Replies to This Discussion

Permalink Reply by Korrie on May 14, 2011 at 6:27pm

I insert, clip the transmitter up as instructed, make sure the Dex has the little icon present that it is communicating with the transmitter, but do not start sensor on the dex until the morning. I keep the receiver with me during the night so they "commuicate" just no actual readings. Once you are up in the morning (and I have learned to even wait until my sugars are pretty stable) hit start, the dex will always go through it's programmed start upand prompt you to enter two blood sugars when it's ready.
To restart the sensor, I have allowed mine to completely quit on it's own at the end of 7 days. Most of the time, I go ahead and just tell the Dex to start new sensor right away - unless I am unstable - then I wait until things have settled down again to begin again. Again, the Dex will do it's programmed start up and prompt you to enter the two blood sugars when it' ready.
The "start new sensor" icon is not on the screen unless the 7 day period has fully ended, or you went in and told the Dex to stop sensor yourself. Once you begin a new sensor, that option dissappears from the screen on your Dex.
Good luck! I love mine!

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Permalink Reply by jrtpup on May 18, 2011 at 10:33am

A bit late Melitta, sorry! I know a lot of people start their sensors before going to bed, but I've gone low too many times during the night to want to risk it. I've only been using it for a few weeks (I'm in love!), but haven't had any issues starting a new sensor during the day and making sure I'm stable before entering the initial 2 BG readings.

When it asks you to recalibrate twice a day, wait until you're stable if you're not already. The dex won't show the number you enter right away - remember it's behind fingersticks. Don't know exactly how it works but there's some algorithm that determines what new number will show.

How's it going so far?

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Permalink Reply by Melitta on May 18, 2011 at 4:56pm

Hi Jrtpup: I just started on Saturday, so in my first week, and like you I started during the day. I am absolutely blown away by the Dexcom's accuracy! Plus it is easy to insert and easy to calibrate (as you suggest, I only calibrate when I have that horizontal arrow). I had tried the Medtronic Guardian two years ago, and it was so wildly inaccurate and difficult to calibrate that I just gave up. So I am REALLY happy to be having such success with this Dexcom, albeit only a few days in yet.

Thanks for the support!

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Permalink Reply by jrtpup on May 18, 2011 at 5:22pm

That's great! I think I was dependent on it within a couple of days ;)

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Permalink Reply by Rickst29 on May 21, 2011 at 10:19pm

I disagree with the "twice per day" schdule which the current device spits out. During the first two days of my use, a Sensor's output current versus true bG characteristics are changing too rapidly to "get by" with only two re-calibrations. (The Sensor wire surface, your body tissue reaction, and the reagent break-in are ALL changing quickly.)

I have four recommendations WRT calibration. This post lists them, and my reasoning behind them: http://www.tudiabetes.org/xn/detail/583967:Comment:1865789

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Permalink Reply by dickengel on May 19, 2011 at 3:51pm

I have used mine 4 months now and I regularly calibrate at each meal (4x/day). I never pay attention to the arrows when I calibrate and have not had an issue with it. Dex claims it doewsnot matter and I have not had an issue using it this way. I figure if i need a fingerstick, I might as well input it to the Dex. I will start a new sensor most anytime of day - I dont like doing it before bed because it needs the 2 hour calibration. I restart up to 2 times and usually get 12 to 21 days on a sensor.

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Permalink Reply by Melitta on May 19, 2011 at 8:38pm

Thanks, Dick. Tips like yours are so helpful to me, since I am just starting out and finding my way. So far so good!

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Permalink Reply by Terry Keelan on May 19, 2011 at 10:03pm

Welcome to the Dex.

I never have inserted my sensor at night but I just might try it. I usually insert in the morning.

I calibrate when I'm told to and every once in awhile when I feel like it. Be careful not to fall into the trap of constantly calibrating because you think the numbers need to match exactly. It will drive you nuts.

To wear past seven days I either let the sensor run its course then restart it or stop it myself when I get the warning that it will expire soon. The major issue I've had with +seven day use is keeping the sensor secure to my abdomen.

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Permalink Reply by dickengel on May 20, 2011 at 4:26am

Terry two items that help on the sensor to the abdomen:

Tegaderm or" ReliMed" Transparent Thin Film dressing. I use 4" X 4 3/4 these usually last a week. When the edges are peeling I use scisors to remove all the dressing from the skin but careful not to pull off the cloth dressing area on the dex. Then I put on a coating of IV prep and secure a new dressing. I cut a rectangular hole in the dressing for the size of the transmitter. I have also tried tape called FleciFix - you can order either online - I think the flexifix is better but I have 1 1/2 boxes of the ReliaMed. The tape is more economical. You can either use the 4 inch and cut the rectangular hole or they also sell the 2 Inch and then use 4 strips around the perimeter. I prefer the 4"

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Permalink Reply by Rickst29 on May 21, 2011 at 11:58pm

Dick, I could be wrong, and YMMV, but it's possible that you're working WAY too hard at this -- and getting worse results than you could be getting.

I'll SWAG that you could have better lifespan by using "Skin-Prep" as your bottom layer, right on your skin. "Skin-Prep" and "I.V. Prep" are both made by Smith+Nephew, and the packaging is nearly identical, and the ingredients are nearly identical... but the purpose, and the balance of ingredients in the formula, are a lot different. (That's why they make two DIFFERENT things.)

I.V. Prep is for short term appliances, things which are "punched in" for only a few minutes or hours. In contrast, the on-label usage indication of Skin-Prep is for "long-term adhesion of medical appliances". (Direct quote). Which happens to be exactly what we're doing!

With Skin-Prep, the secret to good results is TOTAL dryness. Go with the single-use, foil-wrapped wipes. You will want to apply it the entire "target area". (Your insert site, the Dexcom pad, and the surrounding area which you will cover with Flexifix strips.) Yes -- you shoot the needle in right through the Skin-Prep barrier layer, it seems to have no effect on Sensor readings or lifespan.

** BUT **

The key to using Skin-Prep is assuring TOTAL dryness before putting the Sensor pad down. You need to have the hair dryer ready to grab, already running, when you wipe your target area.

So the order is: clean your skin really well.

Then, if you're OCD about infection (as I am), you'll wash a small area, about the size of U.S. Quarter, with antiseptic-soaked Q-tips. This biological cleaning is right at your is your at your wire-insert target. PVI, the "orange stuff" widely used in USA emergency rooms and Doctor's offices, is pretty good for this. It's cheap and over-the-counter at any drugstore. But it's more likely to cause allergic reactions than CHG. CHG is more widely used in EU facilities for exactly this reason -- but in the USA, you'll need Scrip to get it. You need to keep this small area wet for at least 30 seconds, so plan on using more than one Q-tip. If you do this, note the exact location of the Center of your sterile "Target", because the Skin-Prep solution is going to wash away the color.

Now turn on your hairdryer (low). Wash your hands again, because the hairdryer handle was filthy. Now tear open the Skin-Prep foil, and wipe firmly over the ENTIRE area which you will using. More than once, but don't let the pad go dry. With your other hand, grab the hairdryer IMMEDIATELY and tilt it into the wet area from underneath.

Skin-Prep starts out as an extremely "runny" liquid. Gravity will try to make it flow downwards (from the top of your "wet area", towards the bottom). This is a BAD THING, because the place where your adhesive tapes need the most help is along the top edge. (In addition to being an edge, the TOP edge is the one which gets hit by shower spray- at an angle which tries to separate the tape from your skin.)

Keep the hair dryer going until the appearance changes from "liquid" to "dry", and then to "shiny, crackled". TRUE dryness is the stage with nearly microscopic cracks on the surface, and in most climates, YOU CAN'T GET THERE without using a hair dryer.

Unlike the Skin-Prep to hair-dryer stage, you can take a few moments of time here. Personally, this is when I put the hair dryer back in it's place, and re-wash my hands, clean the Transmitter really well, and open the Sensor package. Then I set the Sensor pad in place and shoot the wire in. Remove the "Shooter", insert the Transmitter, making sure to hear TWO clicks upon pressing down and latching it in place. (Both sides! Not just one!)

If you're starting the Sensor immediately, do it now. Personally, I always use an old "battery-worn-out" Transmitter to protect the sterile area and wire insertion for a period of "pre-warmup" time.

Now, I just cut two full length strips (4") and two shorter strips (2.5") of FlexiFix. (The shorter strips need to be centered on the roll, so that you have the seam to pull away the paper tape in the middle. Don't cut from just one end!) Cut them about one inch wide. There's no need to "round the corners" of the bottom piece, but the sides and top should have their upper corners rounded off. This helps to prevent them from starting a "loose flap" at one of the top corners. The inner edge, of course, is next to the Transmitter assembly. IMO, you only need to cover the Transmitter assembly in higher-pressure water situations (water skiing, hard swimming with racing turns, or Snorkel/Scuba).

Long ago, I would carefully cut a donut-hole (for the Transmitter) into the middle of a single, bigger piece of FlexiFix. But, with Skin-Prep assisting the tape, this is just as good. With this battle plan, I haven't had even the slightest bit of "upturned corner" in my 14-15 day Sensor schedules. (I.e., 14 days "running", plus 6-24 hours of extra warmup time.)

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Permalink Reply by dickengel on May 22, 2011 at 3:31pm

Im workin too hard?

Your process seems way too complicated - I guess we each do what works fr us. I have mty sensor in and started in less than 2 minutes and once a week I take t minutes to replace the transparent dressing. Also dexcom recommends against using a skin prep over the area that the sensor is inserted.

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Permalink Reply by Rickst29 on May 25, 2011 at 12:53pm

I'm not as skilled as you in in the task of of cutting a rectangular "window" out of FlexiFix. A thicker, less flexible, or less sticky tape material would certainly be faster; but these properties are the reason why FlexiFix works best for me. 4 separate side strips at about 30 seconds each (including cutting, rounding off the outside corners, and application) takes me about 2 minutes to finish.

In contrast, my "extra work" is in the "Operating-Room" quality skin cleaning. Nearly all of the "off-label", restart-and-use-longer-than-7-days people on this board find the accuracy and reliability of days 8-10 to be much higher than days 1-2. Many of us continue getting superior results until day 14, or even longer. BUT: I'll SWAG that FDA probably advised Dexcom that they would never, ever approve the device if Dexcom asked for more than 7 days. The reason? amateur site preparation, creating a high risk of non-sterile conditions.

If you're only using IPA -- non-sterile conditions are pretty much assured, no matter how long and hard you scrub. It just doesn't have the killing power to do the job; especially in the case of viruses. Scrubbing longer and harder is BETTER, but (imo) it's not sufficient for a 14-day insertion.
They can only talk recommend IPA, because that's the approved site preparation method. They also can't talk about restarting a Sensor, because use beyond 7 days was not approved. (BTW, these two issues are probably related: I'll SWAG that FDA advised Dexcom, informally, that a request for more than 7 days of continuous use would be rejected, because of the risk of infection damage created by amateur site preparation. If that risk were not present, the Gen-3 device probably already had sufficient accuracy and reliability to justify a 10-day approval: Many people on this board find R and A to be much better on days 8, 9, and 10 than days 1-2.)

FDA has become increasingly strict about vendors discussing "off-label" usage. They have apparently slapped Dexcom, hard, for "off-label" use by children and younger teens. The approved labeling specifies alcohol, and only alcohol, as the site preparation method. Dexcom is required to warn against using anything else.

The dry barrier layer left on your skin by a Skin-Prep application is definitely harmless for the current version of the Sensor wire, and all of it's it's predecessors. (I've used them all.) You must make it completely dry ("hair dryer"); and obviously, if you have an allergy to the Skin-Prep chemicals, it won't work for you.

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