G6 transmitter battery replacement

The last big question on the G6 is “Can you replace the G6’s transmitter battery?”

Happy to report that you can, indeed!

I don’t have any fancy videos of it yet, because I was just focused on making sure I could do it vs. document it well on video.  I have replaced loads of G5 transmitter batteries using the guidance on this great video.  The same basics applied to the G6 transmitter work too…grinding down the grey plastic/epoxy, peel up the top tab carefully, and then pop the battery out.

However, I didn’t find the G6 quite as easy to replace the battery as with the G5.  It’s definitely doable, and I’d get better with practice.

Here’s the note-worthy differences and things I learned:

The G6 only has one battery, not two.  And the battery is accessed from the underside of the transmitter, as opposed to the top like the G4/G5 transmitters

The battery that the G6 uses is also quite a bit bigger than the G5.  If you want to order replacement batteries for the G6, here’s a link for a set on Amazon.  They are Maxell CR1632 3V lithium batteries.

The other major difference is that the battery (1) goes closer to the edge of the transmitter and (2) there are little wings to help the transmitter lock down inside the sensor.  Both of those combined to make it just a little bit more difficult to do the grinding down to expose the battery.

Here’s a picture mid-grind:

While you are grinding, you have to make sure not to go too low on the corners above the little locking wing indents.

You also have to be aware that the top tab on the battery has a different dimension than the G4/G5 transmitters.  The tab is much skinnier and has a few weak points built in…presumably to make the tab much harder to successfully bend up without breaking it.  There are three weak points that I could see.

Therefore, I was trying to be especially careful on that edge-located weak point as I ground down.  I did at first manage to get the 2/3 tab up just fine at first.  But, in removing the battery next, I ended up losing the long end of the tab (it broke at the middle weak point pretty easily).  The next time I do this, I will work harder to remove more epoxy around the edge weak point more carefully…will probably let me remove battery easier (see dicussion below) and maybe keep more of the tab.  It’s going to be a balance though, too much grinding and you’ll take the whole tab off at the edge weak point.  Based on the teardown pic though, probably salvagable if you did.

Battery removal was the hardest part.  I think it’s really important to get as much of a clean edge around the battery as possible.  Since the battery was much bigger than the G5 batteries, I found it was actually a lot harder to get leverage going to pop out the transmitter.  There was a lot more resistance to popping out than on the G5.  Possibly because I was too conservative on getting clean edge at first (definitely a contributor, I think)?  Or maybe because I wasn’t using a longer lever to start?  I don’t know…but eventually I did have to get out some vice grips and that made all the difference.  Since I was able to hold the transmitter more forcefully, I could apply a better pressure.  Worked SO well though, that it just popped super hard and fast.  Oops.  Did that little tab that normally sits under a battery go flying across my laundry room?  Could have.  I won’t know for sure until other people get a chance to open up their transmitters over the next few months.  😉

This is what it looked like when the battery was finally totally removed; a slightly shorter top tab (but still strong and in good shape) and a questionable bottom.

I assumed that there must have been a contact tab underneath that went flying.  So, I ground out a little on the bottom to expose the contacts and put a little bit of solder down.  Once I got that done, new battery was laid in and tab bent down to make contact on top again.  I did use a touch of super glue to hold the top tab down, just to be sure.

And voila…it works.  A G6 with a replaced battery.  I sealed it back up with two-part epoxy and the transmitter is working well again.

Don’t forget to use the reset transmitter app to be able to use the official Dexcom apps after a battery replacement.

 

What’s your “why”?

I need your help, please.  I’d like to hear your “Why I restart my dexcom?” stories.  Can you please read this post and let me know your why?  Do you have examples to share?  I’m sharing mine.

This request for input is partly motivated by this article in Diatribe where they state:

“This [restart topic] is a complicated issue, since many people pay a lot of money for CGM and the ability to extend a single sensor’s wear time – e.g. to 14 days – makes CGM more affordable…We’d like to see an end to complaints about not being able to “extend” the system – or even whether it’s possible. It’s been decided, and we believe this decision is in the best interests of people with diabetes, the system, and providers.”

Here’s my problem with that…it’s not about money by and large.  Let’s expand our vocabulary as a community and take this as an opportunity to think about what CGM *really* means for us.  An expanded conversation may just help educate the CGM manufacturers and insurance industry to make changes so that restarting is indeed a thing of the past…WITHOUT sacrificing what we are really after…LESS downtime, LESS hassle, MORE reliability for our MEDICALLY NECESSARY equipment.

I’m a bit tired of the “restart conversation” being boiled down to money so very often.  Yes, money is a factor.  But…for so many of us…money is not the primary driver.  The real driver is about redundancy, dependability, and flexibility in our medically necessary equipment.

Medically necessary or Helpful tool?

Do you feel like your insurance understands how valuable this CGM is to you?  Or dexcom?  Do they understand?  Framed another way, do you think that insurance/dexcom kind of view your CGM as a “helpful tool” vs a “medically necessary” device?

For many in the community, we view this as a medically necessary device whereas insurance/dexcom view this as a helpful tool.  There’s a BIG schism between us and our supplies as a result.

Insurance approves, and dexcom builds, a CGM system that has gaps in my BG coverage.

  • A mandatory minimum 2-hour window without BGs.
  • Prescribed supply chain that has zero tolerance for inevitable equipment failure or travel.
  • No opportunities to take steps to provide a backup plan for truly CONTINUOUS glucose monitoring.

Why is that supply chain setup like that?  Because CGM is still widely viewed by outsiders as a “helpful tool”.  But, those of us on the inside of managing this disease who choose to use a CGM…it’s actually a medically necessary device.  CGM has shaped how we live our lives, and allowed us to live a life more closely mirroring those of our non-pancreas-challenged friends.  That’s not selfish or asking for too much…it’s actually also a good business decision for the medical community.  Win-win.

With the approval of the G6 for no-finger-check management decisions, this means more people are relying on the device for their medical safety.  Blood glucose meters are left behind more often.  BGs are checked quickly on a phone or watch so that other life decisions can be made more quickly.  Travel has become a bit less intimidating.

So yeah…it’s medically necessary.  It allows my daughter to not have to restrict her life or “take the blame” for having a disease…but rather she can be protected medically as she leads a normal life.  She can do the things that otherwise might be so difficult to traditionally manage BGs during (trampoline parks, long backpacking trips, stressful job situations) without having to put herself into medically-dangerous territory.

The Diabetes Burden

Living with diabetes brings all sorts of burdens…not the least of which is managing all the situations that you need to plan for backups.  Backups upon backups upon backups.  Because you can’t be at the beach one afternoon and tell diabetes “hey, I forgot to pack the glucagon this one time, so give me a hall pass today, ok?”  I wish it worked like that.  And you know what?  A person with diabetes shouldn’t have to be any more perfect than their non-diabetic friends.  They forget things too…it’s just not life-threatening when they do.  And a person with diabetes shouldn’t be blamed when things go wrong with all the spinning plates they manage…it’s just life that a plate falls once in awhile.

Let’s expand our thinking…in an ideal world, how could your diabetes burden be lifted if insurance/dexcom viewed the CGM as medically necessary?  Prescriptions could be written and filled so that you could:

  • have an extra sensor/transmitter in your work desk…no longer need to leave work because your CGM failed and you don’t have enough supplies to keep duplicates at home/office.
  • travel for an extended period without wondering how you are going to get your supplies while in the jungles of Costa Rica, for example.
  • have access to enough supplies that you could wear overlapping sensors to provide redundancy and overlap.

What’s your “Why”?

To end the “restart discussion”, we need to open the discussion about WHY we restart sensors.  It is not about money.  We do our community a disservice when our articles only discuss this as a factor.

It’s about being able to depend on a medically necessary device.  And a medically necessary device needs to have a robust backup plan and solid supply chain.

My “why” is because I am filling that gap.  Exactly 30-day supply leaves no room for error.  It doesn’t have to be like that.  There are things that the industry can do, if they can shift their thinking away from this restart issue being about money.  It’s about a medically necessary device in my daughter’s life and I need it to have backup and continuous operation.

As I sit on the phone now with Dexcom because our G6 sensor has failed (bent wire when it was inserted last night) and I have no G6 sensors on the shelf (it was the third in our box of 3 for the month…next one doesn’t ship out for 2 days)…I’m reminded of my why.  I’m filling a gap that doesn’t have to be there.  I should’ve been able to pull this sensor hours and hours ago when I knew it was bad and simply replaced it.  Instead, we’ve absorbed the burden that doesn’t need to be there simply because I have no backup on a shelf and I’d hoped a miracle recovery would’ve been possible.  We can do better than simply calling this a “money” issue.  It’s our medically necessary device that allows her to live a normal life safely. Today will be a medical burden and it didn’t have to be that way.  A small shift in thinking could make this go away and I wouldn’t ever have to write another post about restarting sensors.

 

Please share your why in the comments.  Please…I’d like to have this conversation.  It’s important.

Restarting G6 sensors and transmitter

{starting note:  Added video for Option 1 and Option 4}

“10-day hard stop on G6 sensors.” – love, Dexcom

Did that one thing alone stop you from considering the G6?  Well, good news…you can actually restart the sensors (and the transmitter).  The only thing that stops at 10 days for sure is the “no-calibration” aspect of the G6.  That part goes away no matter how you choose to restart a sensor…and probably should as no studies are published for how long the G6 self-maintains calibration after 10 days anyways.   Actually have had some success in no-calibration restarts using the code now.  Just working on determining the correct combination of steps to reliably reproduce that.

There are four ways to restart a G6 sensor, listed below from easiest to hardest. (Technically, Options 1 and 2 (and to a lesser degree Option 3) are so much easier than Option 4…that it’s almost not worth mentioning Option 4)

  1. Use the G6 receiver to restart
  2. Use the phone to restart (without receiver)
  3. Use the resetTransmitter app
  4. Remove the transmitter from the sensor

Let me just get this out there early (and I’ll repeat it throughout)…the key to doing either Option 1 or Option 2…YOU WILL NEED TO FINISH THE RESTART PROCESS BEFORE YOUR 10 day SESSION EXPIRES.  Don’t wait for the “you have 2 hours left in this session” notification…by then you are already too late for Option 1 or 2.  Technically, you need to (1) start at least 2 hours and 10 minutes before the 10-day session expires and (2) finish the restart process before the 10-day session expires…if you don’t you’ll be forced to use Option 3 (and that can take some time for the first time user).  SO…my piece of advice…set a timer, calendar appointment, or task so that on the morning of the 9th day (or sooner) you start the process.  That will buy you a little bit of nice breathing room on the timing of everything.  There’s no reason to wait until the last minute to do this process…day 7, day 8, day 9…they all would work.  If you like routine like my family does…EVERY WEEKEND we just do this process sometime during the weekend.  That way we aren’t hurried, I’m not watching the clock, and it becomes an easy routine, and we never bump-up against the 10-day deadline.  (We use Option 1.)

If for some reason you didn’t get a chance to prepare for Option 1 or 2 far enough in advance of the 10-day expiration, then you will need to use Option 3.  Said another way: Option 1 and Option 2 have a two hour and 10 minute process minimum to finish and if your sensor session expires before you finish, you will be forced to use Option 3 or 4 (or just put on a new G6 sensor).

So let’s discuss each of the processes in detail.

Option 1: Use G6 receiver

This is the easiest and preferred method because you don’t have to lose BG data during the restart process.  You can just keep looping (if you are a looper) and watching BG data on your phone, Nightscout, and Follow apps the whole time.

REMEMBER TO START THIS PROCESS AT LEAST 2 hours and 10 minutes before the session is due to expire.  Giving yourself at least an hour extra is even better…so at least 3 hours before would be great!  We do this process every weekend just so we don’t have to track the timing.

  1. In your Alerts settings for the receiver, it’s a good idea to turn off the “signal loss” alert during this process.  Your receiver is going to have signal loss for two hours and it would be annoying to hear that alert for the whole time.  Just a good idea before you get started.
  2. Watch the receiver get a fresh BG value.  Usually this happens just seconds after the phone app gets a new BG.  During this process, the transmitter and receiver briefly talk and then disconnect from each other for the next 5 minutes.  We are going to use that disconnected state to our advantage to restart the sensor.
  3. Wait about 15 seconds or so after the new BG value came in and then press the “Stop Sensor” option ON THE RECEIVER (not on the phone).  You’ll be told “Are you sure you want to stop your sensor?  It cannot be restarted, a new sensor is required.”  Answer Yes.  You’ll see a little progress bar go by for stopping sensor.
  4. On the screen that appears after the progress bar, press New Sensor.  You’ll be promoted to choose between “No Code” or “Enter Code”.  You can choose either.  If you choose to “Enter Code”, go find your code from when you originally inserted the sensor (the one printed on the adhesive cover of the sensor).  Contrary to early rumors, not all the sensors in a box have the same code. That code is the calibration code for the particular sensor wire that sensor is using.  If you don’t have that code saved, go ahead and choose “No Code” (don’t just randomly use the code from a different sensor in your supplies).  Realize, no matter which option your choose, YOU WILL BE PROMPTED FOR A CALIBRATION EVERY 12 Hours WITH A RESTARTED SENSOR (even if you have the code entered).  [Note: I have since had some sessions restart without a calibration request if I used the code again…I’m working on understanding what factors determine the calibration requests at restart…stay tuned.]  If you don’t enter a calibration, the sensor session will keep going and you’ll get a second reminder at 20 minutes.  If you don’t calibration then, you’ll get a reminder every 5 minutes…but the sensor session will keep going (just like with the G4 and G5 systems).
  5. After you finish with the Code entry decisions, you’ll need to press the “Start Sensor” button that will appear on the receiver.  You’ll see a “starting sensor” progress bar for a few seconds and then the 2-hour sensor warmup countdown circle will be displayed on the receiver.
  6. From this point forward for at least two hours…you need the receiver to NOT COME INTO COMMUNICATION WITH THE TRANSMITTER.  There are several ways to do this, some ideas:
    • Put the receiver in the microwave.  The microwave blocks the communications between the receiver and the transmitter very effectively, just make sure you don’t turn on the microwave during the 2+ hours you’re waiting, or
    • Put the receiver in a faraday bag (costs less than $10 and it can act just like the microwave, but a lot more portable and easy to manage), or
    • Put the receiver “far enough away” that it stays out of range of the transmitter.  Neighbor’s house, the corner of your backyard, etc.  Just so long as it is far enough away that the transmitter and receiver won’t accidentally talk to each other during the 2+ hours of waiting.
  7. During this 2+ hours of waiting, the receiver will have “signal loss” message.  That’s a good thing.  Don’t worry about that.
    • You can wait longer than 2+ hours without a problem…so long as you don’t wait so long that the sensor session expires on the phone while you are waiting. I’ve forgotten and waited 12 hours before…it still works so long as the session on the phone was still going.
    • Also during this 2+ hours of waiting, you’ll have BGs on the phone app uninterrupted.  Your Nightscout site, dexcom follow app, dexcom G6 app, and Loop app (if you use it) will all continue to work as usual.
  8. After waiting 2+ hours at least (I usually go at least 2 hours and 10 minutes just in case), bring the receiver back into communications with the transmitter.  Within 5 minutes, the receiver will connect with the transmitter again.  And then 5 minutes after that, the receiver and phone will magically light up with the “enter 2 calibrations” request. [NOTE:  sometimes you will just automatically get the session started back up again without the 2 calibration requests if you used your code to start it again.  I’m not yet certain what combination of events determine whether you can always reliably have a no-calibration start…but I’m working on that.]
  9. Enter the calibrations in both the phone and receiver at the same time.
  10. Congrats, you’ve just restarted your G6 sensor session.  Your newly started session will expire 10 days from the time that you did Step 5, so plan ahead if you are going to do any subsequent restarts.

If you want to see a video I did using the G5 (similar process to the G6 described above) using a microwave…check it out here.  I will make one for the G6 specifically soon.

Here’s the video for the G6 Option 1

Option 2: No-receiver restart

For non-US residents, sometimes you can purchase the G6 system without the receiver.  So while you can still restart the sensor session without it, the disadvantage (vs. using Option 1) is that you will not see BGs for two hours during the restart process.

REMEMBER TO START THIS PROCESS AT LEAST 2 hours and 10 minutes before the session is due to expire.  Giving yourself at least an hour extra is even better…so at least 3 hours before would be great!

  1. In phone’s bluetooth list (in iPhone Settings), “forget” the Dexcom transmitter ID.  In fact, “forget” all your old Dexcom transmitters if you don’t regularly delete them.  Old ones don’t need to be saved.  By forgetting the Dexcom transmitter, we are preventing the transmitter and app communications during the restart process…and that’s a good thing.  We don’t want them paired during the 2 hours.
  2. Go to G6 app on the phone and “stop sensor” from the Settings menu. You’ll be told “Are you sure you want to stop your sensor?  It cannot be restarted, a new sensor is required.”  Answer Yes.
  3. On the screen that appears after, press “New Sensor”.  You’ll be promoted to choose between “No Code” or “Enter Code”.  You can choose either.  If you choose to “Enter Code”, go find your code from when you originally inserted the sensor (the one printed on the adhesive cover of the sensor).  That code is the calibration code for the particular sensor wire that sensor is using.  If you don’t have that code saved, go ahead and choose “No Code” (don’t just randomly use the code from a different sensor in your supplies).  Realize, no matter which option your choose, YOU WILL BE PROMPTED FOR A CALIBRATION EVERY 12 Hours WITH A RESTARTED SENSOR (even if you have the code entered).  [Note: I have since had some sessions restart without a calibration request if I used the code again…I’m working on understanding what factors determine the calibration requests at restart…stay tuned.]  If you don’t enter a calibration, the sensor session will keep going and you’ll get a second reminder at 20 minutes.  If you don’t calibration then, you’ll get a reminder every 5 minutes…but the sensor session will keep going (just like with the G4 and G5 systems).
  4. After you finish with the Code entry decisions, you’ll need to press the “Start Sensor” button that will appear on the screen.  You’ll see a “starting sensor” progress bar for a few seconds and then the 2-hour sensor warmup countdown circle will be displayed on the phone.
  5. Wait at least 2 hours, but not so long that the old sensor session will expire during your wait.  If the old session expires before you finish the remaining steps…you’ll have to move onto Option 3.
  6. Your G6 app will also likely switch to display “signal loss” during this time.  That’s good, too.  If any pairing messages come up for the transmitter, say no.
  7. After the 2 hour wait, restart the phone (hold down the power button and slide to turn off the phone).  Open G6 app. This will trigger the phone to try to re-pair with transmitter.  Accept the pairing request now that you’ve waited at least 2 hours.  If you don’t get a pairing request within 5 minutes of the restart, you may need to restart the phone one more time.
  8. Within 5 minutes of re-pairing, you’ll be greeted with two calibration request and a new sensor session.  Enter the calibrations and you’re good to go.

Option 3: Reset Transmitter

The last resort for restarting a G6 sensor session, Option 3 should be saved for when you’ve accidentally lost track of time and won’t be able to finish Option 1/2 before the 10-day clock runs out.  It’s not because it does anything bad…it just takes a bit of manual hassle and more technical effort than Options 1/2.

  1. Build the ResetTransmitter app as described in my blog post here.
  2. Make sure your G6 session has ended.  You cannot be in an active session for a transmitter reset.
  3. Go to your iPhone’s Bluetooth area (in Settings) and “forget” the Dexcom transmitter.
  4. Close the Dexcom G6 app (double tap home button and upswipe the app to close it)
  5. Shutdown and restart your iPhone.
  6. Open the ResetTransmitter app and enter your dexcom transmitter ID and press the Reset button.  Within 5 minutes you should get a pairing request to accept.  The reset success message will appear within a very short time after the pairing is accepted.
  7. IF you don’t get a pairing request within 5 minutes in Step 6, restart the phone again.  Double check all the dexcom transmitters have been deleted from the bluetooth list on the phone.  Double click the iPhone home button and make sure the Dexcom G6 app is not open.  Open the ResetTransmitter app again and see if you get a pairing request within 5 minutes.  (The toughest part of this process is getting the transmitter to successfully unpair and re-pair between apps.  Sometimes it takes a lot of restarts and patience…but it does work eventually.)
  8. After the transmitter has been reset, you can reverse the process.  Forget the Dexcom transmitter again from Bluetooth list, restart the phone.  This time open the G6 app and wait for the pairing message to appear within 5 minutes.  Once you get a successful pairing established, you can start a new session on your sensor again by following the normal sensor start process.
  9. As part of (re)starting a new session, you’ll be promoted to choose between “No Code” or “Enter Code”.  You can choose either.  If you choose to “Enter Code”, go find your code from when you originally inserted the sensor (the one printed on the adhesive cover of the sensor).  That code is the calibration code for the particular sensor wire that sensor is using.  If you don’t have that code saved, go ahead and choose “No Code” (don’t just randomly use the code from a different sensor in your supplies).  Realize, no matter which option your choose, YOU WILL BE PROMPTED FOR A CALIBRATION EVERY 12 Hours WITH A RESTARTED SENSOR (even if you have the code entered).  [Note: I have since had some sessions restart without a calibration request if I used the code again…I’m working on understanding what factors determine the calibration requests at restart…stay tuned.]  If you don’t enter a calibration, the sensor session will keep going and you’ll get a second reminder at 20 minutes.  If you don’t calibration then, you’ll get a reminder every 5 minutes…but the sensor session will keep going (just like with the G4 and G5 systems).

Option 4: Remove the transmitter

The G6 transmitter is surrounded by plastic entirely.  The locking wings for the transmitter are located under and inside the plastic ring surrounding the transmitter, making them very inaccessible by fingers.  Therefore, popping out the G6 transmitter is a bit cumbersome, requires some small pointy tool, and frankly would be a little hard to do if you like to wear your sensor on your arm.

Technically, if you remove the transmitter, you can replace it back onto the same sensor (and tape it back down so it stays locked in place, if you’ve busted the hinge point in the process of removing the transmitter).  This would allow you to restart a sensor session on the same sensor.

I’m only mentioning this option for full disclosure of ALL the options…but really this shouldn’t be used.  It’s so much easier to use one of the first three options that this should be considered just an academic possibility.

Video of how to remove the transmitter:

Restarting G6 Transmitter (avoid the 90-112 days Dexcom shut down)

The Dexcom G6 transmitter is just like the G5 transmitter in that Dexcom artificially kills the transmitter by 112 days of use after first activation.  If you’d like to use the transmitter beyond the 112 days, and instead use the transmitter until the end of its battery life, you can use the same process described in my G5-reset-transmitter post.  The G6 transmitter can be reset at any time just like the G5 transmitters.

Reset G5 Transmitter

First, let me preface by saying that I adore, love, respect, and covet my Dexcom system.  It gives us a stability with type 1 diabetes that we would never be able to do without now.  But what I’m about to tell you is a bit of a hack on their system.

There’s been one thing I really have not enjoyed about moving from the G4 to the G5 system about four months ago.  The G4 transmitters were warrantied for 6 months, but usually the battery in those would go for a year…meaning we had the opportunity for much of the transmitter’s useful life to have a backup on the shelf at all times.  If the G4 transmitter failed for any reason, we could pick one off our shelf and not stress about how long it would take to get a new one.  Overseas travel and 2-week long diabetic summer camps were not a big deal…we could pack a backup.

Then we switched to the G5 system at the beginning of this year so that Anna didn’t have to carry a receiver while she did track team workouts.  This dramatically improved the likelihood that she would stay in good BG range during workout because our DIY loop system would have BGs available the entire workout to help her insulin needs.  If Anna had to carry a receiver during track workouts, that would’ve been the straw that broke the camel’s back in terms of diabetes gear she was willing to manage.

So, we’ve loved the G5.  It has worked well; not really having any problems with signal loss, BGs are accurate, we have enjoyed Clarity reports.  All good EXCEPT those G5 transmitters being shut-off by Dexcom  at 112 days.  At 90 days, you get a warning and your warranty is up.  At 112 days, your transmitter is artificially shut-off even though the batteries have some useful life left.  How much life?  Well, that depends, but for most users it is about a couple more months of life.

The problem with this system is that my insurance covers 2 transmitters in one order every 6 months.  So, for the first 90 days (3 months) after a transmitter order, I will nicely have a backup sitting on the shelf in case things go wrong.  BUT, for the next 3 months, I will have no backups on the shelf.  If that second transmitter dies early, I would have to wait for Dexcom to send us a new one.  If we were overseas or traveling, this could be very inconvenient.  I definitely won’t have one to send with Anna to her 2 weeks of summer camp based on how I can forecast our insurance refills already.

And here’s the really great news.  You can now reset the clock on that 112 day shut-off by building your own iPhone app.  This doesn’t buy you heaps of extra time…as the battery will only go for about 2 more months (maybe even less?) past 112 days…but that could be just enough time to start to be able to keep a backup transmitter on the shelf for longer between orders.

Another really good plus?  You can use this reset on G5 transmitters that have had their batteries replaced AND still use the Dexcom official app…you won’t have to try to use a different app (like Spike-App or X-drip+).

HOW TO BUILD RESET APP

What you will need:

  • iPhone (iOS 11.0 minimum)
  • (this may also work on iPod…but I haven’t tested it yet)
  • Apple computer (macOS 10.13.2 High Sierra minimum)
  • Xcode 9.3 (newer versions will work too…blogs are bad for “current” version references lol)
  • Apple ID email

Check to see if you need to update your macOS based on the version of iOS you have.  You can check your macOS by clicking the apple logo in your computer display’s upper left corner and selecting About this Mac.   If you are due for an update, click the Software Update button.

Download and install the app called Xcode from the App Store on your computer.  When the installation is finished, open Xcode by double-clicking on it from your Applications list.

Note: If this is the first time you are opening Xcode, you may get an initial message telling you that Xcode is installing command line tools.  Please let that run and complete the installation.  Command Line tools are a needed installation.

Go to the Xcode menu on the top of your screen, and click on Xcode and then Preferences...

Within Preferences, click on the Accounts tab and then the + button in the bottom left corner to add an account.  You are going to add an Apple ID type account.

Enter in your Apple ID email and password.  This process automatically makes a free Apple Developer account associated with your Apple ID email.  The account will show up in your Xcode preferences now with your name and (personal team) as a suffix in the name.  Once your account is added, close the Preferences screen by clicking on the red circle in the upper left corner.

Download the code for the ResetTransmitter app that we are going to build by clicking HERE

Open your downloads folder and navigate to the CGMBLEKit-master folder and then find the file CGMBLEKit.xcodeproj folder.  Double-click on that file and the project will open in Xcode automatically.

Click on the open button when the message appears asking:

“CGMBLEKit” is a project downloaded from the Internet. Are you sure you want to open it?

{Take the time now while the project opens to plug in your iPhone to the computer using your lightning cable.  Please accept any prompts about trusting your computer and unlock your phone so that it stays awake through the build process of the app that we are about to finish.}

Now click on the CGMBLEKit at the top of the left column, and then click on the small box as shown on the screenshot below to show the list of “Targets” below it.  Select the “ResetTransmitter” target.

Now, look at the screenshot above.  See that part highlighted in blue? You will need to change the loopkit part of the Bundle Identifier to a unique-to-you word.  Make sure that when you make the edit, you do not delete the period before and after.

Once you have the name edited, then go down to the Team section and select your (personal team) signing name from the drop down menu selection.  [Note: if you have a paid developer account, you can use that signing name instead.]

After you finish signing, a Provisional Profile will automatically be created and you’re close to done.

If you see a prompt under the status area below the Team about your device not being registered, please click on the Register Device button provided there to register the iPhone to your developer account (see screenshot below).

Now, navigate up to the top of your window and select two things; one from the left side of the box you’re going to select ResetTransmitter and from the pop-out, you’re going to select your phone’s name from the very top of the device list (not just your phone model…you want to go all the way to the top of the list for your phone’s name).


Stop and double check….most common mistake is forgetting to select ResetTransmitter as shown in the screenshot below and mentioned above.  Do not leave the selection on CGMBLEKit…if you do, your app will build properly nor will it appear on your phone.


If your phone/device name has (untrusted) after the name (see screenshot below), please open the phone and click on the Trust button that should appear on the main screen.  If the (untrusted) tag hasn’t disappeared after that, just unplug and replug the phone into the computer.  That should get rid of the (untrusted) tag.  If you try to build an app onto an “untrusted” device, you’ll get an error message reminding you to do the steps above.

When you’re done, the screen should look like the screenshot below; ResetTransmitter on the left, your phone’s name on the right, and no red error messages under the signing team area.  If your screen looks correct, then go ahead and press the build/play button.

Depending on if this is the first time you’ve built on Xcode, you may get prompts for codesign access and keychain access.  If those prompts appear, please enter your computer’s password and click on the always allow button to confirm.

Also, if this is your first time building with this developer account onto your iPhone, you may get another warning that the app could not launch because an issue with trust on your Developer Account on your phone.

Follow the directions on the warning.  Open your iPhone Settings >> General >> Device Management and then select your Developer App certificate and trust it.

Once you click the Trust on your iPhone, go back to Xcode, click on the blue OK button for the warning and then press the build/play button one more time.  This will finish the build of the app onto your phone.  Success!  You can unplug your phone from the computer and use the app now.

 

USING THE RESET APP

There is some warning messages in there about the use of this app.  When the app was first written, the code writers were uncertain how Dexcom Share and Clarity servers would treat information coming from a clock-reset transmitter (i.e., would data still be uploaded properly). The app has been in-use by many people now and the Share and Clarity services are, thankfully, not impacted by the reset transmitters.

You cannot reset a transmitter that is currently in a session and/or paired with Dexcom or Spike, or any other device/app.  So, stop any currently running sessions, and quit the dexcom app.   Forget the transmitter from your iPhone’s bluetooth list.  Forget all Dexcom transmitters from the list…no reason to keep old ones that you aren’t using anymore anyways. Re-open the ResetTransmitter app, enter your Transmitter ID and press the red Reset button.  Within 5 minutes you should get a pairing request.

If you do not get a pairing request and instead see a message “Unable to parse auth challenge: timeout” that means your transmitter is still busy with another app.  Double-click the iPhone’s home button and scroll through the open apps.  Upswipe on the Dexcom and the Reset apps to close them.  Restart the phone, re-open the Reset app, enter in the transmitter ID again and press the red Reset button again.  Within 5 min you should now see a pairing request.

If you STILL don’t see a pairing request, some users have reported that turning off Dexcom’s cell data within the iPhone Settings >> Dexcom G5 app can also help release the transmitter from Dexcom app’s influence.  If that fails…you can try deleting the Dexcom app and reinstalling it at the end of the reset process.

If you still don’t get a pairing request, make sure the transmitter is within pairing range of the iPhone (but not in active session).  The Reset app needs the transmitter close enough to be able to pair with it in order to reset the clock.

Once you press the pairing request, the reset command is immediately issued and you should get a confirmation screen like below:

You can now close the Reset app (double-click phone’s home button and upswipe Reset app) and forget the transmitter in the iPhone’s bt list again.  Reopen your Dexcom app and you’ll be able to use your transmitter for another 112 days or until the battery gives out…whichever comes first.

The free developer account that you signed the Reset app with only allows the app to be used for 7 days.  After 7 days, the app will simply produce a quick white screen and self-close if you try to open it.  You can rebuild the app anytime after the 7 days to use it again.  Simply double-click on the file in your CGMBLEKit folder download to open the project in Xcode again, plug in your iPhone, and press the build/play button.  All your previous changes will have been saved, so the rebuild is quite easy.

You can reset any amount of transmitters.  The app does not know transmitter ownership, nor does it have a limit on how many times you can use the app to reset transmitters.

The transmitter does not have to be on a sensor in order to be reset, just needs to have battery life left and not be paired already with another app.

Fiasp Day 17 update

Our Fiasp experience started October 11th.  Here’s what I was expecting:

  • increased insulin resistance
  • fast insulin

Optimistically, we gave our first Fiasp bolus.  Full of excitement.

fiasp1

After 24 hours, here’s how I summarized our experiences:

fiasp

1. If Anna started to rise with pretty significant IOB, I adjusted basals up. The last adjustment was leveling out beautiful, then started to climb for three consecutive readings about +3 or +4 each time, but the important part is that it was happening with 1.8 u IOB. That means she was really short on basals since it was nearly 3 hours after she had last eaten.

2. Also, she climbed more than 150 mg/dl from eating one single uncooked spaghetti noodle. Do I really think that was all noodle? NOPE. Definitely another sign that basals were too low. Shouldn’t be spiking that bad from small food.

3. Only one adjustment was to lower basals…when she had dropped significantly and had negative IOB. That was the adjustment right before the steady line at night. I had apparently gone too far with the earlier basal increase.

4. We prebolused the first meal by about 8 minutes I’d say. A peanut butter sandwich that she overcounted carbs on. That’s the only low we corrected on this graph. (Fiasp rebounds quickly from inadequate basals). Tonight’s sandwich is the same meal, but bolused with a stronger carb ratio, and no prebolus. Looking better.

In short, an awful lot more insulin needed almost right away. Like A LOT more. BUT, the no prebolus thing is real. And Loop’s fiasp curve is working better and better as I get my settings better fleshed out.

We had a couple good days, but then things started to get a little worse for wear around day 4.  We were having an awful time of:

  • volatile BGs, more lows to treat/more highs to stare at and wonder
  • fast insulin
  • insulin sensitivity
  • frustration with looping
  • distrust of looping (both Loop and OpenAPS, I tried both)

Our days just got progressively worse.

fiasp2

Then on the evening of October 18th, we just had a lot of stubborn lows and I was sick of spending so much time on diabetes again.  We were treating a lot of lows in advance on those graphs.  I had a choice between throwing the Fiasp into the trash (considered mailing it to a friend but wondered if that would even be considered “nice”) or *gasp* suck it up and go back-to-basics.  I opted for back-to-basics…aka open loop test all our settings.

fiasp3

It didn’t take long to find my first problem on open loop.  Notice on the screenshot above, the low near midnight after a manual correction?  WOW, that correction brought her down over twice as much as I’d expected and I needed to treat a low.  Basals were too strong and I suspected my ISF was way off, too.  I lowered basals as I treated the low but didn’t adjust ISF at the time (after all, I was still open looping so ISF wasn’t actively being used other than by my brain if I wanted to do a correction).

For two days, I opened my loop so that I was in control.  I tested basals, tested ISF, tested carb ratios, watched my IOB, and watched Loop predictions during all of this.  Things got better pretty fast.  After a day and a half, things had smoothed out quite a bit with a lot of adjustments.

IMG_7132

The screenshot above shows a few things I learned.  That dip at middle near noon…Anna’s PE class.  She is very sensitive to her lunch bolus since PE comes right after.  We are still working on that.  It’s not a fiasp issue, per se.

But, the more subtle observation?  See the Loop prediction?  Loop was predicting that she would start coming back up around 12:30pm.  But instead, she was still heading down.  This started me wondering if either my carb ratio was still too strong, and/or if I needed to maybe shorten our default carb absorption times.

It became pretty obvious that my carb ratio was still too strong in the next few meals.

carbratio1

Basically after two days of open loop use, I learned that my basals had been too high, my ISF had been too weak, my default carb absorption times needed to be lowered, and my carb ratio was too strong.

The odd part to me was that you’d think that with all those indicating that I would need less insulin…we would’ve only been battling lows while closed looping the week before.  But, we weren’t.  We were fighting lows and highs.  I think that all the suspends to keep us from going low were leading to some strange rebounds with fiasp.  It was really hard to see through all the looping noise to figure it out though.

In the end our average numbers by comparison have ended up as:

  • Novolog: ISF = 40, Basal = 1.0, Carb ratio = 7.5
  • Fiasp: ISF = 58, Basal = 0.85, Carb ratio = 10.5

Our settings now are working much better.  We closed loop again and are happily looping on Loop.

IMG_7335

Other than the standard things we learned on open loop regarding basals, ISF, and carb ratio…we also decided to shorten the 1.5x carb absorption multiplier that is default in dynamic carb absorption.  Basically, we shortened our default carb absorption buttons to 1, 2, and 3 hours for lollipop, taco, and pizza.  Other than that we are using the standard Loop settings.

Why did I adjust the default carb times?  Because of the way Loop calculates bolus recommendations, the quicker peak time of Fiasp will predict an early low after eating meals compared to a similar meal with Novolog.  So, even if everything else is equal, a meal bolused with Fiasp will tend to get less of a bolus typically for an average meal than a bolus with novolog in Loop, and this effect gets more pronounced the longer the carb absorption is entered.  Therefore, that 1.5 multiplier will tend to lower the recommended bolus even more.  What we found happening was a smaller upfront bolus would be followed by a high temp/high BG, and then we would crash later as the later carbs (from the rest of the 1.5 multiplier area) wouldn’t be there to support the earlier high temps.  So the upfront and later parts of the meal were being affected by the multiplier. (*screenshot from a pizza meal below and part of this screenshot was also affected by our settings still not being tuned, so take it with a grain of salt.)

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On novolog, we never had this issue I suspect because the peak time of novolog was so slow that dynamic carbs had enough time to adjust the predictions before the high temps came on and couldn’t be recovered from.  And we prebolused a lot, so the insulin was pretty active by the time she ate to help prevent spikes.

So, in summary, I’m stoked on Fiasp.  It’s been great now.  BUT, it didn’t behave like others had experienced…so keep your mind open.  Perhaps we will find resistance later, after longer use.  If we do, I’ll be sure to document.  And, if you find yourself slumping into confusion initially with the change from novolog/humalog…don’t be afraid to open loop to get your feeting solidly beneath you again.  A day or two of open looping can save you from wanting to poke eyeballs out.  And, sadly, some meals can still really benefit from a 5-7 min prebolus even on Fiasp.  The really fast carbs are still faster than Fiasp.  Simply announcing those carbs won’t be enough for my teen’s fast digestion.  We are learning which foods need prebolus and for how long…but the list is A LOT SHORTER than with novolog (novolog list included just about everything but water and ice).


Side note (because I also love the not-perfect-examples, too): Fiasp still doesn’t save you completely from a really poor carb count and a busy teen.  Example, she ate 20g uncovered just before I picked her up from karate.  I didn’t know that and she was just distracted.  We almost immediately went to In-n-Out where she scarfed a double-double with a HUGE french fries basket.  We were way off on carb counts (originally this graph only had 80g on it because I didn’t know about the previous 20g and I didn’t know she was getting fries, too).  We adjusted carbs a couple times as I found out about things…and gave the suggested corrections as we adjusted.

But, the recovery from such a bad carb count, no prebolus, and eating 20g without any bolus for that portion…really quite fantastic and quick.  3 hours after that meal was eaten we are recovered…and I don’t think we would look like this with novolog.

oops

(As with all things, don’t take my word as gospel on Fiasp.  I’m still experimenting. YDMV.)