Dueling CGMS

Today marks my 13th day experimenting with a new CGMS - the Dexcom 7 Plus. I didn't think I could be converted from my beloved Freestyle Navigator after 2 years and 10 months of loyal service, but I've been playing "Dueling CGMS" and find that it's a fair trade-off. I'll discuss this in detail in a minute...

I have been meaning to write this post for some time. Accompanying it was to be a flurry of photos comparing readings from my Omnipod PDM, my Navigator, and my Dexcom.

Then I dropped my iPhone 3GS into a gutter and it swam in sewage for two days before a drainage crew fished it out. The photos did not survive. (And I'm using a go phone until the new iPhone comes out.)

So here it is...the good, the bad, and the ugly. Just without fun comparison shots.

Navigator still impresses, as I thought it would, in one of key three areas in which I was testing it - the range between the receiver and transmitter. Dexcom 7+ is certainly an improvement over the trial Dexcom 7 I used on loan from my endocrinologist's office 3 years ago, but I still feel like I have to lug the receiver from room to room. It's far too large to wear comfortably for me right now, but at least it picks me up if I'm not touching it (unlike the D7 I tried).
SCORE: Nav 1, Dex 0

I expected Navigator to win in overall accuracy, and I won't lie - it does, BUT I found that Dexcom's claim for better accuracy in the low range was spot on. Dexcom can detect that I'm 43 mg/dL when I'm 42 mg/dL. (And it did.) Navigator isn't that tight in the lower range, but it continually beat Dexcom with rising blood sugars. Overall, I find that Dexcom is a little hypersensitive to rising numbers, assuming often that I'm as much as 100 mg/dL higher than I actually am. Case in point: I was getting in the car to drive somewhere, tested on my PDM and it read 189. Navigator showed me 183 and holding. Dexcom was just sure I was 231 and rising. Another time, Dexcom read that I was 250 when I was 160. I feel it may give me more of a sense of failure, honestly, because the peaks are much steeper. But you've got to appreciate its algorithm and shorter lag time, too. When I'm more stable, it's very accurate.
SCORE: I'm going to call this one a tie, which puts us at Nav 2, Dex 1

Comfort. I really remembered Dexcom's sensor wire being less comfortable than I'm finding it now. Granted, maybe they made an improvement between the Dex 7 that I tried and the Dex 7+ - anyone know? I'm delighted that I can't feel it in either of the two locations I've tried. I find insertion to be equally comfortable/painful to that of the Navigator, but it is much more convoluted. Navigator was simple to insert one-handed. I had a tough time getting Dexcom on my arm by myself (on my stomach, it was simple). And while the transmitter is a tiny little thing, it takes up about the same amount of space as Navigator once you consider the adhesive, which is much better adhesive than the Navigator's adhesive.
SCORE: I'm actually going to give this one to Dexcom. Nav 2, Dex 2

Software. Easy. Dexcom wins this. Though I'm a Mac user, I can easily run the Dexcom software on Parallels. The Dexcom software is not quite as good as CoPilot, but I haven't been able to upload my Navigator in 19 months because CoPilot for Navigator is absolutely incompatible with Win7, which I installed the week before I went into the hospital to give birth to Sweetie. I begged one of the CoPilot engineers to fix this known issue. That was only 3 months after I discovered the problem. They can bite me. What good is a CGMS when you and/or your medical team can't review the data?
SCORE: Nav 2, Dex 3

But...I hate that Dexcom doesn't allow me to review standard deviation, averages, or high/low values immediately on the receiver. Navigator puts it on board. I'm not going to give Nav extra points for this though because I'm that ticked about not being able to use their software.

Alarms. They both have predictive alarms, but I sincerely appreciate being able to set some to vibrate on Dexcom rather than Nav's choice of low/med/high volume beeps. What I will miss about the Navigator though is the ability to mute all alarms (except lows) with a single button sequence. Before a performance the other day, I felt like it was a huge chore to go into five separate areas to turn high alarms, low alarms, rising alarms, falling alarms, and out of range and other alerts to vibrate. Navigator lets you mute all alarms for one hour, but it will breakthrough for low alarms and sound them anyway. At least I can put those on vibrate with Dexcom. And I prefer Dexcom's snooze alert. Navigator constantly beeping every few minutes when I'm already high and cranky sometimes sends me hurling it across a room...not to mention my friend R's point that it can also cause you to overtreat with subsequent boluses or glucose because of the too frequent reminders about a high or low.
SCORE: Toss-up. Nav 2, Dex 3

Calibration. Navigator asks for 4 calibrations in 5 days. Dexcom asks for 14 calibrations in 7 days. Navigator has a built-in meter for calibrating. Dexcom doesn't. This one goes to Nav.
SCORE: Nav 3, Dex 3

Backlight. Navigator asks for a button sequence to activate the backlight. It has to be done when the receiver is in sleep mode - can't be done from any of the active screens. And if you hit the wrong buttons, say in your sleep in the dark, you have to wait for the screen to go to sleep again before trying a second time. It's SO frustrating. Dexcom activates the backlight whenever you view the screen. Thank you, Dexcom.
SCORE: Nav 3, Dex 4

Additional Info. My Navigator transmitter fell off twice in the 5 days I ran it against Dexcom, which stayed safely and snugly attached to my belly. It fell off because I'm using a broken transmitter that the company can't replace due to a "supply interruption" that is quickly approaching its second year. Unacceptable. They have the transmitters. They have the receivers. They don't have the legal right to manufacture them due to bureaucratic BS. So there they sit in a warehouse (or so I imagine). Sensors expiring, customers asking questions that remain unanswered, Abbott not caring because the Navigator represents a tiny tiny percentage of the 6% of their company that is Diabetes Care. They're much too busy producing Similac and other big money products. They let go of all of their sales people for the Navigator and have basically tucked their tails between their legs. Dexcom gets extra points for being a reliable, focused company with their customers' best interests at the forefront.
SCORE: Dexcom wins.

One Hundred and Thirty Four

I got up in the middle of the night last night to go to the bathroom and decided to test my BG before I went back to sleep. I'd been trending in the low 80s before bed and had munched on 3 Hershey Kisses to bring it up a bit. How'd I do?

134.

Not bad, but not where I wanted it to float til morning either, so I took a portion of my pump's suggested bolus and climbed into bed.

Ten minutes or so ticked by and I was still awake. Hubster stirred and reached over to "wake" me sleepily, as he often does to check on me.

"How are you?"
"134," I answered.
"34?"
"134. I'm fine."
"Do you need something?"
"One hundred and thirty four," I hissed back, articulating each word.
"When did you test?"
I looked at my PDM. "Eleven minutes ago."

He got out of bed and wandered out of the bedroom. A few minutes later, he reappeared and shoved a Rice Krispie treat and two Kashi granola bars in my hand.

"That's only sixty, but it's enough to get you started," he said.
"My blood sugar is ONE HUNDRED and thirty four, honey."
Awkward, sleepy silence. "What?"

I explained again.

"I thought you were saying you wanted 134 grams of carb. I thought it seemed excessive, but I thought, for a 34..."

He had stood at the pantry, racking his brain to try to do convoluted midnight math to come up with the right items to equal 134g of carb.

I don't remember at what point we both started laughing, but it took me another 15min to stop giggling and go to sleep.

"Why do I have the feeling the whole DOC is going to hear about this?" he mumbled as he drifted back to sleep.

I woke up three hours later to my Navigator beeping that I was 69. Luckily, I had a ridiculous stockpile of carby goodness to raid on my nightstand. I chose the smallest item (17g) and woke up two hours after that in the low 100s.