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Dexcom Tegaderm Sandwich

The Dexcom Tegaderm Sandwich

T1dLife-the-dexcom-tegaderm-sandwich

is simply a method I've used and perfected since Coral's previous D-nurse mentioned it to help keep her Dexcom G5 CGM sensor on for the minimum of seven days without any skin irritation. Coral has sensitive skin and cannot wear any fabric dressings such as Grif Grips, Pump Peelz or even Tough Pads. She can't even use Skin Tac because it causes a severe rash with tiny red bumps and is extremely painfully itchy. See Dexcom calibration tips below.

Firstly, I'd like to strongly advise that you refer to Dexcom's User Guide and Setup Wizard before and in addition to this blog. It's available direct from the app on your smart phone - which I hope you've installed before coming here. This will eliminate basic questions such as, "How do you start the sensor?" or "Do you need the [G5] receiver with you at all times?" or "How often are you supposed to change the sensor?" Also, understand that Dexcom may not be available internationally such as in the UK or Asia. Again, refer to their website and contact your insurance provider to see where and if it's available for you.


Also, note that we've been using Dexcom G5 continuous glucose monitor since April 2016. Coral was diagnosed with T1d on March 11, 2016 when we were living in Honolulu, HI. Our very first Diabetes Educator and Nurse Tabisola suggested it and we get the process started with insurance (previously HMSA PPO) since it can take a few weeks to complete. This post is to simply show you how we change her sensor and to provide you with some tips beyond what a typical Dexcom Technical Support or Customer Service rep might tell you in in this particular case.

Now, let's begin. You'll need the following if you're to be prepared to change a sensor:
  1. Sharp scissors - to cut out circular hole in the first Tegaderm and then another hole the shape of the Dexcom sensor's clear platform in the second Tegaderm
  2. Tegaderm - order on Amazon and this is what you'll be using beneath and over the Dexcom Sensor like a "Tegaderm Sandwich"
    • Order a small pack to see how it works out first and then order in larger quantity if it doesn't cause a skin reaction
  3. IV Prep swabs for pre-cleansing and to leave an adhesive residue for the Pump Site and both Tegaderms
  4. New Dexcom Sensor - Do NOT open until ready to use immediately
    • I like to mark each bag with the time and date I started the sensor for future reference in case it fails before the seventh day so they'll replace it free of charge
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T1dMom Tips:
  • I used to be able to change her sensor while she was awake. Now that she's more self-aware, I change it after she's been asleep for at least a solid hour and her BG is steady. You can also use doctor prescribed lidocaine cream, plastic wrap, on the site 30min prior to The Plunge.
  • Dexcom won't advise using the thighs or any alternatives to the belly, lower back and arms - we do said, thighs and arms only, since she wears her pump in a SPIbelt around her waist and rotates pump sites between her thighs and upper buttocks.
REMOVAL
  1. Unisolve Swabs - to remove previous pump or Dexcom site adhesives. Very effective, more so than any other adhesive remover that's been recommended by nurse acquaintances
  2. Witch Hazel Wipes - it soothes the skin, use after completing removing any sticky residue and adhesives
  3. Neosporin - to heal and prevent scarring or infection from old site
MENTAL PREPARATION
  • Patience - it takes up to 20 min of your day or evening to change a pump or Dexcom site
    • You will eventually get into the flow of this new T1dLife
  • Perseverance - keep at it even when its most inconvenient and T1d is being a beach
    • Be realistic about your expectations
    • Technology only works as good as its user
  • Self-dedication - the right mindset will help you get through this site change and many more
    • Whether you're doing it for your T1dChild or your self, know that it will ultimately save your life and improve your target range within weeks
    • Thus, improving your overall quality of life and preventing long-term complications in the future
I cannot say how many times Dexcom has saved Coral's life from alerting me of a hypo or low blood glucose when we were out adventuring or especially overnight - when T1d sneaks it's nasty presence back into your room. Do I sleep well overnight? Not really. I still wake 2-4 times a night or as needed to at least check the dexcom app or the receiver on my nightstand. I'll prick her toe or finger to check her actual BG if I feel the Dexcom reading is off - as should you whenever in doubt. I may not always be able to prevent a hypo overnight, but at least I'll be able to wake her to drink juice really quickly. If Dexcom beeps to alert me of a high BG (typically over 180), I'll give her a small correction usually between 0.05-0.10U or as needed.

***
I have a strong message to the parents who deliberately do NOT check their child's blood sugars overnight at all nor have them wear a Dexcom - Dead in Bed Syndrome is real. Just because your T1d child may have miraculously bounced back from their hypo the other night, doesn't mean that will always happen. Their liver will not always pitch in to help their pancreas generate the glucagon it needs to raise blood sugar levels. In addition to that, severe hypoglycemia (for most, under 40 mg/dL) would likely require an injection of Glucagon and a trip to the hospital - if they make it. Frequent episodes of hypoglycemia is damaging for a developing child's brain cells. Check your child every night as many times as needed. Is your sleep worth your child's life?
***
Once you've gotten used to inserting the Dexcom sensor and over the thought of checking the app a ridiculous amount of times per hour, get the book "Pumping Insulin" by John Walsh and Ruth Roberts on Amazon. It will teach you how and when to properly calibrate the sensor and lists many other technical aspects you should definitely learn in order to be successful in managing this disease with a CGM and/or insulin pump.

DEXCOM TIPS (per Pumping Insulin):
*Always use your own good judgement - you know your body or child's body better than anyone else
  • Calibrate when trend arrow is straight to get the most accurate readings
    • On rare occasions, we enter her actual BG twice if Dexcom's really off (over 50 mg/dL or "points")
  • Keep in mind there's a 15-20 minute lag time the sensor has due to the algorithm, any fast-acting carbs, or physical activity
  • Know what the trend arrows mean (varies per person)
    • Straight Arrow Up = add 20-30 mg/dL to the reading
    • Double Arrow Up = (poke to check) and add 30-40 mg/dL to the reading
    • Straight Arrow Down = minus 20 mg/dL (unless about to eat fast-acting carbs)
    • Double Arrow Down = Drink a carby beverage NOW to prevent hypoglycemia and check BG in 15 minutes

I hope this post has been helpful. I am in no way suggesting you do exactly as we do and always implore others to educate themselves in order to take control of T1d. Seek medical advice from a licensed physician such as your endocrinologist. Be your child's best advocate in all things especially when it comes to their health. Please share with your diabuddies and those newly diagnosed who may be interested in getting started with Dexcom. Follow @type1diabetic_life on Instagram and/or @typeonediabeticlife on Facebook. Mahalo for your support and have a good glucose day!

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Disclaimer: The information on this site is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. All content, including text, graphics, images and information, contained on or available through this web site is for general information purposes only. All photos, unless specified otherwise, are the sole property of Typeonediabetic-life and may not be used or duplicated in any fashion without written consent.

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