Why I Didn’t Buy a Dexcom

I had my monthly prenatal appointment with my Endocrinologist last week. We have seen each other once a month and traded e-mails once a week for eight months now, so we seem to sort of “get” each other now. My appointments are friendly and chatty. This month, he gave me a good ribbing for choosing not to purchase the Dexcom after my trial. He says I am the only person he’s ever met who decided that she didn’t really need it.

While he is right that I did choose not to purchase the Dexcom after my trial, his understanding of my reasons for doing so are a little off.

Let me start by saying that the device is impressive. I tested a Medtronic MiniMed CGMS several years ago when it was in trials. It was clunky, was not remote, and was not waterproof. You had to put the thing in a little waterproof shower pouch that you could hang around your neck in the shower. Really? You had to go to the doctor’s office to have the sensor inserted. To top it all off, the thing was testy. The first time I trialed it, it crapped out after just a day. The second time, the result were better, but you could only wear it for three days. Probably the worst part about the device was that it did not communicate any of its information to me, the patient. Instead, all of the information was stored in the device until the doctor downloaded it. So much for catching highs and lows.

Today’s CGMs are in another realm completely. The Dexcom sensor was really pretty simple to “install” and the user interface on the device itself, while basic, was relatively easy to figure out and was functional. The sensors are now remote, so I was not tethered to the device, and they’re also waterproof, so I could attend water aerobics and take a shower without worrying about a shower pouch. Perhaps most importantly, this new generation shares its information with me, so I have “real time” information about whether my BG is trending up or down, or is out of range. I’ve got to admit, that’s pretty helpful.

When I trialed the Dexcom, I managed to get over 14 days out of one sensor, although by the end, I was seeing a lot of ??? screens. The low and high warnings were a bit annoying in the beginning, especially when I was recovering from a low and it was STILL beeping at me. The lag-time was frustrating. But once I got the alarms set to the right levels (60 and 160 worked well for me,) this annoyance was somewhat tempered. Of course, the fact that it caught untold numbers of pending highs and lows during the trial is not lost on me. My graphs and charts from the second week, once I got used to the thing, were amazing.

So why didn’t I buy? It basically comes down to a sort of psychological burden. I really felt like the thing just put too much of my focus on this damn disease. Before the Dexcom, I was already testing 16 times a day. Now I had to do even more finger sticks either to calibrate, or because Dexcom thought I was high or low and I needed to confirm. It was like the thing was whispering in my ear all day, “Hey you … you’re diabetic. Don’t forget.”

I’m also really hung up on the idea of yet another hole in my skin. I don’t like wearing all of these devices on my body. When the pros outweigh the cons, I’m willing to do it, but otherwise, I’d like to get away from sensors and infusion sites. If they ever figure out how to put the two together into one site, then I would be really interested.

The device is big and cumbersome, too. It did not fit in most of my pants pockets, and the clip was worthless. The size and shape were a constant reminder … when the darn thing popped out of my pocket in the bathroom … when I would leave it on my desk at work during a meeting … when it took up precious real estate on my nightstand where it was jockeying for position with my tester and my juice boxes and my box of Dots.

In the end, I looked at my current diabetes regime, the fact that my A1C’s have been amazing throughout my pregnancy, that my baby is healthy, and that my non-pregnant A1C typically hovers in the 6.0 range, and I decided that the slight improvement in my control was just not worth the psychological pressure.

The day I returned the device to the sales rep, I caught a low in the 20’s only because I tested. I didn’t feel it. I wondered if I should have bought the Dexcom. I still wonder sometimes. And maybe I will change my mind one day, when my A1Cs are not as good, or the lows and highs are more frequent. But diabetes, and life in general, is all about balance. We need to find a way to manage this disease while staying mentally healthy, too. And the best way to do that is different for every one of us. For now, I think this is the best decision for me.

Dexcom trial: A mixed bag

Today is my first day on the Dexcom trial. And it’s a mixed bag.

I inserted the sensor this morning. It took a little help from my husband, because I put it on my upper arm and we couldn’t figure out how to detach the applicator portion from the sensor pod. After a bit of fumbling, we finally figured out that we did not have the transmitter latch all the way down against my arm, so the pod would not release the applicator. Once we figured that out, it came a part easily enough.

The actual insertion was not too bad, although I did feel it. I think I would get better at it with practice, though, so the pain issue is not a big concern. The applicator really helps with this. It is kind of awkward, but once you use it once or twice, I think that you probably get pretty good at it, and it helps get the sensor at the right angle, keep it going in straight, etc. An added bonus is that it sort of hides the REALLY long inserter needle from you. Now, about eight hours after insertion, I can still feel the sensor under my skin, but it is not too bad. Occasionally I will turn my arm just right and it will pinch a bit, but mostly it just sort of feels like an infusion set.

The sensor pod and sensor are pretty low profile, but being the klutz that I am, I managed to get it caught in both my sports bra and my shirt sleeve this morning when I was getting ready for work. The tugging was a bit uncomfortable, but the adhesive held firm. I imagine you get used to having the thing attached to you, though, and automatically compensate during these sort of maneuvers.

The bad news is that it has been pretty inaccurate all day. It has been off by as little as 10 mg/dL (this was nice, but unfortunately fleeting) and by as much as 50 mg/dL. The worst part is that it is constantly buzzing to tell me that I am either low or dropping, even though my sugar has been primarily in range. I even changed the low alert to 70 (the default is 80,) but this has not really helped. I have been calibrating quite often in the hopes that this would help the sensor find the right level … this seems to be helping a smidge.

Another con is the size of the receiver. This thing is huge, and I am struggling to find a good place to stash it. You might remember from my maternity clothes post that most of these clothes do not have good pockets and certainly don’t have waistbands. So it is difficult to find a place to attach the receiver. Also, the receiver itself does not have a clip, so you have to use the case if you want to clip it to something. The case that came with the loaner that the Dexcom rep sent me for the trial absolutely wreaks of cigarette smoke, so I am not using it. Instead, I am carrying the receiver around with me, leaving it lay out on my desk, or tucking it into my sock (although it keeps trying to pop out.)

Perhaps the best part about the CGM is the trending arrows, which tell me if I am heading up or down and at what rate. I’m finding that this helps me decide when to test and treat. That is, if I am heading up or down fast (one or two arrows straight up or straight down), I will test and, most likely treat with either insulin or food. This is helping me treat before I get too low or too high.

All-in-all, I am not sure how impressed I am. It is still early, but, as I suspected, the inaccuracy is downright annoying. I’m definitely going to ride it out, though. Maybe I will get used to it, or maybe it will get better. The main goal here, of course, is to stay in range more often. After this trial, I will have to compare my BGs during the trial to my pre-trial BGs and see how they look. If I was able to stay in range more often, than maybe it is worth both the investment and the annoyance, at least during the pregnancy.