Today, I had to return the Minimed Guardian back to the endo’s office for the rep to pick up. Since using it, I’ve been going over and over in my head of the pros and cons of the system, and making the decision of whether or not to go with it. After much thought, I did decide to try to get insurance approval, so we are currently waiting on the doctor’s signature on the form and then it’s on to insurance.

Some of you (@jessmeandd !) have probably been wondering why I would make the switch from Dexcom to Minimed. Well, my Dexcom is starting to go whacky with the numbers. Sometimes its ok, but others, not at all. And to be honest, the calibrations to get it back in line were becoming more of a hassle than anything, and every time I call customer support, they blame it on me, not the receiver. They would tell me I’m going out of range too much and that my calibrations were done when it was out of range… NOT so. It can be sitting beside me, well within range, and lose signal. And calibrating? I know that I cannot calibrate while it is out of range, so if it says its out of range, I ALWAYS wait until its back in range and then a little longer and THEN I calibrate. One rep even told me that it must be because I’m calibrating in that 5 minutes between sensor readings! I’m sorry, but how on earth am I supposed to time my calibration to take place at the same time it’s getting a sensor reading?? And with it being out of warranty now since September (the unit is 21 months old – that’s a lot longer than most get out of their systems!), I don’t really see where I should have to prove to them so much that the lost data is not my fault if the darn thing is sitting beside me. But that’s a rant for another day.

Another reason is because I have a year and a half left on my insulin pump warranty. Granted, I know that Animas is trying to get FDA approval here in the US for the Vibe pump+CGM system, but (1) we don’t know for sure that they will and (2) we don’t know when that will be. So, I wanted to see my options. Since both the Dexcom and the Guardian both have a year’s warranty on them, and my insurance allows for upgrades/replacements after warranty has run out (provided that it is still a medical necessity), I thought I would try the Guardian CGM system to see how I liked it and if it would be something I’d be okay with if I were to choose to go with the MM Revel when pump upgrade time comes.

So, if you’re wondering my pros and cons of the system, here they are:

Pros:

Multiple times for bg ranges. Unlike the Dexcom where you set one minimum and one maximum for the 24 hrs, you can choose to have different min/max bg ranges throughout the day when you need them.

Predictive Alerts: While the Dexcom does allow you to set a low range that is above the minimum 55 alarm, it doesn’t have a way to guess and alert you that you are probably going to be low within 30 minutes (or whatever time you set) like the Guardian. Once you hit the number, it alarms. With the Guardian, whether you are falling fast or “coasting” low, if it thinks you’ll be low within that time you set, it will alarm. And trust me… it does.

BG history:  You can scroll backwards on the graph to see what it calculated the BG reading at as far back as you’d like. So, say you’re 80 now, but you want to know what it said 30 minutes ago… or an hour before… you can scroll down to go backwards and it will show you the number that you were.

BG Average: You can actually go into the menu and find out what your BG history average has been over time for one or several days. I LOOOOVED seeing that!

Better tracking for no-pumpers: For those of you who like to take pump breaks, you can use the Guardian’s “capture” feature to put in BG values (with or without using them for calibration), food, insulin (long acting or short acting – unlike the Dexcom), and that all that good stuff.

Memory: Unlike the Dexcom, if you walk away from the receiver or if it loses signal, as long as you’re back within range within a maximum 40 minutes (set in the settings), the transmitter keeps a “memory” of your BGs and transmits them to the receiver when you’re back in range! The Dexcom? Walk away for more than 5 minutes and you start losing data. So, you can take a shower and leave the MM receiver in your bedroom and come back (unless you like the ultra long, hot showers) and all the data it “missed” will be transmitted for you to see!

No Contraindications: YOU CAN TAKE TYLENOL WITH THIS!!!!! Sorry, Dexcom… I really wish you didn’t have that drawback. Would have been nice during the first part of my pregnancy to not have to worry about acetaminophen being in something I took for a headache since it’s the only drug WIDELY approved for preggos and headaches throughout the entire pregnancy.

Sensor Auto-injector: You can use the “harpoon” (Thanks, Martin! {@woodonwheels}) to inject the sensor. So I know that when it pops it in, it’s going to go in right. I’m always afraid of doing the Dexcom sensor because I manually have to push it in, and sometimes, the sensor ends up not going in right. I’m not one who can suck it up and manually push a needle in me fast. Never have been, never will be.

Cons:

Accuracy Lag: Now, before you think “why on earth is she going to try to get a CGM that’s not accurate??”, here’s what I mean. Where the Dexcom would catch a rising BG almost immediately, the Guardian seemed to have about 20 minutes lag time before realizing I was going high. But it would catch up and would most of the time be more accurate than my Dexcom. The only time I had a problem was when it thought I was going high, but it went above what I really was… but it straightened itself back out with no problem.

Calibration:  Having to make sure your bg is steady to calibrate could be a pain, but if you’re someone who wants the number to be almost exactly what your meter says, then this CGM… well, any CGM, is not for you. As long as you keep an open mind that it’s allowed to be 20% off, then it’s okay. But if it’s more than that, making sure that your meter is showing tests that you’re not rising then using them to calibrate is fine. I don’t like that you can’t calibrate if you’re trending up or down – like you can with the Dexcom – but I did notice that if you calibrate when they suggest (Fasting BG, before meals as long as the prior meal was more than 2 hours before), that it did stay relatively accurate.

Same-Side-Syndrome: You do have to keep the Guardian on the same side of you as the sensor… it does lose signal if you clip it on the opposite side of you. Unlike the Dexcom that really doesn’t care. But really, that’s just an inconvenience sometimes, its not THAT big of a deal.

Shorter Sensor Life: The Guardian is only approved for 3 day wear – Dexcom is 7.. BUT that’s okay with me because to be honest… by the third day on the Dex, my skin is so itchy that I’m fighting to keep it in. It would be nice to be able to take it out and not worry about it a rash popping up by the end of the week.

So, all that being said, I am hoping to hear something very soon from the insurance lady at MM saying that everything has been approved and it’s being shipped. But until then, I’m keeping my fingers and very swollen toes crossed that it will be.

Yesterday, I was set up on the Minimed Guardian CGM at my endo’s office after I had asked for a trial run. 

Insertion of the sensor was nothing like I thought it would be after watching some videos on YouTube. It was similar to just using the Inset set that I use with my Animas pump. As a matter of fact, the harpoon (as my friend Martin calls it) and it’s spring-loaded fast insertion was, in my opinion, preferable to the Dexcom’s  manual push insertion. Of course, we could have just put it in a good spot and it wasn’t so bad, but I can only speak from yesterday’s experience.

Getting it started up was easy.. just like the Dexcom. You have the two hour wait then calibrate. The only difference is that with Dexcom, as soon as you put in the two starter readings, you have feedback right there. With the Guardian, you only put in one reading and it calibrates within 10-15 minutes. That part is kind of annoying, but otherwise not THAT big of an issue. I’d rather have that than the Navigator’s 10-12 hour startup period.

The rep told me that I could calibrate any time the reading was level and that it would give the best results after the first three readings. So, I thought I’d be smart and calibrate every two hours instead of the two, six, and 12 hour recommended “first” calibrations. Shortly after I did the second one, I got a calibration error. So, being a user of the Dexcom, I was going to wait 5 minutes and plug in another one. Wrong. I got another calibration error and was told to replace the sensor. Yeah, right! I only had that one sensor and I felt like it had to be something I screwed up (seriously, leave it to me to royally mess something up!), so I called the rep who put me in touch with the local patient care rep. She called me and walked me back through setting up the same sensor just to restart it and start over. After starting over, the sensor seemed to work just fine and I did the calibrations at the times she told me to do them. She said what could have happened was that since I was trying too hard to keep a steady line for calibrations by not eating, my glucose was too low to get a good average throughout the afternoon. And go figure, it seemed to be true.

Since then, I have been watching and comparing it with my Dexcom, and it’s been pretty well on target, both staying within the 20% guidelines required, with a couple of really off numbers. I have started a flickr set and I’m taking pictures and posting them there throughout these next few days if you want to keep up with how they are comparing.

I have already decided though, that even though I love my Dexcom system, it is starting to fail (losing signal even within range, whacko readings, etc) and IF (and that’s a big IF) the Guardian system works out, I may switch over to them. I still have a year and a half left on my pump warranty, and with the CGMs only having a year warranty, I’m sure that I’ll be able to come back to Dexcom when they have the Animas Vibe here in the US.

Why would I consider switching? Because, if it works, I have more options:

1. I can take a pump break and track things in the CGM rather than in a logbook. And yes, I know Dexcom does allow some tracking, but not as much as the Guardian offers.

2. I can take tylenol and not worry about it messing with my sensor.

3. I’ll have predictive alerts. And after those worked pretty well last night in my sleep, I was able to catch a low before I got too low. Granted, you can set a low alarm on the Dexcom above the minimum 55mg/dl, but I do like that with the Guardian, I can set a time (say, 30 minutes) that it thinks I’ll be low. Yeah, I may be 82 now, but it may “sense” that I’ll be below 65 within 30 minutes and I need to do something about it now. I like that.

4. No special charger for the receiver… just a standard battery. And the charger for the transmitter is portable. In other words, no special plugs to keep up with! That’s a plus in my book!

Now granted, these are nice things, but if the accuracy isn’t there, it’s not going to do me any good. So, I’m hoping this trial period proves to be a success, but if not, that’s ok. I’ll just look into getting my Dexcom replaced.