Dexcom Stops Caring

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We're in the dog days of summer, which, if where you live is anything like here in Los Angeles, it's been hot. And it doesn't look like it's going to let up anytime soon. And the problem with all this heat for us diabetics is that all this extra sweat tends to make our Dexcoms fall off early. And when you combine that with all the summer activities of pools and beaches, and all the summer camps for kids where they spend all day running around in the heat and water, you can end up with quite a few Dexcoms that fall off early. And while I wish this was a feel good story about new adhesives making Dexcoms stay on for longer, this is actually a story about how Dexcom is making life harder for people with diabetes in order to boost their profits. And there isn't any way to stop them. Yet.

So back to our sweaty summer problems. People have been looking for ways to keep these expensive Dexcom continuous glucose monitors on our arms for the entire 10 days that they're supposed to. You might try additional adhesives like SkinTac or purchasing extra adhesive patches as an extra barrier to keep it stuck on. Now a lot of things can impact how long the Dexcom stays properly attached on someone besides how much time you spend in the summer heat. Everyone's skin is different and different amounts of oil produced by the skin can make it harder for that adhesive to stay on. Or they might have skin allergies that require people to change their sensor much more often or they'll be covered in painful rashes. But the biggest factor in keeping a Dexcom on is actually the Dexcom itself.

Most of you probably know what a Dexcom is and looks like. But a little background in case you don't. Dexcom is one of many different continuous glucose monitors on the market, which continuously measures the amount of sugar in the fluid between your fat cells and uses that to determine what your blood sugar is. The Dexcom works by inserting a small wire through your skin, passing the data to a transmitter that sits on top of your skin, which stays on by a piece of adhesive like a band-aid, And then it transmits that data over Bluetooth to your phone or receiver every five minutes. This replaces pricking your fingers and testing your blood, resulting in a lot less prick, but also a lot more data, since no one is going to prick their fingers every five minutes, 24 hours a day.

This technology is incredibly useful for people with diabetes, with studies showing that the data can help reduce an HbA1C by 0.4 to one whole percentage point compared to just using finger sticks, which is crucial in preventing some of the long-term side effects of diabetes. They also have alarms that can indicate when a blood sugar is going low or is low to prevent people from passing out. It's also necessary for new insulin pumps that use this data to automatically adjust the flow of insulin to keep people's blood sugars in range. In fact, technology like this is so useful that JDRF found that 673,000 people with type 1 diabetes will die early in the next 15 years because they don't have access to technology like CGMs.

So you can see why these devices are so important and why having one on for the entire 10 days it's supposed to be on would be beneficial. Only having your Dexcom on you for half a year would drastically increase the dangers of low blood sugars and drastically decrease the time your blood sugars are in range. And that's why Dexcom has always replaced sensors that fall off early. It could be the ninth day and you're at the gym pumping iron and the sensor falls on the floor. You call it in and you get a replacement sent to you. This policy has made sure that diabetics are safe and don't have to spend nearly $400 a month MSRP out-of-pocket for these expensive devices because their insurance won't cover any extras.

Now Dexcom’s latest sensor, the G7, is much smaller than the previous generation, about the size of a quarter. And it doesn't take a lot of imagination to realize why it's much more convenient to wear something smaller on your body. But in reducing its size, Dexcom has also reduced the size of the adhesive that keeps it stuck on. And this reduced footprint means there's less keeping this thing on your body from sweat, showers, or even getting stuck on a shirt when you take it off. Dexcom does include an additional adhesive that you're supposed to put on top of the G7, but, in my experience, an adhesive on top of another adhesive never stays on as well.

The other big difference with the G7 is Dexcom changed the adhesive itself. I know people who never had an issue with the old sensors falling off, but now that they're on the G7, even with Dexcom's additional adhesive patch, it falls off like it's using gift wrap tape.

So about two months ago, Dexcom said they would no longer replace sensors that came off early due to “user error.” They've separated the adhesive failing from the electronics failing and put the blame on their adhesives on us. This includes things like, quoting Dexcom's website here, “sensors removed for a procedure, user application errors, etc.”

Here's a much abbreviated, real list of reasons that actual diabetics told me caused their Dexcom's to fall off early, that would no longer be replaced by this new policy:

Sweating it off during practices and workouts for college sports.

Falling off of a nine-year-old who plays sports, swims, and gets it caught on backpack straps. You know, kid things.

Nurses having patients pull them off or having to take them off while patients are getting an MRI in order to deliver life-saving medications.

Removing them for radiology, mammograms or biopsies.

Doctors taking them off when the patient is in the ER.

Or having to remove them early because of skin reactions.

For any of those incidents, Dexcom would only replace up to three Dexcoms within a 12 month period as a quote “goodwill replacement.” The rest? You're out of luck. You either have to live without it and risk dangerous, low blood sugars or worse health outcomes long-term, or you have to pony up $400 to buy a three-pack over the counter. Which is $200 with Dexcom's coupon, a coupon that they can get rid of at any time.

Dexcom’s CEO, Kevin Sayer, who has a compensation package of over $15 million a year, and who does not have type 1 diabetes, said that despite the company projecting over $4 billion in revenue in 2024, that it was “not fair” to replace all the sensors that fall off of patients. You know, the ones whose lives they say they're improving because of their product. Whose lives or children's lives could be lost by not wearing it. He said that Dexcom found that 95% of the people who use Dexcoms don't even have three sensors fall off in a year. Which could be true. And if it is, it means that they've instituted this three sensor a year replacement policy specifically designed to punish the 5% of users who need more than that. Like athletes, nurses, and kids.

And I think what really gets under my skin about this policy change, besides the fact that this will be very expensive and dangerous to that 5% of Dexcom users, is that this shows how the leaders at Dexcom like Kevin Sayer don't see people with diabetes as, well, people. People who do things besides exist with diabetes and refill Dexcom prescriptions every 90 days.

Kevin Sayer has never had a Dexcom fall off while delivering packages in 90 degree heat. He's never had a kid accidentally pull his Dexcom off his arm while playing around. He's never had the reschedule his MRI to a day where he's changing his sensor already, so he doesn't have to take it off early. He's never walked a little too close to a doorframe and have it rip off right in the middle of a vacation.

This is what the diabetic experience is: to have companies tell you to be a warrior against diabetes while also forcing you to spend your life always worrying that you won't be able to afford another CGM if you actually go out to enjoy your life.

On Dexcom's website, it says their mission is empowering people to take control of health. What's clear in this policy change is that their mission is really only empowering people who can afford to take control of health. Dexcom's adhesives and this replacement policy, our choices by Dexcom and Kevin Sayer to put profits over patients.

Now we can talk at length about the issues of a for-profit healthcare system. But that won’t help you stay alive right now. Try additional adhesives like SkinTac or test different additional patches that you can put on top. Make sure you keep your Dexcom as dry as possible or wear short sleeves after getting them wet so they dry out quicker.

And it's important to note that Dexcom is not the only CGM company, though people have different success with different sensors based on their own body. Abbott's Freestyle Libre CGM lasts for 14 days, does not have this dangerous three sensor a year replacement policy, and a head-to-head study found that it's way more accurate than the Dexcom G7. I'll link that study in the show notes. And a funny aside, the study also found that Dexcoms fell off of its participants more than the Freestyle did. Plus it's cheaper. And it now works with both Tandem and Medtronic insulin pumps. And if you don't use an automatic insulin delivery pump, you can try Sensionic’s Eversense sensor, which is implanted in your arm for six months at a time. And they're working on a sensor that lasts for a whole year.

And then I'm going to ask you to please take the time to email your senators and representatives and tell them that this policy puts you in danger, both in the short term and long-term. I know this is not as sexy as posting about this on Instagram, which you should still do, but changing policies like this will make the biggest difference in your long-term access to CGMs, insulin, and everything else. So to make it easier for you. Beta Cell Action has a form you can fill out to send a pre-written letter to your representatives. There's a link to that in the show notes too.

And remember, when you post that picture of yourself at the beach with your Dexcom on your arm, that Dexcom and Kevin Sayer do not care about you or your Dexcom Warrior hashtag. They only care about your wallet. And how much more money they can get from it.