LifeAfterDx--Diabetes Uncensored

A internet journal from one of the first T1 Diabetics to use continuous glucose monitoring. Copyright 2005, 2006, 2007, 2008, 2009, 2010, 2011, 2012, 2013, 2014, 2015, 2016

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Location: New Mexico, United States

Hi! I’m William “Lee” Dubois (called either Wil or Lee, depending what part of the internet you’re on). I’m a diabetes columnist and the author of four books about diabetes that have collectively won 16 national and international book awards. (Hey, if you can’t brag about yourself on your own blog, where can you??) I have the great good fortune to pen the edgy Dear Abby-style advice column every Saturday at Diabetes Mine; write the Diabetes Simplified column for dLife; and am one of the ShareCare diabetes experts. My work also appears in Diabetic Living and Diabetes Self-Management magazines. In addition to writing, I’ve spent the last half-dozen years running the diabetes education program for a rural non-profit clinic in the mountains of New Mexico. Don’t worry, I’ll get some rest after the cure. LifeAfterDx is my personal home base, where I get to say what and how I feel about diabetes and… you know… life, free from the red pens of editors (all of whom I adore, of course!).

Wednesday, May 15, 2013

Return of the “???” monster

The bane of many a Dexcom 7 Plus user was the infamous triple question mark icon:


Officially, it meant that the receiver couldn’t understand the signals coming off of the sensor. Basically the receiver was asking the CGM sensor, “What the fuck are you saying?” Of course users would also start off by asking the receiver, “What the fuck?” and end (hours later) by screaming at the receiver, “WHAT THE FUCK?!!!!!”

Naturally, the dreaded triple-Q icon showed up at the worst possible times: when you were going to bed with a ton of insulin on board, when you had the flu, were getting married or divorced, going to prom, or competing in a pie-eating contest.

A triple-Q could last for... well, that was the crazy thing. It might last 15 minutes. It might last an hour. It might last six hours. It might go on forever. For me, being hypo unaware, I’d pull the plug after four hours. Longer than that was just too risky for my body and too much for my nerves.

Of course you could try feeding the system more fingersticks to snap it out of its funk. That’s what we all did, even though the manual said not to. And you could try shutting the sensor down and restarting it, but then you had the whole two-hour start up thing with no guarantee it would work. It was frustrating, scary, and highly vexing. You never knew when, or if, you would get one.

The triple-Q was also the harbinger of transmitter death. Yep. The only way you knew your transmitter was giving up the ghost in those days was a combination of ??? and crappy readings. That’s one big improvement of the new G4. It will tell you when the transmitter is starting to crap out. There will be a pop-up screen, so they tell me, and you can always go Main Menu >> Settings >> Device Info, and there it is, third from the top: Transmitter Battery.

Mine is still OK, although it’s getting a little long in the tooth. My G4 was in the first wave shipped after FDA approval back in late October of last year. That means it’s about 6 and a half months old. In transmitter years that’s geriatric. It doesn’t have long to live. In one of those Deals with the Devil, the engineers at Dexom agreed to the following pact with the Prince of Darkness: Give us power over long life. To get the marvelous new transmitter range we all love (and demanded) they had to sacrifice how long the thing would last.

I chatted with the friendly Dex crew at their booth at the AACE meeting in Phoenix a couple of weeks ago, and they are preparing their souls for the inevitable flood of calls and fights with insurance companies now that we are six months post-launch.

Fights? What fights?

Well, even though the G4 prescription clearly states that a second transmitter at six months is part of the deal, the Dex gang aren’t sure how the insurance plans will really react as this starts to come up for the first time. The folks at Dex are expecting some rough water until everyone gets onboard with the tides of the new world order.

OK, I promise to give up on nautical metaphors.

But back to triple-Q. When the new G4 arrived, I was disappointed to see the triple-Q icon was in the manual. (Yes, I actually read the manual cover to cover.) But that said, for months and months and months I didn’t see one. I began to think I wouldn’t. Then it reared its ugly little head back in mid-December, ironically on my sister’s birthday. Yeah, I know, I should ‘a posted about it. I can’t remember why I didn’t.

Then in Arizona two weeks ago, this happened to me:

And, yes, you read that right. The time on the lower right of the monitor is correct. Of course this happened at 5:35 in the morning. Mountain Daylight Time. Which Arizona doesn’t observe. It was 4:35 in the morning local time. Damn it.

Did the triple-Q wake me up? No. It’s a silent killer. You only know you’ve got it when you look to see your blood sugar and see that you can’t see it. What woke me up was the sensor suddenly thinking I was at 50 mg/dL and about to die shortly before the stupid thing crapped out. (I wasn’t at 50 mg/dL and I wasn’t about to die.)

Anyway, as my transmitter is geriatric, I worried that this latest triple-Q might be the first sign of an impending transmitter heart attack, transmitter stroke, or other form of transmitter death. So the next morning… actually later that same morning, but after the sun woke up… I asked one of the tech guys at the Dex booth about it, and he told me that, no, the triple-Q isn’t a sign of a dying transmitter anymore. Once the transmitter gets to within a week or two of its death, it will signal the receiver and you’ll get a pop up telling you to call customer service for a replacement.

So the triple-Q is still with us. Less common than before, in my experience, and the few times I’ve gotten them they haven’t lasted very long. And now the triple-Q is no longer a harbinger of transmitter death. But it’s still vexing that every once and a while the receiver can’t understand what the sensor is telling it. WTF?

Bottom line, same monster: Just a bit tamer.


Anonymous Colleen said...

Thanks! I didn't know you could check on the battery in the settings. Guess it would help if I read the manual?

6:44 AM  
Anonymous Anonymous said...

Thanks for the post. Just a couple comments from my experience...

I got my G4 during that same first wave. Talked to Dexcom last week, new transmitter is on it's way. Already met my deductable for the year, and Aetna covers 50% of contracted rate after that for my particular plan. Six month prescription was a non-issue. That being said, I have been told they are one of the easier companies to work with.

I always restart my sensor at 7 days and generally get 10-14 days total out of it. I almost always get the ??? at some point during the second week, and this is how I know that sensor is done. I gave up on fucking with the little fucker at that point since I'm saying "fuck it" to the FDA approved 7 days at that point anyway. Have probably only seen the ??? during the first 7 days once, so it does indeed sound like a tamer beast that still lurks in the dark if you're changing out at 7 days.


10:38 AM  
Blogger Jonah said...

One thing I've noticed that is really different about the G4 and 7+ with ???s, aside from them being less common in the G4, is that the G4 shows a false plummet of my blood sugar right before going to ???, which the 7+ did not do.

2:22 PM  
Blogger Val said...

Caution about the low transmitter battery warning period: mine only showed up three days before my transmitter died completely.

In theory, that would be enough time to get a replacement on order. In reality, the first two warnings were at 3 or 4am, which for some reason I didn't recall during actual daylight hours.

Thus, it was a Friday before I placed my order, two and a half days after the first warning. At 2am saturday morning my dex started showing the transmitter icon with a slash through it, and never came back. Now I am stuck dex-less until dinnertime tuesday, one of my longest CGM breaks since december of 2005.

So if you do see the "order new transmitter" warning pop up, no matter the time of day or night, tape a test strip to your finger or something to remind you to get that replacement in the mail ASAP!

3:06 PM  
Anonymous Anonymous said...

I love your style. As I type this, my Animas Vibe is saying "What the fuck???" And of course, it's 1:17am and I can't call anyone at Animas to bitch. So, I will have to leave it for now and hope my cat wakes me up if my sugar drops (yes, this has happened). Moral of the story: Fuck technology, get a cat (or a dog). Cheers!

11:20 PM  

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