Dexcom One CGM - In Review

It's been a number of years since I last used a Dexcom CGM. In 2018 and 2019, I used the Dexcom G5 followed by the G6 and my experience was "patchy" for various reasons. So, it was with hesitancy that I accepted the Dexcom One "Starter Pack" during my latest diabetes review appointment. It was offered to me following the sharing of my experiences of Freestyle Libre 2.

Firstly, how wonderful to have a choice of blood glucose tech. I know most areas in England and Wales are offering a choice of Libre 2 or Dex One yet many are still finding it difficult to access one or the other - mostly Dex One - at the time of writing this blog post.

The Starter Pack contains everything you need for 10 days CGM use - 1 transmitter and 1 sensor. You'll need to install the Dexcom app on your phone and create an account if you don't have one already. Then, you're ready to go!

You'll need to "pair" your phone with your Dexcom One transmitter. Pairing is a simple process, just follow the steps on your phone screen. Once you are paired up, you can insert the sensor using the single use applicator. By the way, be sure your phone is compatible with the CGM. Dexcom will have a list of compatible handsets on their website. 

The sensor applicator looks and feels a little like a computer mouse. There is one orange button to insert the sensor under your skin and a small protective orange strip to cover it. You'll need to snap that off before you press the orange button. You'll also need to remove the two slips of paper that cover the sensor adhesive area. Once the paper is removed, hold the applicator against your skin and press the button. Sensor inserted! Just ease away the applicator and dispose of it as best as you can. It's a pretty chunky lump, making recycling difficult. Some have suggested breaking it up with a hammer to make recycling easier. I think Dexcom could do a lot more to be planet friendly, here.

Before you go waving a hammer around, pop the transmitter into your sensor. Next, follow the app instructions to begin the warm up process. If you've never used a Dexcom CGM before, then get ready for a wait. The Dexcom One takes 2 hours to warm up so, maybe don't do this right before bed.

The warm up process was problem-free and BG values began to appear. The first few readings were pretty close to my actual blood glucose. "Great!" I thought, until my BG dropped so low that numbers became letters on the Dexcom app. However, I wasn't hypo. Things didn't get any better for a good 6 hours, throughout that time I remained outside of the hypo zone. I decided to let the CGM "bed in" and, erm, go to bed.

I don't know if it was just really tired from sitting in a box on my living room floor for a few days, but the rest seemed to do the CGM good! Fasting BG in the morning was very close to the Dex One number, which was also very close to the Libre 2 number (I'm wearing both devices at the same time). 

Heading towards 7 days with Dex One, I've become comfortable with it and I have begun to trust it. Compared to Libre 2, it has been closer to my actual BG for more of the time.... just! The difference between the two is very minimal for me. L2 is reading a little lower (it usually does) than Dex One, but not by worrying amounts. 0.5 mmol perhaps as an average.

Accuracy aside, the Dexcom One app is a very stripped out affair compared to LibreLink. It will offer some eA1c info via Clarity and some Time In Range data, but there is no place to leave notes and no way to screenshot the app. Read this in your best Nick Jonas voice - No screenshots? Really?! Some of you are going to suggest using third party apps and you're right. You can screenshot and note leave using different apps. However, I'm not a fan of unofficial apps when it comes to my data, support, security, yada yada. Also, the tech newbies don't want to be overwhelmed by having to install multiple apps to do things they could do with one app on LibreLink. I'm not a newbie, I'm just big hearted and I care about the people who are.

The app is my only gripe, really. Yet, it works and how often am I going to leave passive-aggressive notes about the sensor accuracy? Do I really need to screenshot my BG to encourage keto diet zealots to question how long I'll be keeping my toes with those numbers? Maybe not. I've drifted off track. My gripes aren't a big deal. They're little annoyances. The important thing is the CGM works well. At least, after the first 6 hours.... 8 hours if you include the warm up. Yeah, that first day is pretty annoying. I can accommodate that, though.

What else? 

- It's ergonomic. No sharp edges to catch on clothes, bed sheets, other humans, etc.

- It's simple to set up. Minimal steps and great on-screen instructions.

- Satisfactory accuracy vs Libre 2.

- 10 day wear isn't wonderful. That's 3 sensors per month vs the near 2 for Libre.

- 90 day transmitter usage is... okay... remember GlucoMen Day have rechargeable transmitters that last for 5 years.

- Waste could be better. That big lump of applicator, 3 times per month. Eeek.

That's about it. Soon, I'll need to make a choice for NHS purposes. Dexcom One or Libre 2. Which one do you use? Have you been given a choice?  

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Freestyle Libre 2 - In Review

 

It feels like it's been a long time coming for UK based people living with Type 1 Diabetes. The Freestyle Libre 2, the sequel to the box office smash original, is now here and is available to eligible diabetics on the NHS.

I don't really do reviews. If you've seen my vlog then you'll probably be aware that I focus my attention on talking to other people living with diabetes, sprinkled with the odd rant about whatever issue is burning in my belly at the time. So, I'm going to keep this "plain English" and try to focus on areas which I think are important to me. If you're especially interested in an area that I don't touch upon then do leave a comment below or get in touch via the usual channels.

What's in the box?

Does it look familiar? If you've used the original Libre then it probably will! It's exactly the same thing. All your old favourites are here; Insertor, applicator, 2 handy alcohol wipes and an instruction manual which you've never read. There isn't anything noticeably new. Even the outer packaging looks the same apart from a number 2.

Not that the packaging really matters, aside from the waste (I'll get on to that soon). You're not really here for that. You're here because it's new and you've heard it works "like a proper CGM". It's true, it does. 

Users of Libre 1 can turn their sensors into a CGM via a nifty piece of kit called a Bubble or a Miao Miao. Essentially, both are Bluetooth devices that can sit on the top of your Libre sensor, taking in all that lovely data. That can then be sent directly to your phone and an app such as Diabox. No need for scans! Cool! Well, yes apart from the need to purchase a third party piece of hardware and turn a reasonably flat piece of tech, in the Libre sensor, into quite a bulky lump on your arm (or wherever you choose to wear yours). 

"Hold my pint!" exclaimed the boffins at Abbott and they set to work to remove the need for a third party device, uglying up their little discs of loveliness. The result is Libre 2 and it works just like Libre 1 did with Bubble or Miao Miao.

Accuracy!? Tell me about the accuracy!

No blinding with science, here. If you want to hear about MARD and the likes then those figures are freely available on other good web sites, and some bad ones. For me, so far, I think it's as good if not better than Libre 1. I've tested it against my most trusted blood glucose monitor at different times of the day, when high and when low and it's pretty close, sometimes exact. Day 1 was a little "out" on the numbers but I was expecting that after reading about similar stories on social media. It did settle down after around 6 hours.

Diabox? Huh?

You're going to need it to take the data automatically, like a CGM. The app can be difficult to find but do ask for help on Twitter via #GBDoc if you're struggling or visit this tweet by my friend Louise. When it's working it'll look a little something like the image above. Your numbers might be different (better). The app allows you to customise alerts and turn off the ones that you don't want, or find the most irritating.

There may be other ways of turning Libre 2 into a CGM. You may want to explain those to me! Feel free by using the comments box below. I've heard of some sort of patches for the LibreLink app but I couldn't locate the info and I'm impatient to use new tech.

What about LibreLink?

You're going to need to keep that. If you're NHS funded then you're very likely to be sending your data back to your clinic via this app. So! Remember to scan! Or your clinicians will think you've given up or have departed this world. The sensors keep 8 hours of data so, how often you scan is up to you. I try to have a flash every hour or so. It also serves as reassurance that your Diabox numbers are tallying up with the scanned sensor numbers.

The leftovers?

I'm not mad, I'm just disappointed. Having used a different CGM recently, by a company who are taking packaging and hardware waste very seriously, it's a real blow to be faced with an "updated" version of this product and the waste is still the same as the original.

There it all is, including a previously worn sensor - for the sharps bin.

I know Libre 3 is on the way and I have high hopes for improvements in every dept, especially in left over waste. Don't let the planet down, Abbott! 

Should I get one?

If you're NHS funding eligible, yes! I know some of you are happily finger pricking, some don't like the idea of wearable tech on their bodies, 24/7, some might feel overwhelmed by the process of getting one and the new avalanche of data. I get all that. Here's what I've discovered:

- Less finger pricking means less burden. Don't buy into the idea that you'll never finger prick again. You will need to when you're having a hypo or need to check that your sensor is working accurately.

- You don't notice it. Some sensors sting for a while but pretty soon you'll wonder if it's still on.

- You're in control. Look at your data as often as you feel comfortable. If you're used to finger pricking 8 times per day then you are allowed to check your sensor 8 timer per day.

That's all I have to say. I hope you've found that quick review useful. Again, if you would like to know specifics then please get in touch.

KISS

 

Happy St Valentine's Day!

Today probably means very little to some of you. If you're single and looking for love or heartbroken or lonely then today might be pretty painful for you. I'm sorry if you fall into those categories. Rest assured, life rarely stays the same if you seek out ways to change it. If you do fall into the painful categories then I have great news! This blog isn't about St Valentine's Day! Woop!

The title of the blog is wrong. It should really read "K.I.S.S"

Keep It Simple Stupid

And that's what I want to touch on, today. Keeping things simple. Sorry about the photo, by the way.

I've had two experiences with the NHS in the past week. Let's look at the good experience, the simple one, first:

- I noticed that Freestyle Libre 2 was now available to NHS patients. I've been a Libre 1 user since 2017, self funded for a while and NHS funded latterly. My initial thoughts on Libre were mixed. I vlogged about it! You can watch one of those videos here : Freestyle Libre Inaccuracy - A Diabetic's Rant More recently, I've been a happier bunny. Accuracy has improved, I've found inserting the sensor into a thigh to be far better in terms of sleep and general comfort, no fails and nothing has fallen off. Cool, so Libre 2 seems like a natural progression. Here is what I went through to get it on my prescription:

Friday, 1.30pm - I emailed my practice nurse and politely asked if my Libre prescription could be changed to the new version.

Friday, 4.00pm - The nurse replied to tell me that has now been done.

That's it.

I felt like rushing to my doorstep and applauding.

No red tape, no need to sign anything, provide BG data, travel to the clinic, complain on Twitter, nada, nothing. Super duper!

And the not-so-simple experience?

- My lovely pharmacist called. He was processing my repeat prescription and, after scanning the 'script "barcode" his computer said 'No!'

In England, people with Type 1 Diabetes are medically exempt from paying for prescriptions. We fill out a form, the doctor signs it off and we get our medical exemption letter, card, number, whatever it is. That is then given to our chosen pharmacy and we're good to go! free meds!

Only the exemption award trophy expires after 5 years. Somewhere in the dark recesses of my mind I remember renewing this before. And here we are again. 

In a pandemic.

Stay home, shave wives, protect the DFS sale... or something.

It's also winter. And despite climate change, it's really cold in England, right now. Snow and ice on the pavements. Did I mention that I have a visual impairment?

Those things aside; even if life was totally normal and it was a beautiful day for a 4 mile stroll, what an utter ache in the plums! A 4 mile stroll encompasses the journey to the GP surgery and home. Assuming I fill out the form at home and not in the surgery (stay home) then it's another 4 miles. Then it'll be time to show my exemption to my pharmacist.

It's totally pointless to renew a medical exemption for a life long condition. It causes additional stress and burden. In my case, it's pretty dangerous.

I know this is probably on the agenda of things to change. I'm happy to hear that, but I wonder just how complex is it? In the scheme of things, it's not a massive issue but it is an issue and one that every person with T1D will face every 5 years. It needs to stop. This renewal system needs to be dragged into 2021. There is no cure for what I have.

C'mon NHSE and prescription processors, let's sort this one out. It's really simple and once it's done you'll look much less stupid.

 (Thank you to Julie Tickle for sending the renewal form to me in the post, saving me from one perilous journey.)