Good advice about the insurance! I’ve been thinking about that. It would make sense they either cover the meter and strips or a CGM and since I just refilled the strips, I doubt they will cover a CGM until 90 days out. I will call them to verify.
Honestly, where you’re sitting, I would forget about G6 and just focus on the G7. The G6 is excellent, but “old” technology that is getting phased out. There’s no reason to get attached to it now. The G7 brings forward the best of what G6 has, but is smaller, has fewer parts to manage, is more accurate, has a shorter warmup time, and runs for a bonus 12 hours so you can change it whenever it’s convenient. The only reason to consider the G6 is if you want to try and get the Mobi in November, and you said you’re willing to be patient if you choose that pump
, so that’s a moot point.
With every CGM system, you need something that gathers the data (sensor), something that beams that data through the air (transmitter), and a computer with a screen that grabs onto that beamed data and displays it to you (receiver, phone, or insulin pump). With the G7, the sensor and transmitter are combined into one piece, now called just a sensor. There’s only one consumable item that needs to be ordered and applied, the sensor, and you throw it away at the end of 10 days. There’s no screen, though, so you need at least one more device. The G7 will connect to 3 different devices, and you can choose to use 1, 2, or 3 of them. You can choose between using your phone with the Dexcom app installed on it (yes, it works with iPhone), a compatible insulin pump, a compatible watch, and/or the receiver that Dexcom sells. You don’t HAVE to have the receiver, but you can if you want to, or if your insurance requires it. Even if you have it, you don’t have to use it. The receiver is basically just a mobile phone that is built to run Dexcom and do absolutely nothing else. It’s something else to carry and keep track of, but because it’s purpose built, it has a very reliable connection to the sensor. The problem with phones is that they like to turn off apps running in the background, unbeknownst to you, to save battery life, so you risk not getting an alert if you go high or low when the app isn’t working right. That’s a relatively low risk risk, though, since there are ways to make phones behave.
There’s really no reason to wait to get a CGM either. CGMs are often referred to as the second best thing to ever happen for diabetes, just after us getting insulin. The American Diabetes Association is a big proponent of them because they’re proven to improve outcomes and reduce risks associated with hypoglycemia. If I were you, I’d start pursuing the G7 now, then you’ll be all situated and comfortable with the technology when it comes time to make your next pump decision.
I’ve only focused on Dexcom’s G7 because you mentioned Dexcom being your doctor’s preference. There are a few other options on the market like Eversense (works for six months, but still requires fingersticks and isn’t compatible with insulin pumps for automatic insulin adjustments) and Freestyle Libre (quite similar to Dexcom G7), if you want to explore your options.
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The Mobi works pretty much the same as the tslim just no pump screen. I use the t connect ap. And I bolus from t connect sometimes. That’s what’s where we will be bolusing with the mobi. It’s not complicated really.
Thank you, Robyn. That clears it up for me.
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With a CGM you will still need strips just a lot less of them. I have a prescription for 100 strips / 90 days but I probably only use 1 or 2 strips a week.
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My insurance covers both the Dexcom and up to 200 strips/month. Both are covered through pharmacy benefits. For me, the Dexcom (and Medtronic Guardian sensors) work well but they can be off by a lot on the first day, so I do test frequently then. Once I’ve calibrated it several times and it’s where it needs to be I test at most once a day. I often go days without testing. But I definitely do need to keep strips on hand.
Well, I’m on Medicare and I’m sure their rules are more stringent than private insurance. I will check but was told that they don’t cover both strips and CGM. It’s either/or. If necessary, I will pay out-of-pocket for the strips, especially since I won’t need as many.
I doubt if my Medicare plan will pay for both CGM and strips but I will check.
I’m on Medicare and they pay for mine.
I was diagnosed with type 1 diabetes in 2016 at age 60. Within 3 months, I had a tandem t:slim pump and a month after that I had Dexcom CGM. Currently I have Tandem T:slim with control IQ and Dexcom G6. I have always been happy with these devices. My HbA1c is typically 5.4-5.6. The main adjustment has been to get all the settings right regarding basal rates primarily. My basal rates range from 0.1 to 0.675 depending upon the time of day.
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You are doing great! Don’t be overwhelmed. There’s lots of help upgrading. I have been diabetic for 51 years. I’ve only been on Medtronic pumps since the 90s. The newest 780G is blowing my mind! You use it with their G4CGM and you’ll hardly have to do finger sticks very much. The pump practically does everything. I’m sleeping all night without highs or lows. I’m using 10% less insulin than I was a month ago. I cannot say enough wonderful things about it!
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I started using a CGM one month before my first pump, last March. I wish I’d gotten a CGM much sooner.
You can get more directly usable information from a CGM than you can get control from a pump using finger stick tests. That it will “sample” every 1-5 minutes offsets the slight time lag by showing you a running average. I’ve done 2 finger stick tests on washed clean hands within 5 minutes and gotten results so far apart that I had to do a third test.
It takes a while (days) to learn how to interpret CGM data, a little longer to figure out how to use that nuanced display - longer when you have to deal with monthly metabolic cycles. Once you do, you can quickly “see” exactly how your body reacts to a food, to stress, exercise and insulin. That can be used to tune your diet or your insulin dose. The graph eliminates the need for remembering “where” you were, what you did previously.
btw, Medicare will cover more than 4 strips per day, but the doctor has to insist that it’s medically necessary. You are in a chicken and egg situation with a low A1C. You’d need to not use more than 4 and go out of control to prove you needed more than 4. You can get a Medicare CGM by just having the doctor order it.
With type 1, the CGMs that use dediated receivers are covered under Medicare B, the ones that don’t but use a phone only, aren’t covered.
Tubed pumps are covered under Medicare B, “pod” pumps are covered under Medicare D Supplements. Insulin is covered by the same part as the pump, with no annual deductible for the insulin, $35/month copay. Medicare requires a dedicated receiver for the Dexcom CGMs, whether or not you have a pump.
Between tubed pumps there’s not a lot of difference as far as overall "ease"of use combined with reliability. They are all designed to provide similar results - better than the AACE/ADA targets better than 75% TIR - IF you use cookbook basal rate, ICR and CF AND you estimate meal sizes reasonably well.
They are designed to meet the FDAs requirements, not to produce optimum results, but safe ones better than not using them. (Every clinical trial of “hybrid closed loop” pumps shows 80% of users having A1Cs over 8% and overall 0.5% lower than before using them.) They all use different “algorithms”, all can be adjusted to get relatively better results. imo The Tandem pump currently has more ability to be adjusted - if you chose to use it.
I chose the Tandem pump last year for three reasons: it could be updated and the company had development and integration agreements with multiple CGM makers, and insulin pumps is the company’s only business. The Dexcom G at that time was the top rated CGM and Medtronic didn’t have a comparable product.
You should be able to come up speed faster than I did. It took a month for me to analyze and refine my diet, another to learn the pump and gain the confidence to experiment to determine my basal rate, and get a close estimate of my CF and ICR. My last 3 A1Cs averaged 5.2%.
I inquired about this early on when it wasn’t clear that the G7 would have a stand-alone receiver (problem for Medicare). But I was told the TandemX2 itself is acceptable as a receiver under the meaning of the requirement.
Thank you so much for your response and good information! The more I’m learning, the less stressful it feels.
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You come to the right place.
Hi there! Decisions, decisions! I had the same worry that learning new procedures would confuse me majorly. Lemme tell ya—it does NOT! It has simplified my diabetic life in all ways (Type I 55 years!). I have Tandem and Dexcomm. There is no need for finger sticking. Lots of people use their phones to communicate with the Dexcomm, but I use the pump itself. They talk even if I don’t listen, lol! Dexcomm tells my if I’m high or low according to the limits I set. Tells me to charge, change my site, etc. I have two sites, one for insulin and one for Dexcomm. Dexcomm lasts 10 days, the pump until it runs out. I charge the whole thing via USB about every other day. The newer Tandems have Control IQ, which will increase or decrease my nasal rate. I’ve only had that a few months, but it’s really cool and easy—not like I feared at all. The “pokers” are super painless and auto inject themselves. In the summer (Texas), I cover the sites with a stretchy patch that peels off when I change sets (I work outdoors a lot and can sweat them off). I can bathe and swim, and detach the pump tubing for a while if I want. I don’t need to use any of the glue-down liquids. The Dexcomm 7 is about to come out, but I forget what’s new about it. Good luck, I know you’ll love it!
Thank you so much for your positivity and encouragement, Dottie!! You make it all sound so simple. I’ve been so busy lately but next week I’m going to call my insurance to discuss what is covered and when. That way at least I’ll be moving in the right direction with a plan. I’m glad your system is working well for you. I think I’ll do things the way you are. I’m not crazy about using my phone for any of it. The battery wears down too fast the way it is.
I feel like I’m the only one who likes and still uses Medtronic. I recently upgraded to the 780 but still using the g3 sensors. When I can get the g4 I won’t have to do blood sugars anymore and no calibrations. I can say my data is fantastic using the g3. I hit my first 100% day in range a few days ago.
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I used several Medtronic pumps, last one was a 523 paradigm with dexcom. Now using Tandem X2, with dexcom integration CIQ.
Heres a review of both Medtronic and Tandem
Thank you, Sam! That is a lot of good information to think over and process.
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