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Spoiled for choice at a price: Dexcom vs MM 640g

Discussion in 'Parents of Children with Type 1' started by suej, Mar 25, 2015.

  1. suej

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    After 2 years of Dexcom envy ( Ben started CGM with Enlite May 2013) which has given me much peace of mind when it works but also a lot of frustration with sensors fading away before 6 days, some failing to initialize, the fiddly sertor and pressure sensitive issues, Dexcom (without share) is launching here next week.

    Co-incidentally (or perhaps not) Medtronic is rushing to launch the 640g here and I may be allowed to trial the 640g - the rep has not got back to me again though. And they will release the 730g in 2 years they say with a 3rd gen enlite sensor. We seem to get new stuff at about the same time as Europe and Australia.

    Dexcom interestingly will not be releasing the share and say that the phone app (no actual timeline available) is under development and will go to both android and apple devices, so possibly quite soon? I think #wearenotwaiting and #openaps are having a very beneficial spinoff by putting pressure on the companies.

    My gut feeling is to go with Dexcom, can members who have experience with both please advise me?

    Both will make a big hole in our mortgage. The 640g will retail here for about R45000 (about $4000) - $1 = R13 and would buy a loaf of bread, not sure how else to compare them. There would be no upgrade rebate and our 530g only 2 years old, and potentially I would then be tempted to buy the 730g in 2 years time for a similar price. Medical aid helps with sensors but not hardware.

    Startup costs for Dexcom would be about R13000 ($1000) then about R4500 ($400) for box of 4 sensors. And perhaps in 2 years time there will be a pump that twins with it as an APS.

    So is the Dexcom sensor really a better sensor, that usually works for 2 weeks? It would be so nice to insert a sensor only once every 2 weeks, it is not our favorite activity. For me this is a big issue as a working sensor allows me to more calmly cope with what D throws at our family. With Enlite sometimes I feel I am managing 2 problems - a problematic sensor and D, and the 640g can only be as good as the sensor.

    Thank you
     
  2. Mish

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    I can only speak to my experience with the older MM sensors (prior to enlite) compared to the G4 sensors. In short, it's night and day. There's literally nothing I liked better about the MM sensors and a ton of things I like better about the g4 sensors. For us, even the fact that the MM CGM was integrated into his pump was a negative, not a plus, because we couldn't hear the alarms at night. I can't speak to any of the new MM pumps with the shut off or whatnot, but he still uses our old MM pump and we have no issues with that at all.

    So, plus for G4 (just our own experience, yours may differ) over the MM sensors
    * insertion is painless. For months he'd insist that the sensor really didn't go in because he was so used to the pain of the MM sensor
    * we get a full 2 weeks out of each sensor. It's rare that we get any less. And restarting after the first week involves nothing on his part - no removing the transmitter, etc. It's just a quick restart of the receiver.
    * start up is this: insert, and start, which takes about 30 sensors. Calibrate 2 hours later.
    * Calibration is simple. We calibrate when it tells us to calibrate and we don't lose BG info if we don't want to calibrate. We have no trouble calibrating during highs or lows or moving BGs or before eating, etc. I felt like we were tied to the MM calibration schedule in a way that I didn't even realize until we didn't have to do it.
    * accuracy is ridiculously good. I allow him to bolus off the readings at school. We just had terrible accuracy on the MM which make it useless for us.
    * alarms are loud, and the range is great, so I can keep the receiver in my room at night, and he can do what kids do - sleep.
    * having a separate receiver allows me to check his BG info without bothering him.

    There was just literally nothing I liked more about the MM sensors.

    Good luck. :)
     
  3. jenm999

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    Have not used the enlite but can confirm that we always get 2 weeks per sensor. We use liquid skin-tac to secure it and reinforce with hypafix tape toward the end of the 2 weeks, that's it. It's crazy accurate and once it's in he's completely unaware of it. I also love having the receiver next to me while I sleep because he wouldn't wake up - if the only receiver is the pump then it only works if your child wakes to alarms which I know many kids do not.
     
  4. Ali

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    Have not used the Dex system in years but currently use the enlite. Easy insertion, painless, typically I run at least 12 to 14 days with good results, very accurate. Much much better over the prior sensors. I can only use sensors of either type on my arms to get good results. I also do not like to leave them in beyond 14 days as I just get squeamish about it :) and tend to get itchy from the tapes. Ali
     
  5. Megnyc

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    I have used both enlites and dex G4. I have found the dex to be vastly superior in nearly every way. Super easy, dummy proof insertion. I get 2-3 weeks easy out of a sensor. The accuracy is simply incredible. I routinely bolus off of it. Customer service is great and they will (at least in the US) replace every sensor that does not last 7 days without hassle even if the reason for changing early is a lack of accuracy or itchiness/tape issues. That is unusual but possibly helpful for you to know since it sounds like you will be paying part of the cost out of pocket.
     
  6. suej

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    Thank you so much for your perspectives and advice. I do think we will go with the Dexcom. Ali, I am so impressed you can get 12-14 days with enlite, very rarely do we go past D7 and often isigs dropped below useful levels day3+.

    Ben has used enlites on upper buttock below beltline (Tummy reserved for sets only), but I want to try his arms - is that what many kids do? And skin-tac sound a brilliant idea, and I would so love to have his receiver by my bed at night. At the moment we have a DIY system with very sensitive mic on his bedside table leading to a powerful amplifier/speaker in ours, as of course he does not wake to alarms.
    Thank you
    Kind regards
     
  7. jenm999

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    You will love the Dexcom. It's a game changer and allows us to be a bit more aggressive with corrections and targets.

    You may not need a microphone at all. We have a 2000 sf house and have a "sweet spot" where we can put the Dex and it will pick him up anywhere in the house. From his bed to my nightstand is not a problem. The range of the Dex is huuuge.

    We do back of arms and save belly and butt for sites too. This particular sensor we are on now is more on the outside of the arm and we have had our first ever compression lows when he lays on it. Best bet for us is the fatty back of the arm. It doesn't interfere with any of his activities and he can't lay on it (we only get compression lows if his entire body weight is on it; if he's on his back the weight of his arm is not enough to affect it).
     
  8. dpr

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    We love our Dex. We always get 14+ days out of it and have had 2-3 that went around 3 weeks. I highly recommend it.
     
  9. rgcainmd

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    We reserve my daughter's arms for Dexcom only, as that location gives us the best accuracy. We average 10 to 12 days, but got 14 out of our last sensor (which I expected to last less than the average because she was swimming and snorkeling in salt water). We'd probably get more days out of each sensor if my daughter didn't spend so much time in water.
     
  10. suej

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    Dexcom sound wonderful - meeting rep next week. The MM 640g with predicted low suspend is tempting, but for me it can only be as reliable as the enlite sensor, which has driven me to tears once (3 failures in 3 days). So I will go with Dexcom and if Medtronic have fixed their sensor ( the 3rd generation enlite) that is due to be released in 2 years time with the next generation pump with low and high predictive insulin adjustments I will have had experience with Dexcom and be better able to decide whether it is worth going back to enlites, or getting a new pump if Dexcom have developed APS in collaboration with another company. I must add that the 530g as a pump has been great (tho' our first pump so can't compare) and the helpline and customer services also really good so I am really grateful for that.
    Thank you for your input
    Kind regards
     
  11. ltomovski

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    We have never used dexcom so I will share my experience with Enlite only. First of all we are using Enlites 2 ... these are used in western Europe and in order to differentiate from the 1st gen they have yellow dot on the box. As we used 1st gen before I can compare these two .. 2nd gen are way accurate than the 1st gen and the number of bad ones (the once that last 2-3 days) are very small in number .. We use Enlites for 7 days as we do not want to risk false readings .. we calibrate three times a day .. and the accuracy is very good .. in fact we do not check BG for boluses .. we only check BG if something not expected, is happening with my sons BG so we need to double check ... We mainly calibrate when we have flat profile but there is no problem calibrating when falling or raising .. I just do not see the need to risk .. as I already told you we calibrate three times a day so one can always find good time to calibrate .. If you miss a calibration you do not see BG but you still see ISIG values .. As MM user ISIG ration BG/ISIG is very important and we always keep track of it .. for example normal mmol/isig ratio is 0,26 and it stays the same almost all for the sensor life .. if the ration goes 0,4 0,5 this is indication that the sensor is going bad .. Enlites 2nd gen also seems not to be that sensitive on pressure and this is important as for a kid we place the sensors on the bottom. About Dexcom I like the idea of having even better sensor in terms of accuracy but I doubt I will use a sensor stuck on my kid for 14 days .. I think it will be bad for the skin .. now with Enlite for 7 days we need some time for the skin to heal I can not imagine how the skin will look like after 14days .. About threshold suspend and predictive suspend .. We are not using threshold suspend .. as it is not needed for the moment .. In Bulgaria we buy pumps ourselves so I will not go for 640g coz I prefer to save my money for 670g .. If you are not aware of 670g it is called hybrid loop ... it will use low predicted suspend and it will self bolus on high sugar.. it will use Enlite 3rd gen which has to be better from 2nd one .. note in USA 3rd gen will be offered as soon as 640g hits the market .. so if MM has no problem with FDA we should see Enlite 3rd in 2016 in USA. 670g will hit the US market in 2017 and EU in 2018
    Regards
     
  12. Mish

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    1) that's always been an annoyance. Why can't MM just allow you to see the readings? Why must we have to do all that work to read the sensor or know when the sensor is going bad?

    2) it's not bad for the skin. Your skin looks bad because you're using a product that's horrid for the skin with a sensor that's too huge. Most of us have zero skin issues with 14 days of sensors. Many do it longer, again with no irritation and no skin issues.

    3) ha. ha. ha. ha. ha. ha. ha. IF you see that by 2018, then you'll be lucky. It only took them roughly 7 years to get the "parent monitor" through the FDA and to market. And that is a worthly piece of overpriced junk that looks like it came out of the 1970s, and didn't even have the decency to have a dimmer switch. Why does it take MM 3x as long to get things through the FDA?
     
    Last edited: Mar 29, 2015
  13. Megnyc

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    I agree with the bolded. For anyone curious, I attached a picture of my skin after I just removed a dex sensor I used for 21 days about 3 hours ago. I only removed it because I believe it might be reading slightly low at night and I don't want to be woken up tonight to a false low. I wear the dex sensors on top of a tough pad, taped with opsite. Other than changing the opsite every 7-10 days I do nothing for those 21 days. As you can see from the picture, my skin under the dex sensor/tough pad combo is much more dry and "flaky" than the surrounding skin but there is absolutely no redness or irritation. It doesn't bother me and goes away in a few days but I imagine if it did bother you/your kid, moisturizer would fix it easily. Just for the record, before I started using tough pads my skin was an absolute mess under the sensors. But now it is great, no issues at all. One thing I find that really helps is to use unisolve or any adhesive remover to get the sensor off so my skin doesn't get irritated from that process (which I think can be more irritating than the actual sensor adhesive itself). Sometimes I only get 14 days but I don't really try hard to extend it and if I have any concerns about a sensors reliability I change it rather than waiting it out.

    Oh, and my last reason I greatly prefer the dex. No more lost sensor alarms! And no more meter BG now alarms! It's funny I didn't realize how much the endless alarms annoyed me until I switched to the dexcom. Sorry, one more thing. Also, I used to obsess over the ISIG and whether or not the ISIG was high enough to restart the sensor. To not have to concern myself with that is a huge relief.
     

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  14. ltomovski

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    2)Not sure If I understood you correctly but did you state that MM sensor is "too huge" compared to dexcom .. I have never seen dexcom in person but according the the pictures and videos all over the internet it seems its the other way around. About skin irritation .. in the first year of use we did not get any ... but then out of nowhere upon sensor removal we have red skin in the shape of the transmitter .. We have seen some dermatologists and they said its probably allergic reaction to the transmitter material .. I also notice if water goes between the sensor tape and the skin it starts itching we tried several skin preps but with no success .. atm I put a tape stuck on the transmitter thus separating it even further from the skin .. it does have an effect.
    3)I know the history of MM and FDA .. but this time I am pretty sure things will go through as scheduled .. but in my case I am more interested in EU schedule as we live in EU... as far as I know MM always go to market as scheduled in EU

    @Megnyc .. for how long have you used sensors? How many locations you use to rotate sensors? if its not a problem .. how old are you ? My son is 7 years old .. small body .. bigger skin inflammation as the body is still young
     
  15. Megnyc

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    I used Medtronic sensors for around 7 years and dexcom sensors for about 1.5 years. I'm 21 years old. I mainly wore the Medtronic sensors on my arms so a total of 4 sites. The dex I rotate over maybe 6 sites.

    The transmitter reaction you are talking about is not uncommon. See if you can order Johnson and Johnson tough pads where you live. If you can't, you can try asking a pharmacist for a hydrocolloid dressing and then cut a square and place it under the transmitter. I believe that will solve your problem.
     
  16. Ali

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    I have worn both and I had no difference in skin reaction. For me MM was more on target. I think it is very individual in terms of skin reaction and readings. If you read the research literature it is very difficult to come out with a clear cut winner. If I am wrong please show me. Not being snarky, really asking show me:) Dex is ahead in some areas, MM in others. I am happy to be proved wrong, I have not researched in three years, but please make sure you are comparing apples to apples, and the same testing criteria. The skin reactions are hard to test for. But I do think that the skin issue is legitimate and just can not be known till you wear, and I do think that the Dex and MM work better with different bodies, and again you may just have to try both. The other issue is what does being spot on with a meter mean?? As has been discussed countless times, meters and meter readings are "suspect", so when we as individuals discuss this, keep it in mind. I always assume my meter is only accurate by about 20+ or 20- points and if it is critical then retest and average. Your BG is changing always. Any glucose measure is just an average of BG values. You need to learn to average and guess; should I average high or low based on what my insulin is and my eating has been. It is just freakin tricky the more in control we want to be. I err on the hight side as I have spent too too many years in that low range. Ali
     
  17. Ali

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    This is what my sites look after removing a MM sensor. The BG alarms now are irritating:)
     
  18. Ali

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    I look the same after removing my MM. I agree the BG now is annoying but I love not having to carry an additional device and having a shut off if I go too low.
     
  19. hawkeyegirl

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    My son reacts to both MM and Dex, but it's different. With MM, he reacts to what I believe is the heat of the transmitter. If we didn't put tape between the transmitter and his skin, he would have a raised welt exactly in the shape of the transmitter left on his skin. With a piece of Opsite between the transmitter and his skin, no welt.

    With Dex, he had no reaction to it for about the first year he wore it. Then all of a sudden he started reacting to the tape, badly. We now insert through a Tough Pad, and his skin looks great when we take it off.

    We have never used the Enlites, but we had better luck with the Sof-Sensors than most. I don't think our accuracy with Dex is loads better, although it does track more accurately in the high ranges. The biggest difference is that Dex is just so much less WORK. Less fussy, fewer alarms, needs less babying at start-up, keeps reading if you miss a cal, etc. The sensors do last longer, too. We virtually always get 14 days, and I never pushed our MMs past 7.

    I'm not saying I'd never go back to MM, but they're going to have to come up with something pretty darn good.
     
  20. Megnyc

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    I personally prefer the dex but I have not found it significantly more accurate than the enlites or sof sensors. This is a simple comparison of the two that found the dex was much more accurate than the enlites. There are easily a dozen studies out there that show that the dex has a significantly lower MARD than the enlites. All the studies would have used the same testing criteria and most used a lab quality BG meter. In general, from my perspective most people have less skin reactions with the enlites than the dex. A decent number of dex users do have an allergy to the adhesive but I have never heard of anyone who was not able to get around it. I have also never heard of people routinely going 2+ weeks with enlites while most dex users do that.

    The only point of my post was to say that people who are wearing the dex for 14+ days are typically not harming their skin. Everyone should use whichever sensor best meets their needs.
     

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