Tag Archives: CGM

Prickless.

No, this is not a story about removing the president of the United States from office.

Instead, this is about something I did recently.

I went a full day without doing any fingersticks. Twice.

I got the idea when a Dexcom sensor ended, and I still had about four days left in my trial of the Freestyle Libre (Disclosure: Abbott paid for the reader and two sensors. Opinions are my own).

At first, I wasn’t sure about only wearing a CGM that I didn’t have a lot of experience with. But during the trial, it had been pretty reliable. Then I thought, “the Libre doesn’t require fingersticks, even for calibration… what if someone didn’t want to do one?”. So I spent an entire day, a Sunday, not using my meter even once.

Then, once I got through a day using only the Libre, I knew I had to do the same thing with my Dexcom G5. The Dexcom only requires fingersticks for calibration, so in theory at least, after calibration, I could go quite a long time managing my diabetes with only the Dex. Dexcom’s turn came earlier this week.

I don’t know a single person using either of these systems who ever actually does this. I’m sure there are, but I haven’t seen anything about it anywhere. How was my experience?

In a word, I was terrified. When you rely on pricking your finger with a sharp (okay, blunt) object multiple times per day for years on end, drawing blood and using that blood to give you a handle on your diabetes, you get used to it enough to rely on it first. For me, my meter is my truth teller.

Occasionally, my CGM will give me a weird reading I just can’t believe. When it does, it’s important, even comforting, to know that I can grab my meter and trust what it tells me. But the thing is… more often than ever before, even in these moments, the meter and the CGM are very close.

I didn’t have any notable moments during the two days. No big highs, no major lows. I just lived my life, checking my BGs only via my CGM display. Managing insulin dosing and carb intake accordingly. Out of sheer instinct, I took out the meter a couple of times each day, nearly checked, but then put it back in the drawer with a laugh.

Since things worked so well over these two days, you may be wondering if I might want to ditch the meter entirely. The answer is No. As I said, when it comes to blood sugar, I’ve come to rely on my meter as the one bastion of truth above all others.

But… I could see backing off on glucose checks in my future. Maybe I won’t check seven to ten times each day. Maybe four or five, or even three or four might do the job. Maybe it’s time to think of my CGM as more than just an emergency alert system.

What this experience has done is give me the feeling that I can step back and reassess whether I need to give my continuous glucose monitor more of a place at my diabetes table. I would have never guessed that I might do that. I’ll still keep my meter handy. But going forward, I’ll be just as likely to rely on my CGM.

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The Freestyle Libre (part 2): Final Analysis.

Disclosure first: I was given the Freestyle Libre continuous glucose monitor to try at home. Abbott is covering the cost of the device and two sensors. I am not being compensated in any other way. All opinions on my brief experience with this device are my own, as always.

My trial run of the Freestyle Libre CGM was pretty smooth sailing.

There are a number of things I should cover, so let me give you the rundown of what I’ve observed:
 
 
– First of all, as I mentioned earlier, the sensor warmup period is a lengthy 12 hours. It’s great that there are no finger sticks involved, but there certainly are when you have to wait 12 hours for your first CGM reading. You still have to know what’s happening with your blood sugar over the course of 12 hours. So even though I’m not using them to calibrate (the Libre is self-calibrating), I’m doing a fair amount of fingersticks during that 12 hour warmup period.

It’s been mentioned elsewhere that the warm up time in other countries is significantly less than 12 hours, so here’s hoping that gets ironed out soon (also, more on the “careful” versus “full gusto” submission processes with FDA below).
 
 
– Unlike what I’ve been reading from others who have been doing the same trial, the numbers I saw from the Freestyle Libre were almost always higher than what I saw from my Dexcom or my Accu-Chek Guide meter. When my numbers were lower, they were pretty much in sync, single digits separating the numbers on the screens. When the number got over, say, 140 mg/dL, the numbers on the Libre were higher.

In these situations, the Dexcom always showed the lower number, and the Libre the higher number. The number from my glucose meter was somewhere in the middle. Like this:

Obviously, I don’t know this for sure, but to me, this would indicate not a failure, but a difference in how the glucose data is being interpreted by each individual CGM. As many will tell you, it’s not usually the number, but the trend that’s important. Plus, if glucose is being interpreted a specific way on a regular basis, it’s easy to account for that, or at least understand when to do a BG meter check to make sure.
 
 
– The size of the sensor is very small compared to any other CGM sensor on the market (for those of us in the USA, about the size of a half dollar). Insertion was easy (don’t forget, my user guide was in Spanish, so I did my insertion based on online tutorials). The comfort level wearing this on my upper arm is without compare. And it stayed on, without the need for extra adhesion.

This might be a factor to keep track of down the road… If they get enough competition, I can foresee Dexcom breaking the mold, so to speak, and speeding up work on a smaller sensor and transmitter option.
 
 
– There is certainly a convenience factor in being able to take the reader, scan it over the sensor on your arm, and see a new reading instantly. Even less than a minute apart. For the record, Dexcom gives you a new reading every five minutes.

This is not a big deal to me, but I have to admit that sometimes, I found it easier to have the reader next to me when I slept, and instead of reaching for my phone and getting the number in the middle of the night, I just scanned and saw the number on the Libre reader.
 
 
– That said, I have my phone with me throughout the entirety of my waking hours. To roll out a medical device in this day and age, and not have a Bluetooth/Mobile option of some kind attached to it is a real shortcoming. Especially considering the reader options are significantly limited. There is a mobile app for Freestyle Libre available in other countries (known as LibreLink), but not yet in the USA.

I get it… Abbott either wanted to make sure they got the Freestyle Libre approved as a standalone without having to get the mobile app approved at the same time, or they couldn’t get it approved right away and went instead for just the sensor and reader. They’re probably working feverishly to get the mobile app okayed as soon as possible. I’m only speaking for myself here, but that’s a dealbreaker. Double dealbreaker if the mobile app eventually comes out only on an Apple platform (LibreLink is available in other countries on Android, so yay).

You might wonder why, in this case, I seem to be holding Abbott to a higher standard than maybe I held Dexcom a few years back. Why? Because it’s 2018. In case you haven’t noticed, we’re in a digital, mobile-manipulated world, and yes, I’m expecting industry to keep up with the times. Is that asking too much?
 
 
– One additional item: There have been rumblings about the lack of alarms with the Freestyle Libre. That’s true in a sense, because alarms are not part of this package, unless you’re actually scanning the sensor. You, as an individual user, will have to figure out whether that’s important to you or not. I’ve also heard a lot about alarm fatigue from the Dexcom, so I will leave it up to you to decide what is best for you.
 
 
Overall, I think the Freestyle Libre is a good option for People With Diabetes. The cost is less than the Dexcom, the readings are accurate enough for this cowboy, and you can’t beat the size and comfort of the sensor. I also think this might be a super option for some (if they can get it approved by insurance), because of the longer sensor life (10 days versus 7 days for Dex), and the fact that finger sticks are not required (other than sensor calibration, finger sticks are not required for Dexcom either).

Bottom line: For now, I’m not moving away from my Dexcom. If there’s a mobile app that allows me to see the reading on my phone, and helps me share data? Then I’ll be happy to take a second look.

Again, and I don’t think I can say this enough, it is wonderful to have an additional CGM option, and one that isn’t forced to be linked with a specific insulin pump. There are plenty of reasons to like the Freestyle Libre, and only a couple of reasons for me to hold off on a full throated endorsement (for now).

The Freestyle Libre (part 1)

Disclosure first: I was given the Freestyle Libre continuous glucose monitor to try at home. Abbott is covering the cost of the device and two sensors. I am not being compensated in any other way. All opinions on my brief experience with this device are my own, as always.

You might have noticed a lot of talk about the Freestyle Libre gaining approval by the U.S. Food and Drug Administration a couple of months back. That means that we here in the United States now have access to a device that has been a hit in Europe for a couple of years now.
 
 
Since I was given the receiver and a couple of sensors to try, I am happy to share my experiences using the Freestyle Libre. The setup was easy and completed without even checking the enclosed user manual and other material (more on that in a minute).
 
 
The initial two things I have to say about it fall under the Bad Thing/Good Thing heading.
 
 
Bad Thing: all of the documentation I received is in Spanish. The user manual and quick start guide are all en espanol. I can read and comprehend some Spanish, but not enough to feel confident using a medical device.
But… Good Thing: The online tutorials were terrific, and all I needed to get started.
 
 
Bad Thing: The Freestyle Libre calibration process takes 12 hours.
Good Thing: It’s true… this CGM does not require a fingerstick to calibrate.
 
 
I think that’s enough to start with. If you want to see what others have to say about the Freestyle Libre, just look around a bit… you’ll find plenty of information and opinion. Then come back here, as I will likely have more to tell as the next 20 days or so pass.
 
 
One more thing: I am thrilled that there is another tool for People With Diabetes to choose from to help them manage their misbehaving pancreases. As a community, I hope we can continue to encourage and empower choice and access for everyone.

The Dexcom G5 Mobile App. I’m a fan.

After last week’s whiny post about how I’ve been so disappointed in my diabetes devices lately, I feel compelled to let the pendulum swing in the other direction and give credit where credit is due.

About a week and a half ago, Dexcom rolled out its G5 Mobile app to Android users. Finally. Okay, I said I would give credit where credit is due. And kudos to Dexcom, who, as far as I can tell, is the only device maker to develop software to use on an Android platform. Yay!

I know all of you iPhone Dexcom users are yawning right now, but please give me a moment to be happy too. I’m a person who can appreciate the wonders of a good smart phone, but I can’t bring myself to pay hundreds of extra dollars because there’s an image of an apple on it. After years (literally, years) of waiting for an Android option, Dexcom has come through.

Among other things, this means no more carrying around the receiver. I’m a guy who carries too much in my pockets already. I do not need one more thing to lug around, and even though the receiver wasn’t too big, not having to carry it around feels like a big weight off of my… pockets.

In addition, I’ve finally completed my Clarity account setup, which means my endocrinologist can get my Dex data too. No more downloading the data at the office visit. She’ll have it already. Cool, huh?

I’m getting the hang of navigating the G5 Mobile app. It took me a couple of days to realize that I needed to turn the phone to landscape view to be able to see more than the last three hours’ worth of data. Once I do, it’s just a push of a button to view my data in 1 hour, 3 hour, 6 hour, 12 hour, or 24 hour increments. If I hover my finger at any point in the graph, it will show what my reading was at that very point.

And I have to admit to having a little fun with the alert sounds. Instead of the basic Vibrate, soft, attentive, etc. settings available on the receiver, I have 23 different sounds to choose from. So if I want to have my low alert set to Truck Siren or Blamo Dings, I can do that. Nice touch.

I get that making an app work on two different platforms is extra work, but I am SO HAPPY that Dexcom has made the effort. Reducing the burden of managing diabetes is a good thing, and to that extent, Dexcom has done it.

The Dexcom G5 Mobile app for Android users is available for free in the Google Play store right now.

My apologies for the off-center views of my phone screen. Security features built into the app will not allow for a screen capture, so I had to take photos of my phone screen.

Disclosure: I was not given anything or asked to write anything about the Dexcom G5 Mobile app. All opinions are, as always, my own.

Device failures.

I’ve nearly had enough.

The past few weeks have been full of diabetes device failures, and I’m actually asking myself how much more I can take.

Dexcom sensor failures are frustrating me more than I can express here. Since January, roughly one out of every two sensors fail without working more than a day, or ever working at all. I mean, how long do you put up with that kind of unreliability before you chuck it into a box and give up?

And believe me, I’m doing the insertions exactly the way I’m supposed to. Every time I do an insertion, I’m still going back to the online tutorial to make sure I’m not missing anything. The failed CGM sensors have definitely become my biggest diabetes nightmare.

I’ve even stopped contacting Dexcom support about it. The calls are all the same: the support person goes through their script so they can cover everything they need to cover… I get that. Usually, after about half an hour on the phone, they agree to send me a new sensor. But… how much is the sensor, and what is my time worth? In addition, I’ve had to replace a transmitter and a receiver too. In a little over five months. It’s quickly becoming not worth it.

But my pump issues are still there too. I have an Animas Vibe pump where a 200 unit limit to my reservoir isn’t really an issue. But it’s not really 200 units. Because once the pump says the reservoir is at 0 units, the pump stops… even though there are usually around 20 units left in the reservoir. So, something that could last 3 ½ days (for me) winds up lasting barely 3 days, if I don’t have other issues. Why do I have to waste 20 units of insulin every few days?

Which I almost always do, because my Medtronic infusion sets can’t seem to go more than 2 to 2 ½ days before they just don’t want to work as well anymore. At that point, I still seem to get insulin, but instead of hovering between 80 mg/dL and 120 mg/dL, I suddenly go up to 220 to 320. So I have to bolus huge amounts of insulin to try to bring my glucose level down. When I change out the set my BGs go immediately down to a reasonable level again. Why can’t an infusion set be made well enough to last the FDA-mandated three day limit? Or greater?

These are all issues that I did not experience in the five years I was managing diabetes through my previous pump and no CGM. Let me put it another way: my A1c is climbing, due only to medical device failures. This leaves me asking even more questions. Like:

Why can’t device makers make something that is simple, and not as susceptible to breakdowns?

I understand the all-consuming need to develop the next special product with all the bells and whistles, but… why can’t there be a simple option that I can use? My previous pump seemed to do everything I needed it to do. Why can’t I just choose a new version of that?

I actually like my Dexcom when it works… why can’t it work more often, with fewer breakdowns of the individual parts?

I hate to pick on individual companies. But the truth is, if these were cars, I would probably choose not to drive as opposed to breaking down on the side of the road every few days.

Granted, there still aren’t many (in a trending sense) people who are managing their diabetes through pumps and CGMs. But I don’t think that should be a reason for me to settle for inferior products. It certainly isn’t a reason for me to continue to pay for said products without noting where they are coming up short.

And without saying that maybe some device companies need to go back and make their current products as reliable as they can before devoting resources toward the Next Big Thing.

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