Canadian seeks CGM in the US
Hello,
I've been looking into getting a Dexcom CGM. Unfortunately, I'm in Canada where it's not yet available and no one seems to know when it might be.
So, from the forums I've gathered that I will need a US mailing address for Dexom to ship the supplies to and I will need to pay for an endocrinologist appointment in the US to get a prescription.
I have a couple of questions:
1) How do I find an endocrinologist who will be willing to do this? Do they gladly prescribe it to anyone willing to pay for the product without that person actually being a patient? I'd probably head to Buffalo (I'm in Toronto), and I can't seem to figure out who I would go to. One site said a physician referral would be required, as it is to see a specialist here in Ontario. Can I get an appointment without a referral?
2) What comes first? Do I get the prescription first and then contact Dexom, or vice versa? Do I get the prescription, send it to Dexcom, order the product and supplies online, and have it shipped to a US address?
3) Has anyone done this before? I've heard and read that it's possible as a Canadian but it seems so difficult (and covert!). But, I'm not liking what I'm hearing about Medtronic's CGMs, and I use an Animas pump. I'd like to hold out for the Dexcom to be available here but I've been living alone since the summer and having some unexplainable lows at night. It would make me feel less powerless about those, I hope, as well as helping me sort out all sorts of other control issues.
Thanks for any tips or words of wisdom! I'm just playing with this idea, so any input is appreciated.
I've been looking into getting a Dexcom CGM. Unfortunately, I'm in Canada where it's not yet available and no one seems to know when it might be.
So, from the forums I've gathered that I will need a US mailing address for Dexom to ship the supplies to and I will need to pay for an endocrinologist appointment in the US to get a prescription.
I have a couple of questions:
1) How do I find an endocrinologist who will be willing to do this? Do they gladly prescribe it to anyone willing to pay for the product without that person actually being a patient? I'd probably head to Buffalo (I'm in Toronto), and I can't seem to figure out who I would go to. One site said a physician referral would be required, as it is to see a specialist here in Ontario. Can I get an appointment without a referral?
2) What comes first? Do I get the prescription first and then contact Dexom, or vice versa? Do I get the prescription, send it to Dexcom, order the product and supplies online, and have it shipped to a US address?
3) Has anyone done this before? I've heard and read that it's possible as a Canadian but it seems so difficult (and covert!). But, I'm not liking what I'm hearing about Medtronic's CGMs, and I use an Animas pump. I'd like to hold out for the Dexcom to be available here but I've been living alone since the summer and having some unexplainable lows at night. It would make me feel less powerless about those, I hope, as well as helping me sort out all sorts of other control issues.
Thanks for any tips or words of wisdom! I'm just playing with this idea, so any input is appreciated.
Replies to This Discussion
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Permalink Reply by Peter Weissenstein on -
If you are concerned about the lows - have you considered getting a Diabetes Assistance Dog? In addition to helping you when you have lows a dog will also get you out to exercise as well as provide companionship. As to getting a CGM for use in Canada the Toronto to Buffalo drive is not that far nor is a bus ride that expensive. Get a mailbox at Mailboxes etc at a convenient Buffalo area location and use that as your US address. As to the order of things - first find an endocrinologist in the US who is willing to take you - not because you are a Canadian but because unfortunately endos are in huge demand and there can be a long waiting period to get in to see one. Be prepared to pay (in US dollars or with a credit card if they accept them) for your appointment prior to service as you will be coming in as a patient without insurance. I don't think that it is "covert" but you do have to realize that Canadian Customs will have the right to a) impose a large import duty or b) confiscate the device as it is not approved by the Canadian Medical Establishment yet. Have you contact the Canadian equivalent of the FDA to find out if anyone is doing test trials in Canada for any brand of CGM. If someone is and you can get accepted into a test trial then you would have no problems at all,. Finally remember that the US uses mg/dl for meter measurements while in Canada you use mmol/l. This is extremely important to keep in mind as you will have to do some conversions at one point or another. So a 5.5 while normal in Canada is really easy to confuse with a 55 (which is actually a 3.0) Just FWIW. So what happens if you are using a CGM and you have a drastic low but it reads in mg/dl? Well for starters - in an emergency the EMT may not realize you are using mg/dl and your treatment/care would be off... Only reason I know this is because for several years I was working both in the US (where I live) and in Canada. Since meters can no longer be changed between mmol/l to mg/dl and back due to people accidentally switching the readings and running into the aforementioned problem (mostly in the US according to the meter companies when I pushed for a reason) you may be opening a can of worms that could make matters worse. (I handled the cross border situation by having two meters - one labelled US and the other Canada.) Finally support. You won't get it if you phone from Canada. (You could use a Skype outbound calling number and get a US number but see - now you are adding MORE expense and hassles to using the CGM) Other options being developed (and again - you might see if you can become a guinea pig for them) are Glucose Sensing Bio-implants and several non-invasive techniques. (You can get more info on this at Wikipedia by searching for Blood Glucose Monitoring.)
At any rate - if you haven't done so yet, join MedicAlert Foundation Canada (http://www.medicalert.ca/en/index.asp and buy the bracelet. Keep your med list etc up to date. This gives you GLOBAL coverage in case something happens. (I say the bracelet because when I was looking I was told by many EMTs and firefighters in several States as well as up in Quebec and at one of the GTA hospitals that the wrist is the first place they look when someone is unconscious.) The advantage of the MedicAlert ID is that your ID number and a phone number that can be called collect is on it along with whatever info you want there. They also keep a full record of your doctors, medications, next of kin or emergency contacts or whatever you want them to keep on file. Updates are free and they can share the information with medical professionals when contacted if you aren't able to speak, etc. Whatever you decide - good luck with it.
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Permalink Reply by Terrie on -
Wow, Thanks for all this information Peter. You mentioned items that I hadn't even thought of. You're Very thorough. I was wondering about the Dexcom also. Unbelieveably, what a royal pain. for sure. Rules are rules, I guess.
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Permalink Reply by Jessie on -
Thanks so much, Peter. You've given me a lot to think about!
I had been thinking about the mmol/l to mg/dl difference and decided while not ideal, the value of the information I was getting from it would hopefully overshadow the inconvenience. I'm familiar enough with the numbers from reading the forums and such that I figured I'd have an idea of what's going on. I didn't really consider the chance that I could misread and act on it when low. Though I wasn't planning on using the CGM to decide treatment/doses, you never know what can happen.
I have considered a service dog, for a few months now. I love the idea. However, there are issues such as my living in a very small apartment and the even higher cost of one of these dogs. I also don't know how one goes about getting one in this area, but perhaps I'll do some more intensive research.
I wear a medical ID bracelet, though it's not MedicAlert. I plan on re-joining MedicAlert before I travel.
Again, thanks for all the ideas. I've emailed Health Canada to ask about CGM trials. It would make everything a lot easier if they were just approved here (and covered by insurance)!
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Permalink Reply by Bob on
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A general practitioner can prescribe a GCM for you, so no need to wait for an appointment with an endo (a GP will also cost less!) I would also contact Dexcom to ask whether they would be willing to sell you one of their receivers that displays in mmol/l (I believe they sell these to European markets.) It's worth a try to explain your circumstances. Perhaps you can even buy one without prescription in a foreign market.
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Permalink Reply by Jessie on
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Thanks!
Yeah, I was wondering about buying one in the UK if a prescription is not needed. I might have someone in England willing to ship it to me.
Excellent to know that I can see a GP!
I would love to contact Dexcom and discuss this, but I'm a little worried they will just refuse to deal with me if I say I'm in Canada. Is this an illogical fear? I think I contacted Abbott a while ago just asking if they have any idea idea when the Freestyle Navigator might be available in Canada and they just said they weren't allowed to sell to Canadians.
I'll see what I can do! Thanks a lot for your response.
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Permalink Reply by Franco on
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Double check with Abbott but not the US Abbott, contact Abbott in the UK they are very independent from the US. I was able to get Abbott software 2 years before it was available here in the US from Abbott in Germany. The new Navigator is available in the UK, then get your friend there get it and ship it independently to you. I have no idea what kind of Rx requirements there are but Abbott UK should be able to tell you that, even if they could ship it to Canada. I would think it should be easier for a Canadian to get something out of UK easier than we could. If you find out any ways of getting it out of the UK post it here. I've been trying to get one out of one of the EU countries for months.
I find the Navigator a better CGM than the Dexcom especially for nightime hypo's, I sleep through the whimpy alarms on the Dex, the Navigator doesn't stop until you wake up and turn it off, I've slept through the Dex low alarm several times and ended up dangerously low.
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Permalink Reply by Kelly WPA on -
Dexcom uses Federal Express to ship and a lot of companies like Dexcom won’t ship to one of those mailbox places or a PO Box.
Unless you have a friend that is friends with a doctor, I would think that you would have a hard time getting a doctor to sign the paperwork with one trip in to see him. Some people here have to jump thru hoops to convince their doctors that they have been seeing for awhile to sign the papers. It is true that a PCP type doctor can sign the paperwork – my paperwork was signed by a PCP. Dexcom might have a list of “Dexcom friendly’ doctors that they could give you but you still might have to make more than one trip in order to get it.
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Permalink Reply by gooberific on
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thank you everyone for all of this information.. i've been struggling with this too.. i very much want to get my 9 yr old son onto a Dex as soon as possible. i was wondering what kind of process you'd have to go through to get one from the US. i wish someone could give me a concrete date on when the Dex will be available in Canada!!
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Permalink Reply by Jessie on
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I heard that the problem is that the Dexcom interferes with our weather balloon signals. Ugh!
When I emailed Dexcom looking for updates last month, they said:
"Thank you so much for taking the time to contact us. We are looking forward to being able to provide our product some time in 2011. Unfortunately, I can't give you an exact date at this time."
I wish I knew this was true. If I knew it would be available in 6 or 8 months, I'd be able to wait. But, it gets pushed back so many times. It seems so strange and silly that we don't have access to these devices I know would make such a huge difference in my life.
I think I've given up on getting one in the US. It is a lot of hassle for a device that will ultimately be in the wrong measurements for me. I've been looking into the UK; if you know anyone there who would be willing to ship it to you, they don't have the same types of restrictions. No prescription is required. The primary thing working against us other than the distance is the steep exchange rate.
If you take one of these routes to get one, please tell me about it!
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Permalink Reply by doodlebug on -
Hi Jesse
What was the outcome of your search? Did you get a CGMS? I'm looking into it and figure a lot may have changed since you were looking. Any other entrants to Canada and what about accuracy these days?
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Permalink Reply by Jessie on
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Hi doodlebug. Apologies; I missed this!
I did end up getting a Dexcom system when I went to the UK in the summer, and brought it home with no trouble. It's been really marvelous, and it's helping me gradually but steadily bring down my A1C. I'm actually surprised still by how accurate it is most of the time, and it hasn't given me any problems. I've only had one bad sensor in all the months I've used it.
As I mentioned below, I've been using the Medtronic CGM for the past month for a medical trial, and can't say I'm a fan. There really has been a big difference in accuracy for me, as well as a huge difference in comfort!
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Permalink Reply by Jen on
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This has been an interesting thread ... I am also interested in a CGM but use an Animas pump so don't want to use Minimed (plus have heard bad things about it, plus would not be able to see the receiver) and would like a Dexcom. Been waiting for them to be available forever. I also heard the stuff about the weather balloons. Obviously it didn't come out in 2011 like the Dexcom person thought, but I really wish that it would come to Canada soon!
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