicare cutting the sensor reorder so close and not giving enough time for someone to get them if there is a “hiccup” in the processing.

So my questions are:
If you are using a DexCom G6, do you still do fingersticks?
How often and what are the circumstances? (You don’t specifically have to be specifically have to be Medicare to answer these questions).
What I’m trying to do is broaden my knowledge of possible situations so I can formulate a stronger argument. Some may have reasons that I haven’t thought of or dealt with yet so I hoping to get other perspectives.

Thanks for any input!!

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I still do a fasting finger stick daily to compare results.

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Yes, we still need to do fingersticks now and then. At a greatly reduced rate than before, but still they are necessary, especially on day 1.

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When I first start a new sensor I will stick 2 times the first day. If everything is running correctly I will back off to one stick ever other day.

Over the life of a sensor, which for me is 14 to 21 days, I normally fingers stick between 1 to 3 times.
Once in a while this number goes up to 5 to 8 times. But that has only been a couple sensors I have tested this many times for.

Here is info direct from Dexcom website.

"No need to calibrate with a blood glucose meter, eliminating the need for fingersticks.‡

‡ If your glucose alerts and readings from the G6 do not match symptoms or expectations, use a blood glucose meter to make diabetes treatment decisions."

It clearly states there are times a BG check should be done.
“No need for calibrations” except…when you need to confirm sensor BG that does not match symptoms. If your doctor prescribes bg strips, with that justification, I hope it would be covered, but may need additional documentation from dr.
I am not on Medicare, but I know there are some on MC that are getting strips covered with G6.

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Thanks to everyone for the feedback. MM1, that is where I was coming from too. DexCom G6 do not need fingersticks to calibrate which is very different from someone never needing fingersticks ever. I have also been seeing and hearing mixed responses on whether people can get strips with their G6 or not. Because it has only been recently that Medicare patients have been getting the G6, Medicare has been a little more lax but I’m slowly hearing and seeing more and more people having issues. I know of one person who the pharmacy went to fill the strips and told her that she couldn’t have them because when they were billed it showed up on the system that she had a G6 and so Medicare will deny payment as “duplicate therapy” for the test strips. I think we are just starting to see the beginning of this issue. The whole Dexcom/Medicare/DME suppliers relationship is still trying to find it’s “footing”. As the processes start to get more smooth (in theory) and suppliers get a better handle on the “dos” and “don’ts” of Medicare and CGMS, then we will see more backlash about getting test strips.

I’ve been on Medicare since last April, started the G6 the month before.

My private insurance dropped test strip coverage years ago, so I went to a subscription plan for 100 strips/month. I still use this plan today which gives me plenty of test strips, because I mostly do a fasting fingerstick. I rarely have to calibrate.

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Wow!! I have never heard of that…Where I live, private insurance is required to provide coverage. I have never heard of a subscription plan for test strips. Do you mind me asking what that is through?

This link describes a few, although is 2 years old. Some are strips only, some include more coaching and feedback to your test results.

https://www.goodrx.com/blog/should-you-be-subscribing-to-have-your-test-strips-delivered/

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I stick between 2 and 20 times a day on G6. 2 when its accurate. 20 when its inaccurate. I get them over the counter at Walmart because I dont want to meddle with insurance if I dont have to. They are already refusing to count my G6 towards deductible this year because it was not the 1st expense in the calendar year. It was the 1st bill I received, but it was not the 1st date of service. That makes my deductible $550 more than it should have been.

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I am not on Medicare so I don’t have issues about cutting it close and not getting sensors in a timely fashion. But since using the G6 over a year ago, I don’t test. Maybe once I awhile during warm up especially if driving during that time frame. I haven’t filled a test strip prescription since I started the G6. But I do think we should always have back up no matter if you are like me and never test or if you have problems with accuracy and test 3 or 4 times a day. Your doctor really needs to help you push back on whatever you need to manage your diabetes, not what everyone else is doing. Good luck with another insurance battle.

I’m also not on Medicare, but I’m fortunate enough to have the ideal body chemistry for the G6. I pretty much never test anymore during the initial 10 days. I used to test 1-3 times during that initial 10 days just to test the accuracy, but it’s always spot on. I do test twice a day after a restart, mostly because I promised my husband that I would since I’m trusting pump automation to it. I would honestly be happy to just do the one calibration after a restart and leave it to work it’s magic. Except for the initial reading after a restart which is always 100+ points high, it nearly always matches my meter within 3 points, and it’s never been more than 12 off. That 12 points was with the one sensor in my experience that I didn’t care for, as it kept reading just ever so slightly low, but was enough of a discrepancy to spoil my stats with artificial “low” data, do I did test and calibrate a little more with that one.

Of course, if I had Medicare coverage and was getting cheap/free sensors garaunteed every month, then I wouldn’t need to restart and would almost never need to test at all. I get that I’m in the rarity for having such INCREDIBLY good luck with my Dexcom experience, though.

I generally test once or twice after starting a new session with a new sensor. Then I only test if my symptoms don’t match the Dex or after a ‘sensor error’. In most cases the fingerstick and Dex correlate and I don’t need to calibrate. When I restart I also calibrate once at the beginning of the session then test 1-2 hours after to make sure things are right.

Yesterday I was in the hospital for an outpatient procedure that required anesthesia. The hospital BG measurement was only 2 pts off my Dex reading - 185 vs. 187)! They had never seen a CGM correlate so well.

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Medicare just reduced the price they pay for the g6 because you “dont need” to calibrate the system - we all know how that goes. so if you’re getting a g6 thru a DME they wont get paid from medicare for test strips because medicare believes the g6 alone is enough to manage your testing. there are some relatively cheap test strips on the market that you can get from walmart to keep on hand. or you can switch to the freestyle libre (like im on :)) and medicare will still pay for a nominal amount of strips

Need is an interesting word. I’m in the first 4 hours of wearing a Dexcom G6. I might do a few sticks over the next 7-10 days to see if both thermometers are giving me the same “temperature” but I do not care. I do not expect my fellow Americans to pay for two thermometers in my house which may or may not be calibrated. The trend & volatility of each is more important than in absolute measurement.

First of all, thank you for your input and welcome to the community!! The A1c IS an important tool in diabetes management but, often times, it is like looking a puzzle piece and trying to figure out the picture from that piece. The A1c has it’s weaknesses. The fact that it is just an average can be one of it’s biggest weaknesses. You could have blood sugars that run 120 for 18-20 hours of the day, then go up over 400 for a couple hours while you are a sleep and still have a hemoglobin A1c of 6.7%. By the A1c standards, your diabetes is great but reality is you have a couple of hours every day that your blood sugars are doing damage to your system. You could also have blood sugars that range from 30 to 450 and still have a “good” A1c because the highs and the lows balance each other out for a good average.

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I am impressed with 20!!

That is so cool!!

I’m sorry that I apparently neglected to reply to this post.

I use a subscription program through Accu-Chek for the Accu-Chek Guide test strips. I have been getting 100 strips/month for $29.99, but I may drop down and get 50 strips/month for $19.99.

I’m generally using one strip/day to check my fasting BG.

There are other programs out there like One Drop. They offer a variety of plans that also include coaching and an app that some folks like. For me, I couldn’t get decent results from the meter (always read too high).

Diathrive is another one, but I haven’t tried them.

Also Livongo offers a subscription plan, but I believe it’s an employer-based plan. IOW, they don’t have an individual sign-up plan.

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We finger stick most when determining if a low is turning back up and at the appropriate rate. The G6 can take quite a few readings to catch up from a low. A fast and low under 50 can take 20 to 30 minutes even though BGs are back in range within 5 to 10 minutes of treatment (juice).

Plus, there’s the 2 hour warm up period where you may need to test multiple times for keeping close tabs on your BGs or just for a meal or 2. If you ate and went low in that 2 hour span, then you’d need a few test strips.

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