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About Getting Your Dexcom G5

Discussion in 'Parents of Children with Type 1' started by rgcainmd, Oct 6, 2015.

  1. rgcainmd

    rgcainmd Approved members

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    Good question...I don't actually know, and I've run out of test strips for her old Accu-Chek meter to use as a double-check (and who's to say the Accu-Chek is more or less accurate than the Dexcom at any given "low-risk" time...) I guess I just go with my gut after taking into account all the factors I can think of that may be contributing to a low or high. If I'm feeling especially antsy about the whole thing, I'll have her wash, rinse, and dry her hands thoroughly and do yet another fingerstick. On those occasions, the new meter reading is usually closer to the Dexcom reading and I go with the Dex.
     
  2. njswede

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    I don't know if this is helpful to anyone, but I just got off the phone with Dexcom and this is what I learned:

    If you have a Dexcom G4 transmitter that's about to go out of warranty (ours will in 3 weeks), they will replace that with a G5 and bill it to the insurance company with no out-of-pocket cost (provided the insurance company doesn't charge you a co-pay). So for us it made sense to wait a few weeks and get a G5 for "free" (as in "insurance pays for it"). However, it appears you'll have to explicitly ask for it.

    The receiver is the same hardware, so they'll just send you instructions on how to upgrade the software on it and it "becomes" a G5 receiver.
     
  3. sszyszkiewicz

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    The G5 uses the 505 algorithm which has a MARD of like 9%. the pediatric G4 has a MARD of 13%
     
  4. Christopher

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    I was actually asking how people determined which number was the most accurate between the Dex and their meter. But thanks for that info.
     
  5. rgcainmd

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    9% MARD is good enough for me!
     
  6. sszyszkiewicz

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    The answer is "yes" :)

    I actually have a process to decide. At fingerstick time if the two numbers are really different (by more than 20 points), i insist on another fingerstick with a thorough handwashing before any calibrations are done. Usually the second time is alot closer to the dex and i am done. If the second number is still far away from dex i check a strip with the fluid that ensures the strips are ok. if the strip passes the test I calibrate the dex with the second fingerstick, otherwise I get a third fingerstick from a new jar of strips. Whatever that one says i calibrate the Dex. I have made it to step 3 only 3 times.

    Its obtuse but repeatable. I have found no less than 3 vials of bad strips and one potentially bad meter (Johnson and Johnson insisted they send us a new meter after the third vial) using this process over the past 18 months, which is kind of unfortunate if you think about it.
     
  7. Megnyc

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    You know how I feel about this but the answer is yes for me. I don't think it is any riskier and in many cases is much less risky than dosing off a standalone finger stick. Also the arrows are virtually always correct so again that decreases the risk compared to a standalone finger stick.

    I have now been using the G5 for a week (just restarted my sensor) and have been using the current 505 algorithm since it came out. I am down to 2-3 finger sticks a day this past week and those are just to calibrate or if I am driving and have a lot of insulin on board. I test a lot less now since I can see the number on my phone so I am more inclined to bolus off it. I do give corrections off the dex and that does not concern me. I do test before corrections if I am over 350 because I have found the dex tops off in the low 300s even if I am in the 400s or 500s. Fortunately that happens only every few months. I routinely correct numbers in the 200s off it though. I have no need to test after treating lows because with the 505 algorithm I see virtually no lag.
     
  8. rgcainmd

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    Virtually no lag after treating lows will be a very welcome change.

    BTW, our shiny (it's actually matte) new Dexcom G5 transmitter was waiting right inside the front door when we got home. Can't wait to fire this baby up after my daughter gets home from marching band practice later tonight. (I'm so proud of her; she's still in middle school [8th grade] but is in the high school marching band.)

    Question: Were we supposed to receive TWO transmitters? I thought I read in someone's post that they were sending them out in pairs...
     
  9. mamattorney

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    We don't have our G5 yet, but my daughter doses of the Dexcom now. I do ask her to check at lunch, so she does a fingerstick in the morning (calibration 1), at lunch, and before bed (calibration 2). So, I guess the only meal she doesn't check before is dinner, but she never checks before snacks and only checks otherwise if something feels "off".

    I guess it's not so much that I trust the dexcom more than the meter, it's just that I became less convinced that the meter number is absolutely, positively correct. Once you go there, it's not a huge leap to trust the dexcom since the numbers are generally close when we do a confirming fingerstick.

    Why did I become disillusioned with the meter - because only rarely do the two fingersticks that you need to calibrate a new sensor match. And those two readings are taken within seconds of one another and use the exact same blood sample. When I realized that not even two back to back readings of the same sample come out the same, I realized that every single bolus is given based upon a guess. It's based upon a number and her pump spits out a very precise dose of insulin based upon that number, but who's to say that a different test strip wouldn't have produced a different number and I wouldn't be giving her a different very precise dose of insulin for the same bolus.

    Since we're just "guessing" anyway regardless as to how to arrive at the number, she may as well guess off the number that doesn't require her to poke herself (and has directional arrows that we use those arrows to increase or decrease the bolus)
     
  10. jenm999

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    YES! I also discounted the Omnipod at the beginning because it only dosed at .05u increments but that precision is moot when MARD is +/- 9%!
     
  11. Christopher

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    Thanks for providing your process. Definitely something to consider.
     
  12. Christopher

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    So last night I charged the One Touch meter (haven't used it since we got the Omnipod) and did a comparison with the Pod PDM. Here were the results:

    PDM= 205
    One Touch= 258
    Dex= 257

    (rough numbers, I know, but we ate dinner out.)


    I know this is only one test and I plan to do another one tonight, but since the One Touch and the Dex were so close to each other, this really has me doubting the accuracy of the PDM. I really like the Omnipod but if the PDM is not going to be "accurate" it is slightly disappointing and worse, it is going to affect her A1c. Yes, I know I can just use the One Touch for fingerstick tests, but that means she has to carry around even more stuff and when I upload the PDM info to diasend it will not have any bg numbers. I guess I could test with the One Touch and then enter the bg into the PDM but to me that is just making things more complicated not less.

    Am I over thinking this?
     
  13. rgcainmd

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    Are you overthinking this? I think not.

    We are looking at the same issue. I've always just more or less blindly trusted the PDM meter and calibrated her Dexcom G4 system off of it. We've consistently found the Dexcom reading to be very close to the PDM reading (after the first 10 hours or so), which is good, but I'm wondering whether the Dexcom was just accurately mirroring the inaccurate PDM readings we were using for calibration... I don't feel like getting more AccuChek test strips in order to compare its readings with those from the PDM (as who really know how accurate the AccuChek readings are [+/- 20%?]), but I also don't want to be making dosing decisions based on numbers that may be 50 or more points off...

    Has anyone done a more lengthy comparison of their PDM meter readings with readings obtained from a different meter? I'm considering calling both Dexcom AND Insulet to try and get some answers. (I clearly must derive some perverse pleasure from being placed on hold...) :p I'll post if I get any useful information RE this issue from Dexcom and/or Insulet.


    ETA:
    Sooooo, I just got off the phone from speaking with representatives from both Insulet and our good friends :mad:at Abbott. I discussed my concerns regarding the accuracy of the Freestyle meter built into the PDM with the Insulet rep, who didn't have a whole lot to offer other than I should check the meter with control solution. Always on the prowl for a freebie, I asked if Insulet could send me a vial of said control solution gratis. Anthony, who is one of the nicest Insulet reps I've spoken with to date (which says a lot because I've always found Insult's reps to be exceptionally polite and helpful and I'm being dead serious) gave me a toll-free number to call Abbott in order to beg for some free control solution. Here is where I, an indignantly entitled American citizen, pause in order to climb up on my soapbox: Even with what is likely the least sucky health insurance (Federal BlueCross/BlueShield) in our blessed United States of America, and even with a co-pay assistance card, I still pay a small fortune for Freestyle test strips. So I feel self-righteously entitled to a damn free bottle of control solution. I convinced the Abbott rep to convey the many, many details she requested RE my daughter's T1D history to her supervisor to obtain the permission necessary to send me one freaking free bottle of control solution. Cripes, you'd think the stuff was made from the tears of virgin unicorns based on the time and effort it took me to get them to agree to send me one little free bottle... Anyway, I'm under the impression that using this control solution will only tell me whether the Freestyle meter built into the PDM is WAY OFF THE MARK. And what will that truly tell me about the accuracy of our particular PDM's meter? I guess I should just be happy that: 1) I'm getting a free bottle of control solution from the Great Wizard of Abbott and 2) if our PDM's meter is significantly inaccurate, then it's effed-up in the "right" direction because my daughter's HgB A1C is always surprisingly lower than I expect it to be based on 30- and 60-day BG averages I obtain from her PDM records. (And no, my daughter's low A1Cs are not due to a high percentage of low BGs, OR to an undiagnosed hemoglobinopathy because I've already brought up this concern and had her tested. Please don't ask which tests, because I honestly can't remember.) Bottom line is, the Dexcom G4 has worked very well for us in conjunction with the readings we get from my daughter's Freestyle PDM meter (however inaccurate those readings may be) and I'm hoping the G5 that we spent 45+ minutes on the phone last night with a stellar Dexcom rep installing will be even better. Good A1C's are not the end-all and be-all of great T1D management, however, and only time will tell if my daughter will have complications in the future. All we (every parent of a child with T1D) can do is our best with the resources we have at hand.
     
    Last edited: Oct 8, 2015
  14. Christopher

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    rgcainmd, thanks very much for the detailed (and witty) response! If the Dr. gig doesn't work out you should consider becoming a writer ;-)

    I will try the control solution thing but I agree with you that it would only tell me if the PDM was totally out of whack and may not really help the main issue.

    I did another test last night and here are the numbers:

    PDM= 142

    One Touch= 195

    Dex= 187



    So it is still 40-50 points lower. Ugh.
     
  15. rgcainmd

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    Chris, you should call Insulet after you have another few days worth of data. I bet they'll send you a new PDM.
     
  16. jenm999

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    Agreed. Our PDM is pretty accurate (ha!) I think - every once in awhile we test it against a one touch meter, a standalone freestyle meter, control solution(s) and our own nonD blood and it's fine.

    I would love to find some household liquid with a consistent sugar content to use as control solution. I always laugh when I test with the control solution and look on the bottle. Oh look, as long as the number is between 124 and 296 it's fine! (Exaggerating but not really!)
     
  17. Dad of Daughters

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    Re: shipment of G5 upgrades, I got this email today:


    Dear Dexcom Customer,

    Thank you for your interest in upgrading to the Dexcom G5TM Mobile Continuous Glucose Monitoring System. We are currently fulfilling and shipping upgrade requests in the order in which they have been received with projected ship dates through late November 2015. We will contact you via email with your anticipated ship date approximately one week in advance and you will also receive a notification from FedEx the day your Dexcom G5 Mobile CGM System ships.

    If you need supplies for your Dexcom G4® PLATINUM CGM System with Share in the meantime, please visit us at store.dexcom.com and/or call our customer service department at 1-888-738-3646. Thank you for your continued support.

    Dexcom
     
  18. jenm999

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    I got it too. They said they'd ship end of this week when I spoke to them earlier in the week. I'm fine with our set up but eager for the 505 algorithm! I think perhaps the FDA approval was faster than they'd expected and they are scrambling to get caught up. Good on them though. This time last year there wasn't even a Share receiver yet and now we'll be bypassing the receiver altogether! (And I think we have Nightscout to thank for lighting the fire under them!)
     
  19. rgcainmd

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    Let's hear it for the We Are Not Waiting movement. There's a lot to be said for doing it yourself!

    We are lurving the G5 so far. DD says it actually does "recover" much more quickly from lows.
     
  20. funnygrl

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    I definitely thought the PDM ran low when I used it. My Dexcom matched it, since I did all of my calibrations from it, but it would constantly tell me I was in the 50's and 60's to the point where my A1c went up- probably from treating "lows" that were 80's and 90's.
     

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