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Dexcom Pros and Cons.

As with everything diabetes-related (or maybe just life-related), there are pros and cons to this whole continuous glucose monitoring thing.  For those of you who are still thinking about whether you want to make this CGM leap, here are my pros and cons of CGMing to shed some light on the subject.

CGM CONS:

The sensor is bulky.  The sensor isn't tiny (about the size of an iPod shuffle), but it's held securely down by the adhesive gauze, so once it's in place, I can't feel it.  This is a big deal for me, since the Minimed CGM was painful for me.  However, it's visible underneath the sleeve of my shirts when I wear it on my arm and it's slightly uncomfortable to sleep on when it's on my back.

Can be "too much information."  Having blood sugar updates every five minutes is awesome, until you find yourself checking it every five minutes and obsessing over each result.  I needed to be psychologically ready for a CGM, and I need to be able to keep it from ruling my life. 

Receiver is enormous.  The Dexcom receiver is pretty big - bigger than my Blackberry - and it's cumbersome to wear.  I usually keep it on my desk, in my purse, or in my coat pocket when I'm out.  At night, I strap it to the headboard of the bed using a headband.  Not a big deal, but it's hard to miss.  Especially when it ...

Beeeeeeeeeeeps! The beeps are LOUD.  Mega loud.  Loud enough to wake me up during the night if I'm low (thankfully), but during the quieter parts of the workday, it's loud enough to distract my coworkers.  I recognize that the beeping is important, but it's not always convenient.

Adhesive sort of sucks.   This is my biggest compliant about Dexcom sensors.  The things do NOT want to stay stuck for more than five or six days.  I shower twice a day (before work and after the gym) and I wear clothes that rub up against the sensor, no matter where I place it.  Even with SkinTac, the edges of the sensor start to peel up at about the five day mark, and it's loose and ready to fall at the 7 - 8 day mark.  (And sometimes, the SkinTac and the Dexcom adhesive and a not-so-helpful bandaid create a huge and ugly problem:  frigging ouch.  See the photo on Flickr for a full rundown.) 

Ouchy Dexcom

I do not like when a $60 sensor starts to peel away.  This is highly annoying.

Insurance coverage battles. While others have had their requests approved without batting much of an eye, my insurance coverage for the CGM had to be fought for.  I battled my insurance company for over eight months before receiving my approval letter.  The insurance hurdles are a definite con, and might make some people reluctant to fight for their right for a CGM.  (Cheerleader note:  But don't let it stop you!  Go for it!)

Doesn't feel "sexy."  (Yes, I know this "shouldn't matter," but these are my personal pros and cons, so roll with me, okay?)  With the pump infusion set stuck into one part of me and the CGM sensor in another, wearing two devices doesn't exactly feel like I'm ready to model for Victoria's Secret.  There have been plenty of times when a moment has been interrupted by the CGM beeping or the sensor getting stuck on my clothes and whatnot. 

CGM PROS:

Low blood sugar safety net.  This was a huge part of why I wanted to use a CGM in the first place:  hypoglycemia unawareness.  I was exhausted and frightened of the lows at 3 am, so having the added safety net of the CGM has been a huge improvement.  The CGM does its job and protects me from plummeting blood sugars.  When Chris is away on business, he prefers that I wear the CGM to keep an eye on those lows.  It makes me feel safe, and I value that "pro" above all others.

Helps me avoid staying high.  My body reacts to blood sugars that are over 260 mg/dl or so, but those 160's and 180's often go unnoticed.  The Dexcom helps me wrangle in these "minor" highs and tighten up my blood sugar standard deviation overall.  Staving off both the lows and the highs will be particularly helpful during my future pregnancy.

Excellent for exercise.  I go to the gym at least five days a week, and my workouts range from walking/jogging on the treadmill to cardio circuit training.  The CGM has been AWESOME at detecting fluctuations in my numbers while I work out, helping me avoid those crash-and-burn lows at the gym and also the highs that sometimes crop up after a hard workout.  (And it was great on our hikes when we went to Acadia - excellent tool!)

Driving safety.  I spend a lot of time in the car driving back and forth to RI, and the drive time is anywhere from 2 1/2 hours to 4 hours (depending on traffic - I hate CT highways).  Having the Dexcom in the center console next to me while I travel is another big bonus.  With hypoglycemia unawareness and blood sugars that seem to be affected as much by my moods as by what I'm eating, having an extra eye on those numbers is crucial to keep be safe behind the wheel.

Integration-free works for me.  I trialed both the Minimed CGM and the Dexcom and for me, the Dexcom being a seperate device worked best for me.  With the Minimed CGM, I couldn't hear the pump alarming in the night because it was buried underneath the blankets.  Having the Dex receiver separate from the pump is convenient for the nighttime alarms and also if I want to avoid having to deal with the CGM for a little bit.  I can shove it into my purse, bury it in a desk drawer, or even walk away from it for a little while if I want.  I like the freedom from being beeped at sometimes.  It sounds counterproductive, but in the longrun, this is a bonus for me.

Trending and tracking.  Here's the point of CGMs - to track the trends of my blood sugars.  The Dex doesn't replace my meter, but instead works with it.  I test on my meter and see a result of 100 mg/dl, but with the Dex, I know I'm "100 going down," "100 going up," or "100 holding steady."  This makes it easy to go into long meetings at work without fearing a crash, and also lets me go to bed at a blood sugar of 90 mg/dl with confidence.

Pretty darn accurate.  I don't expect this thing to be right all the time.  I already have my head programmed to accept that a CGM doesn't replace finger sticks, so when things don't match up all nice-nice, I don't flip out.  Overall, though, I've found that the CGM rides pretty close to my meter.  Dex works better when I'm running a bit steadier, so it's actually a weird sort of incentive to maintain better control to retain the integrity of the sensor.  Don't ask me to mentally make sense of that - I need to take whatever motivation I can and run with it.  ;)

But it does feel sexy.  And this is the flip side to that "con" coin.  The Dexcom is sexy.  It's stuck to me to gain better control of my diabetes.  Good control helps everything from my weight to my hair to my internal organs to my smile.  Being healthy is sexy as hell.  And being confident enough to wear this machine, despite its cons and because of its pros, makes me feel stronger all the way around.  For me, after weighing all these pros and cons, the CGM is definitely worth it.

Conquering diabetes, damnit.

Readers Beware!!:  These are MY pros and cons.  I chronicle my personal experiences with diabetes here on SUM and I'm not a doctor or a CDE or a medical professional of any kind.  I have decided to use the Dexcom CGM after trialing both the Minimed and the Dexcom, but I know plenty of people who are using the Minimed CGM without issue.  For me, the Dexcom was a more comfortable fit into my life, literally and figuratively.  It's all about personal preferences, and these are mine. 

If you're thinking about trying out a CGM, I recommend trialing as many kinds as you can before making an informed decision.  Your mileage on these devices will vary, so it's important to find out what works best for YOU.  Contact your CDE and see if you can schedule a week trial session with different devices. 

If you want to share your perspectives, feel free!  I love that the online diabetes community has become a real source of information for diabetics everywhere who are looking for real information - we are the true mavens of patient experience!

Comments

I would think that having the Minimed integrated with the pump (if you have a Paradigm) is a huge plus to going with it over the Dex. I haven't tried either so I am just speculating. I seriously don't need ANOTHER device to keep up with.

Tony - For me, I couldn't hear the Minimed alarms during the night or if I had the pump tucked away. I also found the sensor to be very uncomfortable. These cons outweighed the convenience of one device. But YDMV, so I recommend trying both to see what works best for you!

Probably wouldn't matter much for me. The Air Force could drop a bunker buster in my front lawn and I wouldn't miss a beat. :D

I will have to try both when the time comes. I guess they let you try before you buy.

Given how hard the diabetic community is fighting to get insurance to pay for CGMs, I've feared that people wouldn't share the cons of these systems. So thanks, Kerri!

It actually took me a good six months to really adjust to having a new device hooked up to my body (in my case, the Minimed system), a new needle to deal with, the 15-30 minute lag time, the system's "quirks" on the first and last days of use and the beeps waking me up at night. There used to be a noticeable shift in my moods when I had it on--I was irritable, prone to crying and more easily frustrated. But I took it off a few days ago and found, for the first time, that I feel far more secure with it on. Most importantly, for the first time in the 13 years I've had this, I finally had an H1c of under 7 (6.6). Part of it is having the trend data and part of it is that if I have to wear this thing, I am going to make it worthwhile and have become more disciplined in all other areas of diabetes care.

So while it definitely takes some getting used to (physically and emotionally), the benefits are huge.

My pros and cons are remarkably similar to yours, although for me it's work safety rather than driving safety and the fact that the Minimed beeps are too damn quiet!

The good thing about MM, though, is that it does allow you to turn all the alarms off. So if I fancy still having the data to check but don't feel I want to be bothered by alarms (as I often feel during weekend days) I just switch the alerts off and check the trends. Not sure if you can do this on the Dex?

Everything in diabetes is a balance, including my emotions about my medical devices, but I do know that over two years since I first used CGM, I still love it more than I hate it.

Thanks Kerri, for posting all your experiences with CGMS. I think it is a wonderful tool in concept, but I have often wondered if it is as good in practice.

One day (like during pregnancy) I hope to try it, but right now I'd feel kind of weird thinking of using it. It feels like my diabetes is not "bad enough.?.". I know... totally stupid, like when people look at your pump and say your diabetes must be really bad. It just seems like you have to have hypoglycemia unawareness to qualify to use it.

BTW, I'm sure I'd become obsessive with that much information. Who could resist checking a lot? I mean, especially after having to worry about stretching test strips to save money!

Lindsay - I have to share the pros and the cons, because obviously nothing is "perfect." :)

Caro - I can turn the alarms off on Dexcom, but only the high ones. The low alarm is defaulted to 60 mg/dl. I've turned off the high alarm a few times during meetings where I didn't want to BEEEEEEEEP! And I totally agree with you - I love it more than I hate it.

Once again you have come through. I love "real" perspectives from people that are actually using a product.

This helps a lot. Thanks.

see this besides the price is the reason is why I dont have a pump or one of these things . Just not techno savy and would not like the idea of having something attached to me all the time . I also feel free-er with the mdis . I am okay dealing with mdis everyday and I dont obess over any of this . great blog as usual though have a great one dear .

see this besides the price is the reason is why I dont have a pump or one of these things . Just not techno savy and would not like the idea of having something attached to me all the time . I also feel free-er with the mdis . I am okay dealing with mdis everyday and I dont obess over any of this . great blog as usual though have a great one dear .

Kerry

Thanks for the post, very informative for me, very interesting on the comparisons with the MM CGMS. I tried the MM a couple of times in June, insertion was painful & some bleeding occured... the inserter needle is too large. I did try the "Start new sensor" trick, so ran it for 6 days, overall the readings were within 20% of BG's, so that was good.

Personally I like the idea of the MM unit, because its smaller than the Dexcom / Abbotts, but as you point out (Dexcom), those units are big, probably to big for me to put up with.

I think this technology will only be really ueful when the pump and CGMS talk to each other and the basal rates are adjusted automatically - particularly for cutting off the basal for hypo predictions or increasing the rate for excessive BG - not necessarily a full closed loop system though. I wouldn't be surprised if that means you will have to use the same pump / CGMS manufacturer. The cons for me are also very similar, more devices to hang on somewhere, looking at the numbers too much and still having to manually adjust everything.

As several people have said, the tech needs further development and miniaturisation...I'm still waiting on a response from my insurance co. before I can proceed on anything.

Today a wonderful day as far as sensor numbers and finger pokes are concerned ...numbers are the same ( and great I may add ) 522 medtronic pumper and wearing medtronic's sensor . I have the sensor in my right leg and indeed felt pain pangs, when I did my 1/2 marathon training yesterday...actually unusual to have pain and blood ...I have overcome and seeing blood is no concern .Am I addicted to seeing the numbers ??..I think so ...I have had fewer lows and my A1C up to 7.0 ...but quality of life has improved ( living with type 1 diabetes for 26 years , now almost 69 years ) Our extended health benefits pay ( pacific blue cross , Canada !!!! ) for sensors ( 4 per month as far as I know )
Wishing you all a Merry Christmas and good health for 2009 .
N
PS Kerri , I will be on Buzz Bishop's Team doing 1/2 marathon in DW ...wowy ...wish us well on Jan. 10, 2009

I've had my pump for over a year and I still don't like having it attached to me so I doubt I'd want sonmething else stuck to my skin. But I think for anyone who has hypoglycemic a unawareness, these should be mandatory and covered 100% by insurance. Yeah, I know. I live in a dream world.

Anonymous is me , nel, pumper since 2001 ...I neglected to put my name /e-mail address in the proper place ...forgive ( Team Diabetes Canada member ...7 th event just around the corner , short weather in Florida ??)

Focusing specifically on the adhesive issue... I'm wondering how many of us with D (1, 1.5, 2, whatever) have adhesive issues. AmyT's posted about hers on DiabetesMine, and this summer, I've had similar skin issues with every (expletive deleted) method I've tried to keep on the wetpacks I need to treat insect bite allergies. Is it D that's making us sensitive, is it a change in the formulations of the adhesives, or something else?

Hi Kerri, I think that's a fair summary, although I've been using the MInimed system for 2 years and haven't had any sensor pain issues. Also I don't think I could swap my little combined pump and CGMS handily attached by a tube for a separate CGMS monitor, carrying yet another piece of diabetes kit would drive me mad!

On the odd occassion when I feel like a character from StarTrek with my sensor and infusion sets stuck to me I put them both on my back for a while. I know it sounds stupid but if they're on my back I can't see them as obviously when I look in the mirror and that makes a very nice change!

I find the ability to know what my blood sugar is and more importantly whether I'm stable, rising or falling is invaluable. If I don't have the CGMS on and I do a blood test I find myself thinking "wonderful, I'm 100 but what use is that, I want to know which way I'm trending".

My control wasn't bad when I got CGMS - HbA1c's were between 6.5 and 7 but with the CGMS I've had it running at between 5.4 and 5.6 for the past 2 years which is just perfect for me.

I've had a pump for 6 years and I've been using Abbot's Navigator for two months. It's improved my everyday life, I especially sleep calmer, as the low BG alarms wake me up.
I have a lovely 6-year-old daughter and I often think: if only I had such a device during the pregnancy!
Best wishes from Slovenia, Europe.

How in the WORLD do you keep such a firm mid-section??

Please to share.

Kerri, I'm happy to find your blog and read the pros and cons of the Dexcom. I'm having an awful time with my first month's trial. It seems like it would be a great gadget but it can't seem to sense my lows and freaks if I put in calibration numbers that are more than 60 away from its readings. My sales rep/trainer says I'm having more problems than most people but does not offer any useful answers. It's going to have to be more accurate for me to fight my insurance and my hubby's "ick" factor to keep using it. Also my doc says seeing my Dexcom charts for 10 minutes every two months will be enough for her help me 'tune up' my control. Help!

I am due for a new pump, so I am wanting to really choose what is best. I've been on line, read blogs etc but am really undecided at the moment. the Dexom looks great, but I am a minimed pump user, so I was looking at their version as well. The up side to minimed is that there is no additional device to wear, the pump reads the sensor, however the sensors last only 3 days. I am very active, in the gym, run, swim etc. I hate the fact that I can't wear the minimed sensor without taping it. I'm allergic to most tapes. Can you please tell me a little about your experience with the Dexcom vs. Minimed? Do you have to put tape over the dexcom? What do you do if you shower or want to swim laps?

I'm a 60 year old T1 diabetic Had diab. for 55 yrs. I'm scheduled to try a dexcom CGM soon. I suffer from low sugar unawareness and hope this will help. This site has helped me decide to try a CGM. Thanks for the info on your trials.

I am due for a new pump, so I am wanting to really choose what is best. I've been on line, read blogs etc but am really undecided at the moment. the Dexom looks great, but I am a minimed pump user, so I was looking at their version as well. The up side to minimed is that there is no additional device to wear, the pump reads the sensor, however the sensors last only 3 days. I am very active, in the gym, run, swim etc. I hate the fact that I can't wear the minimed sensor without taping it. I'm allergic to most tapes. Can you please tell me a little about your experience with the Dexcom vs. Minimed? Do you have to put tape over the dexcom? What do you do if you shower or want to swim laps?

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