Monday, April 25, 2011

The Dexcom

Continuous Glucose Monitoring... or CGM for short. I've mentioned my trials with CGM before on the blog, when I test drove and decided to purchase the Minimed CGM last year. And now, I've moved to the Dexcom system.

It seems the past few months were filled with trials for me and the dia-beets (no, I didn't misspell it... this is my hubby's affectionate nickname for my diabetes and it's finally stuck it seems). I failed to mention to you, it seems I have a hard time blogging about the tough stuff, I'll have to work on that; but anyhow, I was denied my first time asking the insurance company for a Dexcom system last August.

I'd worn the minimed CGM for about a month when I gave up on it, with 4 months worth of sensors unopened in the box still! For me, the minimed didn't work because it's calibration mechanism required me to have a fasting and stable blood sugar at least 2 times a day (maybe more?). We all know that a very stable (ie. not on the way up at all or on the way down at all) is pretty hard to achieve, much less not eating for 2 hours when you are a diabetic. (esp when you are a stay at home mom and only get to grab handfulls of food throughout the day) :) However, having experienced the knowledge of a bloodsugar trend (ie. I'm "180 on the way up") rather than just I'm 180 and who knows if it's 180 on the way up or on the way down... I wanted that again, and I wanted it bad... only I wanted it to be accurate, which I couldn't achieve with the Minimed CGM because I couldn't calibrate the device as was necessary for the integrity of it's function.

Enter the Dexcom. I complained to my physician only 2 months after he worked to get me the MiniMed CGM how I disliked it. His response... "well you should have gotten the Dexcom, it's a different technology and it works better." UMM... where was this information 3 months ago doc? Oh wait, I'm a vain diabetic and already hate having an insulin pump on me and didn't want to add another medical device to my hot, hot body... right, that's why I went with the not-as-great CGM system. Ok, so doc, I messed up, and I want the Dex.... Wait a year and try again. So, I tried and they said no, silly girl, we just spent $1600 on the last CGM and we're not getting you another (the short of my August 2010 denial letter from the insurance company).

I was sad, I whined and complained. And then I appealed. I lost again. I whined and complained more. I didn't share the hurt with you, and then I decided to let it go, I'd learned my lesson about researching medical devices more thoroughly and about vanity.

And then... a stroke of genius hit... oh wait, my blood sugars suck (the A1C was up to 7.6) and I want to have another baby and I can't until I can get these sugars better... I should tell the insurance company that, then surely they will send me a Dexcom... survey says..... YESSSSSSSS!

I literally felt like the Dexcom fell from Heaven. I'd phoned my diabetes supply company 4 weeks ago to run the idea of a new Dexcom application to the insurance company by them and they said they'd try it, but gave me no time frame. Two weeks later I had a voicemail when I got home... "Jenn, we have your Dexcom ready to ship, we just need the ok, and it's already paid for with this year's deductible." SaaaaaWEET!

Ok, so about the Dexcom... it's the BEST BEST BESTEST thing that has ever happened to me in 16 years of having type one diabetes. I am NOT exacterating yall... I even said yall... so you know this is serious.

1) My first and most favorite thing about the Dexcom: it's ALWAYS right! if it says my blood sugar is 123, then it's really about 123 - were I to check that with a finger stick, it's usually within 5mg/dL... AMAZING. Now... you must know something about CGM when I say this... because CGM works by measuring the sugar in interstitial fluid, there is some lag them if there is a rapid change going on in your blood sugar... it takes about 10 to 20 minutes for the interstitial fluid to reflect the sugar level in your blood when a rapid change is happening. This is just a normal part of CGM technologies to date across the board, they all have this lag time because you are not measuring from in the bloodstream... you can imagine the multitude of reasons why. Anyhow, when I was on the Minimed system, even if I was stable, not going up or down from food or insulin... it would NEVER give that accurate a reflection of my finger stick blood glucose numbers. The dexcom is accurate for me. Like any CGM system, the better you are at calibration the more accuracy you get from the device, but I find that this one is SO much easier to calibrate... I don't have to do it as often, and it's smart enough to deal with a calibration when my blood sugar is on the move. Love it.

2) The sensor is SUPER comfortable. Ok, so you still have to stick something in your body and wear it all of the time, but it is TONS more comfortable than a pump site. And, in my opinion, more comfortable than the Minimed cannula for their CGM as well. The Dexcom sensor uses a wire inserted with a needle that is removed after insertion. (Oh! and on another good note, each sensor has it's own insertion device made onto it, so you don't have to keep up with a "serter"!) I have not been able to wear my insulin pump in about 6 months because I'm running a bit on the thin side with my weight these days. (what with two toddlers and all) :) I was constantly kinking even the 6mm quicksets. Bad days. However, the sensor for the Dexcom has been just fine for me, on #3 now, and they each have made it the full 7 days of recommended wear!

Here's a glance at the Dex in action. I have the sensor with transmitter attached on my back right now, and the receiver (i know, it's GIANT, they promise they are making the next one smaller... maybe even an iPod app in the works) is tucked in the waist band of my pants. As a mom of toddlers I am NEVER sitting still, and the darn device doesn't come with a clip attached, it has a case with a clip... but it sucks, so this is the best I can do for now. More on that later, because I have so much more to say and have to stop somewhere.

Please ask questions and weigh in with your CGM experiences, I'm sure pregnancy on a CGM must be so wonderful, neither Beth or I have experienced this yet!

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