Dexcom is a true favorite for me from not only a nursing perspective but also as a user and a parent. With the newest Dexcom G4 product, Dexcom has taken continuous glucose monitoring to another level.
What is a continuous glucose monitor?
A continuous glucose monitor (CGM) is very self descriptive. It is continuously measuring serous sugar levels, reporting every five minutes. Note this is not a blood sugar value from a blood source. Because of the source you will notice different trends in your sugar levels.
For example with a low blood sugar, the system will alert the user that they are remaining low. The reason this occurs is that one must ingest the sugar source, process it, increase blood sugar levels and then the sugar levels will shift in the serous fluid.
In the middle of the night I usually get one more alarm after treating a low before my serous fluid changes and the CGM is onto the correct shift in glucose levels. If you aren’t patient you will over treat your low and then get alarms for a high blood sugar. Rechecking a blood sugar on your glucometer to ensure your blood glucose is increasing is the prudent thing to do with a low.
See my previous article on our first Dexcom experience with the 7 Plus. In this article I address accuracy, insertion, customer service, annoyances, safety, etc. “Dexcom 7 Continuous Glucose Monitor- A Nurse’s Review”
Why upgrade to the G4?
- Size- It’s smaller and lighter, weighing only 2.4 ounces. The new flat shape fits into pockets much nicer than the old egg shaped Dexcom 7 Plus. It’s also has more of an ipod-like appearance with its new modern features. I personally have a difficult time with the new “mouse” feature to toggle between screens and enter blood sugars, especially when it’s in a case.
- Distance- This is the largest improvement by far for me. With the transmission distance at 20 feet from the previous 5 feet I can essentially be anywhere in my house and the receiver picks right up on my sensor. I love not having the CGM glued to my side or otherwise be forced to see the sensor mark and a lack of data collected.
If you are active in sports, the transmission distance is a huge improvement. If you are playing tennis or basketball for instance, it is still picking up information from the sensor. When you get a quick break you can peek at your reading without waiting and see how you are trending.
- Accuracy- I have found the accuracy to be remarkably better than the Dexcom 7 plus that I was using previously. If I get woken in the middle of the night, it is reliably correct. Dexcom claims an overall increase in accuracy of 19% and a 30% improvement in the hypoglycemic range (which is the best area to make improvements safety wise).
- Comfortability- With the diameter as thin as a hair, I truly don’t ever feel the sensor and neither does my daughter. I must say the new sensor is actually larger than the previous model and has more of a bell shape which I am not as fond of. The sensor can continue to be worn for 7 days (many report wearing it for weeks on end, mine rarely last beyond the 7 days).
I find it to be a bit of a bother during yoga class and it seems to get stuck on clothing more than the previous flatter shape.
- Insertion- The insertion device hasn’t changed which is truly just fine with me. I wear mine on my inner arm (which isn’t a recommended spot per Dexcom, but it works for me). You will feel like “all thumbs” when inserting this until all of steps become second nature.
At age 11 my daughter is able to insert the sensor by herself confidently. She likes the device because it gives the user control when putting it in. The Medtronic device is self firing and Dexcom’s has more of a syringe like feel with the user placing pressure to insert the needle as quickly as they like.
- New bells and whistles- There are 3 colors to choose from, color changes on the screen for low, normal and high blood sugars, and custom tones. If its going to talk to you, why not like the sounds it makes too? These changes aren’t huge for me personally but people are more willing to use devices they can personalize which will increase compliance.
- USB Port and New Software- It is so nice to charge my Dex in my car, plug it into my computer and use the outlet plug for my iphone along with the Dexcom cable.
The portrait report is a one page summary which is fantastic to streamline all of that data. For providers pouring over patient data and analyzing this information to suggest changes this is wonderful news. Billing is also possible now reviewing CGM data using the code #95251. Patients approaching physicians with self tracking data should be a billable service and Dexcom has made that possible.
See what’s next for Dexcom- “Dexcom’s Next Continuous Glucose Monitor- the G5″
Why would you need a continuous glucose monitor?
Safety, what a simple answer. After using any Dexcom product you begin to see the value in trending. Checking a blood sugar on a glucometer just gives you a solid number. We know there is no such thing as a solid number when it comes to diabetes, there are constant fluctuations.
If I put my daughter to bed and her blood sugar is 90 that could present many different scenarios in my mind. First, does she need to eat or will that make her blood sugar high?
With a CGM I can see a straight arrow indicating 90 is a stable number, in which I would just kiss her goodnight. If she is 90 with a slanted arrow down, or one or two arrows down I would know she needs to eat or would be getting low quite shortly. If she is 90 with a slanted arrow up, or one or two arrows up I certainly wouldn’t feed her a snack, in fact I would peek back at her CGM in a little bit to see if she may actually need a correction with insulin.
Who knew 90 could mean so many different things.
Improved glucose control and HgBA1C results are bound to happen if the Dex is used correctly. Looking at trends in numbers, it is easier to adjust basal rates and carbohydrate ratios. The Dex allows for visualization of trouble spots like spikes after meals or lows during the night.
Many people with diabetes complain that they are “judged” by a single number every 3 months at their appointments. Granted, this number may not accurately reflect your control over the past three months. If a child goes through a growth spurt or is ill for a week, that could trash the HgBA1C results regardless of great control the rest of the time. Having a Dexcom summary sheet, it is easy for the practitioner to visualize a patient (and parents) efforts.
Can a child wear a Dexcom G4 Platinum?
Yes. Dexcom is not FDA approved for use in children and that is why Dexcom doesn’t market towards kids. However, insurance companies do cover these monitors for children and cover their supplies. This obviously depends on your plan benefits.
Kids have less real estate than adults do for all of these devices. My daughter puts her pump sites and her CGM on her belly and it gets a bit crowded on that little tummy. She has only taken a 2 week reprieve from her Dex in the past 9 months and that is proof in the pudding that Dexcom has a product that works for kids.
My daughter likes to look at it prior to PE at school and act ahead instead of reacting to blood sugars. If she is in the 80′s she knows she will have to eat prior to class or have a low. Prevention is worth is weight in gold for safety and less interruptions from taking care of diabetes surprises.
{Disclosure- I did receive a free upgrade to a Dexcom G4 Platinum for myself. I did not receive any complimentary supplies or was I asked to write this review. My daughter is still wearing the Dexcom 7 Plus at this time awaiting an upgrade.}