Tag Archives: Dexcom

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.

Like these links, Friday style.

I’m very excited to share these links with you today. One about funding diabetes advocacy, and two about two of my Favorite People to Follow on Social Media. Here we go:
 
 
To begin with, Dexcom employees have just started up a new charitable organization called Dexcom One Step Ahead Foundation. The One Step Ahead Foundation will be funded by Dexcom employee contributions and fundraising efforts by Dexcom employees, and it aims to support grants of $10,000 to $50,000 to “…advance the missions and purposes of tax-exempt organizations that provide services and programs to people living with diabetes and their caregivers”.

I’m all for funding diabetes advocacy. A new infusion of funds like this can help make a real difference, so a big Friday Thank You Dexcom employees!

There’s a short window for this year’s grants… proposals must be submitted from August 22 through September 28. Grant awards will be announced during Diabetes Awareness Month in November. Sharpen your pencils!

To find out more or to submit your own grant proposal, you’re encouraged to contact Dr. John F. Gallagher at drjohnfgallagher@gmail.com. To read more about this generous initiative by Dexcom employees, CLICK HERE.
 
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Those of you who know me know that I live in Baltimore, but did you know that I am not the most popular or the best health blogger in my area? Not by a longshot. Molly Schreiber lives with Type 1 diabetes and Rheumatoid Arthritis, and she has a terrific blog called And Then You’re at Jax. She’s very active in both the Diabetes and RA communities online, and her blog reflects that. She’s also very nice, and she’s pretty funny at times too.

This week, Molly was featured on The Mighty website with her description of her newfound dismay over local businesses that do not have very friendly entrances.
Check this out and see what I mean.
 
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I met Mariana Gomez back in April at the Medtronic Diabetes Advocates Forum. Her friendliness, paired with her passionate advocacy on behalf of people living with diabetes in her home country of Mexico and beyond, was quite impressive, and something I won’t soon forget. Everyone over at her own blog and at EsTuDiabetes probably knows what I mean.

Mariana is a real gem. So I want to share this little piece that DiabetesMine shared on Mariana this week (and don’t forget to look for the one on Molly too!).
If you haven’t heard of Mariana yet, this is a good place to learn about her and her life with diabetes and her impact on the Diabetes Community.
 
 
That’s all for now… but I can’t leave without linking to my own blog, reminding you to nominate your favorite Champion Athlete With Diabetes (even if it’s you) so they can put their very own medal around their neck. Why should the Olympic athletes have all the fun?

Customer service woes? Dexcom’s working on it.

If you’re a User of the most popular CGM on the planet; and if you’ve needed help from Dexcom’s customer support lately; you may have had a less than stellar experience.

I got a chance to speak with Kevin Sayer about that yesterday. Kevin is Chief Executive Officer at Dexcom. He gave me a rundown of how Dexcom is working on solving some of the issues their customers have been facing.

I asked Kevin if the latest customer service initiatives are a function of Dexcom sales growing faster than their customer service function, or if they’re just looking at things with a fresh set of eyes. The answer is yes to both of those. According to Dexcom’s quarterly report released this week, revenues are up 60 percent over this time last year. That’s a lot. He explained it by saying that it’s one thing when Dexcom was growing from 2,500 to 5,000 customers. But Dexcom is still growing fast, and they now have greater than 150,000 customers. That means when you have problems, they become a lot bigger a lot faster than they used to be. So they were forced to take another look at customer service.

As a result, Dexcom has introduced some initiatives designed to reduce the burden on patients who really could use less burden in their lives.

To begin with, they’re rolling out a phone system upgrade. The idea is to reduce wait times and queues. They’ve introduced a new feature where, when phone lines are busy, a customer can opt to have Dexcom call them back without the customer losing their place in the queue. So hopefully, people won’t be on hold forever anymore.

They’re also adding additional customer service reps. Those hires should continue through the month of May.

In addition, Dexcom has made some website upgrades. There are new self service options, and there have been improvements to the online store. Kevin put it this way: “If you’re ordering supplies at 11 o’clock at night, which is what I’d be doing, we want it to work well.”

Finally, there are training and video updates. More descriptive videos, easier access to videos, and the rollout of something brand new for Dexcom: live webinars.

One of the challenges Mr. Sayer relayed to me is the idea that with the Dexcom G5 system, they were no longer answering questions about sensors and receivers. Receivers that Dexcom designed and manufactured. They were now getting inquiries about sensors and phones. Phones that they didn’t design and don’t manufacture. So that slows up customer service a bit, though he feels they’re getting better at it.

At the end of our conversation, we talked about Dexcom at ten years old. How does he feel about shepherding the company into its second decade?

Kevin admitted that there aren’t a lot of examples to go by in the diabetes device world, because so many have gone out of business before reaching the ten year mark. So in a way, Dexcom is blazing its own trail, while still growing its customer base in a big way. And he told me something that I would expect every CEO to say: Dexcom’s patients are the most important part of their business.

Let’s hope that the phone system upgrades, website improvements, and customer service hires help Dexcom come through for their patients for many more years to come.
 

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.
 

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