As you may know I have had the Dexcom G4 CGM since November. In the last 3 months I have learned an awful lot about it that may prove useful to other PWD. These are things I really wish someone had said in the beginning to not only make me feel more comfortable with the technology but with the information overload that can sometimes be overwhelming. So in no particular order here is what I have learned. Please feel free to pass some or all of it along to others:
1. Before you place a sensor anywhere, think about how you move that particular part of your body and also how much you move it. Where does the car seatbelt hit and how do you sleep at night ? Is that location going to be comfortable for a week or longer ? Although the user manual says place the sensor horizontally on your abdomen I personally have worn my sensor vertically on my arm, thigh and "love handles" and horizontally on my stomach and thigh. The most comfortable location I have found for me was horizontally on my upper thigh and that sensor also lasted for 17 days with accurate readings throughout. There are a bunch of really good YouTube sensor insertion videos. A google search will find them for you.
2. If you put the sensor in a place that is uncomfortable or you can't sleep with it take the thing off. I made that mistake once and though I regret doing it, I regret more that I spent a night in pain not being able to sleep. While the sensors are expensive, resenting them is even more costly in the long run. And fortunately I have routinely managed to get more than 7 days out of a sensor so the one that I had to throw out because of poor placement was not costly in that regard.
3. At the beginning of a sensor session my readings have been very erratic so I do not make insulin dose decisions based on the Dex at least initially. I set my alerts very high and very low the first day with a sensor. There is nothing worse than being wakened by a buzzing receiver indicating a low or high when a fingerstick (fs) is normal. I also put the receiver under my pillow. It has never failed to awaken me when it vibrates, but it allows my husband to continue sleeping uninterrupted.
4. When you look at the receiver and your blood sugar is climbing or plummeting, DON'T FREAK OUT. Eventually the arrow will stop going up or down and settle straight ahead. The more stress you put on a number the higher your blood sugar is likely to go. If it is plummeting have some juice, if it is rocketing skyward, do a fs and take a correction dose.
5. Perfection IS NOT ATTAINABLE. I say this as an OCD perfectionist. Since I accepted this it has become far easier to just see the improvements over time and appreciate how the hard work pays off in the long run. I no longer aim for perfect, I just now aim for better. The Dexcom studio software is great for comparative analysis. Just look for progress not perfection.
6. If you have a problem with the sensor, receiver, transmitter call Dexcom tech support. ALWAYS USE THE CALL BACK OPTION. There is nothing worse than sitting on hold for 45 minutes. When they give you the call back option, take it.
7. If you swim for exercise like I do, there is only one sensor location that works intermittently in the pool and that is on the arm. If the sensor is anywhere else be prepared to "lose signal" for the duration of the swim. I usually "carb up" before with a snack of some kind and check before and after.
8. The sensor takes a very long time to recover from a low which makes treating a low and not over doing it a bit problematic. The G4 has only given me a false "low" once so the remaining 4 or 5% of the time it says I am low, a fs has confirmed it. I now treat lows the same way I did previously, but I generally recheck after 15 minutes and recalibrate the Dexcom because it is always still low.
9. I always use some type of auxiliary tape to secure the sensor. The tape that has worked the best for me is called opsite flexifix. I have never had a sensor peel up or pull away, but some people have reported that. The sensor that lasted 17 days was worn in the pool for at least 8 hours during that time and did not peel at all. I trimmed and replaced the opsite tape a few times over the 17 days.
A nice list reflective of hard-won experience! One trick when I place the transmitter into the sensor bodyware is to use a hand-held mirror to confirm up close that the tiny plastic arms that hold the transmitter in place are in fact completely in place.
Thanks for the information. I just wanted to add some words of caution: the G4 is not for making insulin dose decisions. When sensor technology can be used for that then the artificial pancreas will become our reality. Furthermore on the legal side I do expect that the police and court will ask specifically for meter not cgms data in case of an traffic accident. The legal expert will point out the limitations and warnings that have been stated in the CGMS package insert. To not have meter data at hand can really backfire in this situation - at least in my opinion. For lows the Dexcom G4 might be correct to report them for a long period of time. The upper layers of the skin have only limited blood circulation. Thus their BG level can be more than 15min behind the bigger blood vessels. If you have treated the low 15min ago you will still see this excact situation of being low on the Dexcom. This is why the information about the relative changes is much more valuable than the absolute numbers. Despite of these remarks I would love to have a Dexcom G4. The prices in Germany are just too high to think about that (308€ for 4 sensors).
Thanks for the input Holger, as I said, I do not make insulin dose decisions based on the data from the G4. It is merely a guide and especially useful for me since I am hypounaware. It is also nice to be able to take my dog for a walk and not worry about going low or get in the car without having to constantly check my blood sugar. In the US, the 4 pack of sensors is list priced at $ 499.00 my insurance company paid $ 391.00 US for them. Still exhorbitant, but for me it is worth any price to sleep well at night and wake up safe in the morning.
We have been paying out-of-pocket for these for our 10 year-old. Fortunately, our insurance company just approved this item, so they will be covering them in the future. But even if they weren't, I'd still pay for them out-of-pocket--worth every penny! Thanks for all the great tips!
Thanks for the great post. I am still in debate mode about trying the DEX. I tried the Medtronic CGMS and had all the issues you talk about, but could not live with them and for me most sensor sites were bigtime painful.
Still thinking about trying the dex as hypoglycemic unawareness is doing me in.
We just received a brochure from Dexcom regarding the new G4. I thought perhaps it might be a useful tool for my son to achieve less variability for his bg levels.
he is very hypo aware and has not had to correct for one in about 6 weeks. He is following a restricted carb diet and at times he boluses more insulin than he needs which causes some lows. However, I am reconsidering getting the G4 from your information. We would definitely want one in order to make dosing decisions, but it doesn't seem accurate enough to afford him to do this.
Hi Cary, I can only speak for myself because as in everything with D it varies from day to day and certainly from person to person. I have found the G4 to be very accurate, especially in the middle range say 70-170. I find now I check my blood sugar when I get up in the morning and when I go to bed unless I feel low or it buzzes and indicates I am low. The rest of the time I just check the receiver. Since getting the system in November my daily basal insulin has gone from 30 units a day to 22 units a day in 2 shots and my rapid acting dose has also been reduced. I can now see the effect of a brisk walk with my dog or an hour long swim or what happens after a piece of pizza. Seeing it in almost "real time" makes avoiding the pizza or bolusing correctly for it a lot easier.
It has also helped with the hypounawareness problem. For me a hypo is no longer accompanied by the sweaty, rapid heart rate warning signs. It is far more subtle. My vision will get a bit wonky or my brain doesn't process stuff right, now a quick glance at the receiver confirms I am feeling a low. The more I can recognize them from even the subtle clues, the easier they are to avoid.
As I said, I can only speak for myself, but as a T1 for 37 years this product has been life changing for me.
Hi Karen,
I too tried the Medtronic CGMS over the summer, it was the Ipro model so only my CDE could actually download the data, and the damn sensor hurt like hell. If it were the only available CGM I would never get it. The G4 sensor is the width of a couple of human hairs. For me it has been comfortable to wear. The only place where it was painful was on my left arm towards the back. I just put it too far back and couldn't sleep. I took it off the next day. I have worn a sensor on my right arm (non dominant) for better than 2 weeks without any pain. I currently have the sensor horizontally on my abdomen and don't really notice it.
Now that you have gone into more detail I can see how it might be very useful in my son's case. He tests at least 8 times a day, sometimes more. He has had some lows in the 40 range because he did not eat as many carbs as he thought he was going to eat. If he could see the trends in his bg he could compensate earlier and catch most potential problems. You seem to have significantly reduced your insulin. That's always a good thing. His insurance will pay for a unit, but we did not want to waste time and committment if we're not sure of the benefits
$391 are €294 per 4 sensors. That is more expensive than I have assumed. Just 14€ less than the prices in Germany. Taking tax differences and shipping costs into account the prices in our markets are about the same. Anyone interested in founding a buying syndicate to order 100 or 1000 sensors at once?
Thank you for the tips. We just received the G4 for my 7 yr old daughter last night. So far so good. At times it is very accurate (within 10 pts) while other times it is a little off. We did notice the lag when she was low. Even after being treated it said she was 69 when in fact the meter read 115. But overall, it's nice to see the trends and know what it going on. It takes alot of the guessing away. I am really hoping this will help us keep her from going low and figure out what foods are causing the spikes.
HI CLAIRE. I AM RELATIVELY NEW TO THE DEX 4, HAVING SUFFERED THOROUGH DISGUST W THE MEDTRONIC ROUTE. I AM ON MY THIRD DEX SENSOR AND I APPRECIATE YOUR WRITE UP VERY MUCH. I HAVE BEEN HAVING TROUBLE, BUT NOT DEXCOM TROUBLE, AS MUCH AS THAT THE SENSOR IS BUSTING ME IN BAD HABITS THAT I NEED TO CHANGE....SNACKING INSTEAD OF EATING A REAL DINNER. I END UP ESTIMATING AND I THINK OVER RESPONDING TO THE UP ARROW WHEN INSULIN ISN'T IMMEDIATELY DOING ITS THING. STACK AND CRASH COULD BE THE NAME OF MY FIRST WEEKS ON THIS SENSOR. I TOOK A DAY OFF (YESTERDAY) AND PUT A NEW ONE IN TODAY. HERE WE GO W NEWFOUND DETERMINATION.
I LIKED THE IDEA OF ROTATING OFF STOMACH A LOT AND EVENTUALLY WANT TO TRY THAT. MY PUMP HAS CREATED A LOT OF SCAR TISSUE OVER THE YEARS AND IT WOULD BE NICE TO CARRY THE SENSOR ON MY ARM OR LEG....WHAT HAS MADE YOU DECIDE NOT TO USE THE PUMP?
THANKS FOR ALL YOUR CONTRIBUTIONS....KIM
LIKE YOU I HAVE H. UNAWARENESS AND DIABETES SINCE I WAS 11. IM 55. I BLOW MYSELF AWAY W THE HABITS I HAVE PICKED UP OVER THE YEARS. IN THE OLD DAYS, WHEN WE SHOT AND ATE IMMEDIATELY....I NEVER REALLY LEFT THAT SCENARIO, AND NOW I CAN PLAINLY SEE WHAT THAT DOES.
Hi Kim, you sound a lot like me as far as D denial and picking up bad habits. It was so much easier in the "olden days" when at most you peed on a strip or did the clinitest urine test kits. I didn't think about D at all, I just took a shot once a day and forgot about it. Luckily that lackluster attention did not cause any complications so far. But being hypounaware has caused me to lose control of my car once and put my son in danger.
Initially the dexcom was frightening. Stack and crash was my nickname and I responded to every up arrow, even the slight up arrows caused me anxiety. And I would take a shot of apidra to bring it down. It is so hard not to react but after almost 6 months, I finally can just look at the number and leave it alone.
I have not wanted a pump because I like my skin the way it is. I don't have any pits or scar tissue and I want to keep it that way. Shots are not a big deal, the nano needles are 4 mm and 32 gauge and I can take a shot in milliseconds with no one noticing. My last A1C was 5.8 so I must be doing something right. Also I just don't trust the pump technology to deliver insulin in the right amount at the right time, I'd just rather do it myself.
Ya, that is how I did diabetes in youth. I was 21 when I got my first meter...600. and instead of a pinprick it was a real lancing. I do have complications, but feel fortunate. They could be worse than they have been. I get it about the pump, and a lot of people feel that way. Your A1C is great. I think mine was 7 last time. So I have some work to do....but they were much worse than that once upon a teenager and even into adulthood.
I want to look up apidra. The highs I get after eating should mellow out if I wait before eating, but I have heard that there are a lot of newer medications that can be used to moderate highs and would like to know more about them.....Anyway. Thanks for the yacking. I spent half the day on this site but feel like I have learned a lot. Have a great weekend.
Hi Kim, I was on Humalog for probably 7 years for my bolus insulin. I had some severe and extreme lows mostly because my idiot endo had me on a sliding scale without any correction for exercise or dining out. I finally started carb counting last year with a lot of help from the folks here and my CDE at the clinic. I switched endos and the new one is so much better. Humalog for me had much too long a tail it would work for 5 hours or more and I would have too many late lows. Apidra has a much shorter tail for me. It works quickly within 1/2 hour or so and is done and gone in a little over 2 hours so I don't have to worry about late lows. I'm really glad I switched. Some people who pump find apidra goes bad with the heat of their bodies or it just doesn't work for them very well. Others though absolutely love it. I have also switched from lantus to levemir for my basal insulin because it is far more even and doesn't peak in me the way lantus did.
It is still a work in progress but I have learned so much since I stumbled upon this site last year while I was researching the Omnipod insulin pump. The collective D experience here is amazing more than 27000 years of experience living with and/or taking care of someone with D. If you have any questions just ask, start a discussion, someone will have an answer or at the very least a place to begin your search. Take care and have a great weekend too.
It's so weird to be talking to cyberspace and yet feel a personal connection. Thanks Clare. This site is great. Where do you live? Im in St, Louis.
Kim - go to the chat room if you look at the top of the header there is a tab called "chat" I will be in there and we can actually chat online. I am in Boston but my husband went to Washington University in St. Louis.
Hi Clare, thanks for posting the link to your blog. Some very relevant and useful info.
Clare, I'm late in asking, but when you say "low" what range do you mean? Is going down to 65-75 going to knock the Dexcom out of sync?