DexCom G4 Platinum: Follow Up

It's been three months since I first gave my impressions of the new DexCom G4 Platinum CGM and two months since I published a Second Look piece. Today it's time for a follow up...

Overall I am quite pleased to say that everything that I previously reported to you about the G4 still stands as true. Signal distance is vastly improved, insertion is less of an issue from a pain standpoint and accuracy is often spot on. What then you ask prompted me to write a follow up? I wanted to share my experience with DexCom customer service and how they handled my call to tell them that the thumb pad on Arden's receiver was breaking.

Before I get to the thumb pad I want say that not long after we began to use the new G4 I noticed an odd video noise on the screen when the receiver transitioned from screen to screen. It happens mostly when entering a BG, a garbled image appears as the receiver switches from one screen to the next. I never noticed a decrease in the receiver's accuracy so I assumed that the video noise wasn't a critical issue and decided not to call CS over what I deemed a cosmetic glitch.

A few weeks later the thumb pad began acting up. The thumb pad is basically five buttons, up, down, left, right and center. The donut shaped disc handles the directional clicks and the small nub in the middle, selects. Our unit's disc began to not go back into place after selecting down. The disc would rock as it should toward the down selection but then never fully return to it's starting point. I felt like it was only a matter of time before the disc became worn further. I imagined that soon instead of just getting stuck in the down position the disc was going to pop out. I let things go for as long as I could and then I called DexCom this past Saturday morning.

I explained that the thumb pad was loose and getting worse. The kind woman on the phone asked politely if I had dropped it, we hadn't. She verified my address, apologized that it wouldn't be able to ship until Monday and explained how I should go about making the switch once the new unit arrived. The entire call took less then five minutes. It was very pleasant.

It seems that I timed my phone call almost perfectly as nine hours later, as we were preparing to eat dinner for the first time at Harold's in Edison, NJ, (you may have seen the picture on FaceBook of Arden with our "slice" of cake) the thumb pad fell out completely. I used a piece of packing tape to hold everthing in place until Tuesday. Here's what the unit looks like when the thumb pad comes off:

 

Initially I wanted to be annoyed that the receiver had issues after such a short time, but instead I took a more reasonable position. New technology is prone to issues like this, early adopters take a risk in my opinion. As long as the manufacturer stands behind the product and doesn't make its replacement a headache, I'm okay with stuff like this happening. I wish it wouldn't, but I understand. I hope that my issue is either isolated or promptly addressed by DexCom. Who knows, maybe it already has been in more recent runs of the product.

If you are seeing this issue with your unit, It's my opinion is that you can expect it to eventually become a problem that will need your attention.

Please Test

I need this post to accomplish two distinct and important goals. The first one will be simple. I want to thank my wife Kelly and my daughter Arden for both being so amazing. You'll see why in just a moment...

Second and maybe more importantly, I want to take this opportunity to remind everyone that while CGM technology is fantastic, it isn't foolproof. Because of that sometimes ignorable fact, we always have to test. Normally when we speak about this topic it's in response to the notion that you shouldn't bolus based on a CGM number. While bolusing without testing is something that we should never do, most of us probably have... but we shouldn't becasue CGM technology is designed to be used in addition to testing, not in place of.

Tonight while I was with my son Cole at his baseball practice (yes I know it's January) Arden's CGM alarmed and reported, "101 arrow straight down". Kelly, being the D-mom rock star that she is, tested.

Please test because sometimes, not often, but sometimes, 101 is actually 36. The DexCom CGM technology is so wonderful that it's easy to forget that it isn't perfect. I've been as guilty as the next person of leaning on it too much when I know that it isn't always spot on. It's difficult not to, especially after the sensor has been on for days and consistently reporting numbers that are so close to our tests. Next time that I'm inclined to think that way, I'm going to remember something that Arden and Kelly told me when I got home and I hope that you will too.

Kelly later said that she tested Arden because Arden said that her eyes "felt funny". Arden told me the next morning that it felt like she had been looking, too long, into a computer screen and then suddenly turned away. "My eyes were getting dark" she told me, with no inclination for how her words were breaking my heart. 

I gave her the bolus a few hours before at dinner that caused this low... and her eyes got dark.

Most moments with type I diabetes are uneventful. Our vigilance gives us the sense that we have the disease under control, but that's a foolish notion. It's only under our control until it decides that it wants to run away. When diabetes decides to run you can't stop it. Your best hope is to chase after and keep it in sight until it gets tired of running. Then you can stand next to it again, pretending that you are partners.

We're vigilant because we can't predict when diabetes will take off running, that's why we test. You aren't taking the test, it isn't you that's being judged. It's a test of diabetes, an indicator for whether diabetes is going to stand next to you and play nice or run away.

Please test.

DexCom G4 Platinum: Second Look

Arden modeling her G4 tucked into her pocket.

Arden has been wearing the new DexCom G4 Platinum CGM for every second of the last month. I initially wrote a 'First Impressions' piece about three weeks ago - let's see how things have gone since then.

Sensor Life:

The worst kept secret in the DOC is that the DexCom sensors can be restarted at the end of their seven day life and often gain accuracy as the days go on. The package insert indicates that you have to change your sensor site at the end of those seven days, I am in no way suggesting that you should ignore that direction. I'm merely sharing how we do things... Many times in the past the DexCom 7+ would happily restart twice and would still be going strong as the last bit of adhesive was holding on for dear life. So far we haven't gotten a G4 to a second restart, but I'm not giving up on getting one into the three week range. Having said that, two weeks is really very good.

Adhesive:

Not as long lasting as the 7+. The G4 is not weathering showers like that 7+ did even when covered. I wonder if DexCom changed the adhesive, maybe I'll ask.

Form and style:

The reciever is a huge inprovement in both size and shape. I've heard a few call it 'unsturdy' or 'light' but we don't have that feeling. 

The sensor is slightly taller then the last generation. I've asked Arden multiple times if the size change is annoying and she has always answered, "no". Mindful that I don't wear the product I read about what some others have said and I did find a few adults that aren't happy about the increase. Again, Arden is unfazed by the change.

Signal Range:

I have for years been unable to let Arden sleep on the sofa during her sleepovers becasue I wouldn't be able to hear her CGM. Once I even slept on the floor so that she and her friend could 'camp out' in our family room, but that was so uncomfortable that since that day sleepovers are confined to the bedroom. Until last weekend that is. On Saturday night Arden had a friend over to spend the night, she asked just as she always does if they could crash on the sofa, I said yes without hesitation becasue of the G4. Our family room is underneath of our master bedroom and the G4 cruises through walls, floors and ceiling like they aren't there. 

As the parent of a PWD this new feature trumps any other and makes the Platinum a winner in my book. Here is my Instagram picture of Arden's G4 sending a signal through the floor of her bedroom and into our kitchen. Kelly and I were watching 'The Walking Dead' on AMC while Arden slept soundly in her bed. In the past, we would have to pause the show while I ran up and down the stairs like a loon. Now we just listen for the beeps.

@ArdensDay on Instagram

The Sensor Wire:

The insertion of the sensor wire seems less painful but the real win of the wire being smaller is that Arden doesn't seem to notice it under her skin anymore while she is wearing it. It the past with the 7+, Arden would sometimes be bothered by the wire if she moved the wrong way. 

Pound the Alarm:

The alarms on the G4 are louder then the 7+. Additionally, you can vary them if the one you are using ceases to get your attention. So far the default sounds are waking me from my slumber, though Arden never hears them when she is sleeping. DexCom has samples of the alarms on this page of their site (scroll to the bottom), if you'd like to give them a listen. 

Freedom:

With the new signal range comes freedom. In a movie theater I can hold the CGM to give Arden a break. When she gets home she can take it off and roam the house without fear of dropping the signal. Arden sleeps upstairs, we live our life downstairs. I wish you could have heard the lilt in Arden's voice when she gleefully told me, "I just peed without my CGM", she was seriously thrilled that she left her receiver in the kitchen while she used the powder room, thrilled! Connected but frequently untethered is a major advancement in my opinion, it gives back some of Arden's humanity and releases burdens. 

Wrap:

I know of a couple people who have experienced build quality issues, for example Stacey's thumb pad fell off. So far we haven't had any such isues, but be sure that I will tell you if we do. 

I've always been an early adopter of technology that I believe in. I expect a few bumps along the way and take the chance on something new when I think the chance is a good bet. So far, the G4 has been a terrific bet. Wait until you see the signal range and how it changes your life.

Be Well!

Update on Monday, December 3, 2012 at 11:19AM by Scott Benner

This post is a follow up to First Impressions: DexCom Platinum G4 which can be found here.

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 Monday, December 3, 2012 at 11:22AM by Scott Benner

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

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 Wednesday, October 10, 2012 at 3:43PM 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 Wednesday, November 14, 2012 at 11:15AM by Scott Benner

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