First Impressions: DexCom Platinum G4

It's been about a week since Arden's new DexCom Platinum G4 arrived and I've spent enough time with it to share my initial thoughts from the perspective of a type I CareGiver. 

The G4 is smaller, lighter and more modern looking then the 7+. All good stuff. The wire that inserts into the wearer is smaller to try and further minimize the pain felt at insertion. A number of people have mistaken it for an iPod. The signal range is vastly improved and I'm seeing more accurate readings. Best of all, Arden loves it.

Arden's Reaction

Arden's face lit up when she opened the box and found a pink CGM looking back at her. Her excitement level was just as high, if not higher then when we bought an iPad. She was genuinely happy to get the G4. I never thought that I would see a person, let alone a child, that joyous over a medical device but wow was I wrong. 

BG Accuracy

The G4 began to send accurate and reliable readings immediately after the two hour marrying period. We've only inserted one sensor thus far and perhaps we won't get the same instant feedback next time, but I was not accustomed to being able to rely on the 7+ on day one, so hour one was not even in my mind. I'm also seeing a great deal of numbers within what I would call acceptable range of finger stick testing, both up and down the spectrum, 400 - 75 (Arden hasn't had a significant low this week). Last evening, I missed on a late night snack bolus, and when I tested Arden around midnight I got this...

Even though I have no scientific data to back up my statement, I'm comfortable saying that the G4 is more accurate then it's predecessor. Which is to say that it seems, so far to me, to be closer to finger sticks then the 7+. Time will tell how true my initial observations remain.

Signal Range

Sadly our bedroom and Arden's are at completely opposite ends of our house, not even the vastly improved range of the G4 can reach my bedside. While that was a momentary bummer, the rest is all great news. Arden is able to untethered herself from the CGM in our house and other relaxed situations while still benefiting from it's feedback. The range is quite impressive. A few days ago Arden had dental work performed and I was able to wait in the lobby instead of lurking around her during the procedure. The G4 sent it's signal to the receiver in my pocket, the distance wasn't great, maybe ten feet but I was on the other side of a wall. The 7+ couldn't even send a signal through Arden's hip so drywall is a a big leap forward!

We kept her a little high for the procedure

In the past I would have needed to go in and out of the exam room to watch Arden's BG, interrupting the doctor and making Arden feel awkward. But now I'm right where I should be...

Ease of use

We found no confusion moving from one version to the other. Even though the button configuration is slightly different and the screen is redesigned, neither Arden or I experienced any slow down or inability to use and understand the new receiver. There was no transition to speak of, I found the change completely intuitive and unremarkable.

Wrap

The DexCom G4 is smaller, lighter, nicer looking and it works better. Arden has never once mentioned that the transmitter is taller or that she in any way misses the 7+. I haven't asked her level of comfort during the insertion yet, I will, but asking her the first time wasn't going to yield an accurate reply, she was too jazzed up as we put in on.

Meanwhile her poor 7+ is just sitting on the counter as I search for a way to legally donate it to a child in need, which is not as easy of a task as you may think.

More information and final thoughts

Everything you need to know about the G4 can be found on DexCom's website. Colors, size comparisons, tutorials, cute little videos... it's all there. I can't tell you for certain that I would stop using a working 7+ and rush to buy a G4, I'm far too thrifty for that. We were lucky in that our 7+ had run past it's life expectancy and was about to be replaced by our insurance when the G4 hit the market. I would have waited for financial reasons if that was not the case. Never-the-less, if you are eligible for upgrade or thinking about using continuous glucose monitoring technology for the first time, I can't recommend the G4 Platinum strongly enough. It makes our days and nights better and aids me significantly in my daily dance with type I diabetes. I'll post more thoughts when we've been with the system longer. Please feel free to ask any questions that you may have and I'll do my best to answer them. 

Neither I or 'Arden's Day' is compensated for my thoughts or opinions. There is a "I'm not a doctor' spiel at the bottom of this and the main page, please remember it when you make decisions about health matters.

Update

on 2012-12-03 16:23 by Scott Benner

The second part of my review DexCom G4 Platinum: Second Look, can be found here.

Hurdles and hoops

I believe that we all lead similar lives. Our homes are different shapes, our sofas different colors, but generally we all struggle with similar issues and think about many of the same things. On any given day I wake up, go directly to Arden's room, check her BG and then begin my day. In the course of that, and every other day, I have tasks to complete, responsibilities to see to, worries to ponder, and relationships to foster. The minutes pile up to form hours and in the seeming blink of an eye, the day has ended. Most days feel like I've navigated, instead of lived them. 

Each of our two children has their own life that we oversee. School, friends, activities, hunger, health, questions, morality, free time and entertainment. I have the same issues in my day, as does my wife. Additionally, there is work, commuting, debts, and this one strand of carpet that I have to glue back into place as soon as I can find a free second.

Leaves fall from our trees, we pick them up. The floor gets dirty, we sweep it. I get sick, Kelly is tired, my son is learning to be a young man. Cooking, cleaning, shopping, paying. I don't eat the way I should, and that reminds me that I don't exercise the way I should. I reacted poorly to something my wife said, I don't know why but I want to think about it, I want to apologize and really mean it. I would too, if I had the time.

The garbage disposal stopped working, it's okay, I fixed it. Laundry, oh the laundry, it won't stop. Last week we had the JDRF Walk, Hurricane Sandy, my car broke down, and my son left his bat bag across town. Tick, tick, tick, the days fly by, this is life, I'm not saddened by it or even slowed down. This is about what I expected, it's fair, it's what we all do. I'm not complaining, merely shining a light on it so I can say this... People's lives are full, on any given day we all have enough to deal with. An average day offers enough challenge, it's normal hurdles are plenty to keep us busy. When a chronic illness is added to your life everything is magnified by a million. The work, worry, struggle, pain, sadness, effort, it's all magnified. One day a piece of technology comes into your consciousness, a gadget you can't really afford, and don't actually want, but it will help you manage your day a little easier, keep you a little more healthy. Perhaps it can stop something bad from happening. It's like an oasis when you realize it's potential, music plays in your head, stress begins to lift... and then the hurdles appear.

My fuc*ing insurance company changed some bullshit rule and now I have to jump through even more hoops to get Arden her DexCom G4. I need, I really need some bureaucrat, some bastard whose only interest is creating a new process that squeezes two more cents out of the consumer. I need that bag of crap to push a paper from this side of his desk, to that other and make my day just a little more stressful and complicated. I need another hurdle, another task that takes time from the things I actually wish that I could do, the things I want to do, the stuff that might make our lives; better, more loving, fulfilling, easier. 

There are always going to be people and entities that pray on others, but I hope that there is a special place in hell for the ones that line their already full pockets by forcing people that live with diabetes and other life changing, and chronic illness to experience more stress then they already do. Be ashamed.

"I'm sorry but this isn't approved for people under 25". "We only cover 6 strips a day". "Has she had a seizure... she has, good!".

We live a life that includes the possibility of seizing if we take or give too much medication. As screwed up as that is, it's also a life where some faceless person on the other end of a phone call will act like having one of those seizures is good news. They don't have that reaction because the are callus, they have it because the system they are trying to exist in requires something bad to happen to you before it will let you protect yourself. Then, just in case all of that isn't bad enough. Just in case my family actually having to live through a seizure wasn't enough. Even though I'll never, ever, as long as I live, forget the helplessness that I felt as Arden's brain scraped and sputtered to stay alive. Now I need to recant the story to a phone jockey at my insurance company just to keep a benifit that we already have, and then she says, "good". She didn't mean "good", I know that, she meant, "I can use that information to get you..." but she said good, and I had to act like this was happy news.

I didn't have the time or energy to correct her, I just wanted to get off the phone. I had dinner to make, my son needed help with a project, Arden's BG was too high, our dog needed to be walked, my car picked up, there was just a hurricane. Oh and I'd like to sit down for five seconds before I stay up half the night to watch my daughter's BG. 

After a week, countless phone calls, dozens of left messages and emails. Three misunderstandings and an argument that I still don't understand. Arden's DexCom G4 is on the way. In the past, I would have just called DexCom and it would have shipped in a day, but now, now there's a third party supplier, insurance questions, phone calls, emails, and a thousand hoops and hurdles. The best part is that in the end, the exact same thing happened as before. They shipped it. I lost hours and days from my already over-taxed week, but I don't think that they care.

Ignorance + Greed = more money for them and less life for us. Next time my insurance company needs to make an extra dollar I hope they just break into my house and take it. At least then they'd be a proper criminal. 

Please remember that my story is about a CGM, many people have this same story about insulin, test strips, and other much more basic and needed supplies. We shouldn't have to fight to be healthy, and we certainly shouldn't have to give up our already precious minutes to wage that fight.

I want to thank the good people at DexCom for helping me to navigate the third party medical device supply world. This would have taken so much longer and been even that much more aggravating without your guidance.

Arden's Big Blue Test

The walk begins, CGM says 183

We decided to do the Big Blue Test during Arden's 7th Jdrf Walk. Arden woke up in the morning after being a little low overnight, she ate a banana as we were packing for the walk and then bolused appropriately. Normally I wouldn't treat a morning low with such a carbtastic food choice, but we were in a hurry and needed to get Arden's BG up so we could get out the door for the walk. With no pre-bolus to help battle the banana I expected a BG rise to happen in a short time, and as you can see on the DexCom graph (above), that's exactly what happened.

The next BG hurdle came as we waited for the rest of our walk team, and the soft pretzel table beckoned our son Cole. We Cole returned, I watched as Arden's eyes became fixed on the doughy confection. "Dad, can I get a pretzel?". Arden returned with a giant, carb infused, pretzel. I didn't even bother trying to pre-bolus because Arden couldn't decide how much she may eat. I told her to just go at it, and I'd figure it out when she was finished. At 10 AM, just as the walk was beginning, Arden announced that she had eaten as much as she could, which was well over half of the pretzel. I took my best guess at how many carbs she had, closed my eyes, and bolused away. Then we walked...

One hour and fifteen minutes later we stopped on the last leg of the walk to play by the water... Arden's CGM read 189 (image below). I know you are seeing a ton of people holding up their CGMs and meters before and after their Big Blue Test work outs. I know most show a decrease in their BG from just 15 minutes of activity, but this is even more amazing then that, and I'll show you why. I can almost guarantee that without the exercise that Arden did her BG would have been in the mid 300's, if we were lucky. Look again at the few hours prior to the end of the walk. A banana with no pre-bolus, a soft pretzel only 30-45 minutes later, again with no pre-bolus. These two food choices should not only have driven up Arden's BG, but decimated her BGs for the rest of the day. But look what happened...

 CGM says 189 after 75 minutes of walking, even with all of those carbs

The rest of the day and night followed suit.

Before lunch, 2 hours since walk start.

12.5 hours since walk began and after Chinese food at 7PM!

Check out the overnight graph that goes from Chinese food to waking. I made no overnight basal adjustments and gave no bolus.

Arden took The Big Blue Test to help The Diabetes Hands Foundation in their effort to send $100,000 in diabetes relief to places in need. In the process we learned that not only does moderate exercise help to control Arden's blood glucose, but it can provide a full day and night of BG stability. The experience also gave me a lot to think about regarding my own activity level.

I hope you take the Big Blue Test right now, you don't have to be a person living with diabetes to benifit from the activity or help the effort, just click the link. I'm very glad that I did!

Seven. Point. Five.

I've never said the actual number here before. I've never had the nerve to say Arden's A1c is 8.5 and no matter what I do I can't seem to get it to go lower. Back in February when Arden's A1c was at it's lowest point ever, I still couldn't tell you that it was 7.8. We had a .7 reduction in February, the biggest single leap ever, a sign that we had cracked the code and still... I couldn't say the number out loud. As proud as I was of the 7.8, I couldn't bear the thought of you adding .7 to it and realizing that her A1c was 8.5 just three moths prior.

A1c is funny. Everyone tells you not to measure yourself against the number, yet it's the only number that we measure to examine the job we are doing managing type I. I understand why I shouldn't measure myself, but if not with this, how? How do I know if we are doing okay, better, worse?

I tried, just as I always do, to not think about what Arden's A1c was going to be as we walked into her Endo appointment yesterday. I was doing a good job too because I was so focused on the fact that Arden was filling out the pre-visit form on her own for the first time. It made me think back to the first time we brought her to this office, she was two years old and this whole thing seemed like a bad dream. In those days the A1c results made me nauseas. One time, back when the tests took much longer, our NP caught me in the lobby as we were leaving to say that Arden's A1c dropped .2 to 8.7. I cried right there in the lobby when I heard the news and the NP hugged me because I was so inconsolable, so happy, eminently relieved. 

I cried because each point felt like more life, like better days. Forget the notion that we are doing something right or not, I just want Arden to live as long and as healthy a life as possible. Ironically, I want the same thing for all of the people that I love and I'm probably making far worse life choices for myself and others then I do for Arden. Diabetes is the catalyst that makes me pay attention to this degree, it is a curse and a blessing in many ways, this is one of them. Now it's six years later, Arden isn't two, and I'm not new to this diabetes thing. "It does get better", I thought as I watched her write her name on the form. Maybe not easier, but better.

You'll get better, I got better, good things are coming.

So yesterday when the NP told me that Arden's A1c was 7.5. I just smiled and said, "great". Sure my eyes tried to fill up a time or two as she praised Arden for her hard work. I was so proud of Arden that I didn't have time to make the connection between the number and Arden's health. I never thought of it like it meant more days, no arbitrary feelings that we did something monumental or did something that meant the literal difference between having a tomorrow and not. It just felt like an accomplishment, no different then if I had completed an exercise goal or written a blog post. I set out to do something and got a good result. Simple. If next time doesn't go our way, then we try again much like hitting a baseball. Just because you don't always get the result you desire doesn't mean that your approach is wrong, only that you are doing something that has so many variables that it is not reasonably within your control. Your job is to win the ones that you can and not let the others slow you down. 

I think I'm finally past the part where I think of diabetes so fu@&ing literally ever second. Yesterday, I felt happy, not relived, not like I just pulled Arden from the jaws of certain death, just happy. I think one day, if you already don't, you'll feel the exact same way because it gets better.

It was a long road from 9s to 7.5 and we aren't finished yet. The NP asked me what my short-term A1c goal was and I said with some confidence that I think I can get it to 7.1. I've identified two times of day with CGM graphs where I think we can do a better job of pre-bolusing and making better food choices. Those changes should move the number toward 7.1. I'm going to start by trying to effect those moments and see where we are in three months. I'll strike out once and a while, but I bet that by the time another three months goes by, I'll have more hits then outs. This is how, in my opinion, you should measure yourself. Simply by being able to say that you are trying with every ounce of who you are. By understanding that you aren't trying to win and that it's not possible for you to lose. As long as you don't give up, you're doing perfect!

I want to take a moment to list a few of the factors that I believe have the biggest influence on Arden's A1c results. When the NP asked me what my secret was I flippantly said, "Apidra, DexCom and not sleeping", but there is more to it then that. 

Support - Love and support from family, friends and teachers is huge.

Insulin Pump - Being able to give insulin quickly and unobtrusively for meals, snacks and high BGs.

CGM - Arden's DexCom is a window to the past, present and future of her BGs and I couldn't make the pinpoint adjustments that helped us get to this new level without it. It's sad to me each day that the FDA doesn't approve it's use for young people.

Over night monitoring - Arden is sleeping almost half of each day, if you can control the night then a few bumps during the day don't hit the A1c average so hard.

Apidra - Arden's BGs are move stable on Apidra then they ever were with the other insulin she was using in the past. Make sure you are using the insulin that works best for you... not just the one some sales person gave your doc.

D.O.C. - You all give me strength to do these things when I otherwise feel like I can't. It's knowing that one of you is awake, sad, crying, happy or running around out of your mind like me that makes me realize that I'm doing okay. 

As we walked through the lobby yesterday on the way to our car we saw a teenage girl filling out the same form that Arden had just written her name on one hour before. This girl was just on the verge of being a woman and that almost made me cry... but it didn't have anything to do with type I diabetes. It does go so fast, just like they say.

Arden's A1c is Seven. Point. Five!

DexCom G4 Platinum Overview

DexCom just updated their site with a ton of G4 information!

DexCom says:

• 25ft range for flexibility and convenience
• Beautifully colored receivers to fit into your lifestyle
• Less than 1/2 inch thick
• Customizable Alarms -Tones and melodies to suit any environment - Examples of the alarms are available at the bottom of this page.
• New software, DexCom Studio (I'm not seeing a Mac version)

Orders are being taken now at 888-738-3646. I'm on the phone with customer service now... they are unsure of when new G4 will be delivered if you order. I'm being told that a rep will call me back tomorrow with details.

My post with the press release is here.

Update on 2012-10-10 19:44 by Scott Benner

I've ordered Arden's G4 9(in Pink) and the rep tells me that shipping begins on October 29th! 

Update on 2012-11-14 16:16 by Scott Benner

Please follow this link to read my First Impressions of the DexCom G4.