Things I have learned about the G4 after 3 months
As you may know I have had the Dexcom G4 CGM since November. In the last 3 months I have learned an awful lot about it that may prove useful to other PWD. These are things I really wish someone had said in the beginning to not only make me feel more comfortable with the technology but with the information overload that can sometimes be overwhelming. So in no particular order here is what I have learned. Please feel free to pass some or all of it along to others:
1. Before you place a sensor anywhere, think about how you move that particular part of your body and also how much you move it. Where does the car seatbelt hit and how do you sleep at night ? Is that location going to be comfortable for a week or longer ? Although the user manual says place the sensor horizontally on your abdomen I personally have worn my sensor vertically on my arm, thigh and "love handles" and horizontally on my stomach and thigh. The most comfortable location I have found for me was horizontally on my upper thigh and that sensor also lasted for 17 days with accurate readings throughout. There are a bunch of really good YouTube sensor insertion videos. A google search will find them for you.
2. If you put the sensor in a place that is uncomfortable or you can't sleep with it take the thing off. I made that mistake once and though I regret doing it, I regret more that I spent a night in pain not being able to sleep. While the sensors are expensive, resenting them is even more costly in the long run. And fortunately I have routinely managed to get more than 7 days out of a sensor so the one that I had to throw out because of poor placement was not costly in that regard.
3. At the beginning of a sensor session my readings have been very erratic so I do not make insulin dose decisions based on the Dex at least initially. I set my alerts very high and very low the first day with a sensor. There is nothing worse than being wakened by a buzzing receiver indicating a low or high when a fingerstick (fs) is normal. I also put the receiver under my pillow. It has never failed to awaken me when it vibrates, but it allows my husband to continue sleeping uninterrupted.
4. When you look at the receiver and your blood sugar is climbing or plummeting, DON'T FREAK OUT. Eventually the arrow will stop going up or down and settle straight ahead. The more stress you put on a number the higher your blood sugar is likely to go. If it is plummeting have some juice, if it is rocketing skyward, do a fs and take a correction dose.
5. Perfection IS NOT ATTAINABLE. I say this as an OCD perfectionist. Since I accepted this it has become far easier to just see the improvements over time and appreciate how the hard work pays off in the long run. I no longer aim for perfect, I just now aim for better. The Dexcom studio software is great for comparative analysis. Just look for progress not perfection.
6. If you have a problem with the sensor, receiver, transmitter call Dexcom tech support. ALWAYS USE THE CALL BACK OPTION. There is nothing worse than sitting on hold for 45 minutes. When they give you the call back option, take it.
7. If you swim for exercise like I do, there is only one sensor location that works intermittently in the pool and that is on the arm. If the sensor is anywhere else be prepared to "lose signal" for the duration of the swim. I usually "carb up" before with a snack of some kind and check before and after.
8. The sensor takes a very long time to recover from a low which makes treating a low and not over doing it a bit problematic. The G4 has only given me a false "low" once so the remaining 4 or 5% of the time it says I am low, a fs has confirmed it. I now treat lows the same way I did previously, but I generally recheck after 15 minutes and recalibrate the Dexcom because it is always still low.
9. I always use some type of auxiliary tape to secure the sensor. The tape that has worked the best for me is called opsite flexifix. I have never had a sensor peel up or pull away, but some people have reported that. The sensor that lasted 17 days was worn in the pool for at least 8 hours during that time and did not peel at all. I trimmed and replaced the opsite tape a few times over the 17 days.
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Comment by Don on February 18, 2013 at 1:19pm -
A nice list reflective of hard-won experience! One trick when I place the transmitter into the sensor bodyware is to use a hand-held mirror to confirm up close that the tiny plastic arms that hold the transmitter in place are in fact completely in place.
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Comment by Holger Schmeken on February 18, 2013 at 2:08pm -
Thanks for the information. I just wanted to add some words of caution: the G4 is not for making insulin dose decisions. When sensor technology can be used for that then the artificial pancreas will become our reality. Furthermore on the legal side I do expect that the police and court will ask specifically for meter not cgms data in case of an traffic accident. The legal expert will point out the limitations and warnings that have been stated in the CGMS package insert. To not have meter data at hand can really backfire in this situation - at least in my opinion. For lows the Dexcom G4 might be correct to report them for a long period of time. The upper layers of the skin have only limited blood circulation. Thus their BG level can be more than 15min behind the bigger blood vessels. If you have treated the low 15min ago you will still see this excact situation of being low on the Dexcom. This is why the information about the relative changes is much more valuable than the absolute numbers. Despite of these remarks I would love to have a Dexcom G4. The prices in Germany are just too high to think about that (308€ for 4 sensors).
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Comment by Clare on February 18, 2013 at 3:04pm -
Thanks for the input Holger, as I said, I do not make insulin dose decisions based on the data from the G4. It is merely a guide and especially useful for me since I am hypounaware. It is also nice to be able to take my dog for a walk and not worry about going low or get in the car without having to constantly check my blood sugar. In the US, the 4 pack of sensors is list priced at $ 499.00 my insurance company paid $ 391.00 US for them. Still exhorbitant, but for me it is worth any price to sleep well at night and wake up safe in the morning.
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Comment by TC on February 18, 2013 at 5:58pm -
We have been paying out-of-pocket for these for our 10 year-old. Fortunately, our insurance company just approved this item, so they will be covering them in the future. But even if they weren't, I'd still pay for them out-of-pocket--worth every penny! Thanks for all the great tips!
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Comment by Karen on February 18, 2013 at 7:36pm -
Thanks for the great post. I am still in debate mode about trying the DEX. I tried the Medtronic CGMS and had all the issues you talk about, but could not live with them and for me most sensor sites were bigtime painful.
Still thinking about trying the dex as hypoglycemic unawareness is doing me in.
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Comment by CaryJ on February 19, 2013 at 7:09am -
We just received a brochure from Dexcom regarding the new G4. I thought perhaps it might be a useful tool for my son to achieve less variability for his bg levels.
he is very hypo aware and has not had to correct for one in about 6 weeks. He is following a restricted carb diet and at times he boluses more insulin than he needs which causes some lows. However, I am reconsidering getting the G4 from your information. We would definitely want one in order to make dosing decisions, but it doesn't seem accurate enough to afford him to do this.
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Comment by Clare on February 19, 2013 at 8:01am
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Hi Cary, I can only speak for myself because as in everything with D it varies from day to day and certainly from person to person. I have found the G4 to be very accurate, especially in the middle range say 70-170. I find now I check my blood sugar when I get up in the morning and when I go to bed unless I feel low or it buzzes and indicates I am low. The rest of the time I just check the receiver. Since getting the system in November my daily basal insulin has gone from 30 units a day to 22 units a day in 2 shots and my rapid acting dose has also been reduced. I can now see the effect of a brisk walk with my dog or an hour long swim or what happens after a piece of pizza. Seeing it in almost "real time" makes avoiding the pizza or bolusing correctly for it a lot easier.
It has also helped with the hypounawareness problem. For me a hypo is no longer accompanied by the sweaty, rapid heart rate warning signs. It is far more subtle. My vision will get a bit wonky or my brain doesn't process stuff right, now a quick glance at the receiver confirms I am feeling a low. The more I can recognize them from even the subtle clues, the easier they are to avoid.
As I said, I can only speak for myself, but as a T1 for 37 years this product has been life changing for me.
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Comment by Clare on February 19, 2013 at 8:09am
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Hi Karen,
I too tried the Medtronic CGMS over the summer, it was the Ipro model so only my CDE could actually download the data, and the damn sensor hurt like hell. If it were the only available CGM I would never get it. The G4 sensor is the width of a couple of human hairs. For me it has been comfortable to wear. The only place where it was painful was on my left arm towards the back. I just put it too far back and couldn't sleep. I took it off the next day. I have worn a sensor on my right arm (non dominant) for better than 2 weeks without any pain. I currently have the sensor horizontally on my abdomen and don't really notice it.
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Comment by CaryJ on February 19, 2013 at 10:14am
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Now that you have gone into more detail I can see how it might be very useful in my son's case. He tests at least 8 times a day, sometimes more. He has had some lows in the 40 range because he did not eat as many carbs as he thought he was going to eat. If he could see the trends in his bg he could compensate earlier and catch most potential problems. You seem to have significantly reduced your insulin. That's always a good thing. His insurance will pay for a unit, but we did not want to waste time and committment if we're not sure of the benefits
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Comment by Holger Schmeken on February 21, 2013 at 2:09am
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$391 are €294 per 4 sensors. That is more expensive than I have assumed. Just 14€ less than the prices in Germany. Taking tax differences and shipping costs into account the prices in our markets are about the same. Anyone interested in founding a buying syndicate to order 100 or 1000 sensors at once?
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