Tag Archives: CGM

Getting Acquainted.

Now that I’m officially several weeks into my life on Dexcom, I just wanted to scribble down some notes for the purpose of keeping a record on how it’s been going so far.
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This is mostly stream of consciousness, but as usual, my stream of consciousness still contains several words. Hopefully, they are ones you’ll want to read. Here are eight observations on the early going with Dexcom.

1. I know that I have FDA approval to bolus based on my Dexcom G5 readings, but I haven’t done it yet. Okay, I may have pushed a one unit correction bolus through once or twice without doing a fingerstick, but that’s all. I’m not blousing for a meal based on my display. I’m confident in my Dexcom– I’m just not confident that it will be perfect 100 percent of the time, every single day. I would hate to over- or under-bolus based on the one time it’s off by a bit. I hate to think of the result of doing that. So, no dice to the bolus-off-Dex so far.

2. I’ve got to remember to order some Skin Tac or Opsite Flexfix or something to hold down my sensor, and soon. The peeling is real, folks.

3. At the Diabetes UnConference, I checked in with a couple of people to get their pointers on doing an upper arm insertion. I also looked at Daniele Hargenrader’s recent video showing her doing this. Then I did it. Then I loved it. It’s mostly out of the way, and the sensor works pretty good there. And the accuracy has been fantastic. Win-win-win.

4. I’m not interested in using my thigh or forearm for sensor placement. I use my thigh a lot for insulin pump infusion sites, and I’m guessing that using my forearm would be painful. This outlook is subject to change, as I should be from time to time. Also, I may be going back to using my midsection for a while anyway. More about that at another time.

5. Based on what I’m seeing up to now, it looks like the basal rate settings on my insulin pump are, frankly, stellar. Whether I’m high or low (you’re welcome Janelle Monae), once the peaks level out, if I don’t touch my pump, the line on my graph is pretty flat. I’m a little shocked, but happy that my endocrinologist and I were able to work this out without the benefit of a CGM to guide us.
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6. I have avoided the newbie temptation to check my CGM graph every two minutes. I think that’s because of my Dexcom experience during clinical trials. Of course, not checking the receiver all the time means I’ve made the mistake of putting it on the table and walking out of the room every so often. I never said I was perfect.

7. That said, can I just say how much I really hate the fact that I still have to look at a pager-sized display to get my readings? I’m not buying the “We’re working on an Android solution” anymore. You’re not… just admit it. If I’m wrong about that, I’ll be the happiest guy around who ever had to eat his own words, and I will gladly eat those words in this very space.

8. Like anything, when things go well, you tend to see something in a very positive light. That’s where I am now. At the beginning, I had a failed transmitter which also cost me a few sensors, and that was extremely frustrating. I realize that how I use my CGM, and how I react to various things affecting my use of my CGM, may very well change over time. But I hope things remain positive. Because for the last couple of weeks, it hasn’t been a big problem to deal with, and that’s the only way I’m going to buy into the notion of wearing my Dexcom every single day.

Those are my initial observations. I wonder how I will feel about my CGM in a year? Only time will tell. The goal is to make it to another year and find out.

I already have to live with diabetes all day, every day. Why do I have to attach another thing to my body to remind me of that?

So, my new continuous glucose monitor had been sitting in the box it was shipped in since around Thanksgiving.
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Beginning to wear it now is not a New Year’s Resolution, or an effort to game my diabetes data gathering to avoid the high carb temptation that bombards us during the holiday season. No, it’s not that simple. I’m not going gently into that CGM-inspired good night.

Nor do I have a simple answer for why I’ve waited so long to use a CGM, and why I’ve waited so long to start to wear it since it arrived. In this case, the answers aren’t simple. They’re also not pretty.

I can give you reasons why I’ve resisted so long. Worries about having to carry the receiver in my already overloaded pockets (no, I don’t have an iPhone, and until an iPhone carries a price less than a few hundred dollars more than a comparable phone, I’ll stick with my Android platform– which means I have to carry the receiver too). Concerns about using up already valuable real estate by having both an insulin pump and a CGM inserted into my body at the same time.

Any concerns I might have had about appearances, I lost long ago. When it comes to looks, I care a lot more about my clothes than about my devices. So how it looks doesn’t affect me.

Wearing an insulin pump was an easy process for me. No problems getting started or staying with it, and nearly seven years later, I’m a proud insulin pump user. What’s the issue anyway?

I don’t know, but it’s troubling. I know that something is definitely bothering me about this. I can tell by the way I delayed getting started, until the reasons for my delay were outweighed by the embarrassment that I have access to a device that many crave and cannot get their hands on. I must go forward.

Yet, when I did my first insertion, I was using language that would make a sailor blush. I got even more surly as that first insertion didn’t work, because my brand new transmitter was crap from the start. Now I’ve used two transmitters and two (actually three, after working with technical support to get everything right) sensors with nothing to show for them. Finally, on the fourth try, I got it to start up and calibrate properly. But my issues, I fear, go deeper than a sensor insertion.

I think my problem may be the notion, the confirmation, that a CGM gives you data 24 hours a day, seven days a week. In other words, it’s a constant reminder that I live with diabetes, a fact I try to forget every day.

Yet, there’s no question. I must begin my CGM journey. As The Great Spousal Unit shared, and she was right: sometimes, I don’t want to believe what my numbers are without a glucose check. If I’m going to be such a slave to data (and you have to be one if you live with diabetes), sometimes I need data I can access even quicker than a BG check.

But it’s not easy, and I’m not entirely sure why. The trick right now, I think, is to make the physical effort to get started, and then over time, work on what my brain and my heart are trying to tell me.

I recently read a statistic sharing that adults living with diabetes are at least three times more likely to develop depression than other adults living in America. Depression isn’t exactly what I’m feeling. Still, I already know I have diabetes all day, every day… why do I have to wear something additional so I can be reminded of that? All day, every day?

Ultimately, I need to remember that this is a device that could save my life. And over time, I may actually get used to wearing it. I’ll know I’ve turned the corner when my desire to get the data overwhelms the desire to rip it off of my body for good.

Until then, the emotional price of data gathering seems awfully high.

Technology: More to think about, in a good way.

I got through reading this thouroughly engaging post from Kerri Sparling over at diaTribe. It’s a very helpful post that gives People With Diabetes real information to consider when deciding whether to share or not share continuous glucose monitor (CGM) data via NightScout, the Dexcom G5 Mobile CGM, or MiniMed Connect/Carelink.

As I said, I thought the post was very helpful, but what also struck me was how we now have three different BG data sharing platforms to choose from.

When I considered that, I had a reaction that went something like: “Wha… what? Two years ago we didn’t have any! Now there are three!”. On the surface, it’s a no-brainer. Why not be able to share data from your CGM? But it took Nightscout, in my opinion, to get that ball rolling. Once people, and mostly device makers, saw that, and considered the possibilities for themselves, they were all on board. Makes perfect sense.

But there’s something else to consider too. Think about this: If you’re using a CGM and you decide to share, you now have to decide who to share your data with, and the rules regarding that shared data. It’s as if the gods said “Well, you don’t have enough diabetes stuff to think about already, let’s roll out something new to give you even more to worry about”.

That’s in addition to the fact that we now have, essentially, three separate apps sharing data across three separate platforms. It’s great to have choices. The more choices we have, the more likely it is that we’ll find something we really like. We need that. But again… more decisions. Which to choose? That’s easy if you’re using the Enlite sensor from Medtronic. But if you’re a Dexcom user, you have two options to choose from.

On the other hand, these are good problems to have. And parents of kids with diabetes, especially, have been wanting something like this since forever. I know, because I’ve asked them. I’ve been at JDRF Type One Nation events where parents see remote monitoring for the first time and simply ache for it. For them, it’s choices, schmoices. They’ll take anything as long as it works, because it allows for both more freedom for their child, and more knowledge of how the child’s diabetes is performing throughout the day. More choices? More decisions to make? Bring it on! They don’t care. Parents are awesome that way.

It’s very interesting for me, this realization that these three data sharing platforms seem almost ho-hum now. Sharing CGM data already seems like it’s been a part of our lives for quite a while. But it’s been less than two years between having and keeping CGM data to ourselves, and having the ability to share it with people a world away.

We live in a fast-paced world powered by technology. The latest innovations are making their way toward us faster than ever. The trick will be, of course, in not investing our time working for our data. But rather making the data work for us, for our health, for our safety, for our happiness.

You know what? We are worth it. #WeAreNotWaiting
 

Interview: Kevin Sayer, Dexcom President and CEO.

I had a super conversation this week with Kevin Sayer, President and Chief Executive Officer of Dexcom, the most popular continuous glucose monitor on the planet.

This was intended to be a podcast interview, but due to technical issues on my part, we were not able to record our conversation. Too bad, because it really was a good one.

Since I’m not very good at writing down things word for word (one of the many reasons I started a podcast), I will instead give you a synopsis of the questions I asked (in bold), and the answers that were given. Just imagine us talking, and it will be almost like being there.
 
 
First, I asked Kevin about his twenty-plus years of experience in the medical technology and medical device field. What has that experience taught him about the importance of what he does, and how it affects patients living with diabetes?

He answered this by telling me about a Facebook post he read earlier in the day. It was from a parent of a child with diabetes, who was in the hospital. The child was wearing a Dexcom CGM, and had a glucose check performed by a nurse. The check came in in the 240 mg/dL range, and about an hour later, the nurse came back to perform a correction bolus based on that amount. Only the Dexcom the child was wearing had shown that his BGs were coming down, and were still trending that way. After some pleading, the parents were able to convince the nurse to check again before blousing. That check resulted in a reading in the 60s. In this instance, the Dexcom, and the parent’s trust in what they were reading, helped to avoid an emergency, and possibly saved a child’s life. Cases like that help underscore what Mr. Sayer, and Dexcom, are trying to accomplish.

Dexcom has been pretty innovative over the years. In the past year, we’ve seen the rollout of Dexcom Share, and FDA approval of the Dexcom G5. A little over a week ago, they received the CE mark of approval in Europe for the G5, so they’ll be rolling out that product to Europe in the coming weeks. Has Dexcom started shipping the G5 to users in the USA?

The answer is: Yes! Just this week, the G5 started going out to users here in the USA.

FYI: If you are currently on the G4 Platinum product, there are low cost, and in limited cases, no cost upgrades so people can more easily move to the latest and greatest Dexcom system. Go to the Dexcom website for more details.

In the news release on the G5 in Europe, I noticed language that states:

“…the new Dexcom G5 Mobile CGM system does not require confirmatory finger sticks when making treatment decisions.”

Now, we know that’s a no-no here in the USA, and the G5 has not been approved for that here. But I also know there are clinical trials ongoing to help determine the efficacy, I guess, of People With Diabetes dosing insulin based on CGM numbers rather than fingersticks. Other than being the CGM involved in the studies, is Dexcom involved in those trials in any other way?

This elicited a passionate response I wasn’t expecting. Kevin Sayer is firmly behind the idea of using a properly-functioning, properly-calibrated CGM to inform insulin dosing decisions, independent of fingerstick confirmation. Dexcom has mounds of data, from multiple studies, and they are planning to go to FDA at some point to get the, I believe the term was, adjunctive exemption that would allow Dexcom to promote their CGM (either the G5 or a future generation product) in the same way that they are promoting it in Europe. He believes that trending data gathered over hours, rather than a one-time BG meter reading, is a more accurate way to determine insulin dosing decisions.

I’m really blown away by the amount of collaboration that Dexcom has been involved in over the years, and I’m talking several years, at least back to 2007. Most recently, we’ve seen Dexcom become part of the Animas Vibe system, and part of the T:Slim G5 system. In an industry that gets a lot of criticism for not playing well with others, what’s the secret to Dexcom’s success in making these partnerships happen time after time?

Mr. Sayer gave kind of a two part answer to this. In the beginning, Dexcom was very small, and collaborating with a bigger partner was a way to grow the business and forge relationships. Today, it’s about Dexcom being the CGM of choice, and making sure that if a Person With Diabetes wants to use a Dexcom as part of their overall diabetes management, they should be able to do that. And forming relationships years ago helped Dexcom have those conversations with other companies when the time came to branch out.

I also asked: Does he see Dexcom as a leader in collaboration as well as technology? The answer is yes. It happened the way it happened over the years, but yes, Dexcom sees collaboration as essential and good for Dexcom.

Finally, I asked about CGM coverage for Medicare patients here in the USA… rather than talk about what passage of such legislation would mean to his company, I wanted to ask: How does it make you feel knowing that patients on Medicare, some of whom were your customers a year or two ago, are unable to use CGM technology at all, without paying 100 percent out of pocket for it?

This, he admitted, is the biggest thorn in his side right now. It’s the biggest complaint that Dexcom gets on a regular basis. He mentioned that his most reliable customers, in addition to children using the G4 and G5, are those in their 40s, 50s, and 60s, who might be less hypo aware, and rely on the safety of CGM technology to help keep them out of the hospital. And have been steady CGM users for a long time. To take all that away just because you reach a certain age doesn’t make sense. Dexcom is working alongside others to try to convince lawmakers to add a category to Medicare coverage, allowing seniors in my country to continue using CGMs. The patient data and the dollar data backs it up. Dexcom will continue to fight for CGM coverage for patients on Medicare.
 
 
You know, the thing about Dexcom is, you can’t even blink hardly without seeing another announcement about a new product, upgraded technology, regulatory approvals, and continued partnerships. It has to have been an exciting almost nine months as CEO for Kevin Sayer. From my standpoint, I’m looking forward to what the next nine months and beyond will bring from Dexcom.
 

Confession time: CGMs.

So with all of this talk about travel and safety and doing the right thing, I’m still not a consistent continuous glucose monitor user. Here’s my confession:

I don’t want to be a CGM user.

I hope my endocrinologist isn’t looking at this today (she does look in every once in a while). But she’s already familiar with my resistance on the subject. Let me see if I can explain this. I’m sure all of the points I’ll make here can be shot down with common sense wisdom that just about anyone living with diabetes can understand. But there are a few reasons why I haven’t made CGM use habitual.

When I first started using an insulin pump five years ago, I also started wearing a CGM all the time. The CGM I was using was horrible; it had accuracy issues, and it was always painful to insert. It was so frustrating that after about nine months, I gave up on it. I won’t go into it anymore, but I think that was where my reluctance started.

Actually, the biggest, most overriding reason for not wanting to wear a CGM is that I do not want one more thing attached to me 24/7/365. That’s not to say that showing a CGM transmitter in public, at the pool or in the shower at the gym, would cause me embarrassment. Those days are long over. I couldn’t care less about that, and I certainly didn’t have a problem with it when wearing a CGM during clinical trials.

No, the problem of “one more thing” is bigger than that. It’s not only wearing something else all the time. It’s having to plan out site changes for two devices rather than one. It’s having to pack supplies for two devices rather than one. It’s fighting with insurance profiteers over coverage of two devices (and supplies for those devices) rather than one. It’s having to carry around a receiver in my already overcrowded pockets. It’s dealing with real estate issues earlier because I’m constantly violating my body in two places at a time instead of one.

I think there might also be, hidden somewhere deep, an aversion to gathering data for my endocrinologist to go through and find fault with me. My current endo is not like that at all, and I know she would never shame me if my numbers didn’t look so great. However, old wounds take time to heal. On the other hand, this would probably be the easiest place for me to give a little. In reality, I know this would not be an issue, so why should I continue to make it one? Patients are not always perfect either.

After going over my concerns with my endo, she suggested that instead of wearing a CGM full time, maybe I use one for ten days or two weeks in between appointments. That way, she could at least get a little data on how my BGs were trending throughout each day. This seems reasonable, and not too intrusive. But has that made me start the process over again? No. Old wounds take time to heal, and old habits die hard.

I’m not sure I’m solving anything here. But this is how I deal with issues like this: I talk about them, to myself, family, and friends, and in doing so, I often talk away some of the concerns (read: fears) of change. I know that CGM technology is better, and with the rollout of Nightscout and Dexcom Share, many people are able to add an additional layer of security in the advent of a hypo away from home. Why wouldn’t I want to make that a part of my care too?

I don’t think I’m there yet. But I’m getting closer. Secretly, I’ve even made lists of who I would share my data with… even “backups”.


 
 
 

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