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[IPu] Fw: [IP] Dexcom CGMS (I LOVE this machine !!!)



Hi All,
Very interesting comments from Pumper regularly wearing a
CGMS (Continuous Glucose Monitoring Sysytem).
Janette

From: "Rick Stockton" <email @ redacted>
To: <email @ redacted>
Sent: Sunday, June 04, 2006 1:20 PM
Subject: [IP] Dexcom CGMS (I LOVE this machine !!!)


 I'm a customer, with no financial interest in the company and it's 
sales....
except, I'd be unbelievably pissed if they went out of business.

For me, this device is the BEST THING since the switch from urine
testing to blood testing. Yes, BIGGER than the introduction of "fast"
insulin analogs.

 - - - -
My background:

T1, very unstable bGs (up and down at rates of up to 50mg/dL per hour,
when even in retrospect, I CAN'T EXPLAIN WHY).

HbA1c: Got a 6.1 last year, but at the cost of MANY severe hypos.
(Severe == my wife did the Glucagon thing, I didn't have enough brains
left to get sugar tabs myself.) Typical is about 6.6, still with bad
(sub-50) but treatable-by-myself hypos at the rate of 2 per week.

Hypo unawareness: I feel nothing different at 80, 70, 60.... not 'till
55 or so.
- - - -

Using the Dexcom:
The most important thing is, the Dexcom shows a graph right on it's
screen, with a reading every 5 minutes. I click the "graph" button, and,
even though the ISF data is about 20 minutes late compared to capillary
bG, I can ---> TREAT THE TREND <---, instead of the bG !!!!

If a high is leveling off, then I know not to push more Insulin. And if
I'm falling at 50 mg/dL per hour, IN A STRAIGHT LINE, I know that I've
got to address it immediately, even if my bG is currently 130-140. If
I've been eating tabs, but the trend is leveling off at a nice bG, then
I know that I don't need to eat more.

If, on the other hand, I've gobbled some tabs and my bG is still
trending flat, I can gobble more tabs with GREAT CERTAINTY that it
really is the right thing to do. (Unlike the "wait 15 minutes... gee, do
I need more tabs or are they coming on late this time guess.)

When I look at the curve, I can project the next 20 minutes (4 readings)
pretty accurately most of the time. Per above, it MIGHT take off at
anytime, higher or lower, but (1) I'll see that, and (2) that now data
value sets a new curve, I can "envision" the revised Trend and do what
it needs.

YMMV. But for me, this is absolutely incredible. Since I started it, a
couple of weeks, NO bad hypos, day or night. I'd normally have had 4 or
5. (I have mine set to buzz when the ISF-based measurement drops to 90.
That's higher than default value of 80, but I can drop fast. If it hits
90, I blood-stick right away.)
- - - -

 Handling the cost:

 There's a little secret which (I think) EVERY Dexcom user knows:

 Although the FDA approval is currently 3 days per $35 sensor ($12 per
day, OUCH!!!!), Dexcom has applied for a 7-day indication. And right
now, you can fool a Dexcom into an "off-label" 2nd, and maybe even a
3rd, 72 hour period as follows:

When the times up, remove the Transmitter from your sensor (leave your
sensor in). Then, after a while, run the procedure for a "new sensor.
When it shows the transmitter in place, OK? screen, put the transmitter
back in. Calibrate as new (double calibration), and you're probably good
for another 72 hours.

The one I'm wearing right now is on DAY 10, a 4th period, and the
numbers are still good! I'm gonna take it out tomorrow, resulting in a
cost per day of just $3.19. But I can't recommend that anyone consider
going this long, unless you're willing to compare against a meter MUCH
more often than "required". The big savings is getting from 3 days to 6
or 7. The 7 day approval period would be $5 per day, I think that's a
very good deal.
 - - - -

 Other costs:

 The "Transmitter" has no recharge capability, when it dies you have to
buy a new one. Est about 6 months, at $250 that's another $1.37 per day.
The main part, the "Receiver", is rechargeable but doesn't have
replaceable batteries. They think that the battery will start failing to
take a charge in about a year. At $500 for 12 months, that's another
$1.37. Sensors aren't waterproof, you have to cover them with a
waterproof "shower cover" at 60 cents each. So, everything combined,
you're looking at about $8 per day (based on 7-day use). I'm operating
at about $6 per day. It isn't currently covered by insurance. (Although
it's deductible, of course.)

- - - -

The competition:

 Look here for info and links:

 http://www.childrenwithdiabetes.com/continuous.htm

 The Abbott Transmitter will be waterproof. But the initialization time
is 10 hours, I think that totally sucks rockz. Some people might prefer
the shorter straight-in sensor canula. Although I use a straight in
infusion set (Ultraflex), I'm absolutely not bothered by the longer
angled canula of the Dexcom. If the Abbott goes for only 5 days and
Dexcom does get 7-day approval, Dexcom might have an advantage (depends
on the Abbott price per sensor). Both systems show graphs right on the
monitor, I feel that a graphical display is CRITICAL. The Abbott has
replaceable batteries on both the Transmitter and the Receiver, that's a
substantial price advantage (Almost $3.00 per day.) The rest, for me,
comes down to Abbott's as-yet unannounced pricing.

 The Medtronic is, in my opinion, hugely worse in MANY ways. The
'advantage' of putting all your eggs (CGMS and Pump) in one "basket" is
it's only excuse for living, and frankly, I strongly prefer separate
devices. Most importantly, the Medtronic doesn't graph on the Monitor
display-- to get a graph, you have to put it into the docking station.
Punching through a list of numbers versus seeing a graph is no contest,
in terms of usability. The Medtronic, with docking station, costs nearly
5 TIMES as much money ($500 start up Dexcom promotional price versus
$2400 Medtronic price). The Medtronic monitor does have replaceable
batteries, saving $1.37 per day. The cost for the transmitter matches
the Dexcom (lasts twice as long, but costs twice as much). And the
sensors require refrigerated storage, that's an inconvenience.

I frankly don't understand how they Medtronic competes with Dexcom at
all. The only explanations I can think of are: They've been approved for
9 months (versus only 3 for Dexcom), so Medtronic has had 6 months with
no competition to establish a presence in the marketplace. And Medtronic
has a lot more Sales Reps, the CGMS is Dexcom's only current product.
And maybe a lot of Endos don't want yet another Sales rep from yet
another company paying calls at their offices. But that's it. I think
the Medtronic PRODUCT is VASTLY inferior, even if I ignore the $1900
purchase price premium.

 - - - -
final comment:

 In our member profile statistics, the highest choice for tests per day
is "over 15". That hardly seems appropriate, I'm getting 288 tests
automatically! (About 300 total per day.) :)
 .
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