Hey everyone. Before we get into today's episode, we've got a quick update to share. You might have noticed things look a little different. That's because "Real Time, Real Talk" is now called "GlucoseTech." While the name has changed, everything you know and enjoy about the podcast is staying the same. You'll still get the same conversations, the same expert insights, and the same technology shaping diabetes care. This new name simply streamlines branding at Dexcom. So if you see GlucoseTech in your feed, don't worry, you're in the right place. Thanks as always for listening. Now let's get into the episode of GlucoseTech. Welcome to GlucoseTech. This is a podcast dedicated to US-based healthcare providers treating patients with diabetes. I can't tell you how many texts I received about, "Can I eat this? Can I eat that? What do I do now?" And now I don't even get those texts. I still have those patients who have my cell, but even my new ones, I say, "Here's my phone," and they don't contact me because the Dexcom tells them what they need to know. So I honestly feel like the burden is alleviated or mitigated with this rather than making it greater. But I tell people I'm like Cherlock Holmes, like, "I literally know what you did minute to minute during your day." I said, "Do you eat breakfast at 7:30? And then you probably eat lunch around 11:00." And it's like, "How did you know all that?" I said, "It's on your Clarity report. It's on your Dexcom."
Welcome back to GlucoseTech. I'm Cher Pastore. Today, we're going to be talking about something that HCPs ask me about a lot. How do I implement continuous glucose monitoring into my practice? So how do you really make CGM work, especially in a primary care setting? Implementing continuous glucose monitoring can sometimes seem overwhelming. How do I get my patients connected? What do I do with all of this data? How can I really get this started? So today, we are going to walk through, step by step, how you can implement CGM into your practice. We have a special guest today, Dr. Swamy. She's an endocrinologist. She's been using continuous glucose monitoring in her practice for a long time, and she's going to give you her expert tips, and she's going to let you know just how you can get started using CGM. Welcome, Dr. Swamy.
Hi, Cher. Thank you for having me on. I'm really excited to be here. Hello, everybody.
Welcome. Okay, great. So Dr. Swamy, before we get into our real episode, just tell our listeners, because they don't know you, but I know how great you are. So just tell our listeners a little bit about yourself, about your practice, and how you got started using CGM.
Sure. So I am a pediatric endocrinologist. I won't share my age, but I've been doing this for a very long time. And I'm the medical director of what's called the Chicago Children's Diabetes Center. I'm part of a larger academic institution, and our clinic is actually quite demographically varied. So we have a clinic on the South Side of Chicago where the majority of patients have Medicaid, and then we have clinics offsite in a different state, actually, and those are mainly private pay. And the reason I bring that up is it is so very different in setup, payer mix, everything, and their knowledge base and ability to do it. But I think universally, regardless of that, Dexcom works.
I love it. So does that mean you had to set it up differently in these different places?
No, we have a central hub where we did it.
Okay. But I think what the expectations from patients were different when we went in, and we realized it was so simple and easy, it actually didn't matter. So what we thought might be an issue wasn't.
I see. And to give a little bit of background, and to be fair, I also wear a CGM, so professionally, this is my life. I actually only manage patients with diabetes, by choice. And personally, my entire family has type 2 diabetes, so this is my Stelo. Hopefully it won't go off while we're having this podcast. I might have eaten a Trader Joe's caramel. But yes, I very much believe in the power of CGM in our lives, and I think it's completely metamorphosized the way I live my life.
I love to wear CGM also. I don't have it on right this minute, but I do love mine. Okay, so now maybe tell us, when did you first start seeing the power of CGM in your practice, like with your patients? Because I know you've been using it for a while. I know you do see a lot of patients with type 1, so maybe tell our listeners how you just got started.
Sure. So my exposure to CGM was actually over 20 years ago when it was first coming out. I was in a training institution where we saw a lot of patients with diabetes, and now I manage a clinic where we have close to 1,000 kids, and actually adults, we go until about age 25, with diabetes. And we were really waiting for the official approval, so 2018 is when Illinois Medicaid approved it for the Medicaid population. So since then, nearly everybody in our practice has it. I would say about 98% of our patients are on CGM, and maybe 98% of those are actually Dexcom. And so, I think it's something that I can't do medical management without. So I tell my patients, "This is a tool that makes me a better doctor, and if I don't have it, I don't feel like I'm giving you what you need."
I felt the same way. So I came from practice as a dietitian diabetes educator, and it was like if people would come in, sometimes they would have glucose readings, sometimes they wouldn't. Yeah. And I would say, "Okay, can you put this on?" We'd have a sample, and I'd say, "Can you put this on? Wear this for seven days, come back, and let's look at your data." So yes, I completely know what you're saying.
And I think just to what you're saying, Cher, is how did I get started? So I'm about five feet tall, but I tell people looks can be deceiving, so I'm kind of a bully when it comes to technology. And I love my patients. We have to have a relationship of trust, right? So I say, "Do you trust me? I'm just going to put this on you, and I promise you that you're going to like it better than 40-something fingersticks a week." If we come in saying, "When are you ready for this?" If they don't know, I don't think that people are going to be ready. So the onus is more on us to say, "Here's what we're going to do." That's what I do, and that is what my entire staff does. So we just put a CGM on as if it is part of their diagnosis. So the minute they're diagnosed with diabetes, whether it's as an inpatient or outpatient, they get a CGM. Okay. And it's not even a discussion, honestly.
Now, Dr. Swamy, I just want to ask you, what if we have some people that are listening to us out there who primary care is their specialty, and they might have patients who have type 2 diabetes who may or may not be on insulin. Would your view change at all? Do you feel as though knowing everything that you know about how much CGM has helped your patients, would you say anything differently?
I would even be more aggressive. I think that we treat type 2 too late, and we're treating it once you hit a certain A1c, and we call it type 2. But I tell everyone, this is a spectrum. It's not like your glucose goes from 124, and you're perfect, to 126, and here you have a diagnosis if we're talking about a fasting or an A1c. It's all a spectrum, and there's just a higher risk as we get older, and especially if you have the genetic background that I do. We have over 100 people in our family with diabetes. So I think it should go even further. We should be encouraging people to use this before an official diagnosis of type 2 diabetes because maybe, just maybe, I can do the things I need to to avoid that and to avoid all the complications that occur as a result of it.
Yeah. So I just want to tell all our listeners out there that we have a product, Stelo, which is for people who have prediabetes. So we do have a product that covers that, too. And I'm glad that we talked about that. I'm like a van. Sorry. Just showing my Stelo. I actually had to change it, so I just put it on. I'm glad we talked about that because I don't want our listeners to just think, oh, it's only for our patients or people who have type one diabetes or who are on insulin, because I think you just really elucidated why it's for anyone who might have any kind of dysglycemia really. 100%. Unless you're checking your fingerstick every few minutes after and before you eat, you'll have no idea the impact of these things, not just food, but life and activities and stress and anxiety and events have on your glucose.
Yep. Okay, so now that we have everyone convinced let's tell our listeners really some practical tips, okay? So I want us to walk through. Sure. If you remember, I know you have a particular protocol, if you will, that you follow. So let's talk about your protocol, but let's also talk about how it could apply to someone else if they don't either have the setup, like how would they do it? Okay, so let's start with yours. So tell us how you do it first.
So you heard about my convincing tactics, or rather my request for people to wear one. So I just say, "Here's what we're going to do, so I can be a better provider for you" and then I put one on them, and then I think the ease of G7 is amazing, actually. And so I feel like some of the hesitation that comes from people is because they actually haven't done it for themselves, so I encourage people to try it yourself. And I literally just put one on before we're recording this, and it took me about five seconds. So that's how long it takes. And we walk through with the patient how to do it. And the first time that I did this, I don't even know how long ago it was, I enlisted our entire staff, including our medical assistants, on exactly how to put it on, and I put it on myself. And then when they saw how easy it was, we said, "Okay, do you think that you can help patients who walk through the door with this?" And they said, "Absolutely." And so they did, and they're stellar. And then the second part was sending the data to me and to their loved ones. So we do have them download the apps that are necessary to do that. Now, the beauty of G7 is it's in one app in terms of sharing it with your healthcare team, and that is in Clarity, which is embedded in the G7 app, and also in Stelo. And for the Follow app, if somebody wants their loved ones to follow their data, it's just another app, but it is not difficult at all. So we have them download that at the time of the visit at the first visit. And then we actually just connect them with our clinic code, which is not even a code. There's no numbers. It's the name of my clinic. So once they just enter the name of the clinic, we're done, and then forever I can see this person's data. And we show them how powerful it is by showing someone else's data that's actually anonymized, so that they can see what I'm seeing about this patient who might be hundreds of miles away from me, but I can actually make a clinical decision, and they say, "Oh, wow, you can see all that." And the other thing that I think is awesome is that the warm-up is so short. So whether we're talking about 15-day, which is an hour, 10-day, which is 30 minutes, or Stelo, which is 30 minutes, it's still very short in clinical medicine, so the minute they put it on, they can usually see their data by the time they've left clinic or as they're leaving. And I always get comments going, "Oh my God, I had no idea it would be this easy." And so I've never had someone say, "I don't want this." I've only had people say, "Why didn't you do this earlier?"
So for now, how long would you say that first visit is? Because I think each visit gets shorter, but also probably when you were learning, or your staff was learning, it might've been a little bit longer, right? So what would you say we're looking at now for that whole first visit? Are we talking like 30 minutes? More? Less?
So, in clinical practice, I know everything's challenging. We're all supposed to do more reviews and cram in more stuff. But it is a little bit more than 30 minutes, but I have a team, so it's not my time, right? It is the educator who goes in and does this, or the medical assistant is doing that, so the patient is spending a good hour. And it's also because they have questions, and they're overwhelmed. So we're addressing all of this at once. The other thing we find is a lot of their questions really relate to nutrition, activity, exercise, and how life impacts their diabetes. So I tell them, "Oh, that's great. Guess what I have for you that's going to answer all that, and not just today, but forever." And so I think it really does help us more than it causes a burden. And my best example is the days I did not have CGM. I was in private practice, and I was new out of fellowship, and it wasn't broadly available, so I would give everyone my cell. And I can't tell you how many texts I received about, "Can I eat this? Can I eat that? What do I do now? How do I prepare for working out?" And now I don't even get those texts. I still have those patients who have my cell, but even my new ones, I say, "Here's my phone" and they don't contact me because the Dexcom tells them what they need to know. So I honestly feel like the burden is alleviated or mitigated with this rather than making it greater.
I agree. Let's try to tell some of our people listening to us, specifically, do you need a tech champion? If so, could it be your medical assistant? But if the person does have more support, then maybe one person puts the device on, and maybe one person downloads the report. Tell us in your practice, now I know you have a big setup, so does one person do one thing, and the other person does the other thing?
Honestly, it's our medical assistant and our nurse educators. So we just kind of take turns depending upon who's in a room and who's free. But any of us can do it, and so I think sometimes we hear the words tech champion, and it becomes a bit daunting. In my 50s, there's nobody else that would call me a tech champion in my family. But for Dexcom, I am because that's how easy it is. And so I tell people my medical assistants can do all this in about five seconds. I mean, they're so much faster than I am. So it is really them, and they are the first point of contact. Right. So what they do is put it on. I say, "Oh, you don't have one. She's going to want you to wear one. Can I put one on you?" And if they're hesitant, then I come in and talk with them. But if they say sure, they put it on, they set up the apps, and we're good to go. And by the time I walk in the room, they say, "Oh, we're connected to Clarity, Dr. Swamy, you're all set." And it's fast, it's efficient, and if it's not them, it's our nurse educators.
Okay. So it sounds like there was some initial training up front. Your Dexcom representative, I think you told me your Dexcom representative helped you, trained you and your staff, and then you got that up and running. So a little bit of learning on the front end, but now that it's implemented, it saves you a lot of time. Would you say that? And not just time, but also the ability to help your patients. Oh, 100%. So when we first did this, there was a different app to share Clarity, so it was a little bit more involved. Now with the G7, we don't have that, so it's even easier and much more streamlined. And our Dexcom representative, actually, she essentially lived in my clinic for a little while because I said, "I know the importance of this tool, so I really would love for you to train all of us." And people turn over, so she did that every quarter, and she just sat there until we could get it. And now it's like a well-oiled machine. So I have everybody's data for the day before they walk into the clinic.
Nice. And that's important for not just peds, but also adult medicine because you can figure out what your clinic's going to look like. You can anticipate who needs more help, who needs less help, perhaps is doing well. So it really has changed the way I practice as well.
Yeah. So let's talk about that now. You're an endocrinologist, so you specialize in this, but what if there's some primary care doctors who haven't yet gone down this road, but they want to, how could we help them? What would they look at? Would they just look at an AGP report, the ambulatory glucose, or do you love the overview report? Yeah. Let's maybe say, what are two first things that you look at?
Sure. I love the AGP report. If there's one thing you have to look at, I would look at that. Because it gives you everything you need. It gives me the time in range. It gives me the amplitude, so how much time are you spending in that? So how much variability is there from there? It gives me also the individual days at the bottom for the last, whether it's two weeks or whatever amount of time that you're looking at. It actually shows me the pattern of glucoses on the individual days, so I'm not just getting an average. So let's say we're using two weeks. I can see the average, but underneath it, I'm looking at the patterns for each day. And I think the reason that's important as well is validating the patient's experience because you may see an average that's fairly high. This is usually my pattern where they might have hyperglycemia, but they'll say, "Hey, Dr. Swamy, that's because I went low, and so I changed my settings," or, "I changed my insulin." And I want to validate that without just being like, "Oh, no, it shows here you're high all the time." So if I look at the individual days on the bottom, it actually shows you what the patterns are. So I feel like the AGP really tells the whole story. If I want to dive deeper into it, then I can look at the daily patterns as well, or the trends. But I feel like the AGP, if I have two seconds, that's what I look at. And in fact, I have clinic tomorrow, and before this podcast, I was actually looking at the AGPs on my Clarity reports for my patients, even if they're on automated devices, because I really like the Clarity report. I like it better than what shows up on their automated device reports.
I agree, and I want to go into it a little further, but I just want to tell our listeners, I think about it like, it's kind of like an iPhone, right? Mm-hmm. Like an iPhone can do so many things, but you really probably don't even want to talk to anybody anymore. You really just want to text. Yeah. But it could text, but it could do a lot of other things, too, right? So I feel like Clarity and CGM is like that, right? You could do the very least, which is like reading an AGP and just getting to time in range to significantly deeper, right? Overview, report, trends, patterns. I think now Clarity has 10 reports. So if you wanted to, you could look more. If you don't want to, you don't have to.
Absolutely. And I also think the power of it is teaching the patient, the person with diabetes. Because the world of diabetes, I don't know, 20, 30 years ago, is people would show up, like you said, with a logbook. I can't remember the last time we've really needed a logbook in clinic, right? We have them somewhere in a dusty shelf, but I think that we've really gone away from them coming to me and saying, "Dr. Swamy, what do I do?" to saying, "Oh, I didn't realize I was going high after breakfast every day," or, "I'm really higher after dinner," whatever it might be. They're recognizing their own patterns. So it's the old adage of, give a man a fish, he eats for a day. Teach a man to fish, he eats a lifetime. So one of the things we do is actually show people how to look at a Clarity report down the road as well. So it's not just a healthcare provider tool, but a patient tool, and as a result, I honestly feel like my patients do far better.
Agree. Yeah, and I think you talked about it a little bit before in talking about a rebound high, right, from a low. This is, of course, someone who is likely on insulin, could be on an oral medication, too. But because sometimes a person would come in, and they wouldn't even know that happened, but they were like, "Oh, I'm just high all the time," or, "Oh, I'm just high because I ate something," or, "Oh, my medicine's not working for whatever reason." But then you could look at the data and say, "Oh, no, this is why that happened."
So, you can tell I make a lot of jokes, but I do like analogies because I think they help people understand. But I tell people I'm like Cherlock Holmes. Like, I literally know what you did minute to minute during your day. I said, "Do you eat breakfast at 7:30? And then you probably eat lunch around 11." And they're like, "How did you know all that?" I said, "It's on your Clarity report. It's on your Dexcom." But that is how much I get from it. So no longer am I looking at three random glucoses with like a coffee stain next to it on a logbook, but I'm actually looking at their day and the story of their diabetes throughout the day. And then I might see a precipitous drop, and I say, "Were you exercising then?" Literally it's that detailed. And so they think I'm some kind of rocket scientist. It's really just the Dexcom telling me all of this information.
Yeah. I would say not difficult, but not easy, right? But once you know what you're looking for, then it's pretty easy. Right, now you know. Yes, you've been doing this, so now you're like, "Oh, I know. They ate, they exercised, they did this." Yeah. So I just, I don't want our people listening to be like, "Oh, how did she know that?" Or, "I'll never know that." It's like in the beginning it's like, "Oh, what?" And then you get it.
Oh, yeah. I think you have to correlate it with their life, but once I see a huge rise in glucose, usually I say, "You must have eaten something." If I see a quick drop and they don't know why, I'll say, "Did you work out that day?" So I actually think it is fairly easy. And I feel like when we teach other people, it just takes one report or two, and they say, "Oh, okay." So if I'm doing a presentation or something, they get it right away.
I agree. I love it. So I hope that there are some people that are listening to us out there, and they want to try it, and they're like, "Yes, I'm ready. I'm ready to do it, but I'm so busy," then okay, let's look at who could you get in your practice, or can you find your Dexcom rep? Just take the first step. I think that's the most important thing. I want people listening to us today, just take that first step, start, learn, and then it becomes so much easier.
Yes, we have so many things to learn as providers and doctors, right? We have so many things every day. It is overwhelming. And I sometimes get credit for being an endocrinologist, but I tell people it's because I can't do primary care. It's just too much. I can't fit all of that. So I think that it is important to ask for help for these things. It's not intuitive, but once it's established, it's easy peasy. It really is. I cannot say enough how much it has changed our practice, made it more efficient. It's well reimbursed, if we're looking at lucrative. And also it's made our patient outcomes better. I think they appreciate that, so.
Yeah. Okay, but let's talk about reimbursement. Sure. Okay. Yeah. Speaking of money. What is reimbursable? How do you do it? Just tell us about that.
So if you place a sensor on somebody, that can be reimbursed. Actually, that's a code. If I read a sensor, and I have 72 hours worth of data, and I'm looking at it, I can bill for that. So, it's an MD, DO, NP, PA, all of the above can bill for the 95251 is the code. I've had it memorized. And you can actually bill for it every 30 days. So I think that is the power of that code. So if you are looking at somebody who's not at goal frequently, you don't have to bring them in to look at their data and bill that code. You can say, "Okay, I'm going to look at this every month," and you can actually do it as an encounter. And it is very well reimbursed. So I tell people it's like an RVU, and it depends on your insurance, but it is paid by all of the insurances. In our clinic, it allowed us to get enough reimbursement to actually validate hiring another nurse practitioner. And so for anyone on this call who's in academic medicine, that never happens. So we were very excited.
Yeah. And do you have any kind of other systems set in place? Do you say on Fridays call all your patients back, or is it really just kind of built into the visit itself, or is there any other nuances?
Excellent. Yeah, excellent question. So I think I shared with you, Cher, about 98% of our patients are on this. So for me, it's built into the visits. I look at everyone's Dexcom data before I see them, and then I can bill that code. But in the interim, if they are not at goal, we do ask them to contact us, and if it's been 30 days, and my nurse practitioner's looking at it, then she can bill that code, or they can bill that code. So it's not just me, but it's my whole team. And I think the other thing is that we tell people we should also do it as a standard of care. So if I put someone, let's say, on a GLP-1 who's type 2, right, it's not just about being on insulin, then we might see a significant reduction in glucoses. We might need to modify their doses of other things. And so we'll say, "Let's talk to you in a month and also look at your... your Clarity report so we can make adjustments. So it's any of us, it's not a special day of the week because these things happen any day of the week, but they just reach out to us, and we do virtual clinic as well as in-person clinic. So it lends itself to being able to use this no matter what. And I think, that's important to know, too. Before, if, or still now, if the patient has diabetes and is not wearing a CGM, basically then we're waiting three months, right, for the patient to come back in to look at their A1c, and we know that negative things could be happening in those three months, right? Absolutely. So it's probably really important to get them in in the 30 days as opposed to waiting.
Absolutely. That's what I meant by I'm a better doctor for you, because now I have more stuff to base this on. It's like giving someone an exam. If I never test you, I'm not going to know if you understand this, right? And so that's what essentially the Dexcom's allowing me to see is not just testing, but really are my doses working well? It's really testing us, right? Saying, "Are we doing a good job of managing this person's diabetes? Do they have the resources they need to do this well?" So, I think those people get more attention, the ones wearing a sensor, and I don't think that's fair to the ones that don't, so that's what I tell them.
Yeah. Tell us, I know you and I have talked about it before, but tell us some of your good patient stories. Did you have one person who was like, "Oh, I'm never wearing this. I don't want to wear this." Or tell us. Yes, and then they're like, "Oh my God, I love it."
So, I have so many, you're right. But, I'm going to go to a peds story. This is, God, probably 10 or 15 years ago, at least. I have a mom with a child that was diagnosed with diabetes when he was 2, and I was actually present at the diagnosis, so I feel like I grew up with this kid. He's now in his 20s and in college. And the first, he was an avid football player, but they wouldn't let him do it at school because the parents couldn't be present for him to play football, because they worked, and nobody was willing to check his sugars. And so we put a Dexcom on him the second we could, right, when it was approved, and she sends me a screenshot of him playing football with his glucose, and she's like, "This is a win." And it was because he was wearing it. She's at work, I'm at work, and she said, "Thank you so much." So I think as small as that sounds, it was so impactful because it allowed this child to be a child and do what he wanted, instead of being limited and living in a bubble.
Okay, you have to tell me to shut up because I'm going to keep giving you stories. Another story is, I was doing virtual clinic the other day, and one of my patients said, "Oh, I'm in London." They were on spring break and they said, "I didn't realize it was my clinic visit," so they still showed up because I have weird hours for my clinics, and they were in London. And so it's like the fact that they were allowed to go to London, it's for college, and that they had this amazing experience. Never have I had so many students study abroad or have international experiences for travel. And literally, at the time the person was in London, I was talking to them, he had a low, and while I'm on the phone with him, or the video call, his mom is calling him going, "Can you treat yourself?" So I was like, this is a whole incredible umbrella of safety and support. So he's talking to his doctor, his parents are contacting him, and that is what this has allowed.
Yeah. I know. Is you have a team, you have a village. The world's their oyster. They're not limited. And then finally, I have a family member, I'll tell you a story of an adult who is in her 90s, and she wears a sensor, and the only reason that she's okay to live alone is because I follow her. And I'm the only endocrinologist in practice in our family, which is funny for an Indian family. I was like, "Is anyone else going to be an endo?" But anyway, and she started having hyperglycemia and lives alone, so I contacted her kids, and I said, "Something's up." And so they went to her house, and long story short, she developed shingles. And no one would've known it because she was sleeping, and I only knew it because of her Dexcom. And because her glucose was just high, and so you knew that something was happening. Her glucose was really high, and I said, "There's something going on. We've got to go there." So I feel like the stories are innumerable. I can give you a million. Like I said, it's kind of the reason that we do medicine, right, is these great stories. But, yeah. Yeah. It's really liberated people. Yeah, and I think that's great because those are all different situations, and really all just so powerful of how it can help so many people. Mm-hmm. Yeah. Absolutely.
Before we wrap up, let's give our listeners some very specific things. So if we have someone, like a clinic out there that's listening today, what do you think is one or two, at least one, one thing that they could do tomorrow to start implementing CGM?
Sure. So the first thing is who benefits from it. So I honestly think it's everybody that has a risk for diabetes or has diabetes, but if you want the specific guidelines, Dexcom developed a site for assistance with this. So it's Dexcom-clinic-workflow-idc. So I know it's a lot, but it's actually very useful to figure out, do I put them on a Dexcom G7, or are they more of a candidate for Stelo, depending upon are they on insulin, are they having hypoglycemia, what's their age, and do we want alerts or not? So that's some of the things that you would work through. And then once you do, I think it's just a matter of getting it as a sample and placing it on your patient and having them download the necessary apps. I strongly recommend that all people in healthcare wear one, so that you can actually tell people it doesn't hurt. I think that's one of the biggest questions I get is, "Does it hurt?" It doesn't hurt. And so what we had maybe 20 years ago did hurt, and I was there for it, and I experienced it. And this is all CGMs 20 years ago. But now it's literally much less intrusive than a fingerstick. And this is something that's giving me data for 15 days, so it's like, yes, I'll take that over all the fingersticks I would've done in that time. So I think having the experience of wearing it is so powerful, that if you're doing that, you'll be able to much better speak to the patients. But even if you don't, I think that site really walks you through all of the necessary steps on how to get it started, how to link them up with an account, and then have them share that with you, and potentially followers as well, if you want to, which I think is really important to do. And it also has information on reimbursement. So it's really a one-stop shop.
Yeah. I think that's so helpful. They could do a few things, right? They can go check out the site if they feel like they need more information. They could go to dexcom.com. They could try to find out who their Dexcom representative is. Yeah. That's another way. That's pretty easy. Or they could just get one for themselves. So, so many things. Yeah, they could just start with. Oh, I think that's so amazing. Okay, great.
Now, is there any one particular tool that you have used that you like? I don't know if you've ever seen the coverage calculator from Dexcom. I don't know if that's ever helped you. Is there anything that you can think of that has helped you in practice?
I honestly think it's the representative share. I feel like I am too busy in practice, and we all say this, to remember the tools, and maybe that's a cop-out, but I think having the person right next to me accessible. So this is what I do with any new technology in my clinic is I say, "I need a technology rep so that I get this." I don't want to be scared of it. I don't want to say I'm not going to do it because I don't know it. I want to accept and learn about it and utilize it, but I really need somebody to help me. And so it's the person. Get with a representative, and they will be there for you and guide you through the whole process, and you will not believe how much of a difference it makes. And you're going to say the same thing patients do, which is, "Oh my gosh, I wish I had done this earlier, so."
You know what, Dr. Swamy, I was just thinking, this means we're officially old, because I was thinking that for my entire- For me, when I was in practice, it was my rep too. Her name was Penny. She came in weekly- Penny... till I got it set up. But honestly, I feel like there are people out there who are probably like, "I could just go online and figure this out." And maybe that's what it is, Shay.
Right. You're probably totally right, because I'm also a caller. You were saying you have all these features on the iPhone, and my friend was joking the other day, because I actually called her, and she's like, "Anita Swamy, I knew it was you, because no one else calls me." And I was like, "Okay, maybe it is a thing." I know. But you're right. You can go on a website. There's a million YouTube videos. I just feel like however you work and however you learn, it's the best thing. I just liked having the person there because it also taught us how to deal with issues. So if a patient said, "It's not sticking," or, "I'm having a little rash," all of that is manageable. I've had people come in and say, "Oh, I tried that, and I got a rash, so I stopped wearing it." And I said, "Oh, did you do this, this, this, this, and this?" And they're like, "No, I've never heard of that." And we were able to really resolve the issue, and they wear one just fine. So I think it's a matter of just knowing all of the resources and the tools, and I feel like however you do it, just reach out to us.
Great. Okay, there was one thing we didn't talk about before we have our last, our closing. Is there a follow-up? So if they come in that first visit, do they automatically come back one week later, two weeks, or how does that process go?
Sure. So we ideally like to see someone within their first several weeks, and this depends on whether you're recently diagnosed. I also do it if you're recently on a new medication. So I think it's really important as we start, let's say, an automated insulin delivery device, or you're newly diagnosed. Those things take a while to really understand how it works. So I like to see those people within a few weeks after. I don't go to three months, because I think three months is a very long time, and people are also like you said, they're getting their data from the Internet, right? So there's a million TikToks and Snapchats and Instagram. I'm laughing because somebody in my family said Instagram, but there's a million things like that. So I really want them to get their information from us, right, their healthcare team. Yeah. So a few weeks at most, and I think that doesn't have to be in person anymore, which is the magic of this. That's why I can do it. It can be a 10-minute telehealth, and I think it accomplishes the same goal.
Yeah. And then have you had any of your patients kind of ask you questions like, "Oh, I learned this," or, "I didn't know this happened," or, "I do want to learn more"? Have they ever said that?
Oh, a million percent. So my family member that I put on Stelo said, because we all have a risk of prediabetes, so I kind of carry it around like I'm really fun at picnics for the family. But anyway, so I was like, "Here you go. You're going to wear this." And he calls me a couple of days later and says, "Oh my god, I never knew I could just be high in the morning, and all I had is black coffee." So then we had a discussion about what did you eat the night before, what was your activity level the night before, and what are the reasons that may happen.
And then another, I think, recent example is my neighbor's dad started asking me, "How many Starbucks creamers can I have when I get it?" And I said, "That's such an odd question." So I said, "Tom, we're just going to put one of these on you." And I literally dragged him over to my house. I said, "I promise it won't hurt." And then don't you know, if I could show you guys, I have 15 texts from Tom in a week because he's like, "I didn't know walking the dog would be so good. I didn't realize this would do this." So I love those. So I tell my patients, "When you have a eureka, I want to know." And so he has since lost about 15 pounds, and it is just from looking at his glucoses.
Yep, true stories. Oh, good.
Okay, Dr. Swamy, before we part today, do you want to share anything else with our listeners? Anything that we might not have gotten to?
No, except my Trader Joe's caramel resulted in my having an 88, so it hasn't hit me yet. No, okay. That means I can have another one. No, I'm just kidding. But no, I use this all the time, and as I said, I've been doing diabetes for 30 years. And people say, "Well, do you still get information from it?" I said, "Absolutely. I'm not a robot. I don't lead the same life every day. So if I eat something out that I didn't before, if I try a new activity, it really does give me information on how it impacts my life and my world." So I love it.
Dr. Swamy, thank you so much for joining us today and for walking us through how to implement CGM into practice. To all our listeners out there, make sure you head over to dexcom.com to learn more about Dexcom, and tune in next time for another episode of "GlucoseTech."
