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LowerA1C - really attribute to Dexcom CGM

Discussion in 'Parents of Children with Type 1' started by cm4kelly, Jun 4, 2014.

  1. cm4kelly

    cm4kelly Approved members

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    My 7 year old son had his yearly checkup today with the best A1C so far - 6.3!

    I really have to attribute this change over the last year to the Dexcom CGM. It has been such a great tool to help us adjust basal rates and see his patterns during the day. His A1C prior to Dexcom ran around 7.2/7.3.

    6 months after Dexcom - down to 6.7
    1 year (and about 2 months) after Dexcom - down to 6.3

    I would imagine there are studies out there that would go along with this- ? -

    If you have ever thought about Getting a Dexcom - definitely look into it!
     
  2. Lakeman

    Lakeman Approved members

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    I agree. We have had our lowest A1C since getting the Dex. I expect it to be even slightly lower the next time. I assume the reason is that we are able to do corrections pretty much exactly when they are needed. We also fear lows just a little less.
     
  3. Ali

    Ali Approved members

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    Agree. The ability over time to more fine tune basal patterns along with the ability to correct more rapidly plus the ability to adjust everything quickly based on exercise. growth, hormone changes etc amounts to a huge number of hours in a better range of numbers over the course of months and years. It is very cumulative.
    ALi
     
  4. susanlindstrom16

    susanlindstrom16 Approved members

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    Wow that's awesome! We got the dexcom brochures at our endo appt last month. I have been sitting on it because my daughter is only just now getting to the point where pump site changes are not such a big deal, 6 months later. So I've been hesitating about introducing another insertion into our routine.

    This may be the push I needed, so thanks!
     
  5. mamattorney

    mamattorney Approved members

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    Hooray for Dexcom and for your child's success! I feel the same way for sure.
     
  6. jenm999

    jenm999 Approved members

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    This is awesome! I have all the dominoes lined up to get a Dex for my son at his endo appt on Monday. That will be just under 3 months from diagnosis. His A1c was 10 at admission to the hospital (amazing that he was not in DKA). I would be interested in hearing what you all have said to your docs to get them to prescribe it. My son is still honeymooning and his numbers have been great, but he still goes low a few times a week and goes to the nurse several times a day when he feels funky (he's not always low, sometimes he's high). It's not a big deal because he's only in first grade but it will start to be an issue because all that time away from class will really add up. Also, to be honest, I want it for ME so I can worry less, knowing that we have more info than just the fingersticks every three hours or so (esp. during the night, on play dates, date night etc.)

    A few questions for you seasoned Dexcom users:

    Do you still test at 2 am?
    How is the A1c done - finger stick or blood draw?
    Any suggestions for lobbying the doc?
    Any suggestions for preparing the kiddo?
     
  7. Snowflake

    Snowflake Approved members

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    We do still test overnight almost every night, but often based on what the Dex is showing rather than according to an alarm clock buzz at a particular time. Every once in a blue moon, she coasts all night in the low to mid 100s, and we just let it ride based on the Dex. Honestly, I think I'm a lighter sleeper now because I glance at the Dex frequently, instead of doing the one wakeup with the alarm. But I have SO much more peace of mind, so I think it's worth the tradeoff. I'm curious to hear what others say about this question!

    The A1c is done at our clinic via finger stick.

    Lobbying the doc was pretty easy. A parent on one of my FB groups suggested that we pursue it right after dx, and we brought it up at our first appointment. The endo asked a few skeptical questions -- "Are you sure you want that much information?" "Are you sure she'll wear it?" -- and within 10 minutes we had the paperwork started. For your situation, I would just focus on the fact that you have a young child who might be hypo unaware (if he is), and who spends a lot of his time with other caregivers.

    As for prepping the kiddo, the sales reps for the two companies let us parents test drive the insertion. Maybe they would do the same for your child when/if you meet with them so that he can get an understanding of what will be involved? The first few Dex insertions were a little scary for my daughter, but she got used to it very quickly, and she doesn't even flinch when we do it now.
     
  8. Mommy For Life

    Mommy For Life Approved members

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    DD has been on the Dex for almost 3 months. I still test in the middle of the night if DD has had a very active day of summer fun ie swimming. But the majority of time I take a quick peek at dex and if DD is safe...I go back to bed.
    At our endo, the A1c test is a quick finger prick and the results are available in a few minutes.
    To get the dex from our endo, we had to show DD was having trouble with lows.
    My DD watched a few videos on youtube...Diabetic Danica does a great tutorial on how to insert the sensor. You may even find a few videos of younger kids wearing a CGM. DD says it doesn't hurt a bit when I insert the sensor.

    Good luck getting the Dex!
     
  9. Cheetah-cub

    Cheetah-cub Approved members

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    Getting the Dexcom was much easier and quicker than getting the pump. You don't need to lobby your doctor for it. Just pick up the phone and call Dexcom, and they will help you through the process.

    I called Dexcom. They send me a form to fill out. I filled out a month long worth of BG logs. The insurance company wanted to know the patient checks BG at least 4 times a day, and they wanted to see the amount of lows during the month.

    I also send them our insurance information, and my doctor's contact information. Dexcom then took it over from there, they got our doctor to sign off on it, and got it approved by our insurance.

    I think it was approved in about a week. So, no need to lobby your doctor to initiate the process, contact Dexcom directly yourself. You will get one quickly.
     
  10. mamattorney

    mamattorney Approved members

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    In answer to your questions:
    test at 2:00 am: no

    A1c: fingerstick

    lobbying the doc: If you are confident and definitive, "I want this for my child", not "do you think this is a good idea", I don't think you'll have much pushback. Based on what you wrote though, I hope you don't have issues with insurance. Our insurance absolutely requires BG excursions below 60 and above 250/300 and hypoglycemic unawareness. In fact, the doctor forgot to fill out a portion of the form the first time around and Dexcom knew it wouldn't get approved as completed, so they sent it back to the doc so that they could check all the necessary boxes. You've said your child's numbers have been great. So, if you have insurance like mine where they must see these particular things to approve the Dexcom - and you don't have them - you might have to fib and have the doctor fib as well. If your doctor will only go with meter readings and you don't have those numbers on the meter, I don't know what you'll have to do - appeal, I guess.

    preparing the kid - I waited until my child wanted one, so I'm no help here. Her numbers were a little all over the place and the constant checking and correcting/treating was driving her nuts. I rarely bug her now - and don't have to because I can change basals and I:C to match her current situation so there's not so much correction going on. Way fewer fingersticks that's for sure. She tests even less than I'd like but I try not to sweat the small stuff - if Dex says she's in range, she probably is.
     
  11. jenm999

    jenm999 Approved members

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    Thanks all for the replies (and sorry to hijack the thread!).

    By "numbers are great" - there is still room for improvement! According to a quick search of my onetouch software, we've got 73% of our readings between 70 and 180, with 10 hypos for the month of May. But this does not include readings at school, where he has had at least 2 lows per week (I'll be picking up the meter from school and downloading it into our database this weekend). Sometimes he feels them, other times we do a fingerstick and it's, say, 44 and we have no freaking idea how/why! It's the TRENDS I want. And it's only going to get more volatile as he gets older, grows, goes to camp, and comes out of the honeymoon.

    We have BCBS and I am told they usually approve everything the doc prescribes. I already called Dexcom and did all the paperwork, but the doc wouldn't sign without seeing us first. This will be our first appointment with her since diagnosis - most of our appointments have been with the CDE, nutritionist, social worker, etc. to get a hang of this. I think perhaps she just resisted because she hasn't seen us? Hopefully an assertive attitude, charts showing a few unpredictable lows per week, and Dexcom handling the insurance for us and we will be OK.
     
  12. Snowflake

    Snowflake Approved members

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    Fwiw, we had Texas BCBS when we went through the Dexcom approval process. They didn't give us any pushback at all.

    However, our daughter didn't have much of a honeymoon, and her numbers were truly terrible at the time we got the Dex (largely from difficulty determining the correct Lantus dose and split). DD was also completely hypo unaware, and remains partially so now. I think with a 6 yr old, hypo unawareness should strongly bolster your case, even if the numbers don't fit some insurance company formula.
     
  13. sszyszkiewicz

    sszyszkiewicz Approved members

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    I still test at least once after DS goes to sleep, a couple of hours after Lantus, just to make sure the Dex is close. Its very close 90% of the time, but 90% is not 99.9% so one fingerstick before I go to bed does not bother anyone.
     
  14. Lakeman

    Lakeman Approved members

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    I do not test at any particular time at night. Instead I test if the Dex indicated that a test is in order (bearing in mind that you cannot trust it 100%)
    The clinic does the A1C but a kit can be purchased at the pharmacy not that I have ever done that.
    Do not play up how good your numbers are but instead acknowlege how many lows or highs you have and how much anxiety you have.
    My daughter was convinced as soon as she saw the diabetic danica video. She was so impressed with Danica that it motivated her to do the first insertion herself.
     

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