[Diabetes-talk] DexCom G5 Mobile CGM system

Sun Feb 14 00:19:33 UTC 2016

Hi Tom and all!
Very interesting post. I hadn't known about the Medtronic Connect system. I
gave up on my Dexcom G4 system because of having to carry around the extra
box that did me no good at all. 
And now I have different insurance, bummer! In order to get coverage for the
G5, well, basically, I'd have to lie. They require 30 days of readings which
have to be at least 4 per day. And at least 5 of those readings must be
below 40. Hypo unawareness does not happen to be my problem, thank goodness.
But given how many people I meet that have the CGM, I bet I'm not the only
one who has the nerve to just make up a log. When will these companies admit
that better diabetes control costs them less money? ?Sheesh!
Stay tuned and thanks for the nice descriptions.
Veronica

"Guide Dogs, First Hand", Veronica Elsea's classic album is now available on
iTunes, along with other music from her and from the Guide Dog Glee Club. 
To learn more, visit:
http://www.laurelcreekmusic.com
                Veronica Elsea, Owner
Laurel Creek Music Designs
Santa Cruz, California
Phone: 831-429-6407

-----Original Message-----
From: Diabetes-talk [mailto:diabetes-talk-bounces at nfbnet.org] On Behalf Of
Tom and Eileen Rivera Ley via Diabetes-talk
Sent: Saturday, February 13, 2016 12:21 PM
To: diabetes-talk at nfbnet.org
Cc: Tom and Eileen Rivera Ley
Subject: Re: [Diabetes-talk] DexCom G5 Mobile CGM system

Hello Ed and all interested in CGM, pumps and accessibility, 

Fair warning, this is a lengthy post... 

Ed - I am also using the DexCom G5 Mobile system(G5 stands for fifth
generation), and have been since it first became available as an upgrade to
the prior system late last year. I am late in providing an update to this
list, and for that I apologize. The DexCom G5 Mobile is quite a breakthrough
in terms of accessibility over their previous DexCom G4 Share system. 

As you describe, nearly all aspects of the day-to-day use of the system,
including setup and calibration can be managed by someone who is blind. I'm
glad to hear that your A1C has fallen into a healthier range since you began
to use the CGM. Mine did also, and in general, the statistic I've heard
reported is that on average, a person's A1C will lower one full point when
using a CGM consistently. 

Hang in there with pulling the plastic covers off the adhesive. In the
beginning I had some issues as well, but now very confidently handle
applying the sensors to my skin. I've included at the end of this email a
lengthy description of how I go about putting on my sensors. 

Not being able to detect a low blood sugar before it is dangerously low is
known as hypoglycemia unawareness, and if your insurance covers CGM use,
having hypoglycemia unawareness gets you automatic approval for use of the
CGM. CGM can truly be a life saver, and I know both my wife and I sleep much
easier now. 

Now, in terms of the Medtronic system, they are marketing the Minimed 530G
(I think the G stands for Guardian). This is a combination insulin pump and
CGM system. It still requires you to have two items inserted under your
skin, the canula for the pump and the sensor for the CGM, but the pump unit
handles both the display and input for both the pump and the CGM. The
feature that sets this pump and CGM system apart is that the pump pays
attention to the CGM readings, and when the CGM indicates you are going low,
if you do not respond, it automatically turns off the pumps basil insulin
delivery for up to two hours. This is the first time ever in the US a pump
has been approved that takes data from a CGM and makes a decision for the
human wearing the pump. That in and of itself is a landmark accomplishment. 

In terms of accessibility, They offer a system named Minimed Connect, which
can be used in conjunction with an iPhone or iPad app to display information
about the Minimed 530G pump and CGM on your phone. By the way, I believe one
must purchase the Medtronic Connect system to have the iPhone app display
the CGM and pump information; for DexCom the system connects to the iPhone
at no additional charge. I spoke with another blind person who uses it. It
does have a few advantages over the DexCom G5 Mobile system if you use a
pump, because the Connect app lets you get information from your pump as
well in an accessible form. I use a pump, and I always have to ask others to
tell me how much insulin is left in my cartridge, how much insulin is still
active in my body since my last bolus, and what my pump battery level is.
With the Minimed Connect system, the blind person can now access that data,
along with the CGM current reading, right from the iPhone app. The
availability of the pump information on the app is a first, as far as I
know, for any pump. 

That being said, just from the CGM pperspective, the Minimed Connect falls
way behind the functionality available via the app for the DexCom g5 Mobile
system. As I said earlier, the Minimed Connect app only lets one view the
data from the app; you cannot interact with the pump or the CGM via the app.
So, with the DexCom G5 Mobile, you can use the app to start and stop your
sensors, enter your twice-daily calibration values, set all your individual
alert levels and sounds for your high and low thresholds, and you can even
enter your diabetes-related activity into the app, such as how much insulin
you just took, how much carb you just ate, how much exercise you just did,
and other items such recording that you are ill. 

All that data, in conjunction with the blood glucose readings from the CGM,
can help you and your diabetes health team determine how to best adjust your
particular carb to insulin ratios, basil levels on your pump, etc. 

On the Minimed system, all the functionality I just described for the DexCom
has to be entered on the Minimed pump system, which is absolutely not
accessible. 

Another advantage of the DexCom system is that all you need to carry with
you is your iPhone. The DexCom sensor you wear on your body transmits the
information directly to your phone. On the Minimed system, you have to carry
another small device with you, named the uploader, which is about the size
of an automobile key fob. The Minimed transmitter on your body first sends
the information to the uploader, and it in turn sends it to the phone. So,
it is small, but the uploader requires charging, and it is one more item to
remember, and potentially to forget. 

Finally, a wonderful advantage of these new CGM systems is that they also
automatically send the blood glucose data to the CGM company (either DexCom
or Medtronic) where it can be viewed by you or your doctor. The web-based
DexCom product for viewing your data, identifying blood glucose trends, and
tracking how you re doing is called Clarity. As I said earlier, the
Medtronic name is Minimed Connect. DexCom offers Clarity for free. 

So, when I see my endocrinologist, she can call up my data from the DexCom
site. I do not need to have my CGM uploaded to her PC in her office, nor do
I need to give her my blood sugar logs. For better, or worse, my life as a
diabetic is available to her, in living color. 

Of course, there are many privacy safeguards in place. Your physician can
never see your data unless you provide them access, and you can limit how
long they have access. If you provide your doctor ongoing access, for three
months or six months, for example, they can log in and see your data even
whenyou are not at the office. And, the clarity system also let's you simply
email a report to your doctor. 

I hope that soon, everyone on this list that can take advantage of a CGM can
start using one. . I'm encouraged that at some point Medicare may start
covering them. 

All the best, 
Tom Ley
What follows next is a description of how I put on a sensor. 

How I put on a new DexCom G5 Mobile sensor without sight
First, I find that often, the sensors come out of the large sealed plastic
coverings such that the adhesive oval area is curled downward, so the
adhesive is not flat. I make sure I bend up the oval shaped adhesive area
all the way around until it is flat again. 

The covering over the adhesive is made of two pieces, each piece covering
half of the adhesive. The two tabs you pull on are right next to each other,
in the middle of one of the long sides of the oval. 

I usually start off by holding the sensor by the adhesive area with the
fingers on my right hand, holding on the right side of the adhesive area.
When I hold it like this, the bottom of the adhesive area is facing me, with
the long body of the sensor that contains the inserter kind of falling back
and down away from me to the right. 

Then I find the tab for the left half of the adhesive with my left hand, and
making sure my right hand is only grasping the right side, I pull the tab on
the left side toward  me and down to remove it. Lacking another hand, I
usually put the piece I just removed between my lips to hold it until I'm
done. 

Then, I very lightly grasp the now exposed sticky adhesive part with the
tips of my left fingers. I grasp the smallest part I can, about in the same
place the tab was that I just removed. And, I can now let go of the sensor
with my right hand.

It is important not to get the adhesive stuck to your clothes or anything
else. I hold it away from my body. I might say also that I always stand when
I put on a new sensor. 

Now, I use my right hand to find the tab for the other half and pull it
toward me and down until it separates. I then hold this one between my lips
as well. I'm sure it would make for some humorous watching if anyone videoed
me while I was doing this!

Now, the entire adhesive is exposed, and I'm holding on to the adhesive with
my left fingers, but just the smallest part is sticking to my fingers. Now,
I grasp the body of the sensor inserter with my right hand, and very
carefully unstick mhy fingers from the adhesive. If done carfully, none of
the adhesive will be sticking to itself, or anything else. 

Next, I carefully use my right hand to maneuver the sensor to the place on
my abdomen I plan to insert and touch the adhesive to my skin. Then I
qquickly run my finger over the adhesive to make sure it is well attached
all around. 

Hope this helps!

Tom 

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