4 ms·

Dexcom and Freestyle both have options (G7, FSL2) that have a much narrower form factor than the old sensors. They end up being far more reliable, because the s

by mlsu 3y ago

Dexcom and Freestyle both have options (G7, FSL2) that have a much narrower form factor than the old sensors. They end up being far more reliable, because the sensor doesn't dislodge. The new Dexcom sensors are more accurate. Less drift and no calibration. Out of pocket cost is obviously your own situation but I think anyone with T1 should look at them. For me they are life changing, even moreso if you have a pump that can deliver based on CGM readings. Plastic waste situation is still bad.

coldpie 3y ago
Glad to hear they're improving, though the waste situation is bizarre. I will probably go back on one at some point, I didn't hate it, just didn't feel it was worth the cost/benefit ratio. It didn't impact my A1c, I've always been in the low 6s, and I've only had two lows that I would consider significant in my 25 years with the disease. Benefit just wasn't there for the hassle and price.
- mlsu 3y ago
  That is impressive control, especially with no CGM!
user_7832 3y ago
> The new Dexcom sensors are more accurate. Less drift and no calibration. As someone using a freestyle libre who's never calibrated, how often do you need to calibrate it? Reason for asking is that I'm likely to switch to the g6 if I go with the TSlim X2 for looping. TIA!
- mlsu 3y ago
  No calibration is required for Dex G6/G7. I think you can optionally calibrate the G6 but I never have nor have I ever had to. I am going to be biased: I both work on and use the t:slim X2. It is well worth it, especially if covered by your insurance. CIQ took me from ~70 to 85%, sometimes 90% time in range; my understanding is that it's the best closed loop algorithm out there currently. Regardless of which pump you end up on, having a closed loop system will significantly improve your control and helps you get that extra little push from the 7's into the 6's a1c range, which I'm sure you know is tricky to do manually without lows.
  - user_7832 3y ago
    Thanks! Hearing (I'm assuming) a fellow T1 using and working on a TSlim is quite a good recommendation haha. It's good to hear that calibration isn't really required. My "concern" (or rather, apprehension) with the TSlim/G6 setup (which fortunately should be fully covered by Dutch insurance) is that I'm aware I can do a DIY loop using the omnipod dash and with a libre/g6 (using a 3rd party app like diabox & nightscout if necessary). From what I've heard TSlim does seem to be the best "official"/FDA approved loop; however AndroidAPS looks very powerful and probably has much finer tunings possible. However my diabetic nurse is strongly against the Dash/DIY setup, which is understandable (she isn't familiar with it and can't guide me, I'm also close to the 150u/3day limit, and it's my first time with a pump.) For what it's worth an A1C of even 8 would unfortunately be an improvement where I am :') so I'd rather be sure of reaching say 7 rather than try aggressively for something like 6.3 (which I had achieved in a distant era...). I think I'll try the 1 year trial option if I can, the thought of locking in a 4 year period feels quite long. If you're familiar with them, what are your opinions on diy loop setups? Do you have any other suggestions for someone in my situation? Thanks a lot!
    - mlsu 3y ago
      I actually have tried the DIY loop with the older insecure Medtronic pumps that could be controlled over radio. It was openAPS. I'm not sure if there are others or how they work. It ended up being fairly inconvenient. My setup was a pi zero with a radio bonnet running on my desk; it would connect to the internet to pull CGM data, and deliver boluses accordingly. I think the main issue was that I wasn't babysitting it enough to know if it was working or not. It was hard to see/understand bolus decisions it was making unless I checked iob, and it absolutely destroyed the battery life of my pump; I used a AAA once every couple days when I was near my desk, nevermind the battery on the rig (I had it plugged into the wall). Overall, the system that you actually use the most, that is the most reliable, is the most effective system, even if it's a little bit suboptimal. In my case, CIQ is probably a bit less aggressive than the openAPS system; but importantly, it is truly "set and forget." I never have to worry if it's enabled or when, or how, it's just always working, 24/7. With a condition like ours, consistency is the best predictor of performance. That makes it the clear winner imho, unless you really like to tinker with things and you want to be very active with your loop. The other thing is that the software (openAPS) was Javascript and Bash on a Linux system. Those architecture choices just make me nervous. Too many bad things that could happen. I'm not saying it's impossible for open source software to be reliable, certainly not, but the complexity of their system was just too large of a surface area to fully test. There are extremely significant cybersecurity risks using those older pumps also. It's basically root access to the bolus button.
umvi 3y ago
> The new Dexcom sensors are more accurate. Less drift and no calibration. I found the Dexcom G7 to be inaccurate by 10-20 mg/dL out of the box. I have LADA, and G7 initially was giving me a very rosy view of my blood glucose levels, until I started pessimistically calibrating it with a finger prick glucose monitor.
mjaniczek 3y ago
> life changing Yeah, seeing ~300 datapoints a day instead of 4 while pricking your fingers is amazing QoL improvement. Dead serious.

by mlsu 3y ago

coldpie 3y ago

Glad to hear they're improving, though the waste situation is bizarre. I will probably go back on one at some point, I didn't hate it, just didn't feel it was worth the cost/benefit ratio. It didn't impact my A1c, I've always been in the low 6s, and I've only had two lows that I would consider significant in my 25 years with the disease. Benefit just wasn't there for the hassle and price.

mlsu 3y ago
That is impressive control, especially with no CGM!

user_7832 3y ago

> The new Dexcom sensors are more accurate. Less drift and no calibration. As someone using a freestyle libre who's never calibrated, how often do you need to calibrate it? Reason for asking is that I'm likely to switch to the g6 if I go with the TSlim X2 for looping. TIA!

mlsu 3y ago
No calibration is required for Dex G6/G7. I think you can optionally calibrate the G6 but I never have nor have I ever had to. I am going to be biased: I both work on and use the t:slim X2. It is well worth it, especially if covered by your insurance. CIQ took me from ~70 to 85%, sometimes 90% time in range; my understanding is that it's the best closed loop algorithm out there currently. Regardless of which pump you end up on, having a closed loop system will significantly improve your control and helps you get that extra little push from the 7's into the 6's a1c range, which I'm sure you know is tricky to do manually without lows.
- user_7832 3y ago
  Thanks! Hearing (I'm assuming) a fellow T1 using and working on a TSlim is quite a good recommendation haha. It's good to hear that calibration isn't really required. My "concern" (or rather, apprehension) with the TSlim/G6 setup (which fortunately should be fully covered by Dutch insurance) is that I'm aware I can do a DIY loop using the omnipod dash and with a libre/g6 (using a 3rd party app like diabox & nightscout if necessary). From what I've heard TSlim does seem to be the best "official"/FDA approved loop; however AndroidAPS looks very powerful and probably has much finer tunings possible. However my diabetic nurse is strongly against the Dash/DIY setup, which is understandable (she isn't familiar with it and can't guide me, I'm also close to the 150u/3day limit, and it's my first time with a pump.) For what it's worth an A1C of even 8 would unfortunately be an improvement where I am :') so I'd rather be sure of reaching say 7 rather than try aggressively for something like 6.3 (which I had achieved in a distant era...). I think I'll try the 1 year trial option if I can, the thought of locking in a 4 year period feels quite long. If you're familiar with them, what are your opinions on diy loop setups? Do you have any other suggestions for someone in my situation? Thanks a lot!
  - mlsu 3y ago
    I actually have tried the DIY loop with the older insecure Medtronic pumps that could be controlled over radio. It was openAPS. I'm not sure if there are others or how they work. It ended up being fairly inconvenient. My setup was a pi zero with a radio bonnet running on my desk; it would connect to the internet to pull CGM data, and deliver boluses accordingly. I think the main issue was that I wasn't babysitting it enough to know if it was working or not. It was hard to see/understand bolus decisions it was making unless I checked iob, and it absolutely destroyed the battery life of my pump; I used a AAA once every couple days when I was near my desk, nevermind the battery on the rig (I had it plugged into the wall). Overall, the system that you actually use the most, that is the most reliable, is the most effective system, even if it's a little bit suboptimal. In my case, CIQ is probably a bit less aggressive than the openAPS system; but importantly, it is truly "set and forget." I never have to worry if it's enabled or when, or how, it's just always working, 24/7. With a condition like ours, consistency is the best predictor of performance. That makes it the clear winner imho, unless you really like to tinker with things and you want to be very active with your loop. The other thing is that the software (openAPS) was Javascript and Bash on a Linux system. Those architecture choices just make me nervous. Too many bad things that could happen. I'm not saying it's impossible for open source software to be reliable, certainly not, but the complexity of their system was just too large of a surface area to fully test. There are extremely significant cybersecurity risks using those older pumps also. It's basically root access to the bolus button.

umvi 3y ago

> The new Dexcom sensors are more accurate. Less drift and no calibration. I found the Dexcom G7 to be inaccurate by 10-20 mg/dL out of the box. I have LADA, and G7 initially was giving me a very rosy view of my blood glucose levels, until I started pessimistically calibrating it with a finger prick glucose monitor.

mjaniczek 3y ago

> life changing Yeah, seeing ~300 datapoints a day instead of 4 while pricking your fingers is amazing QoL improvement. Dead serious.