Insulin detemir (brand name: Levemir[1]) is a long-acting insulin developed by Novo Nordisk.
Although the FDA first approved personal CGM over a decade ago (Cygnus’ GlucoWatch in 2001), a new device for personal use has not been approved since Dexcom’s Seven Plus in 2009.
Based on the pivotal trials for the Dexcom G4 Platinum and the Seven Plus, the G4 Platinum CGM is nearly 20% more accurate overall and over 30% more accurate in the hypoglycemia range.
In the past, we found that the Seven Plus also had occasional problems with outlier values – those CGM readings that deviate considerably from actual blood glucose values. We’ve seen lately more and more diabetes devices with color screens, and we were psyched to see that the G4 Platinum is no exception. A minor drawback of the new G4 Platinum transmitter is that it is a tenth of an inch thicker and sits a bit higher off the body than the Seven Plus transmitter.
A sensor four-pack will have an official cash price of $349, which will drop to a discounted price of about $260 depending on the insurer. A pediatric indication: Dexcom is finishing up a clinical trial to support use of the G4 Platinum in younger patients. Automatic upload of CGM data to the cloud and remote monitoring: This is hopefully coming with Dexcom’s Gen 5, smartphone compatible CGM. Even less painful: Though we found the G4 Platinum to be slightly less painful than the Seven Plus, those who are very pain sensitive will still likely find sensor insertion bothersome.
Percent “time in range” on the home screen: We hope that FDA recognizes the value of this metric, and we expect to see this in future generations of CGM. Predictive alerts that forecast blood glucose minutes or even hours ahead of time: Dexcom is actively developing an algorithm to increase the warning time for hypoglycemia. Fewer required sensor calibrations (or ideally no required calibrations): Dexcom is actively pursuing both areas of research. Our mission is to help individuals better understand their diabetes and to make our readers happier & healthier. Our mission is to help individuals better understand their diabetes and to make our readers happier and healthier. NoticeboardFlu Clinics - Winter 2016We are now booking appointments for the flu clinic, if you are eligible please make an appointment now. Levemir is used to maintain the basal level of insulin, and can provide up to 24 hours of blood sugar control, though more commonly closer to 12 hours of coverage. Encouragingly, the FDA ended the dry spell in October by approving Dexcom’s new G4 Platinum CGM system (the “G4” stands for fourth generation, since this product follows the STS, Seven, and Seven Plus).
In wearing the Seven Plus and G4 Platinum simultaneously, Adam found the overall accuracy improvement was actually quite noticeable, especially for hypoglycemia. When that happened, no glucose data would appear, and the user could only hope the sensor came back online or prompted for a calibration.
Seeing CGM data in color is a meaningful improvement over the gray Seven Plus receiver screen.

First, the alarms are much louder and more customizable through the addition of a “Profiles” menu. First, the wireless communication range between the transmitter and receiver is significantly longer – over 20 feet with the G4 Platinum vs.
It was noticeably bigger at first glance, though this was less perceptible once it was on the body.
Insurance coverage of CGM has improved dramatically over time – largely through the help of JDRF, patients with type 1 have experienced good success getting their CGM covered. The discounted costs for the sensor system ($800) and a sensor four-pack ($260) are roughly the same as the costs to start on the Seven Plus – we salute Dexcom for not asking patients to pay more for the G4 Platinum starter kit or for the new sensors. A G4 integrated Insulet OmniPod is also in development, and Tandem is currently evaluating the feasibility of integrating the G4 into the new t:slim pump. Dexcom is developing a new applicator for the Gen 5 sensor, and we look for this to reduce insertion pain.
These errors sometimes lasted for quite awhile and in some cases required changing the sensor before seven days were up. The most noticeable size improvement comes in thickness – at 0.5 inches, the G4 Platinum receiver is particularly easier and more comfortable to wear in a pants pocket than the Seven Plus.
Without a doubt, we believe the much improved transmission range and reliability are worth the price of the marginally larger transmitter. Ultimately, most patients should receive a discounted price of about $800 for the G4 Platinum starter kit, which includes the receiver, transmitter, and charger.
If your Seven Plus is still in warranty, meaning it was replaced or newly acquired in the last year, you can upgrade to the G4 Platinum for $399. If you are just starting on CGM now, your doctor or CDE may have to do a lot of legwork through paperwork to get this for you, but over 95% of the people on Dexcom systems do have insurers who cover the costs. Medtronic’s new MiniMed 530G pump will be integrated with the Enlite CGM sensor and is expected to be approved in the first half of 2013. One of CGM’s biggest benefits is that it helps users avoid hypoglycemia (or at least minimize time spent in hypoglycemia), so this improvement in accuracy is very encouraging for patient safety. Through an improved sensor membrane design and better algorithms, the G4 Platinum has reduced the likelihood of these outlier values.
While the G4 Platinum can still have these errors in theory, we have not had any so far in our experiences with multiple seven-day sensor sessions. More generally, the look and feel of the receiver is just smoother and sleeker – it looks more like an MP3 player than a medical device. Seeing the trend graphs in color made it very easy to see how much time we were spending in range vs. Lamentably, we believe this is an FDA requirement, and we hope it will be customizable on CGMs in the future. Moreover, while the Seven Plus transmitter often failed to deliver data to the receiver even when it was within five feet, data gaps are incredibly rare with the G4 Platinum.

Although the actual cash price is $1,198, most insurers have agreements with Dexcom to pay a discounted price for the patients they cover – the benefits of buying in bulk! Specifically, the out of pocket cost for a brand new G4 system and three months of sensors was a total of $840. So keep trying if you don't succeed at first and see here for some background on how to work with payors. Although I love running this will be the hardest thing I have done so far and I'm hoping not only will this be a fantastic event but I want to run in support of an amazing family who I have had the privilege of looking after over the past 14 years as a GP.
In other words, not only is the system’s average accuracy better, but the accuracy range is also narrower. We’ll be surprised if we ever get an “is that a beeper?”-comment with the G4 Platinum. Although Kelly lost (“misplaced temporarily”) the charger that came with her G4 Platinum, we were able to patch one together using the wall outlet plug from a Verio IQ meter and the cable from a FreeStyle InsuLinx meter. One change that we really don’t yet like is that the time of day has now been moved to the bottom right of the x-axis on the trend graph. In fact, we found it can transmit through multiple floors of a house and as much as 50 feet away when it’s in line of sight. The best way to determine what it will cost for you to start on the G4 Platinum is to contact Dexcom. Since being born with congential heart defects, due to a genetic condition, the 2 sisters have faced multiple cardiac surgeries at Glenfield hospital. It’s still there, but it’s not as large or as noticeable as it was on the Seven Plus home screen.
This should be particularly valuable for parents that like to monitor their children’s glucose in another room of the house or on the sidelines of an athletic event – our friend Christine Varon, mother to seven-year-old Lilly, can’t wait for her daughter to use it during swim practices and meets. Currently Amelia is waiting further open heart surgery as previous valve surgery has been unsuccessful. Throughout this the family have received support from Heartlinks who provide accommodation to families to stay while their children are in hospital but also provide for much needed paediatric equipment needed for their surgery.
I know first hand how much of a difference this has made to a family going through so much! I'm hoping the thought of what the girls have been through will spur me round and ensure that no matter how tough it gets the courage they have shown throughout their treatment will set the example of the determination I will need to finish!

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