Dexcom, do they plan on updating?

[Momof4gr8kids]

Does anyone know if dexcom plans on updating the meter used for calibration? I so want both Shane, and Julia to have a CGMS and Dexcom would be my first choice (unless navigator is approved in the near future). The only thing stopping me is that I am not sure I can even buy a ultra anymore. I looked at a few pharmacies, not one had one. I will keep looking though.

[jacone]

We just received our DexCom in the mail and we go to training tomorrow for it. I had the same concerns too about switching meters. While at the Dr. I asked for one from our CDE and all the had were the Ultra2's. When I spoke to our rep from DexCom, she said that they can get us one with our meter. I like to have multiple testers because it seems like they always find legs and move! But, I was told that it is really better to use the same meter for all the calibrations because it maintains accuracy in the CGM.

I was told why the newer OneTouch meters will not work is because 2 years ago when DexCom got their FDA approval it was stipulated that it was to work with the OneTouch Ultra. DexCom plans to change that, but will just incorporate it in future FDA applications.

[rmccully2000]

Dexcom presented recently at the JPMC Health Care conference (http://www.shareholder.com/dexcom/medialist.cfm)and this is what they said about enhancements (the bottom line is that we'll have to use the Ultra until the 3rd generation product):

1st generation has been improved: current 3 day sensors

2nd generation awaiting approval from FDA. Dexcom sent in answers to FDA questions in November and they were not asked to provide further clinical studies, which they view as a positive sign for approval:

Accuracy of the 7 day wear product is better (including fixes from 1st gen issues), has a waterproof claim, smaller needle size, upgraded microprocessors and algorithms. lower cost per day for consumers (which means they will increase the cost from $35!). Outcomes published in December issue of Diabetes Care. Substantial improvement on single point accuracy. Stable strong performance over entire 7 day period. *You will not be able to restart this sensor like you can the 3 day, per FDA requirement.

3rd generation in human feasability studies: further improves sensor
reliability and stability, compatible with any glucose meter for
calibration, design and size being adjusted to market to pediatric
market,

Version 2 of the software is expected sometime this quarter.


The note about FDA not requiring further studies from Dexcom had me thinking about Navigator. They just started a whole new round of clinical trials for Navigator. I wonder if these were required by FDA for some reason and that is why approval has been delayed yet again. Or is it just coincidence? Any thoughts anyone?

Becky,
Mom to Mason, 6 Dexcom, MDI

[rmccully2000]

[QUOTE=jacone;27774]We just received our DexCom in the mail and we go to training tomorrow for it. I had the same concerns too about switching meters. While at the Dr. I asked for one from our CDE and all the had were the Ultra2's. When I spoke to our rep from DexCom, she said that they can get us one with our meter. I like to have multiple testers because it seems like they always find legs and move! But, I was told that it is really better to use the same meter for all the calibrations because it maintains accuracy in the CGM.

QUOTE]

YAY!! I'm so excited for you!!

About using the Ultra.. this is what I have found works good. I have two meters for this reason: if there is a mistake and you get a false high (sugary hands) or false low (wet hands) you do NOT want that to get uploaded to the Dexcom. It could cause you to get an X or recalibration screen unnecessarily. I also use this method if I take a finger poke that is more than 50 points off from Dex (like during a rapid decline or rise) and I think the Dexcom will catch up but I don't want to get an X screen.

So I have two Ultra's. You can only have one set up to the Dexcom at a time. If I am using Ultra 1 and we get a false high/low or it's more than 50 points off during rapid bs movement, I will "install" Ultra 2 to the Dexcom with the calibration cable. This will effectively erase the bs reading on the Ultra 1 since Dexcom only uses values taken after the installation of a new meter.

This is so hard to explain, so ask Dusty about it tomorrow or call me if you need more clarification. This strategy has cut down on the X screens, dead sensor screens and additional calibrations tremendously.

Best of luck!!
Becky, Mom to Mason 6, Dexcom

[Momof4gr8kids]

Jacone, and Becky, Thanks for the info. You've just made my decision so much easier. Thank you both so much for your replies. I think we will start in on figuring out what we need to do to get them each one!

[rickst29]

I've got 3, so I can loose one and still have a spare.

If two Ultras DON'T AGREE all the time, or the second test of the Dexcom "double test" doesn't agree pretty well with the first, change both batteries. I have the impression that the "change battery" indicator doesn't come on until a long time after the reliability of the Dexcom "double-test" begins to suffer. The voltage/current of the 2nd test begins to fall off, in comparison with the first test, and the exact WAY it falls off can make the 2nd reading go either high or low. (And when the battery is worn, the FIRST test is unreliable too.)

These batteries cost next to nothing, I change them WAY more often than I change my lancet. :cwds:

It *is* good to calibrate a lot more often than you have to. When it's really off by more than 50 points (hardly ever happens), I don't do Becky's "swap the meter trick", I have another trick which works:

Dexcom uses only the NEWEST reading, except in the special case of a restart when it uses two readings together.

If Dexcom is too high, I'll gobble some sugar tabs (enough to create a the result within 30-40 points of the Dex) and then do another fingerstick test during the period 10-15 minutes later.

Using EXACTLY this timing catches it at a point where the bG has been raised before doing the bG test, but the ISF which the Dex is measuring hasn't caught up yet. So this test should calibrate the Dex downwards by about 30-40 points. Then the Dexcom starts reading the ISF increase, and after a while I do another test to "haul it down" the rest of the way.


I never experience Dex reading way too LOW, except when I've accidentally slept on it for while. In this case, I just don't calibrate until after I've been up and moving around, and Dex has had a chance to soak up some ISF and approach reality.

I'm right now within the unfortunate 2 hours of knowing nothing, once every 3 days. Better go poke the finger, this makes me NERVOUS! :eek:

[Momof4gr8kids]

Thanks for replying, Rick. You're truly the unofficial CGMS guru.

[rmccully2000]

Thanks for replying, Rick. You're truly the unofficial CGMS guru.

Much thanks from our family also Rick.

When everyone else was posting the negatives about Dexcom, you seemed to be the only one out there telling us about the positives also. At first I thought you were out there pumping up the product, but after having used it, I now understand how awesome this technology is that I want to shout it to the world also!

It's good to know the negatives so you can keep your expectations realistic, but it's also good to know the positives! I was prepared for the hassles, but I was not prepared for how much I would love this technology in spite of the hassles!

Thanks again Rick :)

[rickst29]

I first joined this forum (and THREE others) when I switched to the "love handles" location and realized that there were probably lots of people getting bad results and giving up in frustration, because they kept trying to use the frontal abs as Dexcom's booklet says. (Instead of upper butt cheek or love handles).

There's a lot of sneaky "marketing" going on within Internet Chat boards, and it's good to be suspicious. My very sudden appearance in all these places was suspicious for many people. But after I've posted so much stuff AGAINST the company's financial interests (I was the first person to actually post instructions to "trick it" into more 3-day periods), and so many opinions/discoveries about unrelated products and issues, everyone has figured out that I really am just as I claim to be: an everyday retail customer, not a money-grubbing Marketing Droid. :cwds:

[jacone]

Thanks Becky for all your instructions and helpful hints via email and telephone!

Thanks Rick for your 'love handles' suggestion because TONIGHT was our very first time to use "Dex" (Olivia's new best friend) on a love handle site. The DexCom rep urged me to try abs first, so I remembered what you said Rick and did a love handle site like you suggested. Cross your fingers, so far, so good!

I am a newbie with it, but the potential this product holds is just amazing. It is great to be aware of the negatives so that you are on the lookout and not shocked, but the positives are so much more important.

Thanks to all of you for your tips!

[rickst29]

Thanks Rick for your 'love handles' suggestion because TONIGHT was our very first time to use "Dex" (Olivia's new best friend) on a love handle site.
Since Olivia's only 5 years old, there might not be much room between the rib and waist. Also, children are often REALLY thin, not enough subcutaneous tissue for the Dexcom Sensors to work really well.

So you could find that upper butt cheeks work better, not too high (stay away from bones, stay in a "meaty" place). :cwds:

Do keep us posted!

[EmmasMom]

Hey Amy,

We use both upper butt cheek and love handle areas with great results. I try to keep the love handle sites slightly more toward the back and away from waist bands. Emma has enough flesh in both areas and so far so good!

I hope it all goes really well! I'm sure you're going to love it!! :D

[rmccully2000]

No problem Amy! Like I said to Rick, I want to shout out to all the parents out there how awesome this technology is. Feeling so helpless against this stupid disease that is attacking our babies, it makes me feel like I am at least doing something to help others. 4 months into this and I will do whatever it takes to keep this thing.

Apparently Mason's 1:200 correction factor is changing and Dex saved him from a low tonight. He sat steady around 350 after dinner (miscalculated carbs in homemade food due to a new recipe) for awhile. Finally, when I was sure all Novolog was gone, I gave him barely 1 unit correction which should usually brings his bs down 180 points. Holy cow! Sharp drop down to 90! A few tablets have helped but now I'm upping the nightime correction to 1:250.

Becky, Mom to Mason, 6

[rickst29]

from my "honeymoon" days.

Now I'm privileged (???) to enjoy "meat ax" big ratios (1:10 grams, a full unit per 25 pts of bG, and so on). I shoot a few units too much, it's pretty easy to cover for....

But maybe the demons you don't know ALWAYS look a lot scarier than the ones you live with! I obviously need to change cartridges a lot more often than you do.... but I can ALSO use the insulin straight u100, without cutting it. 6 of one, half a dozen of the other....

[jacone]

We are on Day 4 on this sensor on the 'love handle' location and so far, so good (knocking on wood now). I have given a bath 3 of the 4 days using a shower patch and not getting totally submerged. For bathing purposes I think I will really prefer the 'love handle' location. So, I hope it keeps working!

Rick, I am with you on the ratios and sensitivity factors. 1.5 yrs later for my 5 year old and she is 1:10 on carbs/insulin and 1:100 on correction. I wonder what determines that number...I know different bodies, different situations, but still. I have a 5 year old girl, Becky a 6 year old boy, diagnosed in July 05 for us.

Loving 'Dex'!

[EmmasMom]

I'm glad it's going well!!:) I love these things!!

As far as insulin...
Emma hit that 1:10 ratio around 15 months!!! But her ISF was still 300-ish.:rolleyes: I'll never understand how you can be sooo sensitive to insulin, and yet need the same dose to cover carbs as an adult??? It boggles the mind...

[Momof4gr8kids]

Amy, When I took Julia to her endo appointment last week he told me there is no way with a 1:15 carb ratio, and with her basal increasing that a ISF of 130 would cut it. I tracked every correction I had to do after that, and it has averaged out at 140 for her ISF. I don't get it, obviously he doesn't get it, but Julia is still in what I think is still the honeymoon with her basal at just over 5u per day, and a TDD of about 15. Anyways, it could be the way their bodies use the food, or digest it or something that makes their carb ratio high compared to their ISF. I have also noticed that it takes a lot more carbs then the math would lead you to believe to bring up a low. We have had to treat lows (like 50's, or 60's) at school with about 20 carbs to see good results. It just doesn't make sense, but what about diabetes does?
Jamie

[Ali]

I do get false lows from the Dexcom. Also, I can not use a sensor for more than three days so need a lot of space to accomodate on top of my two day pump site changes. So, do you use any other spots? I am thin so have maybe six spots on my backside and no love handles or non abdominal pump sites being used. I get tons of bad readings at night and missed readings. Any tips you have would be great. Ali



I first joined this forum (and THREE others) when I switched to the "love handles" location and realized that there were probably lots of people getting bad results and giving up in frustration, because they kept trying to use the frontal abs as Dexcom's booklet says. (Instead of upper butt cheek or love handles).

There's a lot of sneaky "marketing" going on within Internet Chat boards, and it's good to be suspicious. My very sudden appearance in all these places was suspicious for many people. But after I've posted so much stuff AGAINST the company's financial interests (I was the first person to actually post instructions to "trick it" into more 3-day periods), and so many opinions/discoveries about unrelated products and issues, everyone has figured out that I really am just as I claim to be: an everyday retail customer, not a money-grubbing Marketing Droid. :cwds:

[rickst29]

she is 1:10 on carbs/insulin and 1:100 on correction. I wonder what determines that number...I know different bodies, different situations...
She and I are actually almost the same!

Her correction ratio is 1u per 100 points because she weighs only about 1/4 as much as I do. Once you remember to factor for body weight, our factors are nearly identical. :)