CGM (Continuous Glucose Monitor) Dexcom7

[peterlemer]

My T1D daughter dani has a CGM ( Continuous Glucose Monitor) Dexcom7 which she bought in the US and came supplied with a few sensors.
However she can only replace these in the UK at £200-260 for a 4 sensor pack, and each sensor lasts 2 weeks max. So a year's continual use will cost £1300-1700. ( you can't buy a year's supply at a time as the sensors go stale PDQ).
She can buy from the USA but needs a certificate of medical necessity each year signed off from a US doctor, which requires travelling there, so that's even more prohibitive.
She is very worried about hypos during sleep but can't afford to replenish the sensors, and the Dexcom7 is the only device as far as she knows, with a realtime display.
Any suggestions as to how to reduce the cost? Are there new sources of sensors? are there other realtime CGMs?

pete

 

[Engineer88]

200 for the sensors is very cheap if you can do it bite their hand off. Thats the cheapest Ive ever heard of and Dexcom is the cheapest brand to use anyway.

 

[pumppimp]

Hi Peter,
I'm facing the same problem would love to get a cgm but unfortunately they are very expensive. Has she formally applied to her consultant to have them supplied by the NHS? Not many people can get funding but it is possible especially if there were certain circumstances eg living by herself no warning of hypos etc. I don't wake up anymore if I have a hypo during my sleep that's why I would like one also to help with the improved control when you're really busy, in my type of job it can take a while to get washed up before I can prick my finger. Much easier just to push a button.
There are other types of cgms out there there was a thread on the blood glucose monitoring bit of the forum where people compared accuracy and cost etc might be worth a look, and maybe a post on that bit of the forum.
Laura

 

[peterlemer]

Hi pumppimp, dani says that the NHS won't support realtime cgm and in any case won't support her as she's hypo aware.
She won't go for non-realtime cgm because she needs to know the trend before she goes to sleep, not a week later when the hospital downloads her data. I hope I've got that right, as we had a very rushed chat over the phone

pete

 

[peterlemer]

Hi engineer88 and others: where do you, or did you, get your sensors from and what did they cost?

I'm thinking of contributing to Dani's costs

cheers

pete

 

[iHs]

Hi

As far as I know -- Applied Therapeutics is the main UK dealer (look for website address in google) in supplying Dexcom cgm and the sensors. Not sure though if the sensors for Dexcom 7 are still available as the latest kid on the block is Dexcom G4.

You can only ring so hope that helps you Peter

 

[Riesenburg]

Hi,

Just as a matter of curiosity, can't she use a meter with test strips to check herself pre-bed time to ensure she's not going to be low? That's what I do (and I'm hypo unaware), I do check a lot of times during the day too (over 10 in total) but have found that a slow carb release meal in the evening with a correct basal dose and readings above 5-6 mmol will keep me from going hypo during the night without much trouble.

Frankie

 

[peterlemer]

thanks iHs, will follow up

pete

 

[peterlemer]

Hi,

Just as a matter of curiosity, can't she use a meter with test strips to check herself pre-bed time to ensure she's not going to be low? That's what I do (and I'm hypo unaware), I do check a lot of times during the day too (over 10 in total) but have found that a slow carb release meal in the evening with a correct basal dose and readings above 5-6 mmol will keep me from going hypo during the night without much trouble.

Frankie

o dear, we've touched a nerve! Here's how she responded:

if you had to, you could say… 'As she has had diabetes for 20 years, she is, funnily enough, vaguely aware that she oughta test before she goes to bed. Sometimes, however, something strange happens, and get this…she isn't the only one it happens to…but sometimes, she hypos overnight regardless of what she has eaten for supper because IT DOESN'T CHUFFING MATTER WHAT YOU EAT IF YOU DON'T GET THE EXACT CARB AMOUNT RIGHT!!!!! AND YOU NEVER EXACTLY KNOW THE EXACT AMOUNT OF EXACT CARBS BECAUSE ITS A GUESSING GAME AND NO SCIENCE CAN TELL ME THAT THAT BREAD ROLL I ATE WITH MY NO-CARB SOUP IS EXACTLY 20G OF CARBS!!!….sorry….and just because one has a reasonable blood result before bed does not mean a hypo will not happen. I seem to have let my 20 years of diabetes suffering cloud my judgement of a reasonable suggestion…however, I am also presuming this person does not know about 'dead in bed syndrome' (i wouldn't tell them if they don't), and perhaps doesn't understand about other like factors influencing ones bedtime glucose reading like…exercise, time of the month, stress, alcohol, too much insulin at lunch, not enough insulin at lunch, too much food at supper, not enough, the weather being hotter, god i'm boring myself…

How about 'thanks for the suggestion, i'll pass it on' ;-)

 

[jrussell88]

I had a similar problem with low overnight sugars so I'll describe my solution in case it sheds some light on your situation.

I was on a long-acting basal dose taken at night, and rapid-acting mealtime doses, however the basal dose for stable daytime sugars gave slightly falling overnight blood glucose, and the problem had been getting gradually worse over a period. Although I always test at night and kept my sugar high before sleep, adverse events sometimes magnified the overnight fall and led to recurring early morning hypos, sometimes severe.

The solution was to split the late-night basal dose into morning and evening doses, 12 hours apart. A 2/3 am and 1/3 pm split now gives me stable fasting glucose levels, suggesting that in my case most of the effect of the ultratard is quicker than the manufacturers suggest, and quicker than when I started on this regimen.

Of course glucose levels can still be thrown off by exercise, illness, meals etc, but it's a lot safer than it was, and although I would much prefer continuous monitoring, I am able to use my standard meter.

The other point I would make is that it is possible to calibrate carbs very precisely with scales and a calculator. Packet bread is labelled with the carb content, and most plain breads are very similar being mostly flour, if you buy loose rolls from a baker. In the old days on a short and medium-acting mixture when the dosage couldn't be adjusted to meals, I weighed everything and ate exact amounts of carbohydrate at different times of day. As long as other things remained the same - exercise, health etc, then it produced very consistent results.

These days things are much easier, but the flexibility of rapid-acting insulin introduces variation in dosage which can be tricky to control. And all the other things you mention continue to knock things off course. However carbohydrate intake is quantifiable when you eat at home and potentially more stable than most of the other factors which affect blood glucose. It sounds like you are taking rapid-acting insulin, but if you are taking a mix of rapid and longer acting then that suggests controlling it tightly with constant doses and carbohydrate intake. Or discussing whether a different regimen would give more stable overnight sugars.

If you haven't had the opportunity you might be interested in the DAFNE course which my brother - an impatient long-term diabetic - found very helpful. On the other hand you may have already figured out what they're teaching.

Apologies if this is off-topic for you but hopefully some of it is relevant.