Diabetes Mine - the all things diabetes blog

GlucoDay and the "Semi-Invasive" Dream

Who's ever heard of the GlucoDay® S semi-invasive continuous glucose monitor?   

I didn't think so.  I picked up a hint from a medblogger's footnote. Then I found it described over at DiabetesMall, although the link to the product on the manufacturer's site doesn't seem to be working.

That manufacturer would be A.Menarini Diagnostics, Italy's largest pharmaceutical R&D company, which released the GlucoDay across Europe a year ago (or two? -- I've had no luck getting hold of them despite attempted introductions).  The GlucoDay is apparently the first system in the world based on a "microdialysis” technique to obtain the CE marking for the Medical Device Directive, required to market any product in the European Union.  But don't get too excited; I read the fine print, and it's only designated for clinical use, "worn by the subject for a 48-hour period."

So why am I bringing this up?  Well, I happen to love innovation, and like Kerri, I'm finding the Guardian MiniLink sensor to be rather uncomfortable.  Meanwhile, I didn't like using the DexCom much at all.  I'm feeling ready for something less invasive.  So these guys had me at semi-invasive.  But what the heck does that mean? 

Apparently the only thing going in your body with the GlucoDay is a "microfiber" inserted under the skin, as part of a small "biosensor."

The description is a bit cryptic, but it appears to be a two-part wireless system where the controller unit is sort of Walkman-sized.  Granted, in this day of micro-devices that's not too exciting, but maybe that's the current trade-off for less invasive.  I love the data I was get from the Guardian.  But I don't love that long cannula and the mobility of the sensor that often makes your skin sore.

So I'm thinking, maybe we've all been too ambitious expecting a jump straight from needles & cannulas to the non-invasive dream.  Maybe there's a step in between -- something semi-invasive that will help us with the comfort imperative.  Then again, the data on that last link is at least two years old.  And then I found this neat overview which is, oh... just about 10 YEARS OLD.

*Sigh...*

Regime Du Jour

A few notes today on what's up with my personal diabetes regimen:

I restarted the Guardian RT continuous monitor a few days ago.  I find that I have to take breaks because my poor belly is scarring up fast due to long-term OmniPod and other sensor wear.  As a result, I'm getting many more frequent occlusion errors -- which means a clog or blockage at the infusion site.  In this case, it's not a tubing or even cannula problem, just a problem of too much thick skin (scar tissue) in the areas where Pods and sensors actually stay on my body.  I do wear the OmniPod on my arm in-between, but I haven't yet figured out how to get the Guardian MiniLink sensor placed there.  And here's why:

The most gi-normous needle I have poked into myself since getting diabetes (or ever).  Not liking that thing!  Also, see that big blue device in the background?  That's the inserter-doohickey.  You have to hold it a pretty exact 45-degree angle to get that big fat needle in right.  How do people manage to use this inserter succesfully on their own shoulders or back, I wonder?  I might need to call my friend's husband, the ICU nurse, to help me out here.

btw, the Medtronic folks requested that I note they have customizable early warning alarms to prevent highs and lows, too, just like Abbott's new Navigator (finally coming to market later this year).  The Guardian gives you a choice of up to 30min. in advance, with alerts that can be set for 5 min. increments. There's also a snooze function, that works just like the one on your alarm clock.  Sometimes I think the finer details of certain features are more important to the engineers than the patients, no?   

In any case, have I mentioned the Apidra?  Yup, I started on Sanofi's new faster fast-acting insulin about two months ago.  I "waited it out" since the first month was rough going for me -- running high a lot in part due to illness and infection.  Now that things have settled down, I still have to honestly report that I haven't noticed any dramatic differences in my post-meal BG levels.  What has changed, however, is how rapidly the corrections kick in, which is a nice plus.  I won't be going back to "slower" insulin any time soon (unless I run out of money -- all that surplus Novolog is still chillin' in my fridge).

And here's something neat: I discovered that my little Securitee Blanket insulin cover is just the perfect size for the Apidra vial!  Very handy.  Although I really do wonder if it hasn't occurred to Sanofi how potentially dangerous it is to make Lantus and Apidra vials the exact same size and shape.  I almost mixed them up more than once. 

I'm still loving the OmniPod, except for aforementioned occlusion issues -- a problem that plagues all pumpers at times, I suppose.  Oh, and that episode about 10 days ago when my PDM suddenly died just as I was attempting to bolus in a tiny little chic French creperie in San Francisco.  When I say "die" I mean it let out a piercing beep that wouldn't stop and flashed a message to call Customer Support asap.  No delivery - Yipes!  Of course I had no backup supplies along. 

Luckily, all we'd ordered was a salmon & feta cheese omelette with salad, so I figured I'd be OK until we got home.  Except for the beeping.  No matter how many times I pushed buttons, it just wouldn't stop.  "Is that you, Mom?  Is that still you?!" my 10-year-old daughter asked sheepishly, as the persnickety French cafe owner glared us down.  I yanked the battery, ate fast, and drove home like a demon.

Thus, the rediscovery of my Securitee Blanket to start carrying extra insulin and supplies around, even when I'm not officially travelling.  You just never know. Insulet did FedEx me a new PDM right quick, I might add. Still, lesson learned.   

Thus, this week's seven words of wisdom for people with diabetes:

Eat carefully.  Test your sugar.  CARRY BACKUPS.

Guardian vs. DexCom, and More CGM Smarts

First off, I wanted to clear up any misconceptions about my perspective on Medtronic's Guardian RT continuous glucose monitoring system versus the DexCom.  Many of you came away from my first post with the impression that I prefer the DexCom (Seven).  Not true.  So far I'm finding the Guardian easier to use and more accurate than the Dex.  A few details to elaborate:

* I find the Guardian much less fussy to wear and use.  Actually, the sensors on both systems are pretty small and comfortable.  But as noted, calibration on the Guardian does NOT require hooking up the unit to a particular traditional meter.  DexCom is slated to do away with that requirement in its next version, but for now, you're stuck switching to the OneTouch and hooking the two up via cable at least four times a day. 

The compact size of the Guardian receiver and built-in belt clip make it easy to wear on your person as well. The DexCom's carrier was always floppy, so I ended up sticking the unit in my purse most of the time, which meant I was always walking out of range and disrupting the transmission between the sensor and receiver.  The alarms are much softer and less intrusive on the Guardian, too. That was a major issue for me personally -- and my husband, when the darn thing was beeping like a semi truck in our bedroom all night long.  And have I mentioned batteries?  The DexCom has to be plugged into the wall like a cell phone for charging, which of course interrupts your usage. The Guardian, on the other hand, just requires a quick AA battery switch.

* I'm also finding the accuracy with the Guardian to be much more consistent.  Yes, it still misses some highs and lows in "real-time," but it's not so wildly off-target that I'm ready to toss it out the window, which was often the case with my Dex.  I have learned that some of this may have had something to do with my calibration skills (see below).  In addition, the Guardian receiver offers much more data you can use.  For example, you can actually scroll through your individual glucose readings over the last 5 hours.  And you see 3, 6, 12 and 24-hour views, versus only 1, 3, and 9-hour views with the DexCom. As noted earlier, you can also input carb counts and insulin doses on the Guardian for detailed record-keeping.

On top of all this, the Medtronic rep spent a good deal of time explaining calibration to me.  I thought I  knew it all, but being reminded about the 10-20 minute lag time between plasma blood (at your fingertips) and interstitial fluid was actually enlightening.  The rep reminded me also how important it is to calibrate ONLY when your glucose levels are stable, otherwise you're just setting up the CGM system for inaccuracy.

Author and nutrition expert Hope Warshaw has written an excellent article in Diabetic Living magazine called (ah-ha!) "Ready for Prime Time? Continuous Glucose Monitoring."  She provides a refreshingly realistic overview of the ups and downs of using this new technology.  See her "Terms to Know" for some straightforward lessons on calibration, interstitial fluid, lag time, and warm-up time.   Great info!

Hope's sage advice:

"When you start using your CGM, take it slow and be patient. Use the numbers as a way to keep track of trends rather than as a signal to enact an immediate response. Focus on fixing one problem at a time and don't let yourself get overwhelmed. Be realistic in your expectations. Continuous glucose monitoring won't produce perfect glucose control, and it doesn't remove the daily challenges you face in managing your diabetes."

Amen. Thank you, Hope.

MiniLinked! My Turn with the Guardian RT

So I'm hooked up... I finally got my chance to try Medtronic's MiniMed Guardian RT, the only other continuous glucose monitoring system currently on the market besides the DexCom.  I am one of the few who's had the chance to sample both.  So far, it's been a somewhat bumpy beginning, which leads me to believe that my initial conclusion was spot-on: CGM is a great idea that's still in its infancy and not quite ready for prime-time.

Allow me to break out a few details on my "first look" at the MiniLink sensor...

UNEXPECTED STUFF

First off, this packaging kind of threw me for a loop.  Does this imply that the MiniLink will allow me to once again indulge in my favorite food in the whole wide world -- carrot cake with cream cheese icing?  Sadly, I think not.

Second, the Guardian receiver looks exactly like a MiniMed insulin pump.  Because it IS a MiniMed insulin pump; it's made from the same casing, that is. Economies of scale and all that. But since I've never used a traditional insulin pump before, it feels weird to have this pager-ish thing hanging off my belt all the time.  I can't tell you how glad I am that I'm not attached to it via long plastic tubing.

Third, this marketing photography is a little deceiving.  Like those who've tried the MiniLink before me, I've discovered that the "shell" portion flops around freely unless you cover the whole thing completely with a clear medical adhesive patch from Smith & Nephew (provided with your Guardian RT supplies).

 

STUFF I LIKE

Calibration is a heck of a lot easier with the Guardian that with the DexCom, for sure.  All you have to do with the Guardian is push some buttons to plug in the BG result you got with your regular fingerstick meter -- whichever model that happens to be.  No need to hook the CGM up to any traditional meter via cable and hope that the two can communicate.

Alarm tones are much softer and less intrusive than with the DexCom.  Good for sleeping.  Good for our marriage :)

Record-keeping prowess!  The Guardian has that MiniMed feature set that allows you to "capture event" -- meaning you can input every BG result, carb count, insulin dose, and exercise session if you want to.  Then use their CareLink software for complete records download.  I haven't tried that yet, but it sounds powerful.

SPEED BUMPS

So far, on Night 1 the unit missed a 220 reading -- it had me at 144 for hours. Dern!

I also lost the first sensor because the rep insisted I try it on my lower back (see pix), and the cannula popped out on Day 2.

I've had "lost sensor" reading 3 times already, for no apparent reason. 

And right at this moment, the Transmitter is telling me that the battery is dead -- after just 4 days of wear.

Hmmph. I charge on.

Testing 1, 2, 3

Not to leave you all hanging: after my latest bout of unexplained high blood sugars (S.U.S.), I was determined to make my actions count.  In fact I was lying in bed awake night after night with a fierce determination to do something -- other than "correct" all day long and write pissy posts about it :)

Was it my insulin-to-carb ratio that had gone off, or was it just that my basal settings were no longer doing the trick?  Start from the ground up, I thought.  Only one way to accomplish that: basal testing.  Oy vey!  That dreaded don't-eat-for-hours / get-up-all-night-to-check-glucose test. I did my homework, and the methodology looked ugly:

• Fast for 4-5 hours prior to beginning the test and do not take any insulin other than that provided by your basal rate.

• With blood sugars between 90 and 140, start the test and measure your blood sugar levels every 2 hours. If BG above or 65 – 165, stop test.

Night 1, test at:

10:00pm
12:00 midnight,
4:00 am,
8:00am.

Night 2, test at:

10:00pm
2:00am,
6:00am.

Not to mention all the daytime tests, every hour on the hour, according to some sources.

YIKES!

But then it dawned on me - D'OH!  This is what CGM is for, Silly.  Why set my alarm for 4 tests a night when the continuous glucose monitor can do it for me?  I still had my DexCom Seven in the drawer where I left it, and suddenly, it looked pretty sexy again. 

What a fantastic invention. Think of the parents who have to basal test their children.  Those poor, sleepless, exhausted people.  I can honestly say I have walked in their shoes...

Anyway, to make a long story short, I wore the DexCom for seven-plus days about week ago now with mixed results. I found it more comfortable and easier to use than my last round.  But the accuracy -- or lack thereof -- was a bit shocking.  It had me at 60 when a fingerstick confirmed 120.  Or it read in the 200's when the fingerstick said 130.  Huh?  Two possible explanations: There's a major lag time that I'd forgotten about, or I had a bad sensor.  Either way, I ended up tossing the data.  No need for my endo to see anything that off.  Still, it made me pay close attention to my readings throughout the day and night. 

I ended up adjusting not my basals, but my insulin-to-carb ratio for bolus dosing, which has helped a lot. I'm running MUCH closer to target these days.

Latest Glycomark results: 4.1 (normal at my lab apparently starts at 6.0)  Oh, when will those post-prandials EVER behave?

Latest A1c: 6.1 !!!   So a big, wet raspberry to the Glycomark test. 

Without frequent lows to offset the high post-prandials, I have no idea what this combo of test results is telling me.  But since the A1c remains the Gold Standard, I'll take that 6.1 and run.  Yay me!

And as for old-fashioned basal testing... that gets a raspberry, too!

Seven Days with DexCom SEVEN

I neglected to tell you all that I've been outfitted with the new DexCom SEVEN wireless continuous glucose monitor.  I'm on Day 4 today, and so far feeling rather ambiguous about the whole affair.  Which is a little unfair, because this version definitely is better than the original.  It's just that I'm still a little disgruntled from my first experience.  Allow me to explain:

I wore DexCom's STS three-day-wear CGM unit for five months last year, from June through November.  (Oh why, oh why, Dear Lord, do these opportunities always pop up right at the outset of bathing suit season?)

I was extremely excited to try continuous monitoring, probably with rather unrealistic expectations for something so new and tentative as to be approved for "adjunct therapy" only. This means, of course, that the FDA is warning patients not to base their insulin dosing or other therapy decisions on the CGM data, due to its indeterminate accuracy.  Ugh. 

Anyway I was an eager and devoted CGM user despite the numerous inconveniences:

1) requirement to calibrate multiple times/day using the OneTouch monitor, which requires a VERY BIG blood drop that must be loaded onto the test strip in one fell swoop -- or you've wasted a strip

2) need to schlep around yet TWO MORE diabetes devices (the DexCom & OneTouch) plus cable to connect them

3) necessity to keep the unit "in range," i.e. very near my body in order to get readings

4) an unclear screen that kept defaulting to this:  "- - -", so you never knew whether the thing was calibrating or had just pooped out

5) not waterproof, meaning you had to use plastic covers to the tune of $1 apiece for every shower, bath, or swim.  The patches also irritated the skin somethin' awful

6) loud alarms that cannot be adjusted or silenced

7) accuracy issues!  The unit CONSISTENTLY read me as too low overnight even though I was in the 80-100 range, therefore the unit would CONSISTENTLY beep loudly and wake me up at night for nothing

Sometime in the middle of last November, I'd just had it.  I did get some good "trend data," but not worth the inconvenience day-in and day-out with no end in sight.  (I'm probably the only fool who wore it so consistently anyway)

So now I've been offered the chance to try DexCom's new 7-day-wear version, which purports to solve many of the issues with the old edition.  First off, it's waterproof.  Hallelujah for that!  No more uncomfortable patches necessary.

It also has a nice clear "status window" in the upper right-hand corner, so you do know if it's calibrating, searching for a signal, or perhaps pooped out.  That helps me warm up to the unit a little.

This one's supposedly much more accurate, but I haven't seen heaps of evidence for that yet. I'm still having problems with issues #6-7 above, and even had to toss the unit out into the hallway last night for the sake of our REM and our marriage.

I'm also still bothered by issues #1-3 above.  I don't like to wear the Receiver hanging off me (it's wireless for a reason, for goodness sake!)  So I keep it in my purse.  Every time I go upstairs and said purse is downstairs, or vice-versa, we lose contact.  Ugh. 

It's a quality of life thing, ya know?

Anyway, I've still got 3 days on this one and then 3 more sensors to go, if I choose to continue.  I know my endo will want me to gather as much trend data as possible.  'Cause that's where the value of CGM really rests right now. 

More bloggers' viewpoints on the DexCom SEVEN can be found HERE and HERE. 

Navigator Study: Foiled by the Skin

I have seen the future of CGMS, and it looks pretty damn good.  OK, I admit, I just caught a glimpse, 'cause I was disqualified for a current study of the Abbott FreeStyle Navigator in the last round due to potential "skin allergies to medical adhesives."  Curse those DexCom shower patches (which irritate my skin and made me look iffy here). Curse them!

Anyway, the Navigator is reportedly hekka accurate.  Even my new endo says so.  (More on that later; and no, I'm not giving out any names).  So much more accurate, I hear, that it will blow away existing CGM models.  Maybe.  Man, I would've liked to take it for a 90-day test drive.

The receiver is certainly smaller than the DexCom's -- a nice compact-like square thingie -- with a FreeStyle blood glucose meter built right in.  That will surely make those many daily calibrations a helluvalot less inconvenient.

The sensor, however, is larger and bulkier than DexCom's, more akin to the size of an OmniPod insulin pod, looks like.  So that's one disadvantage.  But the Navigator sensor will be waterproof, which is HUGE.  No need for those irksome shower patches.  To make it waterproof, naturally they've got to find the magical medical adhesive that will 1) keep the thing on, even when submerged, and 2) not irritate the heck out of patients' skin.  Which brings me back to my disqualification: since my skin reacts quite unhappily to the DexCom shower patch, it seems I may be too sensitive to test adhesives -- at least not if the master plan is for overwhelmingly positive study results.

I had originally reported that Abbott hoped to get the Navigator on the market by the end of this year.  But that doesn't seem to be happening now, does it?  Frustrating, but I guess I'm not the only one willing to wait a while longer for something that really and truly is hekka accurate!

Editor's note: In case you're wondering, I'm taking a mini-break from my DexCom this week, to give both my belly and my wallet a much-needed reprieve.  I'm still enthusiastic about the company and what they're doing, but the required 4+ calibrations per day involving hooking up a cable to a traditional monitor that I don't particularly like (the OneTouch Ultra) can get old -- especially when accuracy isn't great.  *sigh*

DexCom and CGM MADNESS

This time it's not about me and mine, but rather all the people out there writing to me about the DexCom and other continuous monitoring technology:

There was the family who tried to use the DexCom on their 5-year-old boy, and was sorely disappointed (they also sent me the link to the company's recent shareholder Webcast, btw)

There was the guy in Iran who's DESPERATE to get one for his 3-year-old nephew (sorry)

The guy who claims he can wear a since sensor for up to 18 days with excellent accuracy (?!)

And the guy who wrote to say he just ordered a Minimed pump upgrade w/continuous glucose monitor (Paradigm), and was told -- after it shipped -- that the transmitter/monitor is only under warranty for six months... "although it may last as long as nine months." After the battery dies, he'll have to purchase a new unit at full price.  (WtF?)

Plus a host of other people writing to say they either love or hate the new CGM technology. Here I think I can safely say, I told you so.

As for me, I'm still chugging along with my Dex. 

I've developed a new acronym (everybody who's anybody has got one, right?). Mine is for what to do when things go terribly wrong with your diabetes, like my recent string of >200 BG days for no apparent reason:

RUT -

Rebel (F-You, diabetes! Hell if I'm gonna keep any records)

Unwind (Retail therapy usually helps; can be hard on your credit cards)

Troubleshoot (OK, now what can I actually try doing differently this time??  There's always some new strategy to try, barring cutting out carbs altogether, which I refuse to do, kapeesh?)

Note that CGM does not necessarily help you avoid the RUT.  But the RUT helps you continue using your @#!$! CGM when you're ready to punt it out the window.  Kapeesh??

Judgement Day: Disappointed

This is a sorry post to have to pen, folks.  I had such high hopes.  I wish the news were better.  But  after three full months of futzing around with my new DexCom continuous monitor, calibrating and charging and re-initiating at every turn, my A1c has not made significant improvement.

I'm at 7.1 -- up, in fact, from the 6.9 result I got at the (potentially iffy) on-site testing at the ADA Conference back in early June, but still down a hair from my 7.2 result last spring.  Nevertheless: Aaaargh!

Why?  I just don't understand it.  Perhaps it was me; I was not diligent enough...

Oh, but thinking about it, I was.  I was!  I changed my eating habits, opting for entirely different foods at breakfast, for one thing.  I monitored the CGM screen regularly. I checked with fingersticks almost as many times a day as I had before the CGM.  I corrected with additional insulin doses ad nauseam.  And I exercised regularly, of course, like I have been since long before the diabetes entered my life. 

So maybe this is as good as it gets for me.  Maybe I'm just one of those people who can't get their A1c below 7.0 without experiencing frequent lows (which I haven't lately).  'Cause the only time my A1c has been under 7.0 was early on in my diagnosis when I was having an average of, hmm let's see, about two nasty lows a day (!)

Here's a peek at a typical week.  (For symbolic reasons, I chose the Week of 9/11. Click for a larger view). 

Notice how post-breakfast spikes are still a bit of a problem, but only really bad on two of the days.  Otherwise, what I see is a lot of time spent in the target range.  But Noooooooo.  If that were really the case, wouldn't my A1c be a nice tidy 6.9 or less? 

So what the hell do I do next?  Without an iota of help from my insurance coverage, the DexCom's so darn pricey.  I hate the idea of going back to fumbling around in the dark, never knowing which way my BG is headed.  But if it's not making a real impact on my future health, how do I justify it? 

Oh how painful this is to have to disclose. In my heart I still believe that CGM will revolutionize diabetes care...  and it really is just these clunky first-gen products right now that make it so touch-and-go.  Once the vendors can tighten up the accuracy of these devices, it will be a whole new era of living with diabetes, I'm sure.

(Right now, however, I'm having an incredible urge to drown my A1c woes in an entire Family Size Sack of Ruffle's potato chips).

Trouble in Reimbursement City

We've been asking the question, "How soon will insurance providers start covering continuous glucose monitoring (CGM) devices?"  But it seems the more accurate inquiry would be, "Why won't insurance providers 'reimburse' for CGM devices any time soon?"

There are some serious barriers in the way, as I've experienced personally in the last few weeks, submitting multiple claims for my DexCom supplies -- and receiving rejection after complicated rejection.  Each "Explanation of Benefits" form from Blue Shield states a different reason for rejecting my CGM-related claims.  Was the diagnosis info not clear enough?  Was the HCPC (Healthcare Common Produce Code) incorrect or missing?  Well, duh, this is new treatment technology, so no codes exist for it yet!  Which is just the trouble, as it turns out.

To address this issue, the national Medicare Coverage Advisory Committee (MCAC) met in Baltimore on August 30.  Despite the fact that the JDRF and Congress are both pushing hard for coverage soon, this meeting didn't go so well, according to diabetes industry consultant Kelly Close:

"Unfortunately, we felt like we had walked back in time about, oh, a quarter century.  The committee did not make any decisions that will immediately undercut diabetes patients or the companies that sell goods or services to them. But several comments from Medicare panelists raised doubts about the need for one of the most important tools in diabetes management: home glucose monitoring. Frankly, we thought these battles had been won long ago...  Never mind that the DCCT (completed in 1993), plus dozens of other studies since, have provided overwhelming evidence that near-normal blood sugars reduce the risk of complications...  It appears, however, that this memo has not reached some Medicare officials."

[insert cry of consternation, plus expletive, here]

David Kliff, who observes the D-industry from a financial perspective on his Diabetic Investor site and newsletter, explains the obstacles to CGM coverage this way:

"The economic reality of diabetes management centers on two important factors, time and money...  Some companies see the role of the educator and/or physician as being the knowledge enabler. With this approach, the patient merely gathers the information which is then transmitted to their educator or physician for analysis. (But) will the physician and/or educator have the time to analyze all this data and, if they do, how will they be compensated for their time?  Third-party payers are already reluctant to pay for patient education; it’s a wonder that so many companies believe they will pay for data analysis."

The trouble with all these advanced glucose monitoring tools (and "smart" pumps and the like), Kliff explains, is that they provide almost too much information -- too much for the patient to utilize unassisted, anyway.  Think up to 288 glucose readings a day, and complicated trend graphs that require a trained eye to interpret.

In covering the AADE (American Assoc. of Diabetes Educators) conference this summer, Kliff noted: "This is the hidden issue with CGM, as valuable as this data is especially when combined with insulin and food intake, analyzing the data is a time-consuming process. In a clinical setting when patients have the assistance of physicians and educators, this isn't an issue. However, in the real world all this information can be overwhelming...  Based on the products displayed on the AADE exhibit floor, it’s quite clear that increasing patient knowledge has taken a back seat to gathering even more information."

So we've got two principal barriers here:

1) officials' lack of understanding about the value of new glucose-monitoring technology to patients' long-term health (and thus long-term healthcare costs)

2) the costly time required for professionals to analyze CGM data; Who will pay?

So far, it seems only a few "extreme" patient cases have managed to garner coverage for CGM technology  -- where the patient suffered severe hypoglycemia unawareness and was landing in the ER every other week.  There, the insurance provider could see an immediate, short-term cost savings in their own interest.  The long-term for us "middle of the road" patients is going to be a much harder sell. 

Why I'm Still Using My CGM

Yes, I know, I'm very delinquent in updating you all on my DexCom use.  Everybody wants to know if I'm still using it, and what my experience has been.  Well now, it's a mixed bag, that's what.  By all accounts, considering the tsuris (that's Yiddish for trouble/inconvenience) it's caused, I should've given it up weeks ago. But I can't.  I won't!

Reader MikeG summed it up best in a recent comment here:

"(DexCom) is a buggy, first-gen product that takes a lot of work and is often inaccurate... Having said that, ... I would rather go back to 18th century bloodletting than try to treat my diabetes without my Dex. I've also found the cost to be much less than I expected."

My thoughts exactly.  So you want to know the specifics on why I continue to use my buggy, still-expensive, and too-often-beeping continuous monitor? (photo courtesy of Insulin Factor)

Well, first off, Mike also points out that in three months, he's only had two hypos (as opposed to 1-2 per week).  Bravo!  Me too, pretty much.  And Mike's A1c has dropped an entire point, from 7.5 to 6.5.  He feels he can do many things now that he couldn't do before. Bravo, bravo, Mike!  I'm chasing your record here.  I can't prove it yet, but I feel that my A1c is dropping.  And wearing the CGM gives me a huge sense of confidence; I know which way my BG is going, so I don't have to suppress that subliminal panic when I work out or do other activities that make my BG swing.

As far as the day-to-day, it's a constant adventure:

Let's see, I've jumped in the shower forgetting the waterproof cover patch. Oops! Gets you a "shower spike" reading of 380 and above.  Sometimes the unit recovers on its own.  Sometimes you have to re-initiate it, as if you were starting up with a new sensor.

I've forgotten the shower patch was there, and walked around half a day with my Dex under a plastic cover.  Big OUCH removing the patch after that long.

Some nights it has me just under or over my alarm settings (<70 and >220), even though a fingerstick reading shows that I'm OK, so the Dex keeps beeping us awake. Bad Dex! On those nights, my strategy is to stuff it under some clean clothes in the laundry basket in our hallway so we don't have to hear it all night.  That went well, till my 9yr-old asked what that bleeeeeeeppping sound was?  Sorry, honey.

Ooh, and here's the big one: remember how frustrated I was trying to calibrate the thing over and over while we were on vacation in Germany?  Well, I called DexCom Tech Support when we got home and told them what for.  Turns out my unit was part of a "lemon batch" shipped in late June, that had problems with calibration.  So they sent me a brand spanking new unit via FedEx a few days later.  All I had to do was plug in my transmitter's serial number, and now I'm good to go.  Working MUCH BETTER these days, in terms of calibration (less often, and it "takes" the first time) and accuracy as well.

Still, for those who've emailed me asking my advice on getting one, let me remind you: "it's a first-gen product that takes a lot of work."  At least the patient software is available now.  I've got to get on ordering that, although the extra charge kind of makes me mad.

DexCom DM Consumer Data Manager

This just in, literally (just hit my inbox): 

Now you can download your (CGM) data to your PC.

Zoom in on Glucose Trend Graphs or view Trend or Modal Day information.        

The new DexCom DM™ Consumer Data Manager software program enables DexCom™ STS™ System users to download up to 30 days of glucose data onto their PC, and view graphs beyond the 1-, 3-, and 9-hour trend graphs viewable on the STS Reciever. Users can save files and print reports.

Caution: The software does not provide any medical advice and may not be relied upon for that purpose.

More information and purchase is available through the DexCom online store at https://store1.dexcom.com or through Customer Service at 1-877-DEXCOM4 (339-2664).        

$39.00

with either the purchase of a DexCom STS Starter Kit by September 30, 2006 or with the purchase of 3 five packs of STS sensors. List price $79.00.    

That's cheaper than we thought, for a while anyway.   Oooh, this post is SUCH THE COMMERCIAL PLUG, but everyone's been so anxious to hear about DexCom's new patient software that I couldn't resist just slapping it up here verbatim. 

Anyone actually tried it yet?  Let us know!