The only time I got a tingly sensation (hit a nerve) I placed it in the inside bicep. Since then I have used the triceps, back of the arm.
With the G6 i had better results on the tricep than the abdomen.
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Basically the placement “laws” reflect placement sites used during the FDA approval process. Wherever you could inject insulin (or infuse it) is good - so long as the readings are good, go for it. The “police” will only come after you if, say, you have a friend where your CGM, pretending to be you, and you submit the reports saying the numbers are your numbers and the friend doesn’t have D!
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The whole thing is kind of dumb. It’s only based on where it has been approved by the FDA from the testing.
From the Dexcom website:
But yes, the term “allowed” really only means if you call them for a sensor replacement and they ask where you had the sensor, you just reply with what they “want” to hear.
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And that’s the only site that Dexcom submitted based on human trials. I suspect the sample size needs to be larger and to use more sites than upper arm and abdomen.
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You do not have to lie if you place the sensors on your abdomen and then need a replacement. I use the G7, but because the arm location and my OmniPod on my abdomen had trouble “seeing” one another and always lost communication, I was told by my doctor to put them both on my abdomen. The abdomen always has more skin surface than a person’s arm (no matter what size that person is), so by placing the sensor and the Pod both on the abdomen, I have lots of site choices, and I have eliminated the communication issues. When I DO need a replacement, I just call in and when asked where the sensor was located, I say, “On my abdomen, as my doctor ordered.” That’s all they need to hear. I never have had a problem getting a replacement.
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Great idea!!
TY!!
CR
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Ah, that’s very clever!
I have run into stubborn call-center employees at both Dexcom and Insulet who did not like when I told them things they did not think fit into their rules.
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Dexcom states this for the G7:
- Indicated for wear on the back of the upper arm and abdomen for ages 2 years and older or the upper buttocks for ages 2-6 years old
That’s on this page, under the title, “Dexcom G6 features included with Dexcom G7:”
I believe the upper arm was also approved for the G6 even though in the US it was only approved on the abdomen.
On the other hand Insulet say this:
Since many readers are not resident in the UK and will therefore not be permitted to read that page, here are the relevant quotes. Remember, only do this in the UK [bold emphasis added by me]. This quote is about how to deal with lost connection issues:
Make sure your Pod and sensor are placed so that they can “see” each other, and the body is not blocking the signal between the 2 devices.
- Consider sensor site when placing Pod(s): Pod and sensor must be in “line of sight” on the same side of the body for best communication.
[* * *]- If they are in line of sight, move them closer to each other if possible. Pod and sensor should be placed 2.5 - 8 cm (1-3 in) apart, depending on your sensor. Refer to your sensor user guidelines for sensor placement.
Insulet’s general placement advice is given in pictures immediately afterward. I found the pictures to be very clear. These are the two for adults with the sensor on the back of the arm (first) or the front of the abdomen (second), I copied these from the web page (so they are copyright Insulet) for the purposes of criticism:
Those pictures (I think identical ones) are on the other nationality web sites but not necessarily all of them. Canadians get the first picture but don’t get the detailed explanation. USians get both pictures but still no detailed information (I may not have been able to find it…) Here’s the US guide:
The “line of sight” page seems to just be in the UK. Elsewhere I thought I had seen advice (on, possibly, an Insulet US page) to keep the pod six inches from the CGM. The rules vary by country, for example Aussies are told, “Place the Pod at least 7.5cm (3 inches) from your Sensor site.” This is consistent with the Dexcom US instructions for the G7:
- At least 3 inches (8 centimeters) from any insulin pump infusion set or injection site
My guess is that Insulet’s “one inch” is for the Abbott products or, maybe, EverSense.
One thing I find interesting is that Insulet have managed to get their sites approved across multiple different countries whereas Dexcom’s success seems to be far more dependent on both the site and the regulator.
Oh well, time to stop jetting round the world on my private jet. Good thing I was in Vanuatu when I started or I wouldn’t have been able to make it back to Fiji in an hour.
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Since my doctor and I talked about this issue, he really DID tell me to put the G7 on my abdomen. When I tell Dexcom that my doctor ordered me to put it there, they all respond, “OK, if that is what your doctor ordered.” I have never had a problem. Just have the conversation with your endocrinologist, and then you can tell Dexcom that your doctor approves of the Dexcom use on your abdomen.
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I do what works for me. When I was using G6 on my arm, an unapproved site, if I had a failure I would just tell them abdomen. I didn’t lie about other things.
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@jbowler super interesting post, thank you. I have not gone back to read any of this for a long time and I am really glad you quoted this all.
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I’ve heard mixed experiences with alternate sites, but a lot of people seem to have good luck with the thigh. Just make sure you’re following the G7’s approved placement guidelines. Hope the switch goes smoothly!
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