When Dexcom announced earlier this year that it would discontinue the G6 CGM, it prompted me to examine my tech situation. I had been using Dexcom CGM products daily since 2009 beginning with the Seven Plus CGM. I then progressed to the G4, G5, and G6 products. I had hung back using the G4 as I didn’t think the G5 was performing as well as the G4. When Dexcom stopped making the G4, I was forced onto the G5 briefly and then moved on to the G6.
While I was overall pleased with the Dexcom CGM products, I began to find fault with the accuracy and consistency. I integrated the CGM into Loop DIY in 2016 and that focussed my attention on just how important CGM accuracy and consistency was not only to metabolic measures but also to quality of life.
Just what do I mean by “quality of life”? My classic pet peeve and the single circumstance that totally alienated me with the Dexcom products was this scenario. My Dexcom low alarm would wake me up, often around 3 am. Many times I just treated with a glucose tab and try to quickly slip back into sleep. I soon began to suspect that these low alarms were not accurate as I forced myself to finger-stick and be certain the event justified a glucose tab.
What I soon began to conclude is that many sensors, not all, would report CGM BGs in the low 60s while the actual BG was in the mid 70s. This irritated me to no end. A mid-70s BG during the 3-7 am was not dangerous, it was ideal for that time period. This false low also had the effect of turning off my basal insulin to counteract the low. This in turn exacerbated my subsequent BG rise due to the circadian release of cortisol at that time of day.
This didn’t just happen once in a while but with as many as half the sensors I used, especially on day 1 and days 8-10. I put up with it because when the Dex behaved, my BG experience was excellent. With Dexcom’s end of G6 announcement, I decided to consider other options. I heard that Eversense was compatible with Loop DIY, although it required loading a development branch, something that many users had already done and found workable.
I decided in late June that I was going to try the ES 365 and scheduled an implant of July 15. It’s only a small cut, about 1/4 inch, done in doctor’s office and no stitches were necessary. My wound healed well and when the steri-strips came off 9 days post-procedure, I could hardly see where the cut was. The sensor was implanted in my right arm about halfway between my shoulder and elbow and rotated about halfway between my side and front. I chose this spot to accommodate side sleeping and to give me good visibility and access of my left hand. Due to a stroke, my right hand has impaired dexterity.
What I didn’t know and soon learned is that the app that Eversense publishes and the Loop app that lives on my iPhone cannot both communicate with the ES transmitter. Loop DIY has incorporated all the necessary functions that the ES app does. I’m aware that the Twiist loop system is set up to allow commination with both the pump and the ES app.
ES produces vibratory alerts for highs, lows, and lost connections. I usually take off the ES transmitter and charge it when I shower. The Loop app provides a “placement guide” to reposition the transmitter after the recharge session. The placement guide provides a bar graph visual depicting a 0-100, poor to excellent, feedback.
One day I accepted a less than excellent placement guide feedback figuring the positioning did not have to be perfect. The next day, before my usual wake-up time, I was awakened by a vibratory alert signaling a lost connection. The alert instructed me to call customer service.
Customer service was helpful and professional but my call was longer than need due to my DIY Loop circumstance. What I learned is that I should only accept an excellent 100 from the placement guide and when I do, no misconnections happen.
It’s been about 3 weeks since I’ve put ES 365 in the “driver’s seat” to steer Loop DIY. I’ve discovered that ES lags another 15 minutes or so when compared to when compared to the G6 when coming from a low BG. The ES has been very good to excellent in accuracy overall, especially at the alert-consequential low 70s to upper 60s range.
Here’s a BG trace for just after my last meal yesterday till this morning through my typical dawn-phenomena/feet-on-floor cortisol spike. It shows an average BG of 87 mg/dl (4.8) and 10% CV, an exceptional range. I still woke up at 3 am for an hour, however, but that is still a work in process.
My current 14-day AGP report shows 86% TIR (65-120) with an average BG of 98 and time below 54 at 0%. CV = 20.5%.
I’m happy with these results, especially the disappearance of the false low alarms I experienced in far too many Dexcom sensor sessions