March 25, 2025 • 39 mins
Episode Summary
In Episode 27 of Think Like a Pancreas-The Podcast, we dive into the latest advancements in Continuous Glucose Monitors (CGMs).
Dana Roseman, the Director of Technology and Research at Integrated Diabetes Services, shares her expert insights on the notable improvements in CGM devices, emphasizing key developments and future trends.
Finally, Dana and Gary provide a detailed comparison of the features and performance of the Libre3 and Dexcom G7.
Key Topics Discussed- Advancements in Continuous Glucose Monitors (CGMs): Dana Roseman shares her insights on the notable improvements in CGM technology.
- Comparative Analysis: Dana and Gary review and compare the features and performance of the Libre3 and Dexcom G7.
- Expert Insights: Dana provides her expert perspective based on extensive research and professional experience.
- Future Trends: Discussion on key developments and future trends in CGM technology.
Integrated Diabetes Services or email info@integrateddiabetes.com
Byram Healthcare or call
Disclaimer
The information contained in this program is based on the experience and opinions of the Integrated Diabetes Services clinical team. Please discuss any changes to your treatment plan with your personal healthcare provider before implementing.
If you enjoyed today's episode, don't forget to like, follow or subscribe on your favorite podcast app.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:13):
Welcome to Think Like a Pancreas,the podcast where our goal is to keep
you informed, inspired, and a littleentertained on all things diabetes.
The information contained in thisprogram is based on the experience
and opinions of the IntegratedDiabetes Services clinical team.
Please discuss any changes to yourtreatment plan with your personal
(00:33):
healthcare provider before implementing.
Today's episode is sponsoredby Byram Healthcare.
I'm your host, Gary Scheer, and todaywe're gonna be discussing two of
the most popular CGMs on the market.
But before we jump in, make sureto like, follow or subscribe on
your favorite podcast app so thatyou'll never miss an episode.
(00:56):
And for Expert DiabetesSupport beyond this podcast.
Please visit integrated diabetes.com.
Now, let's get started.
I am pleased to be joined today bythe Director of Technology and applied
research at Integrated DiabetesServices, Dana Roseman, say, hi, Dana.
(01:16):
Hi.
Tell us a little about Dana.
Um, well I have been with, um, integrateddiabetes, I think almost five years.
Um, I have had type onediabetes myself for almost 30.
And as I was thinking about talking withyou about this podcast, I was reflecting
on, I think my first continuous glucosemonitor was in... Almost 20 years ago,
(01:43):
that first Dexcom seven, and I don'tknow if you remember it, we probably
have it in a diabetes museum somewhere.
It had this oval shaped receiver thatI remember I used to have to carry with
me when I was training for marathons,and it was so heavy and the problem with
carrying it is that it never connected.
It had question marks in the side.
(02:04):
I don't know if you, we canprobably get a picture of that
somewhere to post with this podcast.
But I remember being so hopeful aboutit, and unfortunately, every five minutes
when I started running, the speed ofmy circulatory system caused problems
with the connection with the CGM,and I would just get question marks.
(02:26):
So it was pretty worthless, and I wouldneed to stop and do finger sticks anyway.
Yeah, that's exactly it.
Yeah.
Yeah, yeah, yeah, yeah.
Brings back such memories.
Right out of our museum.
I
know.
And then after that, I remember doingtrainings, um, all across the country.
On the Freestyle Navigator,you have that brick.
(02:47):
That was a really large brick, butI have to say, I loved that sensor.
It was what, a 12 hour warmup or 24 hour?
I can't recall now.
12 hours.
Uh.
And then, um, I really thought itwas the best thing since sliced
bread and then it disappeared andnow we've got the, the smaller Libre
(03:09):
Trouble was keeping those sensorson because it was absolutely big.
It stuck off the skin about half an inch.
It really, it was three,
I remember the, the team type one cyclistswere really big on using that when,
during their training, but I rememberthey had a like wrapped duct tape
around their arm to keep the thing on.
But it was really, it was, it wasreally amazing when it came out.
(03:31):
It was exciting.
And that was the first thing I think,that I thought, wow, technology is really
gonna come far and wide for type one.
And it, you know, it'scontinued to evolve, obviously.
Yeah, I'm sometimes asked, you know,what I think was the greatest development
in diabetes, and they expect me tosay, oh, pumps or this type of insulin.
I, I think it's the cgm.
I mean, it has really agreed,agreed, changed how we live with
(03:54):
and manage diabetes personally andclinically, it makes such a difference.
Mm-hmm.
I call it my security blanket.
I don't leave home without it.
I, I get it completely.
And there's a lot of differentoptions in the CGM space now,
and particularly in terms of theinteroperability with different CGMs
working with, integrating with differentpumps and different algorithms.
(04:18):
So can you give us a, just an overviewof which systems work with which CGMs?
Well, you're talking specifically aboutthe automated insulin delivery systems?
Mm-hmm.
So, you know, we've got Tandem on themarket, Medtronic, Omnipod, iLet, made
by Beta Bionics, and then there's anew, um, up and coming pump that's not
yet on the market, but I suspect inthe next few weeks when this airs, it
(04:43):
will be on the market called Twist.
Right now I do think things aremoving kind of quickly, and so I'm
gonna say what's available now,but it is always the best thing to
check the manufacturer's website.
Medtronic is always gonna be Medtronic,so you are gonna stick with Medtronic
sensors with a Medtronic pump.
(05:04):
The other pumps kind ofplay well with others.
They're interoperable.
And so Tandem works with freestyle andwith Dexcom, and you always need to double
check your phone to make sure that alsois compatible with some of the systems.
So that's a little bit complex to figureout what works for your particular system.
Um.
(05:24):
Omnipod, iLet, um, all, both, bothwork with Libre, but they have
specific indications if it's Librethree plus, if it's Libre two plus.
Um, and then the new twist pump.
They haven't announced yet whattheir um, CGM is going to be.
But we can't forget, there are smartpens also that pair with continuous
glucose monitors, and that's a reallynice option for folks that don't wanna
(05:47):
wear an insulin pump for whatever reason.
The In Pen is made by Medtronic,and it works of course with the
Medtronic sensor, but it alsodoes work with Dexcom products.
And then the Tempo Smart Penhas a way of connecting with
CGMs through third party apps.
So it can get a little bit complicated andit's nice to have somebody, you know, your
(06:09):
diabetes educator or provider help walkyou through kind of those connections.
Yeah.
So right now Medtronic is stilljust working with their Guardian
four sensor, their latest one.
Yeah.
But I think the Simplera is supposed tocome out soon, which will be smaller,
more accurate, less calibration.
The other pumps, they all integratewith Dexcom, but Libre is becoming a
(06:31):
bigger player in working with those.
How about the open source systems?
Frito,
So that's where I think you have alot more options because open source
means a little bit more customizations,which applies to continuous glucose
monitors as well on top of the pumps.
And so you do have the option forDexcom products, Libre products.
(06:51):
I do think that soon there will be theability to pair it with the ever sense
and then also with guardian sensors.
So it's, it's kind of the fullgamut on the open source systems.
Yeah.
The Eversense it excites mebecause it's, you know, it's
implanted just under the skin.
You don't have to worry about changing it.
The performance of their sensors isquite good also, and they just got
(07:15):
the interoperability designation.
So it can ultimately sync up with,with these systems, it's just, it's not
being used by a lot of people right now.
I had a, uh, an ever sense sensor.
It wasn't put in my arm.
I had it put in kind of my side area.
Yeah.
I don't think I wouldinsert it in my arm either.
Yeah.
And with all the workouts I'd do, Ijust felt uncomfortable having it there.
(07:38):
'cause you have to wear atransmitter on the skin.
Yeah, I mean, the transplanteris a little hunk of junk.
I mean, it's, it's big, notjunk, but it's a big hunk.
Exactly.
And I think that, you know, the idea ofimplanting A CGM was super exciting when
it first came out, but now as CGMs havebecome so much smaller, so much easier to
(07:59):
insert and discard of, it's kind of becomenot such a pressing need, I don't think.
Yeah, honestly, I, I still have thatsensor in my, that ever sense in my body.
I had it put in before Covid, nowwe're talking like four or five years.
And you know, they told me it's, it'sbiocompatible, it's not gonna kill you.
So I just never had it removed.
(08:20):
But it worked for the threemonths and after that I went
back on my Dexcom at that point.
But yeah, is this is this thebaseline we're working out...
it's not gonna kill you.
So that's so much of diabetesand it's not gonna kill you.
It will, it can only make me stronger.
Right, right.
Exactly.
You're more on the cyborg.
The sensor's getting smaller and cuter.
You know, we've got the Dexcom G sevenand the Libre three plus kind of at
(08:44):
the leading edge of CGM technologyas far as what we have available now.
So which systems have you used?
I think I have used every singlesystem that has been on the
market, um, except I have not had,um, the implantable Eversence.
But, um, you know, all the way fromthe early ones we were talking about
(09:05):
earlier, the Medtronic guardian,um, on up to, I guess the, you
know, the G seven, the Dexcom Gseven, and then the the Libre three.
I did recently wear both of those togetheras, um, just my own, you know, experiment,
sample size and equals one, and I worethem on the same place on my body.
(09:26):
I started them on the same day, sothey had that initial warmup together.
So, you know, I, I definitelylike to compare the products,
Well, we're, N equals two, because Idid the same thing four weeks I went
with Dexcom G seven and Libre threeplus and had them right side by side.
Mm-hmm.
(09:46):
On my arm as they were.
I don't normally wear mysensor on my arm, but I did it.
So I wore mine on my leg.
So maybe this is n equalsone In two separate studies
A could be.
I just wanted to follow all of theirlittle recommendations as to where to
wear it so they couldn't come back andsay, "you didn't wear it on your arm,
so it, that's not valid." So, I didjust, just what they told me to do.
(10:09):
I was a good boy.
Okay.
Uh, so, you know, I feel like we've,we've got fair comparison since we both
wore them on the same body part and,and got the side by side experience.
So what was your experiencelike using Libre three plus?
Well, I think I have to give the caveatthat not all technology is perfect, right?
(10:30):
I mean, we are expecting a lot froma small disposable sensor, and we're
not wanting it to have sensor errors.
We're not wanting it to have, youknow, problems with accuracy, but
it's testing interstitial fluid.
Our finger sticks is testing blood glucoseand so that I just have to say that
we're always going to have sensor errors.
(10:50):
I think we'd all like to say that.
Cut to the chase, Dana,
Well, well, the reason is is becausethe Libre three just gave me so many
false lows that I stopped trusting it.
That was my kind of lasting opinion.
Is my Dexcom perfect?
Absolutely not.
But I did end up in the end trustingit a little bit more and I did not
(11:11):
change eyewear, an open source loopsystem, and I did not change the
data going into my pump delivery tothe Libre because I didn't trust it.
I had the same experience.
False lows.
Yeah.
And not just false lows, but false,urgent, severe, you're about to die,
(11:32):
kinda lows that were nowhere near.
Right, and you couldn't change the alarm.
No.
Yeah, yeah, yeah.
With Dexcom, you could make some of thosepersonalized alarms and even target just
nighttime to have a different subsetof alarms, and I couldn't change any,
I mean, the iPhone, youcan't set it to vibrate.
Those urgent lows are gonnabeep, and they beep loud.
My wife was ready to kill me.
(11:54):
'cause in the middle of the night somany nights it was giving me those
lows and I wasn't laying on it.
So I don't think they were compressing.
No, same.
I wasn't either.
And you know what was frustratingis that, um, I mean it was waking
me up, but I knew it was wrong,and so it was just unnecessary.
Were there any things about the Librethree Plus that you found advantageous
(12:15):
that you didn't have with Dex?
I do think it, the insertionprocess was lovely.
It doesn't make as loud ofthe snapping noise with the
insertion compared to the Dexcom.
You know, that noise can sometimes startlepeople, and I thought that the insertion
was very painless and I, I really didforget that I was wearing a second device.
I don't feel my Dexcomtypically, but mm-hmm.
(12:37):
I didn't feel anythingadditional with Libre.
Yeah.
I didn't feel any differencein the insertion process.
I did find the, uh, just tounscrew the cap before inserting
it took a little more strength tounscrew the Libre three plus cap.
And I've actually had somepatients tell me they've had
difficulty, uh, unscrewing that.
(12:59):
That's interesting.
I haven't had that.
Do they measure torque on these things?
I mean, but that is a big issue'cause a lot of people lose grip
strength, especially as they get older.
So yeah, I haven't, I didn't notice that.
Maybe I'm just stronger, Gary?
I think so, yeah.
Texas women have hidden strength.
Yeah.
Yeah.
What did you think about the one minuteupdate on the Libra compared five minutes?
(13:22):
So I'm not used to it.
So initially.
I I was a little bit confused.
It seems like it was changing too much,or, but I actually really liked that and
I could see that as a huge advantage,especially for automated insulin
delivery systems, especially if you weretreating a true low and saw the, um,
the, the correction a little bit faster.
(13:43):
It took me a minute to get used to it.
I'm so used to the five minute delay ofa Dexcom that it did take me a minute.
Yeah, yeah.
The, the accuracy comparisons?
They're pretty close.
Now, the studies that the companiesconduct before launching, 'cause they
have to submit to the FDA, the, theaccuracy is they're reasonably close.
(14:06):
You know, they're around 8% mard,meaning, you know, on average percent.
I know that's what's published, butthis is, you know, I've worn a, a Libre.
Three several times over their launch.
Mm-hmm.
And compared it to a Dexcom.
And every time I do the comparison,I just have staggering false
lows, and I understand that thepublished data says otherwise.
(14:29):
So I'm not really sure if thatis, you know, study protocol
versus real world experience.
There was a recent real world studypublished in the Journal of Diabetes
Science and Technology, and it did showthe Dexcom being more reliable in the
hypoglycemic range, but it showed theLibre being a little more reliable in the
(14:53):
hyper, the high glucose range, so they
....That I do agree with that.
I do agree with, and I think I could,you know, if I, if I never had a low
or a false low, maybe that would,mm-hmm that would shift my opinion.
Yeah, so, you know, accuracy wise,you know, the, the false lows.
I, I, I agree with you completely.
I experienced almost a dozen ofthose in the four weeks that I was
(15:17):
wearing it because I documented them.
I did a finger stick each timethey happened, to confirm
it was a false, uh, alert.
Uh, they did happen quite a bit.
I had, I don't know, I might, Imight have had one with my Dexcom
in that time, if that, if that many.
The false low alerts are anissue and they're disruptive.
(15:37):
And they cause us to losefaith in, in the, the alert.
And I can see people happening.
Well that what happened, is I juststopped paying attention to it.
Yeah, and then that'snot beneficial at all.
No.
'cause someone could be having an actuallow and thinking, no, it's just my sensor.
It does that on its own.
It's like the boy you cried wolf, youjust start ignoring it after a while.
So that is a potential problem.
(15:59):
Well, and the other issue, rememberGary, you can't calibrate it, and so
you can't kind of fix the problem ifthere is a problem with the sensor.
Mm-hmm.
Yeah.
At least with Dexcom, if you fingersstick and there's a big discrepancy, you
can tell it, "Hey, you're, you're runningtoo high, or you're run running too low."
Mm-hmm.
And it'll adjust itself.
Abbott's Libre has neverallowed that to happen.
(16:20):
I found the one minuteupdates sort of useful though.
Because if I was low and I treated it, itwould show my glucose coming up sooner.
Right.
And if I was high and waiting for it tocome down, it would show it's starting
to come down a little bit sooner.
So I kinda like the one minute updates.
I did too.
Yeah.
(16:40):
Having to wait five minutes to see ifa bolus is having an effect or what?
My exercise is doing well, low bloodsugar treatment, doing my sugar seems
five minutes, doesn't seem like a longtime, but it feels like an eternity
also when you're waiting, absolutelywaiting for that glucose value.
So maybe someday Dexcom will show thedata a little bit more frequently.
I would like that.
What about the, the size ofthe sensors themselves now?
(17:03):
Yeah, they're both small, but
mm-hmm.
the Libre is smaller and as a guy, Imean, I couldn't, couldn't care less.
Yeah, but to a woman that'simage conscious, does that
make a difference to you?
That one's the size of a nickel and
I think I am somewhat image conscioustoo, but I think that, you know, the size?
I think it's more of a comfort.
You know, the G, once you move away fromlike the larger, thicker G six Dexcom and
(17:28):
then you move to kind of these coin sizes?
I think they're really similar.
The size of the Libre is really nice.
It's extremely discreet for thosewho want to keep their CGM discreet.
I think the G seven is also discreet,but it is a little bit thicker.
And so, you know, there's plenty ofpeople that I work with who really
don't want any devices showingon their body, and these are just
(17:50):
tailor made for someone like that.
Did you use over tape with your Libre?
I didn't, and I didn't use overlaytape, um, with my G seven as
well during my head to head.
It's winter time.
And so, you know, I do live in Texasduring an August 120 degree month.
I would absolutely need to wearoverlay tape, but, um, you know,
(18:11):
we're recording this in February now.
It's pretty cool out.
And so, um, you know, and I'm notswimming a lot, so I did not use one.
Uh, yeah.
I used overlay tape withboth just to make sure.
'cause the, the workouts.
Sure.
Again, a lot of sweating.
Yep.
I wanted to make sure they stayed on.
Again, I didn't wanna give thecompanies any excuses to say, "Well,
your sensor didn't stay on. Itwas moving. That's the problem."
(18:34):
I, I thought both of themstayed on really well.
I didn't have any issues with that,and I didn't have any skin irritation
also, which some people have.
Skin irritation occasionally from thetaping, and I didn't have anything.
Okay.
So yeah, again, I I didn't feel that.
Yeah, the, the Libre is smaller, butyou get to a point where, how much
(18:55):
smaller do you really need and Right.
The Dexcom G seven is quite small also, soI kinda, like, I didn't, I didn't really
see a distinct advantage, even though theLibre is a little smaller than Dexcom.
Yeah.
One other area where there, you know,people are gonna see a difference is cost.
You know, if insurance covers it, itdoesn't really matter a whole lot, but
(19:15):
for those who maybe have deductiblesto meet or have to pay out of pocket,
there is a price difference between.
Absolutely.
Um, you know, I, I, it alsodepends on what your needs are.
You know, cost is absolutely somethingthat can be a huge barrier for folks, and
(19:36):
the Libre does cost a little bit less.
Um, but you know, there's also theconsideration if cost is really.
Something that's a barrier.
Um, you know, the Eversense is veryinexpensive for the entire year.
You know, I, I do think that it'simportant for people to remember that
they're in charge of their technology.
The technology's not in charge of them.
(19:58):
That's with alarms, that'swith what they're choosing.
And as it relates to cost, youknow, there's not, you don't have
to go to the Dexcom or Libre.
There's other options that might be alittle bit less costly and like what you
were saying earlier in our conversation,that a CGM might be the most important
tool that we have for managing diabetes.
And so finding one that really worksfor whatever your priority is, I
(20:21):
think is really important to remember.
Yeah.
It's, it's the fuelthat drives the engine.
Mm-hmm.
With these automated systems, if you'refeeding good data in, they can function
nicely if the data's interrupted or notaccurate, it's not gonna function well.
Yeah, and that's
why it's so nice to see theinteroperability of all of these
insulin pumps because, you know, usedto be insurance was telling you and
(20:42):
dictating what you had to do, andnow you do have a lot more options.
Sure do.
The, the longevity of thesensors is another consideration.
Uh, Libre three plus,it's a 15 day sensor.
And Dexcom G seven is, is a 10 day,although, you know, Dexcom is trying
the, working towards getting approvalfor 15 day use on their sensors, but,
(21:05):
uh, changing it out three times a monthversus changing it out two times a month.
How much of a differencedo you think that makes?
I mean, it's such a non-issue for mepersonally to change mine out, but I'm
not, you know, a 6-year-old screamingand, and kind of running all over
the house, avoiding that insertion.
I mean, that makes a huge differencefor some families when, you know,
(21:28):
changing out devices can be reallyemotional and, um, just a huge stressor.
But for me personally, thatis like a, a non-issue.
'cause uh, you know, my Dexcom expires,I kind of stick it on and go on with
... Well, these change out.
We've also got warmuptimes to deal with, right?
Where we, we don't have that securityblanket of data flowing through.
(21:52):
Uh, we've got what, a one hour warmuptime on the Libre and it's 25, 26 minutes.
I don't ever keep out that 25 minutes.
I stack my Dexcoms,
And so we know the trick.
Right?
We can get some warmup down to zero.
You wanna share your,your trick for doing that?
Yeah.
Well, and so I take ita little step further.
So the Dexcom G seven gives you a headsup that you've got a 12 hour grace period
(22:17):
that you're entering in, and I use thatgrace time alert to put my new sensor on.
I wanna get the most accuracyfrom the get go of a sensor.
And I feel like it has that wedding periodwhere the filament gets a little bit
more coated with the interstitial fluid.
And so I'll wear a, a sensor, two sensors.
One is activated, one's not.
(22:39):
For a good 12 hours.
And then when my old one expires,I activate the new one immediately
and I get blood sugars immediately.
And then personally, I think it's a littlebit more accurate from from the get go.
Yeah.
I do a similar thing.
I don't do it for 12 hours, Ijust do it for a couple of hours.
Yeah.
But as soon as I activate that new one,since it's been in my skin, it doesn't
(23:00):
require any warmup time, instant data.
Right.
And it is really nice.
I mean, I remember, you know, ofcourse we've all worn sensors that
had, you know, long warmup for years.
And, you know, just waiting forthat information can be really
stressful, especially if you're onan automated insulin delivery system.
You can feed it with fingersticks or maybe you have to wait
(23:20):
to eat a meal and you're justsitting there watching the clock.
So I, I do love thatseamless introduction.
Byram Healthcare understands thatmanaging diabetes isn't one size fits all.
With a full range of CGMs, insulin pumps,and diabetes supplies from top brands.
Byron makes it easy to get what you need,hassle-free, shipped right to your door.
(23:43):
Plus Byron's team of experts helpsnavigate insurance so you can focus on
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front slash podcast, or call 8 6 6 69 2 8 0 2 4 and select option three.
We covered a lot of the potentialadvantages that Libre three
(24:05):
Plus might have to offer.
With the Dexcom G seven, wegot a little longer list.
The compatibility with other systemsis much greater at this point.
That may change down the road, butright now Dexcom is the system that
integrates with the most other devices.
Certainly fewer false low alerts.
Right.
And we know how frustrating those are.
(24:27):
Far fewer false low alerts.
The data should, generally showsbetter accuracy in hits with the
Dexcom compared to the Libre.
You got any idea whythat might be the case?
No, I actually wasn't aware of that.
Yeah.
What are your thoughts?
I'm not sure to be honest, but repeatedlythe manufacturer studies as well as the
(24:51):
real world study that was just publishedin in peds populations just generally
shows better accuracy with the Dexcom,uh, than, than the Libre products.
Well, and I would say a lot offolks, especially pediatrics,
have trouble with compression lowsovernight with their Dexcom products.
And so I wonder if they've carvedthat out of the studies just to.
(25:12):
Identify those as something beingdifferent other than performance.
Possibility.
The trend graph displayI had a big issue with.
Yeah.
The Libre will only showyou a 12 hour display.
It's hard to see what's happeningin the last 30 minutes or so.
That recent trend.
And also, I don't care, yourcontrol, it looked like just awful.
A rollercoaster.
(25:33):
It was horrible,
right?
It's just the...
And it didn't look any, , justbecause it was 12 hours.
If I had expanded it out, I waslike, oh, thank goodness my, my
day doesn't really look like that.
But the other thing that I reallymissed with the Libre was putting
my finger on the app and reallybeing able to move the blood sugar,
the data points
(25:54):
that matched the line.
To me that is so useful for seeingwhen a bolus timing hits or when my
exercise is impacting my blood sugars.
I can learn so much from theDexcom app that I just wasn't
able to apply it to the Libre.
Definitely.
Yeah.
I like, yeah, you can see 3, 6, 12,24 hour graphs with Dexcom, and you
(26:14):
can scroll and see the individualdata points if you wanted to see
at a specific time where you were.
Mm-hmm.
You can't do that on Libre.
The alert options are also heavilyin favor of, of the Dexcom G seven.
Uh, I, I really like someof the predictive alerts.
You don't have those in Libre and theability to customize things like the
(26:39):
delay, uh, the delay high alert...
mm-hmm.
On the Dex Desktop.
So after a meal our glucoses tend to rise,and it might go over our high threshold
temporarily and then come right back down.
We don't need an alarm when it happens.
Right.
If it stays high for a while,
yeah,
we could use the alert so wecan do something about it,
(27:00):
but Dexcom has that delay.
First alert feature that Libre does not.
Also consider that, I considerthat less punitive, right?
Like, you know, your blood sugaris gonna rise, let's not, you
know, make a whole deal of it.
Yeah.
That just wait.
Right, exactly.
And I love that with the fall ratealerts on the Dexcom as well as
(27:21):
the high, we can set a threshold.
So don't alert me if I'm falling fastunless I'm below a certain value.
If I'm high and I fix it.
Yep.
I don't, I don't wanna bedisturbed if I'm dropping fast.
'cause I want to, if I wanna gofrom 300 down quickly, but if I'm
under, let's say 120 or 130 andI'm falling fast, then I wanna know
(27:42):
Sure.
So I can be proactive.
Absolutely.
So.
Dexcom just has, being part about thosecustomized is so much better variety.
You know, being able to do a nighttimesetting versus a daytime setting.
To me, that's one of my favorite thingsabout the Dexcom system is that, you
know, I can be a little bit, well, a lotmore proactive during the waking hours.
(28:02):
This is my personal approach.
I don't need to be reminded, youknow, or alerted if I'm a little
bit high while I'm sleeping.
'cause I know my Automated InsulinDelivery system will take care of it.
But you know, some peoplemay have the reverse.
They want more alarms at night.
Um, and, and I love the factthat you can schedule that.
Yeah.
That is a nice feature.
Especially if you, if youvalue a good night's sleep.
(28:25):
Yes.
Take it.
You can make a big difference.
You mentioned before withDexcom, we can calibrate it.
So if it is not performing up topar, we can tell it, Hey, you're
drifting up, you're drifting downfrom the actual values, and do that.
Being able to get the warmup time reducedor eliminated on the Dexcom is nice.
I, I also like Dexcom's software forreporting data Clarity is, is good.
(28:51):
And also like the Dexcom integrateswith so many other programs.
It really does a lot ofthird party programs.
Apple Health Kit.
Um, yeah, I mean there's a lotof good uses for that data.
Libre is getting better withthat, but they're still kind of
consolidated in just their Libreview program and that's about it.
(29:12):
So that's an issue especially forhealthcare providers because we need to be
able to access data in the systems we use.
The customer support,I felt, came up short.
Again, we're an N of two.
But I was not enamored with Abbott's techsupport, customer support for issues.
First off, they don't have24/7 support They have..
(29:36):
Which is frustrating,especially for a global product.
Yeah.
They have 12/7 support.
Whoever heard of 12/7support for healthcare?
We can only have problemsduring business hours.
Yes, that's right.
Uh, and, and the times that I called, theydidn't offer to replace the sensors that
were giving me a lot of false low alerts.
Their advice was," well, youshould probably finger stick if
(29:57):
you question the reliability."
And then I was given kind of anadvanced, uh, service provider
to try to help me with things.
And I've left him messages for thelast week, and I still got the message
here for when he called a week ago.
He's not returned my calls since.
Oh, and that's just...I'm not happy about that.
Huh?
That is, um, well first of all, it'ssurprising they gave you a phone
(30:20):
number, but that's unfortunate.
He hasn't, or she hasn't called back.
Well, it's a department and Igotta just ask for this guy.
Okay.
Um, and you know, what's as a,
Dexcom does have issueswith wait times, but when
They do, but I don't, the wait times I,um, if I'm having technical problems.
Maybe I would call in, but mostof the time if I need a sensor
(30:40):
replaced, I use the in-app option.
Um, you know, the G seven, you canreport an issue within the app, which
is amazing for those 2:00 AM problems.
Hopefully you're not having a 2:00 AMproblem, but you don't have to wait
online and you can just do it in the app.
Yeah, I've always called in.
So have you had any troublegetting replacement sensors
(31:02):
going the the app route?
No.
I've had a couple of emails askingfor additional information, but I
had a whole box that was faulty.
This was a, a while ago.
And so I reported several at onetime and I got an email, you know,
kind of pushing back a littlebit, but I had the documentation.
One thing with Dexcom is sometimesyou really need the lot number or
(31:23):
the serial number, and so I do keepthose just in case there's a problem.
Actually, I just take apicture of it on my box.
I use my camera roll to keeptrack of things like that.
Yeah, so you either keep the boxor the inserter itself, right?
That has all that information on it.
It's a smart idea.
The, the one other thing I like about theDexcom, it does have a longer shelf life.
(31:44):
So when you get those sensors, they'llbe good for a longer period of time.
They might not expire for eight or12 months, whereas the Libres might
expire in six months, and that canmake a difference, especially if you're
getting a lot of supplies at once.
Absolutely.
You get three monthsat a time or whatever.
You don't want your stuff expiringbefore you have a chance to use it.
(32:07):
Actually are people just traveling abroad?
Kids that are going on a semester abroad?
I mean, there's so many situationswhere you do need a longer shelf life.
All right.
Can you think of any other prosor cons you saw with when you
were comparing the systems?
Um, I mean, overall, I think, youknow, just having a CGM can be so
(32:31):
important and so I think, you know.
We are for sure getting in the weedsand we wanna per, we want a system to
perform at the highest level, but Iwouldn't wanna scare somebody from using
a CGM based on these headaches becauseI think overall, just wearing one is so
positive in your diabetes management,
Yeah.
And know besides working with patientswith diabetes, you do consulting for
(32:56):
healthcare providers who are tryingto kind of upgrade their tech skills.
How do you coach them on thedifferent sensor types or do you
get involved in that with them?
Well, I would always recommend somebodywearing one, even if they don't have
diabetes, just to understand the constantfeed of data, maybe some of the issues
(33:17):
that people experience wearing them.
I think that, you know, that'swhy you and I test things out
just to really appreciate the,the small details of each system.
And I think only then can you reallyhelp coach and be a partner with
someone in their diabetes care.
So as much as possible if somebodycan wear something and understand
an alarm is really distracting.
(33:38):
You know, if you're at a restaurantor if you're at a movie and you get an
alarm, that's not just a diabetes issue.
That's also like a real disruption to yourlife, and those are things that I think
providers should and hopefully appreciatewhen they're working with patients.
Yeah, I like the name for the service youprovide called Elevate Your Expertise.
You know, a lot of people out there arejust not that familiar or comfortable with
(34:01):
all the technologies that are out there.
And you can provide,
Absolutely.
Provide either one-on-oneor small group instruction.
Kind of a teach the teacher sortof thing where you can teach other
clinicians, how to be more comfortableand, and use the tech more effectively.
Well, and one thing that I have beensaying, you know, for years now, you know,
positive or negative diabetes managementhas become technology management.
(34:24):
And so if a provider is not fullyembracing or understanding technology, and
that goes for the algorithms of automatedinsulin delivery systems, I mean, it,
it really, the technology encompasses.
A lot of care right nowthan they really are behind.
And unfortunately patientssuffer in their care.
Yeah.
I had a patient just this morning whowants to give one of the open source
(34:45):
systems, the Loop app a try, and herendocrinologist is giving pushback 'cause
he knows absolutely nothing about it.
Right.
And so, yeah,
I offered to give him a call.
We're trying to help that.
Yeah.
We're doing our best
One office at a time.
Shifting away.
Exactly.
Do you think we need multipleCGM options for people?
(35:09):
Is there a role for Libre threePlus and for Dexcom G or whatever
the next iteration is gonna be?
Probably the eight.
Are there certain people who arebetter suited for certain products?
Absolutely.
And just because I like one, you like theother, you know, someone, a third person's
gonna gonna embrace maybe another option.
(35:30):
And I see that across the board, youknow, cost obviously until we get
insurance companies to pay for everythingacross the board at a hundred percent.
You know, people are gonna haveto consider their monthly budget.
But, you know, technologyis not one size fits all.
And I kind of use the analogy of,you know, you and I are buying a car.
You might need four wheeldrive and a sunroof, but I
(35:53):
want, you know, leather seats.
And so I'm gonna be shopping if Ihave that option for A CGM for the
feature that's really important to me.
Maybe it's the personalized alarms,maybe it is the 15 day wear of the Libre.
Maybe it's the automated systemthat only works with one,
you know, with the Medtronic.
And so I, I try to remind peoplethat, again, they're in control of the
(36:15):
technology, not the other way around.
And we need to figure out whatfeatures work best for your life
and your diabetes management.
And then.
Find the, the technology that works
Well.
One other difference in our car choices.
Mine has the Eagles Super Bowlchampionship bumper sticker.
And yours has,
I know.
Yeah.
Yeah.
Dallas.
Great for you.
Dallas Cowboy.
It's amazing.
Dallas to cowboys.
(36:36):
Dallas, be Eagles fan.
I know.
Not so much for a Cowboys fans.
So just to wrap things up, uh, Ithink when we look at the Libre
three Plus and the Dexcom G seven.
From an accuracy standpoint,overall, they perform similarly.
Uh, we might find that the Libre isa little more reliable at the high
(36:56):
end Dexcom, uh, at the lower end,and certainly with younger people.
Uh, Dexcom seems to perform better.
Feature wise, there are somethings about the Libre three plus
system that are advantageous.
There's probably more features thatthe Dexcom has an as an advantage, but
(37:16):
ultimately the system you choose reallydepends on your personal preferences.
Kind of like when we choose a pumpor an A ID system or algorithm, it's
based on what your personal interestsand preferences and needs are.
And definitely you want to consider whichsystem integrates with the pump or pen
or a ID system that you're utilizing.
(37:40):
I do wanna mention that anybody whowants to learn more about the differences
between these sensors can check out thearticle we have posted on our podcast,
and there'll be a link provided in theshow notes that you can, you can go to,
it has a lot of the details about whatwe discussed today, plus a little bit
more, including some specifics about theaccuracy comparisons based on the research
(38:03):
that's been done on, on each device.
Great.
All right, so I want to thankeverybody for tuning into Think
Like A Pancreas, the podcast.
If you enjoyed today's episode, don'tforget to like, follow or subscribe
on your favorite podcast app.
Think Like a Pancreas.
The podcast is brought to you byIntegrated Diabetes Services where
(38:24):
experience meets expertise, passionmeets compassion, and diabetes care is
personal because we live with it too.
Our team of clinicians all livewith type one, and we understand
the challenges firsthand.
We're here to help no matterwhere you are in the world.
From glucose management to self-care,to the latest tech, sports and exercise,
(38:48):
weight loss type one pregnancies,emotional support, we've got you covered.
We offer consults in English and Spanishvia phone, video, chat, email and text.
If you wanna learn more, visitintegrated diabetes dot for
email info@integrateddiabetes.comto schedule a consult.
On behalf of Think Likea Pancreas, the podcast.
(39:11):
I'm Gary Shiner, wishingyou a fantastic week ahead.
Don't forget to keepthinking like a pancreas.
Welcome to Think Like a Pancreas,the podcast where our goal is to keep
you informed, inspired, and a littleentertained on all things diabetes.
The information contained in thisprogram is based on the experience
and opinions of the IntegratedDiabetes Services clinical team.
Please discuss any changes to yourtreatment plan with your personal
(00:33):
healthcare provider before implementing.
Today's episode is sponsoredby Byram Healthcare.
I'm your host, Gary Scheer, and todaywe're gonna be discussing two of
the most popular CGMs on the market.
But before we jump in, make sureto like, follow or subscribe on
your favorite podcast app so thatyou'll never miss an episode.
(00:56):
And for Expert DiabetesSupport beyond this podcast.
Please visit integrated diabetes.com.
Now, let's get started.
I am pleased to be joined today bythe Director of Technology and applied
research at Integrated DiabetesServices, Dana Roseman, say, hi, Dana.
(01:16):
Hi.
Tell us a little about Dana.
Um, well I have been with, um, integrateddiabetes, I think almost five years.
Um, I have had type onediabetes myself for almost 30.
And as I was thinking about talking withyou about this podcast, I was reflecting
on, I think my first continuous glucosemonitor was in... Almost 20 years ago,
(01:43):
that first Dexcom seven, and I don'tknow if you remember it, we probably
have it in a diabetes museum somewhere.
It had this oval shaped receiver thatI remember I used to have to carry with
me when I was training for marathons,and it was so heavy and the problem with
carrying it is that it never connected.
It had question marks in the side.
(02:04):
I don't know if you, we canprobably get a picture of that
somewhere to post with this podcast.
But I remember being so hopeful aboutit, and unfortunately, every five minutes
when I started running, the speed ofmy circulatory system caused problems
with the connection with the CGM,and I would just get question marks.
(02:26):
So it was pretty worthless, and I wouldneed to stop and do finger sticks anyway.
Yeah, that's exactly it.
Yeah.
Yeah, yeah, yeah, yeah.
Brings back such memories.
Right out of our museum.
I
know.
And then after that, I remember doingtrainings, um, all across the country.
On the Freestyle Navigator,you have that brick.
(02:47):
That was a really large brick, butI have to say, I loved that sensor.
It was what, a 12 hour warmup or 24 hour?
I can't recall now.
12 hours.
Uh.
And then, um, I really thought itwas the best thing since sliced
bread and then it disappeared andnow we've got the, the smaller Libre
(03:09):
Trouble was keeping those sensorson because it was absolutely big.
It stuck off the skin about half an inch.
It really, it was three,
I remember the, the team type one cyclistswere really big on using that when,
during their training, but I rememberthey had a like wrapped duct tape
around their arm to keep the thing on.
But it was really, it was, it wasreally amazing when it came out.
(03:31):
It was exciting.
And that was the first thing I think,that I thought, wow, technology is really
gonna come far and wide for type one.
And it, you know, it'scontinued to evolve, obviously.
Yeah, I'm sometimes asked, you know,what I think was the greatest development
in diabetes, and they expect me tosay, oh, pumps or this type of insulin.
I, I think it's the cgm.
I mean, it has really agreed,agreed, changed how we live with
(03:54):
and manage diabetes personally andclinically, it makes such a difference.
Mm-hmm.
I call it my security blanket.
I don't leave home without it.
I, I get it completely.
And there's a lot of differentoptions in the CGM space now,
and particularly in terms of theinteroperability with different CGMs
working with, integrating with differentpumps and different algorithms.
(04:18):
So can you give us a, just an overviewof which systems work with which CGMs?
Well, you're talking specifically aboutthe automated insulin delivery systems?
Mm-hmm.
So, you know, we've got Tandem on themarket, Medtronic, Omnipod, iLet, made
by Beta Bionics, and then there's anew, um, up and coming pump that's not
yet on the market, but I suspect inthe next few weeks when this airs, it
(04:43):
will be on the market called Twist.
Right now I do think things aremoving kind of quickly, and so I'm
gonna say what's available now,but it is always the best thing to
check the manufacturer's website.
Medtronic is always gonna be Medtronic,so you are gonna stick with Medtronic
sensors with a Medtronic pump.
(05:04):
The other pumps kind ofplay well with others.
They're interoperable.
And so Tandem works with freestyle andwith Dexcom, and you always need to double
check your phone to make sure that alsois compatible with some of the systems.
So that's a little bit complex to figureout what works for your particular system.
Um.
(05:24):
Omnipod, iLet, um, all, both, bothwork with Libre, but they have
specific indications if it's Librethree plus, if it's Libre two plus.
Um, and then the new twist pump.
They haven't announced yet whattheir um, CGM is going to be.
But we can't forget, there are smartpens also that pair with continuous
glucose monitors, and that's a reallynice option for folks that don't wanna
(05:47):
wear an insulin pump for whatever reason.
The In Pen is made by Medtronic,and it works of course with the
Medtronic sensor, but it alsodoes work with Dexcom products.
And then the Tempo Smart Penhas a way of connecting with
CGMs through third party apps.
So it can get a little bit complicated andit's nice to have somebody, you know, your
(06:09):
diabetes educator or provider help walkyou through kind of those connections.
Yeah.
So right now Medtronic is stilljust working with their Guardian
four sensor, their latest one.
Yeah.
But I think the Simplera is supposed tocome out soon, which will be smaller,
more accurate, less calibration.
The other pumps, they all integratewith Dexcom, but Libre is becoming a
(06:31):
bigger player in working with those.
How about the open source systems?
Frito,
So that's where I think you have alot more options because open source
means a little bit more customizations,which applies to continuous glucose
monitors as well on top of the pumps.
And so you do have the option forDexcom products, Libre products.
(06:51):
I do think that soon there will be theability to pair it with the ever sense
and then also with guardian sensors.
So it's, it's kind of the fullgamut on the open source systems.
Yeah.
The Eversense it excites mebecause it's, you know, it's
implanted just under the skin.
You don't have to worry about changing it.
The performance of their sensors isquite good also, and they just got
(07:15):
the interoperability designation.
So it can ultimately sync up with,with these systems, it's just, it's not
being used by a lot of people right now.
I had a, uh, an ever sense sensor.
It wasn't put in my arm.
I had it put in kind of my side area.
Yeah.
I don't think I wouldinsert it in my arm either.
Yeah.
And with all the workouts I'd do, Ijust felt uncomfortable having it there.
(07:38):
'cause you have to wear atransmitter on the skin.
Yeah, I mean, the transplanteris a little hunk of junk.
I mean, it's, it's big, notjunk, but it's a big hunk.
Exactly.
And I think that, you know, the idea ofimplanting A CGM was super exciting when
it first came out, but now as CGMs havebecome so much smaller, so much easier to
(07:59):
insert and discard of, it's kind of becomenot such a pressing need, I don't think.
Yeah, honestly, I, I still have thatsensor in my, that ever sense in my body.
I had it put in before Covid, nowwe're talking like four or five years.
And you know, they told me it's, it'sbiocompatible, it's not gonna kill you.
So I just never had it removed.
(08:20):
But it worked for the threemonths and after that I went
back on my Dexcom at that point.
But yeah, is this is this thebaseline we're working out...
it's not gonna kill you.
So that's so much of diabetesand it's not gonna kill you.
It will, it can only make me stronger.
Right, right.
Exactly.
You're more on the cyborg.
The sensor's getting smaller and cuter.
You know, we've got the Dexcom G sevenand the Libre three plus kind of at
(08:44):
the leading edge of CGM technologyas far as what we have available now.
So which systems have you used?
I think I have used every singlesystem that has been on the
market, um, except I have not had,um, the implantable Eversence.
But, um, you know, all the way fromthe early ones we were talking about
(09:05):
earlier, the Medtronic guardian,um, on up to, I guess the, you
know, the G seven, the Dexcom Gseven, and then the the Libre three.
I did recently wear both of those togetheras, um, just my own, you know, experiment,
sample size and equals one, and I worethem on the same place on my body.
(09:26):
I started them on the same day, sothey had that initial warmup together.
So, you know, I, I definitelylike to compare the products,
Well, we're, N equals two, because Idid the same thing four weeks I went
with Dexcom G seven and Libre threeplus and had them right side by side.
Mm-hmm.
(09:46):
On my arm as they were.
I don't normally wear mysensor on my arm, but I did it.
So I wore mine on my leg.
So maybe this is n equalsone In two separate studies
A could be.
I just wanted to follow all of theirlittle recommendations as to where to
wear it so they couldn't come back andsay, "you didn't wear it on your arm,
so it, that's not valid." So, I didjust, just what they told me to do.
(10:09):
I was a good boy.
Okay.
Uh, so, you know, I feel like we've,we've got fair comparison since we both
wore them on the same body part and,and got the side by side experience.
So what was your experiencelike using Libre three plus?
Well, I think I have to give the caveatthat not all technology is perfect, right?
(10:30):
I mean, we are expecting a lot froma small disposable sensor, and we're
not wanting it to have sensor errors.
We're not wanting it to have, youknow, problems with accuracy, but
it's testing interstitial fluid.
Our finger sticks is testing blood glucoseand so that I just have to say that
we're always going to have sensor errors.
(10:50):
I think we'd all like to say that.
Cut to the chase, Dana,
Well, well, the reason is is becausethe Libre three just gave me so many
false lows that I stopped trusting it.
That was my kind of lasting opinion.
Is my Dexcom perfect?
Absolutely not.
But I did end up in the end trustingit a little bit more and I did not
(11:11):
change eyewear, an open source loopsystem, and I did not change the
data going into my pump delivery tothe Libre because I didn't trust it.
I had the same experience.
False lows.
Yeah.
And not just false lows, but false,urgent, severe, you're about to die,
(11:32):
kinda lows that were nowhere near.
Right, and you couldn't change the alarm.
No.
Yeah, yeah, yeah.
With Dexcom, you could make some of thosepersonalized alarms and even target just
nighttime to have a different subsetof alarms, and I couldn't change any,
I mean, the iPhone, youcan't set it to vibrate.
Those urgent lows are gonnabeep, and they beep loud.
My wife was ready to kill me.
(11:54):
'cause in the middle of the night somany nights it was giving me those
lows and I wasn't laying on it.
So I don't think they were compressing.
No, same.
I wasn't either.
And you know what was frustratingis that, um, I mean it was waking
me up, but I knew it was wrong,and so it was just unnecessary.
Were there any things about the Librethree Plus that you found advantageous
(12:15):
that you didn't have with Dex?
I do think it, the insertionprocess was lovely.
It doesn't make as loud ofthe snapping noise with the
insertion compared to the Dexcom.
You know, that noise can sometimes startlepeople, and I thought that the insertion
was very painless and I, I really didforget that I was wearing a second device.
I don't feel my Dexcomtypically, but mm-hmm.
(12:37):
I didn't feel anythingadditional with Libre.
Yeah.
I didn't feel any differencein the insertion process.
I did find the, uh, just tounscrew the cap before inserting
it took a little more strength tounscrew the Libre three plus cap.
And I've actually had somepatients tell me they've had
difficulty, uh, unscrewing that.
(12:59):
That's interesting.
I haven't had that.
Do they measure torque on these things?
I mean, but that is a big issue'cause a lot of people lose grip
strength, especially as they get older.
So yeah, I haven't, I didn't notice that.
Maybe I'm just stronger, Gary?
I think so, yeah.
Texas women have hidden strength.
Yeah.
Yeah.
What did you think about the one minuteupdate on the Libra compared five minutes?
(13:22):
So I'm not used to it.
So initially.
I I was a little bit confused.
It seems like it was changing too much,or, but I actually really liked that and
I could see that as a huge advantage,especially for automated insulin
delivery systems, especially if you weretreating a true low and saw the, um,
the, the correction a little bit faster.
(13:43):
It took me a minute to get used to it.
I'm so used to the five minute delay ofa Dexcom that it did take me a minute.
Yeah, yeah.
The, the accuracy comparisons?
They're pretty close.
Now, the studies that the companiesconduct before launching, 'cause they
have to submit to the FDA, the, theaccuracy is they're reasonably close.
(14:06):
You know, they're around 8% mard,meaning, you know, on average percent.
I know that's what's published, butthis is, you know, I've worn a, a Libre.
Three several times over their launch.
Mm-hmm.
And compared it to a Dexcom.
And every time I do the comparison,I just have staggering false
lows, and I understand that thepublished data says otherwise.
(14:29):
So I'm not really sure if thatis, you know, study protocol
versus real world experience.
There was a recent real world studypublished in the Journal of Diabetes
Science and Technology, and it did showthe Dexcom being more reliable in the
hypoglycemic range, but it showed theLibre being a little more reliable in the
(14:53):
hyper, the high glucose range, so they
....That I do agree with that.
I do agree with, and I think I could,you know, if I, if I never had a low
or a false low, maybe that would,mm-hmm that would shift my opinion.
Yeah, so, you know, accuracy wise,you know, the, the false lows.
I, I, I agree with you completely.
I experienced almost a dozen ofthose in the four weeks that I was
(15:17):
wearing it because I documented them.
I did a finger stick each timethey happened, to confirm
it was a false, uh, alert.
Uh, they did happen quite a bit.
I had, I don't know, I might, Imight have had one with my Dexcom
in that time, if that, if that many.
The false low alerts are anissue and they're disruptive.
(15:37):
And they cause us to losefaith in, in the, the alert.
And I can see people happening.
Well that what happened, is I juststopped paying attention to it.
Yeah, and then that'snot beneficial at all.
No.
'cause someone could be having an actuallow and thinking, no, it's just my sensor.
It does that on its own.
It's like the boy you cried wolf, youjust start ignoring it after a while.
So that is a potential problem.
(15:59):
Well, and the other issue, rememberGary, you can't calibrate it, and so
you can't kind of fix the problem ifthere is a problem with the sensor.
Mm-hmm.
Yeah.
At least with Dexcom, if you fingersstick and there's a big discrepancy, you
can tell it, "Hey, you're, you're runningtoo high, or you're run running too low."
Mm-hmm.
And it'll adjust itself.
Abbott's Libre has neverallowed that to happen.
(16:20):
I found the one minuteupdates sort of useful though.
Because if I was low and I treated it, itwould show my glucose coming up sooner.
Right.
And if I was high and waiting for it tocome down, it would show it's starting
to come down a little bit sooner.
So I kinda like the one minute updates.
I did too.
Yeah.
(16:40):
Having to wait five minutes to see ifa bolus is having an effect or what?
My exercise is doing well, low bloodsugar treatment, doing my sugar seems
five minutes, doesn't seem like a longtime, but it feels like an eternity
also when you're waiting, absolutelywaiting for that glucose value.
So maybe someday Dexcom will show thedata a little bit more frequently.
I would like that.
What about the, the size ofthe sensors themselves now?
(17:03):
Yeah, they're both small, but
mm-hmm.
the Libre is smaller and as a guy, Imean, I couldn't, couldn't care less.
Yeah, but to a woman that'simage conscious, does that
make a difference to you?
That one's the size of a nickel and
I think I am somewhat image conscioustoo, but I think that, you know, the size?
I think it's more of a comfort.
You know, the G, once you move away fromlike the larger, thicker G six Dexcom and
(17:28):
then you move to kind of these coin sizes?
I think they're really similar.
The size of the Libre is really nice.
It's extremely discreet for thosewho want to keep their CGM discreet.
I think the G seven is also discreet,but it is a little bit thicker.
And so, you know, there's plenty ofpeople that I work with who really
don't want any devices showingon their body, and these are just
(17:50):
tailor made for someone like that.
Did you use over tape with your Libre?
I didn't, and I didn't use overlaytape, um, with my G seven as
well during my head to head.
It's winter time.
And so, you know, I do live in Texasduring an August 120 degree month.
I would absolutely need to wearoverlay tape, but, um, you know,
(18:11):
we're recording this in February now.
It's pretty cool out.
And so, um, you know, and I'm notswimming a lot, so I did not use one.
Uh, yeah.
I used overlay tape withboth just to make sure.
'cause the, the workouts.
Sure.
Again, a lot of sweating.
Yep.
I wanted to make sure they stayed on.
Again, I didn't wanna give thecompanies any excuses to say, "Well,
your sensor didn't stay on. Itwas moving. That's the problem."
(18:34):
I, I thought both of themstayed on really well.
I didn't have any issues with that,and I didn't have any skin irritation
also, which some people have.
Skin irritation occasionally from thetaping, and I didn't have anything.
Okay.
So yeah, again, I I didn't feel that.
Yeah, the, the Libre is smaller, butyou get to a point where, how much
(18:55):
smaller do you really need and Right.
The Dexcom G seven is quite small also, soI kinda, like, I didn't, I didn't really
see a distinct advantage, even though theLibre is a little smaller than Dexcom.
Yeah.
One other area where there, you know,people are gonna see a difference is cost.
You know, if insurance covers it, itdoesn't really matter a whole lot, but
(19:15):
for those who maybe have deductiblesto meet or have to pay out of pocket,
there is a price difference between.
Absolutely.
Um, you know, I, I, it alsodepends on what your needs are.
You know, cost is absolutely somethingthat can be a huge barrier for folks, and
(19:36):
the Libre does cost a little bit less.
Um, but you know, there's also theconsideration if cost is really.
Something that's a barrier.
Um, you know, the Eversense is veryinexpensive for the entire year.
You know, I, I do think that it'simportant for people to remember that
they're in charge of their technology.
The technology's not in charge of them.
(19:58):
That's with alarms, that'swith what they're choosing.
And as it relates to cost, youknow, there's not, you don't have
to go to the Dexcom or Libre.
There's other options that might be alittle bit less costly and like what you
were saying earlier in our conversation,that a CGM might be the most important
tool that we have for managing diabetes.
And so finding one that really worksfor whatever your priority is, I
(20:21):
think is really important to remember.
Yeah.
It's, it's the fuelthat drives the engine.
Mm-hmm.
With these automated systems, if you'refeeding good data in, they can function
nicely if the data's interrupted or notaccurate, it's not gonna function well.
Yeah, and that's
why it's so nice to see theinteroperability of all of these
insulin pumps because, you know, usedto be insurance was telling you and
(20:42):
dictating what you had to do, andnow you do have a lot more options.
Sure do.
The, the longevity of thesensors is another consideration.
Uh, Libre three plus,it's a 15 day sensor.
And Dexcom G seven is, is a 10 day,although, you know, Dexcom is trying
the, working towards getting approvalfor 15 day use on their sensors, but,
(21:05):
uh, changing it out three times a monthversus changing it out two times a month.
How much of a differencedo you think that makes?
I mean, it's such a non-issue for mepersonally to change mine out, but I'm
not, you know, a 6-year-old screamingand, and kind of running all over
the house, avoiding that insertion.
I mean, that makes a huge differencefor some families when, you know,
(21:28):
changing out devices can be reallyemotional and, um, just a huge stressor.
But for me personally, thatis like a, a non-issue.
'cause uh, you know, my Dexcom expires,I kind of stick it on and go on with
... Well, these change out.
We've also got warmuptimes to deal with, right?
Where we, we don't have that securityblanket of data flowing through.
(21:52):
Uh, we've got what, a one hour warmuptime on the Libre and it's 25, 26 minutes.
I don't ever keep out that 25 minutes.
I stack my Dexcoms,
And so we know the trick.
Right?
We can get some warmup down to zero.
You wanna share your,your trick for doing that?
Yeah.
Well, and so I take ita little step further.
So the Dexcom G seven gives you a headsup that you've got a 12 hour grace period
(22:17):
that you're entering in, and I use thatgrace time alert to put my new sensor on.
I wanna get the most accuracyfrom the get go of a sensor.
And I feel like it has that wedding periodwhere the filament gets a little bit
more coated with the interstitial fluid.
And so I'll wear a, a sensor, two sensors.
One is activated, one's not.
(22:39):
For a good 12 hours.
And then when my old one expires,I activate the new one immediately
and I get blood sugars immediately.
And then personally, I think it's a littlebit more accurate from from the get go.
Yeah.
I do a similar thing.
I don't do it for 12 hours, Ijust do it for a couple of hours.
Yeah.
But as soon as I activate that new one,since it's been in my skin, it doesn't
(23:00):
require any warmup time, instant data.
Right.
And it is really nice.
I mean, I remember, you know, ofcourse we've all worn sensors that
had, you know, long warmup for years.
And, you know, just waiting forthat information can be really
stressful, especially if you're onan automated insulin delivery system.
You can feed it with fingersticks or maybe you have to wait
(23:20):
to eat a meal and you're justsitting there watching the clock.
So I, I do love thatseamless introduction.
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front slash podcast, or call 8 6 6 69 2 8 0 2 4 and select option three.
We covered a lot of the potentialadvantages that Libre three
(24:05):
Plus might have to offer.
With the Dexcom G seven, wegot a little longer list.
The compatibility with other systemsis much greater at this point.
That may change down the road, butright now Dexcom is the system that
integrates with the most other devices.
Certainly fewer false low alerts.
Right.
And we know how frustrating those are.
(24:27):
Far fewer false low alerts.
The data should, generally showsbetter accuracy in hits with the
Dexcom compared to the Libre.
You got any idea whythat might be the case?
No, I actually wasn't aware of that.
Yeah.
What are your thoughts?
I'm not sure to be honest, but repeatedlythe manufacturer studies as well as the
(24:51):
real world study that was just publishedin in peds populations just generally
shows better accuracy with the Dexcom,uh, than, than the Libre products.
Well, and I would say a lot offolks, especially pediatrics,
have trouble with compression lowsovernight with their Dexcom products.
And so I wonder if they've carvedthat out of the studies just to.
(25:12):
Identify those as something beingdifferent other than performance.
Possibility.
The trend graph displayI had a big issue with.
Yeah.
The Libre will only showyou a 12 hour display.
It's hard to see what's happeningin the last 30 minutes or so.
That recent trend.
And also, I don't care, yourcontrol, it looked like just awful.
A rollercoaster.
(25:33):
It was horrible,
right?
It's just the...
And it didn't look any, , justbecause it was 12 hours.
If I had expanded it out, I waslike, oh, thank goodness my, my
day doesn't really look like that.
But the other thing that I reallymissed with the Libre was putting
my finger on the app and reallybeing able to move the blood sugar,
the data points
(25:54):
that matched the line.
To me that is so useful for seeingwhen a bolus timing hits or when my
exercise is impacting my blood sugars.
I can learn so much from theDexcom app that I just wasn't
able to apply it to the Libre.
Definitely.
Yeah.
I like, yeah, you can see 3, 6, 12,24 hour graphs with Dexcom, and you
(26:14):
can scroll and see the individualdata points if you wanted to see
at a specific time where you were.
Mm-hmm.
You can't do that on Libre.
The alert options are also heavilyin favor of, of the Dexcom G seven.
Uh, I, I really like someof the predictive alerts.
You don't have those in Libre and theability to customize things like the
(26:39):
delay, uh, the delay high alert...
mm-hmm.
On the Dex Desktop.
So after a meal our glucoses tend to rise,and it might go over our high threshold
temporarily and then come right back down.
We don't need an alarm when it happens.
Right.
If it stays high for a while,
yeah,
we could use the alert so wecan do something about it,
(27:00):
but Dexcom has that delay.
First alert feature that Libre does not.
Also consider that, I considerthat less punitive, right?
Like, you know, your blood sugaris gonna rise, let's not, you
know, make a whole deal of it.
Yeah.
That just wait.
Right, exactly.
And I love that with the fall ratealerts on the Dexcom as well as
(27:21):
the high, we can set a threshold.
So don't alert me if I'm falling fastunless I'm below a certain value.
If I'm high and I fix it.
Yep.
I don't, I don't wanna bedisturbed if I'm dropping fast.
'cause I want to, if I wanna gofrom 300 down quickly, but if I'm
under, let's say 120 or 130 andI'm falling fast, then I wanna know
(27:42):
Sure.
So I can be proactive.
Absolutely.
So.
Dexcom just has, being part about thosecustomized is so much better variety.
You know, being able to do a nighttimesetting versus a daytime setting.
To me, that's one of my favorite thingsabout the Dexcom system is that, you
know, I can be a little bit, well, a lotmore proactive during the waking hours.
(28:02):
This is my personal approach.
I don't need to be reminded, youknow, or alerted if I'm a little
bit high while I'm sleeping.
'cause I know my Automated InsulinDelivery system will take care of it.
But you know, some peoplemay have the reverse.
They want more alarms at night.
Um, and, and I love the factthat you can schedule that.
Yeah.
That is a nice feature.
Especially if you, if youvalue a good night's sleep.
(28:25):
Yes.
Take it.
You can make a big difference.
You mentioned before withDexcom, we can calibrate it.
So if it is not performing up topar, we can tell it, Hey, you're
drifting up, you're drifting downfrom the actual values, and do that.
Being able to get the warmup time reducedor eliminated on the Dexcom is nice.
I, I also like Dexcom's software forreporting data Clarity is, is good.
(28:51):
And also like the Dexcom integrateswith so many other programs.
It really does a lot ofthird party programs.
Apple Health Kit.
Um, yeah, I mean there's a lotof good uses for that data.
Libre is getting better withthat, but they're still kind of
consolidated in just their Libreview program and that's about it.
(29:12):
So that's an issue especially forhealthcare providers because we need to be
able to access data in the systems we use.
The customer support,I felt, came up short.
Again, we're an N of two.
But I was not enamored with Abbott's techsupport, customer support for issues.
First off, they don't have24/7 support They have..
(29:36):
Which is frustrating,especially for a global product.
Yeah.
They have 12/7 support.
Whoever heard of 12/7support for healthcare?
We can only have problemsduring business hours.
Yes, that's right.
Uh, and, and the times that I called, theydidn't offer to replace the sensors that
were giving me a lot of false low alerts.
Their advice was," well, youshould probably finger stick if
(29:57):
you question the reliability."
And then I was given kind of anadvanced, uh, service provider
to try to help me with things.
And I've left him messages for thelast week, and I still got the message
here for when he called a week ago.
He's not returned my calls since.
Oh, and that's just...I'm not happy about that.
Huh?
That is, um, well first of all, it'ssurprising they gave you a phone
(30:20):
number, but that's unfortunate.
He hasn't, or she hasn't called back.
Well, it's a department and Igotta just ask for this guy.
Okay.
Um, and you know, what's as a,
Dexcom does have issueswith wait times, but when
They do, but I don't, the wait times I,um, if I'm having technical problems.
Maybe I would call in, but mostof the time if I need a sensor
(30:40):
replaced, I use the in-app option.
Um, you know, the G seven, you canreport an issue within the app, which
is amazing for those 2:00 AM problems.
Hopefully you're not having a 2:00 AMproblem, but you don't have to wait
online and you can just do it in the app.
Yeah, I've always called in.
So have you had any troublegetting replacement sensors
(31:02):
going the the app route?
No.
I've had a couple of emails askingfor additional information, but I
had a whole box that was faulty.
This was a, a while ago.
And so I reported several at onetime and I got an email, you know,
kind of pushing back a littlebit, but I had the documentation.
One thing with Dexcom is sometimesyou really need the lot number or
(31:23):
the serial number, and so I do keepthose just in case there's a problem.
Actually, I just take apicture of it on my box.
I use my camera roll to keeptrack of things like that.
Yeah, so you either keep the boxor the inserter itself, right?
That has all that information on it.
It's a smart idea.
The, the one other thing I like about theDexcom, it does have a longer shelf life.
(31:44):
So when you get those sensors, they'llbe good for a longer period of time.
They might not expire for eight or12 months, whereas the Libres might
expire in six months, and that canmake a difference, especially if you're
getting a lot of supplies at once.
Absolutely.
You get three monthsat a time or whatever.
You don't want your stuff expiringbefore you have a chance to use it.
(32:07):
Actually are people just traveling abroad?
Kids that are going on a semester abroad?
I mean, there's so many situationswhere you do need a longer shelf life.
All right.
Can you think of any other prosor cons you saw with when you
were comparing the systems?
Um, I mean, overall, I think, youknow, just having a CGM can be so
(32:31):
important and so I think, you know.
We are for sure getting in the weedsand we wanna per, we want a system to
perform at the highest level, but Iwouldn't wanna scare somebody from using
a CGM based on these headaches becauseI think overall, just wearing one is so
positive in your diabetes management,
Yeah.
And know besides working with patientswith diabetes, you do consulting for
(32:56):
healthcare providers who are tryingto kind of upgrade their tech skills.
How do you coach them on thedifferent sensor types or do you
get involved in that with them?
Well, I would always recommend somebodywearing one, even if they don't have
diabetes, just to understand the constantfeed of data, maybe some of the issues
(33:17):
that people experience wearing them.
I think that, you know, that'swhy you and I test things out
just to really appreciate the,the small details of each system.
And I think only then can you reallyhelp coach and be a partner with
someone in their diabetes care.
So as much as possible if somebodycan wear something and understand
an alarm is really distracting.
(33:38):
You know, if you're at a restaurantor if you're at a movie and you get an
alarm, that's not just a diabetes issue.
That's also like a real disruption to yourlife, and those are things that I think
providers should and hopefully appreciatewhen they're working with patients.
Yeah, I like the name for the service youprovide called Elevate Your Expertise.
You know, a lot of people out there arejust not that familiar or comfortable with
(34:01):
all the technologies that are out there.
And you can provide,
Absolutely.
Provide either one-on-oneor small group instruction.
Kind of a teach the teacher sortof thing where you can teach other
clinicians, how to be more comfortableand, and use the tech more effectively.
Well, and one thing that I have beensaying, you know, for years now, you know,
positive or negative diabetes managementhas become technology management.
(34:24):
And so if a provider is not fullyembracing or understanding technology, and
that goes for the algorithms of automatedinsulin delivery systems, I mean, it,
it really, the technology encompasses.
A lot of care right nowthan they really are behind.
And unfortunately patientssuffer in their care.
Yeah.
I had a patient just this morning whowants to give one of the open source
(34:45):
systems, the Loop app a try, and herendocrinologist is giving pushback 'cause
he knows absolutely nothing about it.
Right.
And so, yeah,
I offered to give him a call.
We're trying to help that.
Yeah.
We're doing our best
One office at a time.
Shifting away.
Exactly.
Do you think we need multipleCGM options for people?
(35:09):
Is there a role for Libre threePlus and for Dexcom G or whatever
the next iteration is gonna be?
Probably the eight.
Are there certain people who arebetter suited for certain products?
Absolutely.
And just because I like one, you like theother, you know, someone, a third person's
gonna gonna embrace maybe another option.
(35:30):
And I see that across the board, youknow, cost obviously until we get
insurance companies to pay for everythingacross the board at a hundred percent.
You know, people are gonna haveto consider their monthly budget.
But, you know, technologyis not one size fits all.
And I kind of use the analogy of,you know, you and I are buying a car.
You might need four wheeldrive and a sunroof, but I
(35:53):
want, you know, leather seats.
And so I'm gonna be shopping if Ihave that option for A CGM for the
feature that's really important to me.
Maybe it's the personalized alarms,maybe it is the 15 day wear of the Libre.
Maybe it's the automated systemthat only works with one,
you know, with the Medtronic.
And so I, I try to remind peoplethat, again, they're in control of the
(36:15):
technology, not the other way around.
And we need to figure out whatfeatures work best for your life
and your diabetes management.
And then.
Find the, the technology that works
Well.
One other difference in our car choices.
Mine has the Eagles Super Bowlchampionship bumper sticker.
And yours has,
I know.
Yeah.
Yeah.
Dallas.
Great for you.
Dallas Cowboy.
It's amazing.
Dallas to cowboys.
(36:36):
Dallas, be Eagles fan.
I know.
Not so much for a Cowboys fans.
So just to wrap things up, uh, Ithink when we look at the Libre
three Plus and the Dexcom G seven.
From an accuracy standpoint,overall, they perform similarly.
Uh, we might find that the Libre isa little more reliable at the high
(36:56):
end Dexcom, uh, at the lower end,and certainly with younger people.
Uh, Dexcom seems to perform better.
Feature wise, there are somethings about the Libre three plus
system that are advantageous.
There's probably more features thatthe Dexcom has an as an advantage, but
(37:16):
ultimately the system you choose reallydepends on your personal preferences.
Kind of like when we choose a pumpor an A ID system or algorithm, it's
based on what your personal interestsand preferences and needs are.
And definitely you want to consider whichsystem integrates with the pump or pen
or a ID system that you're utilizing.
(37:40):
I do wanna mention that anybody whowants to learn more about the differences
between these sensors can check out thearticle we have posted on our podcast,
and there'll be a link provided in theshow notes that you can, you can go to,
it has a lot of the details about whatwe discussed today, plus a little bit
more, including some specifics about theaccuracy comparisons based on the research
(38:03):
that's been done on, on each device.
Great.
All right, so I want to thankeverybody for tuning into Think
Like A Pancreas, the podcast.
If you enjoyed today's episode, don'tforget to like, follow or subscribe
on your favorite podcast app.
Think Like a Pancreas.
The podcast is brought to you byIntegrated Diabetes Services where
(38:24):
experience meets expertise, passionmeets compassion, and diabetes care is
personal because we live with it too.
Our team of clinicians all livewith type one, and we understand
the challenges firsthand.
We're here to help no matterwhere you are in the world.
From glucose management to self-care,to the latest tech, sports and exercise,
(38:48):
weight loss type one pregnancies,emotional support, we've got you covered.
We offer consults in English and Spanishvia phone, video, chat, email and text.
If you wanna learn more, visitintegrated diabetes dot for
email info@integrateddiabetes.comto schedule a consult.
On behalf of Think Likea Pancreas, the podcast.
(39:11):
I'm Gary Shiner, wishingyou a fantastic week ahead.
Don't forget to keepthinking like a pancreas.
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