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Any Dex users want to convince us Nav users to switch?

Discussion in 'Continuous Glucose Sensing' started by selketine, Apr 9, 2010.

  1. selketine

    selketine Approved members

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    :p I am struggling with the decision to keep waiting out the Nav or move to the Dex. I know my insurance company would be completely flubber nuttered with trying to switch - but assuming I could - how would you compare the two from what you know - whether you have used both or not.

    I am especially worried about an even worse allergy to the Dex tape than he has to the Nav tape.

    If you kid has a Dex and plays sports - do they just wear the Dex receiver while they play since the transmitter/rec have to be so close to each other to work?
     
  2. hawkeyegirl

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    I know (or think I know) that you are anti-MM, so you can just breeze over this little post if you're so inclined ;), but I'd happily put in a plug for them.

    Features:

    Both predictive and rate of change alarms. Both are highly customizable as to how/when you will be alerted.
    Ability to set different high/low thresholds for different times of the day. We love this.
    Ability to select how often you want a re-alarm for a high or low. (We have high set to realarm at 2 hours, and low to realarm at 45 minutes.)
    Completely flexible calibration times as long as one is done at least every 12 hours.
    The ability to scroll back through and see past readings on the receiver. We use this all the time, and is one feature that I would miss if we ever went to Dex.
    A receiver that is essentially waterproof, and can withstand almost any form of abuse.
    If the sensor gets "off", you restart it, and there's no 2 hour warm up period.
    A 40 minute memory if your child goes out of range - you don't lose any readings if the child comes back into range within 40 minutes.
    No ??? readings. If you lose the signal, it will alarm. Time period for that is customizable.
    We always insert at night, and have good success. Dex recommends against inserting at night, because of the ??? issues.
    No problem with taking Tylenol.
    A crazy amount of info is available on the receiver. We hardly download anymore.
    Even though people don't like to believe it, published accuracy is honestly within a couple of percentage points of Dex and Nav.
    This is anecdotal, but I don't read about people having near the skin reaction to MM tape as I do to the Dex and Nav tape.
    No supply issues, ever. Receivers, transmitters, and sensors are always in stock, and I've never heard of mass quality issues with any of them.
    Top of the line software. Really, truly great.

    Downsides:

    Needle size. I think it's similar length to Dex, but is thicker.
    The transmitter needs extra tape to stay on.
    "Soft" restart needed at the end of 3 days. (Sensor restart - will be asked for a calibration in 5 minutes.) Transmitter must be removed and recharged at the end of 7 days.
    Alarm volume is not anywhere what you're used to.
    Range is not anywhere what you're used to. We get 12 feet max, but the published 6 feet is more common. (We have a Guardian unit too. When he plays sports, we try to get it close to him during time outs and the like. But his pump retains readings during the whole time period.)

    Anyway, feel free to consider this all "blah, blah, blabbity blah" if you're for sure dead-set again the MM. :)
     
    Last edited: Apr 9, 2010
  3. Melissata

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    We are only doing a trial with Dex, but already can see the good things about it. So far, it is far more comfy to her than the Navigator. She has it on her stomach and I didn't use anything but alcohol. No reaction with the tape at all. I do think it has GOT to be totally different than the Omnipod adhesive because she can't wear that on her stomach at all. This tape breathes, so I really think it will stay on better and you may not have as bad a reaction or maybe none at all with this. Of course we may see a problem later. This is smaller so it can be moved around to other areas that he maybe can't wear the Navigator. We have only used arms for Navigator.
    It reconnects itself once you come back into range, no matter how long the time is. You don't lose readings if you don't calibrate on time. And there are no extra finger sticks for calibrations, you just use the ones you are already doing and enter them. It corrects quickly and doesn't fail just because it doesn't like the number that doesn't match up. If they wear it, they can respond to the vibrate and never even have to hear an alarm. The sensor is longer, and I think that it will stay put better. It is thinner than I had imagined, the size of a couple of human hairs. Some people end up with lows and the problem was actually that the tape loosened enough to pull the sensor out a little.
    We only have two days of experience with it, but I am sold. We can always go back to Navigator if we want to later. Unless they make it smaller, I doubt that we would though. The two hour start up time is awesome. The readings were not great that first night, but at least she had something. We started it very late in the evening because the first sensor was bad and had to start another one. Starting it during the day would probably have it more accurate by night.
    The only big issue would be the sports thing, if they tend to have lows and you don't want them to carry it on them.
     
  4. selketine

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    Karla you crack me up!:) Isn't MM supposedly coming out with a smaller sensor (is the the inserter or the actual sensor wire or both?) this summer? The pedi endo is a big MM fan and I think ALL of her other patients who use a cgms use the MM version. Do you insert the sensor by hand or is there an inserter? I guess I shouldn't rule it out. It does seem odd than no one complains about having reactions to the tape.

    I know Carol had trouble with one of her kids and the Dex tape - although initially everything was fine with it for a long time. People do seem to think it stays on better. IF he had a reaction to the tape then we'd need to do the "tough pad" or under bandage thing and I think that is part of the thing he most dislikes about wearing a cgms to begin with. I have a call in to the Dex rep for our area so we plan to take a look at it - mostly due to William asking us to consider it. I think he has seen the Dex and MM on other kids at the CWD conference and he knows that it is smaller.

    Anyone know if Dex or MM has the smaller footprint on the skin?
     
  5. chbarnes

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    We bought the Nav OOP and found it was hard to keep on and uncomfortable to wear. So, we bought the Dex OOP and have been happy. I wish the range was longer. I wish the alarms were louder. I hate it when it goes all question-marky - which isn't often.
    Dex offers a trial period. You should try it for yourself. As I've said several times, all of these systems are accurate enough. You should make your decision based on all the other features.

    Chuck
     
  6. swellman

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    I just wanted to address a few of the Dex "issues" in no particular order or assessment - just random.


    • We're never had a ??? in our about 2 months using it.
    • We calibrate pretty much when there's a significant discrepancy with, what appears to be, no negative effect. We do not, however, enter BGs when the sensor is HIGH or LOW.
    • We never use acetaminophen so it's counter indications do not affect us.
    • The transmitter is not the most ruggedly designed (I'm being somewhat kind here).
    • The trend is about as useful as "scrolling back" IMO.
    • The 2 hour re-start delay is a pain.
    • We get 2 weeks per sensor so far using Mastisol - there is some skin reaction but it clears up over three days using hydocortisone and triple antibiotic. I can't say if this is the sensor tape or the Mastisol - I suspect Mastisol but it keeping ANYTHING on the skin for 14 days is bound to have some reaction, IMO.
    • I would like to see better alarms but it works and they are adjustable.
    • The sensor is pretty small.
    • I would really like the 40 minute data cache - especially during water play. I think am going to lament this this summer.
    • It will be integrated with the OmniPod fairly soon - so, hopefully, only one device to carry.
    • Accuracy has been pretty questionable in the highs (>330) and lows (<50).
    • Fairly short and unpredictable range.
     
  7. hawkeyegirl

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    Yeah, the smaller, more accurate sensor is allegedly coming in FY 2011, so anytime after April 31 of this year. One person on here has heard June, but I personally don't know if it will be that soon. It will be a complete redesign, and I hope they have "borrowed" the basic design of the Dex set-up, because it is nice.

    We use an inserter. It's not particularly pretty, but we numb him up good, and it works.

    I think the Dex has a slightly smaller skin footprint overall, but MM has a smaller TAPE footprint, because there is no tape under the MM transmitter. (You have to use tape over it to keep it on.)
     
  8. selketine

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    So there is no tape on the whole sensor/transmitter piece? Maybe this is why there are few tape problems because people are using their own tape and it goes over the top.
     
  9. hawkeyegirl

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    It's kind of hard to explain. You insert the sensor first. There is a piece of tape that goes under the external part of the sensor, and a small one that kind of goes behind the sensor. So the sensor has its own tape. The transmitter just snaps on the side/back of the sensor and does not have its own tape at all. We tape over both parts, because the last thing I want is a sensor coming out, but the sensor does have its own (small) tape, whereas the transmitter does not.
     
  10. selketine

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    Ok - the Nav transmitter doesn't have tape either - of course the sensor mount has a ton of tape - a big oval of it.
     
  11. Wendy12571

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    Carol,
    Okay, I have used the dexcom since the original system. I never tried a navigator. My feeling is I would use the dexcom due to the low foot print of the sensor does not stick out. I love the graphs the new program gives. The one funny thing I have found is that sometimes I still get readings when I am downstairs just below the reciever. One of the major reasons to switch is the longest I have had to wait for a back ordered piece is 2 days. I will tell you I generally don't get ??? or when I do it means the sensor has bit the big one. I also do the 3 restarts before i give up on a sensor. I would be your trainer for William.
    Wendy
     
  12. dianas

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    I have only so far done a 10 day trial of the Dex Seven Plus but have worn minimed's sensor's for years now. Even before they came out with real time--the CGMS Gold.

    One of the reasons I'm considering the Dex is because of reactions to the adhesives used to hold the Minimed down. I can't use IV 3000, Tegaderm, Tegaderm HP, Polyskin, bandaids, and Flexifix. I've had a little better luck with Hypafix but still have a horrible rash. I've also had a rash where the minilink came into contact with my skin also even if through a barrier. I've tried every skin barrier including using my asthma inhaler and cortisol cream post sensor. Now I don't have any problems with infusion sets--go figure. And I didn't have a problem with the Dex either.

    Which is puzzling because I was hoping that using hypafix would help but it didn't so much. My thoughts are it's because the adhesive on infusion sets and dex is flat against the skin so very little movement. It's secure. When you have to tape over something like the Medtronic sensor and transmitter it's not so flat and doesn't conform as well. In other words the tape moves as I move and therefore causes irritation. It also ended up needing an overall larger footprint on the body of total adhesive in order to hold it down. I'm lucky if I get 5 days out of a minimed sensor. With the Dex I went 10 and it was working well and minimal irritation which happened when I pulled it and not while I was wearing it. (I didn't think I'd need an adhesive remover.)

    I did briefly wear both the minilink and the Dex at the same time for a couple of days. For me the Dex always read just a little bit closer to my fingersticks and it also picked up trends faster but not so much so that I'd consider the Medtronic to be "worse". The Dex would signal a low--I treated and was starting to come back up for about 20 minutes+ before the 722 sounded the first low alarm. I noticed the same thing with high blood sugars. The medtronic was pretty flat around in the 140's but Dex had been climbing and was in the 180's and I decided to do a finger stick. My fingerstick was 229. So I had already corrected the high blood sugar about 20 minutes earlier before the Minimed alarmed high. But when you looked at the graphs over time they pretty much looked identical and not much difference between the two. I had always assumed that the lag time between interstitial readings and blood glucose was universal to all sensors but maybe the reagent Dex uses (or the algorythms) has reduced the lag time compared to Minimed???? It definately seemed to be consistently faster which is why I think it read closer to my fingersticks. The Dex did a better job of defining some problems that the Minimed had earlier hinted at so that I was able to make some pump setting changes that were very effective.

    The Dex was much easier than the Minilink. Could calibrate at any time the rep even said it would be more accurate if you calibrate at a variety of blood sugar levels. You could calibrate if you had arrows. If you were late calibrating you didn't lose the numbers. It also would quickly update the readings after a calibration if it started to drift. I only had one episode of ??? which is Dex's lost sensor/weak signal equivalent I guess and it sorted itself out. I felt like I didn't have to muck with it whereas the Medtronic sometimes feels like you're often chasing after an energetic terrible two's toddler in order to get it to work.

    One last comment. I expected to hate the Dex receiver and not having it integrated-- carrying an extra device around. It turns out I liked having a separate receiver. For a lot of the same reasons parents like having a guardian or want the Sentry. I heard the alarms on the Dex because it was on my nightstand or my desk and not buried under the covers. I could see the results while driving. I thought I would miss being able to scroll through the numbers but having the graphs show up on a bigger screen really helps to see where you've been. The range of transmission was much better for the Dex than Minimed I never lost contact as long as the receiver was within about 5 or 6 feet. With Minimed I can roll over in bed and lose the signal if my pump stayed behind and always had to wear the pump on the same side as my sensor. Always.

    I didn't think the Dex software was as good as Carelink. I didn't have much time to look at it though so may not be a fair comparison.

    The Tylenol issue is a downside of Dex.

    All in all both are good sensors and they have their pros and cons.

    Also keep in mind I'm wearing a 722 pump and that a head to head of a Dex and Revel may be different than what I experienced.

    Diana
     
  13. selketine

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    Well I know we'd be in good hands on that end of it!

    I talked to the Dex rep today and he said that he very much doubted our insurance was one that would pay for the Dex - they have denied other requests. He couldn't talk to me about the system itself as we have to get a script from the pedi endo before he could discuss it with me. I put a call in to her but I'm not sure what to think at this point.
     
  14. Flutterby

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    MM is technicall smaller.. but its so small it doesn't matter.. by like .1 inch or something silly like that.
     
  15. Flutterby

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    there IS tape available through MM that is the shape of the transmitter.. I've never tried it, but I may with Kaylee's reaction.. she doesn't react to the little piece of tape on the sensor, but on the other tapes we use to hold it down.. I wonder if the tape they sell for the transmitter is the same as it is for the sensor.. has anyone tried it?
     
  16. dianas

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    I was always told by Minimed that the transmitter patch was only for the first generation transmitter and it wouldn't work on the Minilink. I've never tried it. I've thought about it though.

    Diana
     
  17. rickst29

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    Also try the Smith+Nephew "Skin-Prep" stuff.

    I'd like to mention my choice (and I react very strongly to Dexcom's tape when I don't pre-treat with this protectant): Skin-Prep.
    That's not "I.V. Prep", and you probably have to buy it via mail order. Packaging is nearly identical (box of 50 individual tear-open foil packs, each containing one pr-soaked wipe). And the formula looks very similar -- but it does something completely different. Instead of performing as an antiseptic wipe, it performs as a barrier film. The packaging bullets talk about stuff like "protection between tape and skin", and "helps tape and appliance adhesion", and "reduces risk of tape stripping.... I.V. Prep boxes say none of these things, because I.V. Prep isn't made for these purposes. (It's only intended for short-term use, not taping long-term "appliances".)

    When properly and fully dried, it keeps the Dexcom tape adhesive from even reaching your skin. (As another plus, it also keeps your sweat from reaching the Dexcom pad... I hardly ever loosen an edge before day 14, when I'm replacing the Sensor anyway.) The thin, dry "film" which gets left behind on your skin assists on BOTH sides. (It helps the adhesive pad stick better, and it protects your skin from the adhesive's chemicals).

    But you have to let it dry COMPLETELY before setting the pad down. (If you don't wait, long enough, then the Skin-Prep solvent mixes with your Dexcom pad adhesive when you press it down -- and the mix attacks your skin. The un-evaporated solvent is nasty stuff, and the mixture attacks even worse than the adhesive would have been without Skin-Prep.) So drying time lasts a full minute, with a hair dryer. (On moderate heat, not just air.) There's another special trick to applying this stuff: You turn on the hair dryer first, holding it in one hand (pointed away from your target area) while you wipe with the other. Then, the instant you have wiped, turn the hair dryer to blow slightly upwards (against gravity) and into the target.

    Why do this? Well, if you're familiar with I.V. Prep and Alcohol wipes, you know how they start out really runny. Skin-Prep is the same way; if you wipe across the "target" area without using the hair dryer, the fluid drains from the top of the wet area towards the bottom (due to gravity). The top side edge is the most critical point for Dexcom pad adhesion. The hair dryer counteracts gravity, keeping the formula in place as it dries into a nice, even layer. (And in fact, the air pressure and heat from the hair dryer help to spread out any "clumpy" spots, pushing them into adjacent thinner areas.)

    Then you set the pad down, and etc. (There's actually a LOT of "etc.". I've got tons of advice on other special "tricks" and techniques for inserting the Sensor and using the Dexcom, I really ought to put them up in a little web site some day.) :rolleyes:
    ***
    If skin-prep doesn't do the job, then you'll be looking at the "helper pad underneath" alternative. Opsite FlexiFix seems to have a higher proportion of happy users than some of the others (e.g. Tagaderm, IV3K) and it comes in big long rolls, less costly to use. Buy the 4" size and cut to size (the 2" width isn't quite wide enough).
     
  18. rickst29

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    That's a big issue with Dexcom -- it's not FDA-Approved for use by kids and younger teens, so one of the "pillars" you'd want to use in order to support an Appeal simply isn't there. There are some recent studies supporting the "effectiveness", but use in a child of just 7 yrs might face arguments about "safety" and "experimental".

    Minimed won Approval for the Guardian in kids by creating a new microcode software package -- one in which the child can't reduce the "Hypo" alarm to an extremely low value (IIRC, the minimum value is 90 mg/dL). But Dexcom hasn't done this, there's nothing the prevent even a child child operator from changing the "Hypo" Alarm value to a value as low as 60 mg/dL. So there are serious objections which can be raised... unfortunately.
     
  19. selketine

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    The Nav isn't approved for kids either but the Dex rep said that age wasn't the issue with Kaiser - it was simply something about them not wanting to give dexcom a contract for a single item since they only sell one thing. I just won't know until I can talk to the doctor. William seems to have a strong idea now that he would like the dex better so I'll have to do what I can!

    He is 8 now btw - I need to change my sig!
     
  20. Flutterby

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    could be.. I never really looked at it because we use tape OVER the transmitter, so we wouldn't need anything under.. I actually put a bandaid on her first, so she doesn't get the irritation from the plastic being on her skin.
     

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