Dexcom G6 Review

• Smaller profile – transmitter is slimmer
• New touchscreen receiver
• Dexcom claims it lasts up to 10 days of use
• Dexcom claims sensor accuracy should not be affected by acetaminophen medication
• Less finger pokes required
• No calibration needed
• Better algorithm – we have experienced better accuracy overall with both blood glucose (BG) readings and trend arrows with the G6 versus the G5 algorithm.
• Easy-to-use one-touch applicator – self-retracting needle leaves sensor in place
• Less pain upon insertion of sensor

The Bad (Cons)

• Due to smaller profile, old sensor must be removed in order to “pop” transmitter out of clear sensor bed to place onto new sensor. Meaning, if moisture collects between the transmitter and sensor bed – which it does regardless of how careful you are in the shower or during water sports, etc; will likely result in either signal loss (poor transmission of enzyme reaction at tip of sensor in interstitial fluid under skin to sensor bed metal contact to gray transmitter) = affecting Bluetooth signal or Data Loss
• New touchscreen receiver – still takes many clicks through each screen and multiple

  

  times to unlock just to hit “ok” to confirm a high BG or low BG alert and make changes to settings. Time-stakingly ridiculous and non-intuitive. Will require a specific code and further instructions to startup if you are upgrading from G5 to G6 in regards for individual new receiver. Otherwise, if completely upgrading to a whole new G6 kit all at once like us, you will not need to contact Dexcom to start using your new G6 receiver. It is pretty bulky and could’ve been made thinner and lighter.

• Although Dexcom claims it should last 10 days, we’re lucky to get it past the typical 7 days as former G5 use. If we do, sometimes the BG readings will be very inconsistent and inaccurate compared to fingerstick values. The first and 10th day of use can be highly inaccurate – enough to make a poor bolus calculation therefore affecting our daughters well-being. Highly inaccurate meaning any reading over 20 mg/dL difference when compared to a fingerstick value.
  • Due to FDA approval and regulation of the 10-day use, Dexcom does not encourage or allow a [simple] restart of the same sensor. Others have tried to restart it using their own technique, we choose not to do so at this time since we like to just try to simplify Coral’s life as much as possible without any added worry of accuracy issues with her CGM.
• Acetaminophen use – if anyone has actually tested this theory out of necessity, please leave a comment below detailing your experience. I am currently under the assumption that it still gives whacky readings while taking this medication.
• Definitely less finger pokes confirmed – we always poke her toe or finger in the morning before breakfast since she’s been fasting overnight. This provides us with a stable BG in most cases and best to be used in comparison with her Dexcom [here on referred to as “Dex”]. If her Dex is off by more than 10 mg/dL and shows a straight trend arrow, I will most likely calibrate it. Otherwise, so far, I have not found the need to calibrate throughout the day as her BGs are naturally fluctuating due to constant activity and grazing on snacks, and other unpredictable factors throughout the day. BOTTOM LINE: Fasting BGs are always best to use for calibration and when Dex has a straight trend arrow. Some exceptions are when Dex BG reading and trend is extremely off, then I will “force calibrate” it by entering her BG twice. Thankfully, with the G6, that has rarely been the case so far.
• Although we have been experiencing better accuracy overall with the new G6 due

  

  to its supposedly improved algorithm, her Dexcom Clarity still does not accurately portray her average BG. For example, her Hba1c is 6.1% or an average of 128 as of today, 11/1/2018. Clarity shows an average of 137 mg/dL (6.4%) over a 90-day period. For us, it seems it’s algorithm for averages still needs some catching up to do. Why does this matter? It’s kind of a downer if the data is wrongly displaying our progress rather than a more accurate number to better motivate us and keep us motivated.

• Yes, the applicator is easier to use. However, due to it’s non-transparent design, we’re not able to see through it and use our beloved Tegaderm Sandwich method. It’s also bulky and creates more waste than the G5. This also makes it less travel-friendly taking up more room in our carry-on suitcase.
• Per Coral, it still hurts a little [depending on where exactly] we insert the sensor on the arm or thigh. She prefers we use prescribed lidocaine numbing cream about 30-45 minutes to insertion.
• Bluetooth signal loss – it is a major and constant daily annoying problem with the G6 to lose BT signal with both the receiver and my iphone 8 – even when both devices are within the recommended 10ft from her. Dexcom will advise to turn the BT signal off and on again and wait a few minutes. They just need to fix this lame and life-affecting problem. My only suspicion is perhaps it is due to the slimmer transmitter profile. It for sure does NOT have anything to do on our part as I’ve heard multiple similar complaints from the T1dCommunity on social media.
• The most Dexcom can do is send a replacement for a failed sensor. For example, one with extremely inaccurate readings majority of the time or one that completely loses signal and gives no readings at all for over 3hrs prematurely to the 10th day. I strongly advise all G6 users to call Dexcom immediately for a replacement since most of them are on back-order which can be anywhere from 7-14+ days. We always request overnight [shipped via FedEx] and they will typically oblige once they are able to fulfill the order.

Thankfully, we received that replacement sensor within a decent time-frame. They ship from either Ontario, CA (newest warehouse) or San Diego, CA (original HQ and warehouse). This particular replacement came from Ontario. This bit of information is mildly important for estimate day of arrival and awareness of how climate temperatures may affect your sensor or transmitter while in-transit. The warmer it is, the less likely the sensor or transmitter will last as long as expected.

• Restart – We all loved how we could simply “restart” the G5 sensor and keep the transmitter in-tact if experiencing moderate to great accuracy of BG readings (within 10 mg/dL or less). Not the case with the G6 as I’ve mentioned above, it is not a simple restart and why would you since it typically gives inaccurate readings or fails near the seventh day?
• Accuracy – overall, we have experienced better accuracy with the G6s “new” algorithm for the first two sensors of the first box. However, I definitely cannot say the same for this current third sensor which I will be changing shortly after writing this blog and calling them for a replacement again. It’s on its 9th day.
• Application process – Inserting the G5 was definitely more intimidating than the G6 given the 2″ needle was visible. Correct me if I’m wrong on the size of the needle – either way, it’s a frickin large needle especially for a toddler. Yet, we were able to see where exactly the sensor was going to be inserted into her skin. Therefore, allowing us to use our Tegaderm Sandwich method of pre-cut Opsite Flexifix tape used to keep her Dexcom on long as possible and act as a barrier to prevent any skin irritation. See Tegaderm Sandwich method here.
• The mobile app – G5 mobile app and G6 mobile app only differ in appearance and still is not up to standards as the Sugarmate app for example. Both G5 and G6 mobile apps lack an intuitive UI or user interface causing more clicks per function just to adjust ones alert settings.
• The Apple Watch app – It took Dexcom years to finally develop an app for the Apple watch since the launch of G5. Now, with the constant iOS updates and Bluetooth signal loss from our iPhone via receiver, it causes the app on the watch to also lose signal. This is a constant daily annoyance.
• Insurance – our insurance is through my husbands job and completely covers all dermal medical equipment (DME) supplies without cost. However, not all insurance providers will cover the G6, but may do so the G5. I believe this is the case with Medicare or Medical. Please do your own research and find out what your co-pays are for either and find the best solution for your self or child before you run out of supplies or if you’re interested in either CGM system.

As for the device in general, we are thankful for how many times it has actually saved her life especially overnight or during any type of physical activity. Basically, when Dex is working great, it sure relieves us of multiple finger pokes and helps us keep her BGs in tighter range for overall better glucose control and lowering and maintaining a healthy a1c (between 6.0 – 6.5% for Coral).

Suggestions for improved user experience

The very least Dexcom can do is a) address the T1d Community’s concerns and all of these technical issues publicly, b) have all staff and upper management be apologetic, compassionate and properly trained, c) improve both the mobile app and UI of the touchscreen receiver, d) another option – recall the faulty G6! It isn’t good enough yet so don’t rush into it. If currently using the G5, request as many sensors from them as you can until they completely transition everyone over to the G6 in 2020. The old applicator and painful insertion is worth the trauma and headaches of the new G6. I will gladly tolerate physical pain over mental anxiety and emotional stress.

Furthermore, I absolutely despise how the G6 mobile app increases the volume and time between repetition of your high alerts regardless of the settings you choose. For example, I’ve set the app to alert for highs on repeat every hour, but it will still alert almost every frickin’ 15 minutes. It also interrupts you during phone calls. This is a nuisance because 1) I’m never on a phone call unless it’s important, 2) I’ve already corrected her high or she has enough IOB and 3) I will have to constantly raise the high alert and then, gradually bring the high alert back down as she lowers into range just to avoid the disturbingly loud beeping. I can see how these alert sound settings would benefit others, but does not apply to our management style. The app should just vibrate for a high alert if currently on a phone call and give the option to select “High corrected, vibrate only.”

Don’t be disappointed if there isn’t another company creating a competitive CGM compatible with almost every smart device any time soon. Why? It takes millions of dollars of funding and research to develop a prototype and then a five-year minimum approval period by the FDA. So, unless you want to use Medtronic’s enlite sensor or the Freestyle Libre, we’re all stuck with Dexcom like it’s a frickin’ Apple cult. Otherwise, my husband would gladly start his own non-invasive glucometer project with a startup of $2.5 million. We’ll thankfully accept Venmo payments [half-joking]. Yes, my husband is way more intelligent and skilled than any “engineer” Dexcom currently has on their staff.

As always, this is just my opinion based on our individual experience. Hopefully, others will have better luck with the G6. I know for a fact, a lot of us haven’t because they’ve reached out to me or have commented on my social media posts in agreement. Do what’s best for you and/or your child, always continue researching, and make smart decisions. This blog and my social media accounts are in no way to be taken as medical advice or literally “followed.” Thank you for your time, understanding, and support.

Mahalo,
Shelsea

Instagram: @type1diabetic_life – follow for T1dawareness posts, cool gear and to view IGTV channel including how we change her Dexcom and Omnipod
Shop: Zazzle.com/T1dLife – shop for T1dawareness products originally designed by me where select royalties will go back towards gifting fellow T1dfamilies and hosting local Los Angeles T1dmeetups

Update 2/20/2019

Further Reading:

• Dexcom Product Guides, G6 System, and Contact info
• Download and learn more about the Sugarmate app and sync it to Dexcom for better alerts and overall added user experience
• Learn how to properly calibrate your Dexcom or CGM and gain more technical knowledge by fully reading the book, “Pumping Insulin” by John Walsh – get it on Amazon now!
• See previous blog post “Dexcom Tegaderm Sandwich” for tons of tips on applying and keeping the Dexcom on longer – NOTE: their clear Overpatches are worthless and ineffective compared to Opsite Flexifix tape buy on Amazon. Seriously, type in my blog search bar for everything we use.
• Due to all the failed G6 sensors, I’ve created a Dexcom Log Sheet (right click, save):