Dexcom G4 User Manual

USER’S GUIDE

Dexcom G4

CONTINUOUS GLUCOSE

MONITORING SYSTEM

Dexcom G4

CONTINUOUS GLUCOSE

MONITORING SYSTEM

4 | Dexcom G4 Continuous Glucose Monitoring System

IMPORTANT CONTACTS AND NUMBERS

Dexcom Website: www.dexcom.com

Your Transmitter ID:

Your Receiver ID:

Your Healthcare Professional:

Nearest Hospital:

Other Notes:

© 2013 Dexcom, Inc. All rights reserved.

Dexcom, Dexcom G4, Dexcom Studio, SEVEN, Stay Between the Lines and The
Glucose Sensor Company are either registered trademarks or trademarks of Dexcom,
Inc. in the United States and/or other countries. All other product or company names
that may be mentioned in this publication are tradenames, trademarks or registered
trademarks of their respective owners.

Dexcom G4 User’s Guide | 5

SYSTEM CONTENTS:

Reorder only the Dexcom G4 System components listed below:

DEXCOM G4 CONTINUOUS GLUCOSE MONITORING SYSTEM

Dexcom G4 Sensor

Dexcom G4 Receiver

Dexcom G4 Transmitter

• sensor

•

transmitter

•

receiver

•

receiver USB charging/download cable

• charger - MT21255

• adapter plugs - MT21561

•

receiver case

•

user’s guide

•

quick start guide

• tutorial disc

•

Dexcom Studio software (optional
and available in select countries –
check with your local distributor)

HEL P F U L HI N T:

Sensors are sold separately. Commercially distributed blood glucose (BG)
meter required for use. Make sure to use the correct version of Dexcom
Studio with your system. The sensor works with the Dexcom G4 family
of products. The Dexcom G4 Sensor, Transmitter, and Receiver are not
compatible with the SEVEN/SEVEN PLUS Transmitter and Receiver.

The Dexcom G4 Continuous Glucose Monitoring System is a

glucose-monitoring device indicated for detecting trends and

tracking patterns in persons (age 18 and older) with diabetes.

6 | Dexcom G4 Continuous Glucose Monitoring System

When you use the system, you will see continuous sensor glucose readings
updated every 5 minutes for up to 7 days. These readings will help you detect
trends and patterns in your glucose levels.

The system includes the sensor, the transmitter, and the receiver. The sensor
is a disposable unit that you insert under the skin of your abdomen (belly) to
continuously monitor your glucose levels for up to 7 days. The transmitter

is a reusable device that wirelessly sends your sensor-measured glucose
information to your receiver. The receiver is a hand-held device that receives

and displays your glucose information.

This user’s guide describes how to use your system.

Please review this user’s guide.

INTRODUCTION

HEL P F U L HI N T:

Dexcom has developed an interactive, self-guided training tutorial for
the Dexcom G4 CGM System based on well-established adult-learning

principles. Some people have found this to be an effective method of
product training. Please review the tutorial on the disc and discuss with
your healthcare professional if the Dexcom G4 training tutorial is an
appropriate training option for you.

Dexcom G4 User’s Guide | 7

INDICATIONS FOR USE

The Dexcom G4 Continuous Glucose Monitoring System is a glucose-

monitoring device indicated for detecting trends and tracking patterns in
persons (age 18 and older) with diabetes. The system is intended for use by
patients at home and in healthcare facilities and requires a prescription (United
States).

The Dexcom G4 System is indicated for use as an adjunctive device to
complement, not replace, information obtained from standard home glucose
monitoring devices.

The Dexcom G4 System aids in the detection of episodes of hyperglycemia

and hypoglycemia, facilitating both acute and long-term therapy adjustments,

which may minimize these excursions. Interpretation of the Dexcom G4 System
results should be based on the trends and patterns seen with several sequential
readings over time.

IMPORTANT USER INFORMATION

Please review your product instructions before using your continuous glucose
monitoring system. Contraindications, warnings, precautions, cautions, and
other important user information can be found in your product instructions.
Discuss with your healthcare professional how you should use your sensor
trend information to help manage your diabetes. Your product instructions
contain important information on troubleshooting your system and on the
performance characteristics of the device.

CONTRAINDICATIONS

• The Dexcom G4 Sensor, Transmitter, and Receiver must be removed prior

to Magnetic Resonance Imaging (MRI), CT scan, or diathermy treatment.
The Dexcom G4 System has not been tested during MRI or CT scans or with
diathermy treatment, and it is unknown if there are safety or performance
issues.

• Taking acetaminophen (paracetamol) containing products (such as Tylenol)

while wearing the sensor may falsely raise your sensor glucose readings. The
level of inaccuracy depends on the amount of acetaminophen (paracetamol)
active in your body.

8 | Dexcom G4 Continuous Glucose Monitoring System

WARNINGS

• Do not use the Dexcom G4 CGM System until after you have been trained or

viewed the training materials included with your CGM system.

• The blood glucose value from your blood glucose meter should be used for

treatment decisions, such as how much insulin you should take. The Dexcom
G4 System does not replace a blood glucose meter. Blood glucose values may
differ from sensor glucose readings. The direction, rate of glucose change, and
trend graph on your Dexcom G4 System provide additional information to help
with your diabetes management decisions.

• Symptoms of high and low glucose should not be ignored. If your sensor
glucose readings do not t with your symptoms, you should measure your

blood glucose with a blood glucose meter.

• Your sensor glucose readings may be inaccurate if you calibrate less than

every 12 hours.

• Sensors may fracture on rare occasions. If a sensor breaks and no portion of it

is visible above the skin, do not attempt to remove it. Seek professional medical

help if you have symptoms of infection or inammation—redness, swelling or
pain—at the insertion site. If you experience a broken sensor, please report this

to your local distributor.

• The Dexcom G4 System is not approved for use in children or adolescents,
pregnant women or persons on dialysis.

• Sensor placement is not approved for sites other than under the skin of the
belly (abdomen).

• If your transmitter or receiver case is damaged/cracked, do not use them, as

this could create an electrical safety hazard or malfunction.

PRECAUTIONS

• Before opening the sensor package, wash your hands with soap and water and

dry them to avoid contamination.

• Before inserting the sensor, always clean the skin at the sensor insertion

location with a topical antimicrobial solution, such as isopropyl alcohol. This
may help prevent infection. Do not apply the sensor until the cleaned area is
dry so that it will stick better.

• Change the site where you place your sensor with each insertion to allow your

skin to heal.

Dexcom G4 User’s Guide | 9

• Avoid areas that are likely to be bumped, pushed or compressed or areas of

skin with scarring, tattoos, or irritation as these are not ideal sites to measure
glucose.

• Avoid injecting insulin or placing an insulin pump infusion set within 7.62 cm of

the sensor in case the insulin affects the sensor glucose readings.

•

The sensor is sterile in its unopened, undamaged package. Do not use any
sensor if its sterile package has been previously damaged or opened.

• To calibrate the system, you must enter the exact blood glucose value that

your blood glucose meter displays within 5 minutes of a carefully performed
blood glucose measurement. Entering incorrect blood glucose values or blood
glucose values from more than 5 minutes ago could result in inaccurate sensor
glucose readings.

•

The transmission range from the transmitter to the receiver is up to 6 meters

without obstruction. Wireless communication does not work well through water
so the range is much less if you are in a pool, bathtub, water bed, etc.

• Sensors should be stored at temperatures between 2° C - 25° C for the length

of the shelf life. You may store your sensors in the refrigerator if it is within this
temperature range. Sensors should not be stored in a freezer.

• Keep the USB port cover on the receiver closed whenever the USB cable is not

attached. The receiver may malfunction if water gets into the USB port.

10 | Dexcom G4 Continuous Glucose Monitoring System

DEXCOM G4 CONTINUOUS GLUCOSE MONITORING SYSTEM:

SYSTEM KIT CONTENTS 5
INTRODUCTION 6

INDICATIONS FOR USE 7
IMPORTANT USER INFORMATION 7

CHAPTER 1: THE DEXCOM G4 SYSTEM BASICS 13

1.1 Sensor Overview 15

1.2 Transmitter Overview 15

1.3 Receiver Overview 16

1.4 Charging Your Receiver Battery 18

1.4.1 Charging Your Receiver Battery from an AC Power Outlet 18

1.4.2 Charging Your Receiver Battery from a Windows Compatible

Computer. 20

1.4.3 Knowing Your Receiver is Charged 21

CHAPTER 2: DEXCOM G4 SYSTEM SETUP 23

2.1 The Setup Wizard 25

2.2 The Settings Menu 28

2.2.1 Getting to the Settings Menu 28

2.2.2 Setting Your Receiver Time and Date 28

2.2.3 Entering Your Transmitter ID 29

2.2.4 Setting Your Receiver Time Format 30

2.2.5 Selecting Your Receiver Language 30

2.3 Checking Information About Your Dexcom G4 System 31

2.4 Transmitter and Receiver Communication 32

CHAPTER 3: INSERTING A SENSOR AND STARTING A SENSOR

SESSION 33

3.1 Before You Start 35

3.2 Removing the Sensor From Its Packaging 37

3.3 Choosing an Insertion Site 37

3.4 Placing the Sensor 38

3.5 Sensor Insertion 39

3.6 Transmitter Attachment 40

3.7 Starting a Sensor Session 42

3.8 Sensor Startup Period 43

3.9 Taping the Sensor Pod 44

3.10 Temporary Receiver Shutdown 44

3.11 The Dexcom G4 System and Water 45

table of contents

Dexcom G4 User’s Guide | 11

CHAPTER 4: CALIBRATING YOUR DEXCOM G4 SYSTEM 47

4.1 Calibration Overview 49

4.2 How to Calibrate 50

4.3 Startup Calibration 53

4.4 12 Hour Calibration Update 53

4.5 Other Reasons You May Need to Calibrate 54

CHAPTER 5: SENSOR GLUCOSE READINGS AND TRENDS 55

5.1 Sensor Glucose Readings 58

5.2 Rate of Change Arrows 60

5.3 Glucose Status Area Symbols 62

CHAPTER 6: ALERTS, ALARMS AND ALERT PROFILES 65

6.1 Setting Your Alerts 67

6.1.1 Default Alert/Alarm Settings 67

6.1.2 Glucose Alerts 69

6.1.3 High Glucose Alert 69

6.1.4 Low Glucose Alert 70

6.1.5 Low Glucose Alarm 71

6.1.6 Getting to the Alerts Menu 71

6.1.7 High and Low Glucose Alerts 72

6.2 Advanced Alerts 73

6.2.1 Setting a Snooze Time for Your High and Low Glucose Alerts 74

6.2.2 Rise and Fall Glucose Rate Alerts 75

6.2.3 Setting the Out of Range Alert 77

6.3 Alert Proles 78

6.3.1 Alert Prole Options 80

6.3.2 Alert Prole Details 81

CHAPTER 7: EVENTS 83

7.1 Eve nts 85

7.1.1 Selecting an Event 85

7.1.2 Setting the Date and Time for an Event 86

7.1.3 Carbohydrates 87

7.1.4 Insulin 88

7.1.5 Exercise 89

7.1.6 Health 90

7.2 Dexcom Studio Software 90

12 | Dexcom G4 Continuous Glucose Monitoring System

CHAPTER 8: COMPLETING A SENSOR SESSION 91

8.1 Automatic Sensor Shut-off 94

8.2 Removing a Sensor 95

8.3 Transmitter Removal 95

CHAPTER 9: TROUBLESHOOTING 97

9.1 Sensor Insertion Troubleshooting 99

9.2 Calibration Troubleshooting 100

9.2.1 Types of Calibration Prompts 101

9.2.2 Status Area Symbols During Calibration Prompts 102

9.3 Calibration Error Troubleshooting 102

9.4 System Glucose Error 103

9.5 Sensor Inaccuracies 104

9.6 Sensor Shut-off Troubleshooting 105

9.6.1 Early Sensor Shut-off - Sensor Failure 106

9.6.2 Manual Sensor Shut-off - “Stop Sensor” 106

9.7 Battery and Charger Troubleshooting 108

9.8 Receiver and Transmitter Communication Troubleshooting 108

9.8.1 System Recovery Check 108

9.8.2 Receiver Error Code 108

9.8.3 Low Transmitter Battery 109

9.8.4 Transmitter Failed Error Code 109

9.9 Out of Range/No Antenna 109

9.10 Alerts Not Working 110

CHAPTER 10: TAKING CARE OF YOUR DEXCOM G4 SYSTEM 111

10.1 Maintenance 113

10.2 Storage 114

10.3 Cleaning and Disinfection 114

10.4 Product Disposal 116

CHAPTER 11: TECHNICAL INFORMATION 117

11.1 Product Specications 119

11.2 Device Performance Characteristics 129

11.3 FCC Requirements 138

CHAPTER 12: APPENDIX 139

Appendix I, Receiver Alerts, Alarm and Prompts 141
Glossary 148
Symbols Used in Labeling 150

Dexcom G4 User’s Guide | 13

chapter one

THE DEXCOM G4 SYSTEM BASICS

14 | Dexcom G4 Continuous Glucose Monitoring System

Dexcom G4 User’s Guide | 15

Plunger

Applicator barrel
(contains small
introducer needle
and sensor)

Transmitter Latch

Safety lock

Collar

Sensor pod

Release Tab

1.1 SENSOR OVERVIEW

The sensor is placed under the skin of your belly and continuously measures
your glucose levels.

The sensor and transmitter (once snapped in) remain on your belly for the entire
sensor session, up to 7 days.

1.2 TRANSMITTER OVERVIEW

The transmitter wirelessly sends your glucose information to the receiver. The
transmitter and sensor are water resistant when properly connected. Do not
throw away your transmitter. It is reusable.

The transmission range from the transmitter to the receiver is up to 6 meters

without obstruction. Wireless communication does not work well through
water so the range is much less if you are in a pool,
bathtub, water bed, etc.

The transmitter battery will last at least 6 months.

Once you see the transmitter low battery screen
shown on the right, replace the transmitter as soon
as possible. Your transmitter battery may drain as
quickly as one week after this alert appears.

16 | Dexcom G4 Continuous Glucose Monitoring System

1

1.3 RECEIVER OVERVIEW

The receiver is a small hand-held device that shows your sensor glucose

readings, direction and rate of change arrow and trend graph. The international
standard unit of measurement used for glucose testing systems (i.e., blood
glucose meters) is mmol/L (millimoles per liter). The transmission range from

the transmitter to the receiver is up to 6 meters.

Your receiver is rated IP22, which means that it offers some protection from rain

drops. Do not spill uids on the receiver or drop the receiver into uids. Keep
the micro USB port cover closed to help prevent uid and dust from getting

inside the receiver.

Wireless communication does not work well through water so the range is much
less if you are in a pool, bathtub, water bed, etc.

EXAMPLE: 3-Hour Trend Graph Screen

Trend Graph Hours

Trend Arrow

Current Time

Most recent 5-minute

sensor glucose reading

Glucose
Target Range

Low Glucose
Alert Setting

Plot of most
recent sensor
glucose reading

Antenna

Battery

Status Area

High Glucose
Alert Setting

Glucose
Values

Dexcom G4 User’s Guide | 17

There are ve receiver buttons to move you through the display screens that

control setup and operation and allow you to change your receiver settings. The
screens display sensor glucose readings, trend graphs and trend arrows.

Your receiver and transmitter are wirelessly paired together to communicate
securely and only with each other.

You will need a commercially available blood glucose meter to use with your
system.

UP button

DOWN
button

SELECT button

RIGHT
button

LEFT

button

18 | Dexcom G4 Continuous Glucose Monitoring System

1

1.4 CHARGING YOUR RECEIVER BATTERY

The receiver battery is rechargeable. The
rechargeable battery will typically last about 3 days
before you need to charge it with the charging cable
provided. Your battery life depends on how often you
interact with your receiver. The receiver will alert you
when the battery charge is low.

The receiver battery may be charged using one of the
following options:

• an AC power outlet

• a Windows-compatible computer (Microsoft Windows 7, Microsoft Windows

Vista SP2, Microsoft Windows XP SP2 or Microsoft Server 2008 SP2)

In order to use a PC cable to charge your receiver, you will need to install the
driver for this receiver. Please see the Dexcom Studio installation card for driver
installation instructions.

It takes about 3 hours to fully charge an empty battery with the wall charger, and
about 5 hours when the receiver is connected to a computer.

You can charge your receiver at any time and the battery does not need to be
drained in order to fully charge the battery.

1.4.1 CHARGING YOUR RECEIVER BATTERY FROM AN AC

POWER OUTLET

The AC power adapter comes with interchangeable plugs.

Install the appropriate plug for your wall outlet style by
sliding the plug down onto the adapter until it snaps into
place.

Low battery prompt

HEL P F U L HI N T:

• When the receiver is used in a healthcare facility, charging must take

place away from the patient.

Dexcom G4 User’s Guide | 19

To recharge your battery, follow the instructions below:

1. Plug the included USB cable into the AC power adapter.

2. Plug the AC power adapter into an AC power outlet.

3. Slide open the USB port cover on the side of the receiver to
access the port

4. Plug the micro USB end of the cable into the receiver USB
port.

Keep the USB port cover on the receiver closed whenever the USB cable is
not attached.

HEL P F U L HI N T:

• Press down rmly with your thumb when sliding open the USB port cover.

To remove the plug from the AC power adapter place both
thumbs on the bottom of the plug and push up until the
plug pops out of the adapter.

5. The battery charging screen will appear on the

receiver.

6. After a few seconds the trend graph will reappear

with the battery charging symbol ( ) shown in
the upper left corner.

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1

1.4.2 CHARGING YOUR RECEIVER BATTERY FROM A

WINDOWS COMPATIBLE COMPUTER

The Dexcom Studio software must be installed to charge your receiver
from a computer.

1. Plug the included USB cable into your computer.

2. Plug other end of the USB cable into the receiver.

3. The battery charging screen will appear on the
receiver.

4. After a few seconds the trend graph will reappear
with the battery charging symbol shown in the
upper left corner.

HEL P F U L HI N T:

• Charge only from a USB port on your computer or the AC power
adapter. Do not use an external USB hub. An external USB hub may not
provide enough power to charge the receiver.

Dexcom G4 User’s Guide | 21

HELPFUL HINTS:

• Charge your receiver battery before each sensor insertion. Periodically

check your battery level to make sure it has enough charge.

• If your battery drains it will retain the time and date for 3 days without

being charged. After 3 days you will be prompted to reset your receiver
time and date (see Chapter 2, Section 2.2, The Settings Menu).

• Only use the Dexcom battery charger provided in the receiver kit. Do not

use any other battery charger.

1.4.3 KNOWING YOUR RECEIVER IS CHARGED

1. As the battery charges, the battery symbol will begin to ll in. The battery is

fully charged when battery symbol is completely shaded.

2. After the charge is complete, remove the cable from the receiver and the wall
outlet or computer USB port.

Start Fully Charged

22 | Dexcom G4 Continuous Glucose Monitoring System

1

More information on main menu options can be found in the sections listed
below:

See Appendix I, Receiver Alerts, Alarm and Prompts, for a list of screens that
may appear on the receiver during use.

Menu Purpose User’s Guide

Reference

Trend
Graph

To display the trend graphs.

• The 3-hour trend graph is the default screen

displayed whenever you turn the receiver on.

Chapter 5

Start
Sensor

To start a new sensor session.

• This option only appears if a transmitter ID has been

entered and you are not in the middle of a sensor
session.

Chapter 3

Enter BG To enter your blood glucose values for calibration. Chapter 4

Proles Proles allow you to customize the sound pattern and

volume level of alerts and alarms to meet your needs.

Chapter 6

Events To enter personal information about meals, insulin,

exercise, and health status.

Chapter 7

Alerts,
High/Low

To change the settings for notications of high and low

alerts from your receiver.

Chapter 6

Settings To change the time, date and transmitter ID, to look

up your Dexcom G4 System hardware and software
version numbers, to view transmitter battery status,
last calibration value, sensor insertion time.

Chapter 2

Shutdown To temporarily turn off all communications between

your sensor, transmitter and receiver during an active
sensor session. You will not receive sensor glucose
readings, and it will not extend the life of your sensor.

Chapter 3

Stop
Sensor

To end a sensor session early.

• This option only appears when you are in the middle

of a sensor session. You will not receive sensor
glucose readings. It will not extend the life of your
sensor.

Chapter 9

Dexcom G4 User’s Guide | 23

chapter two

DEXCOM G4 SYSTEM SETUP

24 | Dexcom G4 Continuous Glucose Monitoring System

Dexcom G4 User’s Guide | 25

This chapter will help you when you rst set up your Dexcom

G4 Continuous Glucose Monitoring System. Read this chapter
before you start.

2.1 THE SETUP WIZARD

1. Before setting up the receiver remove the transmitter from its packaging.

It takes 10 minutes for the transmitter to turn on after it is removed from its
packaging.

2. Make sure your receiver is fully charged (see Chapter 1, Section 1.4,

Charging Your Receiver Battery).

3. Turn your receiver on by pressing the SELECT button on the receiver. When

you turn the receiver on for the rst time, the Setup Wizard will help you get

started by prompting you to enter the following setup information:

a. Select your language.

• Press the UP or DOWN button to choose your

desired language.

• Press the SELECT button to set the highlighted

language.

b. Set the time format.

• Time formats available are either 24 Hour or AM/

PM (12-hour) settings.

• Press the UP and DOWN button to choose your

desired time format.

• Press the SELECT button to conrm changes to

time and date.

26 | Dexcom G4 Continuous Glucose Monitoring System

2

c. Set the time and date. The date format is

YYYY/MM/DD.

• Press the UP or DOWN button to enter the

current date and time.

• Press the RIGHT button (show icon) to move to

the next section.

• Press the SELECT button to conrm changes to

time and date.

d. Enter your transmitter ID.

• Press the UP or DOWN button to enter your

transmitter ID.

• Press the SELECT button to conrm entry of

transmitter ID.

Your transmitter ID is unique and contains a code with 5 numbers and/or letters
and can be found in the following locations:

• On the outside of the transmitter box label.

• On the bottom of the transmitter.

HELPFUL HINTS:

• Write your transmitter ID number down in the Important Contacts and
Numbers list on page 4.

• If you need to change the language, time format, time, date or transmitter
ID after you have completed the Setup Wizard see Section 2.2, The
Settings Menu.

Dexcom G4 User’s Guide | 27

e. Set your low and high glucose alert values. Your low and high glucose

alerts are pre-set to 4.4 mmol/L and 11.1 mmol/L, but can be changed to

meet your needs.

• Press the UP or DOWN button to select your desired alert value. Changes

can be made in increments of 0.1 mmol/L.

• Press the SELECT button to conrm your preferred alert value.

The Setup Wizard is now complete. To begin using your Dexcom G4 CGM
System you will need to insert a sensor (see Chapter 3, Inserting a Sensor and
Starting a Sensor Session).

HELPFUL HINTS:

• You can also change your alert values in the alerts menu.

• The unit of measure (mmol/L) is not adjustable.

28 | Dexcom G4 Continuous Glucose Monitoring System

2

2.2.2 SETTING YOUR RECEIVER TIME AND DATE

To set the time and date follow the steps below.

1. From the Settings menu, press the UP or DOWN

button to scroll to “Time/Date” and press the

SELECT button.

2. Press the RIGHT button to highlight each value in
the date and time. Then, press the UP or DOWN
button to make any adjustments and then press
the RIGHT button to move to the next value. The
date format is YYYY/MM/DD. After choosing the
time, press the SELECT button. You will return to
the settings menu.

2.2 THE SETTINGS MENU

The settings menu shows you how to change the time, date or transmitter ID
after you have already completed the Setup Wizard.

2.2.1 GETTING TO THE SETTINGS MENU

1. Press the SELECT button to turn on the receiver. The 3-hour trend graph will
appear.

2. Press the SELECT button to display the Main Menu.

3. From the main menu, press the UP or DOWN button to scroll to “Settings”
and press the SELECT button. The settings menu will appear.

Dexcom G4 User’s Guide | 29

2.2.3 ENTERING YOUR TRANSMITTER ID

Any time you switch to a new transmitter and/or receiver (as a replacement
to the transmitter and/or receiver that came in your kit) you must enter the
transmitter ID into your receiver. The transmitter ID is a series of 5 numbers
and/or letters that can be found in the following locations:

• On the outside of the transmitter box label.

• On the bottom of the transmitter.

If you have difculty locating your transmitter ID, please contact your local

distributor.

To enter the transmitter ID follow the steps below.

1. From the Settings menu, press the UP or DOWN

button to scroll to “Transmitter ID” and press the

SELECT button.

2. Starting with the rst number or letter (do not enter
“SN”):

a. Press the UP or DOWN button to display to the

correct number or letter.

b. Then press the RIGHT button to move to the

next value and repeat step a. Continue repeating
steps a and b until you have the transmitter ID
displayed.

c. After entering the fth number or letter, press the

SELECT button. You will return to the settings

menu.

HEL P F U L HI N T:

• You can only set your transmitter ID when you are not in a sensor
session. During a sensor session, “Transmitter ID” will not appear as an

option on the settings menu.

HEL P F U L HI N T:

• You might need to reset the receiver’s time and date if the rechargeable

battery is drained. If this happens, you will be alerted and automatically
taken to the time/date setting screen.

30 | Dexcom G4 Continuous Glucose Monitoring System

2.2.5 SELECTING YOUR RECEIVER LANGUAGE

To select your receiver language follow the steps below.

1. From the Settings menu, press the UP or DOWN

button to scroll to “Language” and press the

SELECT button.

2. Press the UP or DOWN button to scroll and
highlight your desired language.

3. Press the SELECT button to set the highlighted
language. You will return to the settings menu.

2

2.2.4 SETTING YOUR RECEIVER TIME FORMAT

To set your receiver time format (24-hour or AM/PM) follow the steps below.

1. From the Settings menu, press the UP or DOWN

button to scroll to “Time Format” and press the

SELECT button.

2. Press the UP or DOWN button to scroll and
highlight your desired time format.

3. Press the SELECT button to set the highlighted
time format. You will return to the settings menu.

Dexcom G4 User’s Guide | 31

2.3 CHECKING INFORMATION ABOUT YOUR DEXCOM G4

SYSTEM

You can check your receiver for information about your CGM at any time.

1. From the Settings menu, press the UP or DOWN

button to scroll to “Device Info” and press the

SELECT button.

2. Information about your sensor session and system
will appear. Scroll down to see all of the Device
Info:

• Insertion Time

• Last Calibration

• Transmitter Battery

• Transmitter ID

• Serial Number

• Part Number

• Part Revision

• Software Number

• Software Revision

3. Press the LEFT button to return to the Settings menu.

32 | Dexcom G4 Continuous Glucose Monitoring System

Once you are in a sensor session, you can check that the receiver and
transmitter are communicating. View the trend graph screen by pressing the

SELECT, LEFT or RIGHT button to see the trend graph.

This antenna symbol shows that the transmitter
and receiver are communicating.

This out of range symbol shows the transmitter
and receiver are not communicating.

2.4 TRANSMITTER AND RECEIVER COMMUNICATION

The transmission range from the transmitter to the receiver is up

to 6 meters without obstruction. Wireless communication does not

work well through water so the range is much less if you are in a
pool, bathtub, water bed, etc.

The Dexcom G4 Sensor, Transmitter, and Receiver must be
removed prior to Magnetic Resonance Imaging (MRI), CT scan,
or diathermy treatment. The Dexcom G4 System has not been
tested during MRI, CT scans or with diathermy treatment, and it is
unknown if there are safety or performance issues.

HEL P F U L HI N T:

• The transmitter and receiver may lose communication at the following

times:

- When they are near metallic objects.

- When you are using an electric blanket.

2

Dexcom G4 User’s Guide | 33

chapter three

INSERTING A SENSOR AND

STARTING A SENSOR SESSION

34 | Dexcom G4 Continuous Glucose Monitoring System

Dexcom G4 User’s Guide | 35

To use your Dexcom G4 Continuous Glucose Monitoring System
you will need a sensor, a transmitter, and a receiver. You will also
need a blood glucose meter and test strips for calibration. Once
inserted and calibrated, the sensor will continuously measure
and display your sensor glucose readings for up to 7 days. The
following sections will show you how to insert the sensor and
start a new continuous glucose monitoring session.

Please review the tutorial on the disc in your kit. The tutorial is
also available online at www.dexcom.com.

3.1 BEFORE YOU START

r

Make sure you charge your receiver completely. See Chapter 1, Section 1.4,

Charging Your Receiver Battery.

r

Check that the date and time are correct on the receiver.

r

Make sure the correct transmitter ID has been entered into your receiver (see

Chapter 2, Section 2.2, The Settings Menu).

r

Check the Use by Date on the sensor. The Use by Date format is YYYY-

MM-DD. Sensors must be inserted on or before the end of the calendar day

printed on the sensor package label.

For patients undergoing an MRI with a retained wire broken off from a Dexcom

G4 Sensor, in-vitro MRI testing did not detect any safety hazards. There was no
signicant migration or heating of the wire and imaging artifacts were limited to

the area around the wire.

Sensors may fracture on rare occasions. If a sensor breaks and no

portion of it is visible above the skin, do not attempt to remove it.
Seek professional medical help if you have symptoms of infection or

inammation—redness, swelling or pain—at the insertion site. If you

experience a broken sensor, please report this to your local distributor.

36 | Dexcom G4 Continuous Glucose Monitoring System

3

REVIEW THE SENSOR APPLICATOR

Review the sensor applicator picture below before using a new sensor.

Plunger

Applicator barrel
(contains small
introducer needle
and sensor)

Transmitter latch

Safety lock

Collar

Sensor pod

Release tab

Sensors should be stored at temperatures between 2° C - 25° C.

You may store your sensors in the refrigerator if it is within this
temperature range. Sensors should not be stored in a freezer.

r

Make sure you are using your blood glucose meter per the manufacturer’s

instructions to ensure you are getting accurate blood glucose values for
calibration.

r

Clean the bottom of the transmitter with a wrung-out, slightly water-dampened

cloth or isopropyl alcohol wipe. Place the transmitter on a clean, dry cloth and

air dry for 2-3 minutes.

r

Make sure your blood glucose meter and receiver date and time match.

Dexcom G4 User’s Guide | 37

3.3 CHOOSING AN INSERTION SITE

Reviewing the tutorial disc would be helpful to learn how to insert your sensor.
Choose a site on your belly to place the sensor. You can choose a site above

or below your belt line. The best areas to insert your sensor are usually at,
“pinchable,” and free from where rubbing can occur such as along the waist

band and seat belt strap.

•

Choose an area that is at least 7.62 cm from where you plan to inject insulin or
from where your pump infusion site is located.

•

Avoid using the same spot repeatedly for sensor insertion. Never use the same
site for 2 sensor sessions in a row.

•

You may need to shave the area where you plan to put the sensor so that the
adhesive patch sticks securely.

•

Make sure there are no traces of lotions, perfumes or medications on the area.

Change the site where you place your sensor with each insertion to
allow your skin to heal.

Avoid areas that are likely to be bumped, pushed or compressed

or areas of skin with scarring, tattoos, or irritation as these are not
ideal sites to measure glucose.

Avoid injecting insulin or placing an insulin pump infusion set within

7.62 cm of the sensor in case the insulin affects the sensor glucose

readings.

3.2 REMOVING THE SENSOR FROM ITS PACKAGING

• Wash your hands thoroughly and dry them.

•

Carefully remove the sensor from its packaging. Look closely at the sensor to
make sure it is not damaged.

•

The applicator is a single use, disposable unit. The safety lock prevents you
from accidentally releasing the needle before you are ready.

The sensor is sterile in its unopened, undamaged package. Do

not use any sensor if its sterile package has been previously
damaged or opened.

38 | Dexcom G4 Continuous Glucose Monitoring System

3.4 PLACING THE SENSOR

1. Clean the area rst with an alcohol wipe. Make sure the area is clean and

completely dry before you insert the sensor.

2. Using the white tabs on the adhesive backing, remove the adhesive backing
from the sensor pod one half at a time. Hold the sensor by the applicator
barrel and try not to touch the sticky adhesive patch.

3. Place the sensor at on your selected area, to the left or right of your belly

button. Make sure the sensor is placed in the same direction shown in the
picture below. You should not place the sensor pointing in the up or down
direction.

4. Press your nger rmly around the adhesive patch to make sure it is smooth.

5. Hold on to the applicator. Then pull the safety lock straight out away from the
applicator, in the direction the arrows show in the following picture.

Remove the adhesive backing

Adhere the sensor on the skin

Remove the safety lock

3

The Dexcom G4 System is a glucose-monitoring device indicated

for detecting trends and tracking patterns in persons (age 18 and
older) with diabetes.

Dexcom G4 User’s Guide | 39

“2 CLICKS”

Push down the plunger – Insert the needle and sensor

3. To remove the sensor introducer needle,
keep pinching up on your skin with one hand.

With your other hand, place two ngers

under the collar. Keep your thumb lightly on
top of the white plunger and pull the collar
back towards your thumb until you hear 2

“clicks” or can not pull back any more. This

step leaves the sensor under your skin and
removes the sensor introducer needle from
your body.

“ 2 CLICKS”

Pull back the collar - Retract

the Needle

3.5 SENSOR INSERTION

Once you have placed the applicator on your belly and removed the safety lock,
you are ready to insert the sensor. To insert your sensor follow the steps below:

1. Using one hand, you may want to pinch up on the skin, at the edge of the

white adhesive. Do not pinch up in the middle section of the plastic base. With
your other hand, place two ngers above the collar on the applicator barrel so
they are resting above the collar.

2. Place your thumb on the white plunger. Push the plunger down completely,

making sure it is ush against the applicator barrel. You should hear 2 clicks.

This action inserts the needle and sensor under your skin.

When you are pushing down on the plunger, do not pull back on the collar.

HELPFUL HINT:

• The safety lock can be used later for transmitter removal. Keep this

piece to help you remove the transmitter at the end of a continuous
glucose monitoring session. When your glucose monitoring session is
over, follow the steps in Chapter 8, Section 8.3, Transmitter Removal.

40 | Dexcom G4 Continuous Glucose Monitoring System

3

4. To remove the applicator barrel, squeeze
the ribbed release tabs on the sides of the
sensor pod (when you squeeze the front
part of the release tabs, the back part of the
tabs will widen, allowing you to pull off the
applicator barrel). After this step, only the
sensor pod will be left on your body.

• Make sure the transmitter latch is down

(against your body) to remove the applicator
barrel.

• Be sure to squeeze in the center of the ribbed part of the release tabs.

• While squeezing the release tabs rock the applicator barrel forward and out

away from the body.

If you have any problems with insertion, save the sensor and applicator and
contact your local distributor.

3.6 TRANSMITTER ATTACHMENT

Once you have inserted your sensor, you will need to snap the transmitter into
the sensor pod. Follow the steps below to attach your transmitter.

1. Clean and dry the bottom of the transmitter with a damp cloth or an alcohol
wipe before every use. Be careful not to touch the metal circles on the bottom
of the transmitter with your skin. For disinfection instructions refer to Chapter
10, Section 10.3, Cleaning and Disinfection. Be careful not to scratch the
bottom of the transmitter as scratches may compromise the waterproof seal.

2. Place the transmitter in the sensor pod with

the at side facing down.

Install transmitter in sensor pod

Release the applicator barrel

Dexcom G4 User’s Guide | 41

3. With one hand, you may want to pinch up on your skin at the front edge of the
white adhesive.

a. Place one nger on the transmitter to keep it in place while securing the

transmitter into the sensor pod.

b. Pull the transmitter latch over the

transmitter to snap the transmitter into

place. The transmitter should lie at in the
sensor pod. You should hear 2 “clicks.” If
you do not hear 2 “clicks,” the transmitter

might not be fully snapped in. You can release your pinch on the adhesive
edge at this time.

c. Make sure the transmitter is secure by sliding your rst and second ngers

under the sensor pod wings and press down on the transmitter with your thumb.

4. Hold the transmitter in place with one hand. Using
your other hand, remove the transmitter latch by
holding the end of the latch and quickly twisting off
the latch away from your body.

HELPFUL HINTS:

• Make sure you hear 2 clicks when you snap the transmitter in place (see

Step 3). Failing to seat the transmitter completely may lead to a poor

sensor connection and allow uids to get under the transmitter. This can

lead to inaccurate sensor glucose readings.

• Do not remove the transmitter from the sensor pod while the pod is

attached to your skin.

Remove transmitter

latch

Transmitter latch

42 | Dexcom G4 Continuous Glucose Monitoring System

3.7 STARTING A SENSOR SESSION

Follow the steps below to tell the receiver that you have inserted a new sensor.

1. Press the SELECT button to turn the receiver on.

2. From any trend graph, press the SELECT button to
display the main menu.

3. Press the Up or DOWN button to scroll until you

highlight “Start Sensor.”

4. Press the SELECT button to conrm the start of a
new sensor session. The start sensor processing
screen will appear to let you know your sensor

session has been activated and your 2-hour startup

has begun.

5. Your receiver will then return to the 3-hour trend

graph.

6. Check your receiver in approximately 10 minutes

after starting your sensor session to make sure
your receiver and transmitter are communicating.

The antenna symbol should appear in upper left
corner of trend graph. If the out of range symbol

appears in the upper right corner of the trend
graph, see Chapter 9, Section 9.9, Out of Range/
No Antenna.

3

HELPFUL HINTS:

• The start sensor menu option will disappear from the main menu. The

option will only appear again after an active sensor session ends. If
you do not see the start sensor option on your menu screen, you can

continue that session or stop the session (refer to Chapter 9, Section 9.6,
Sensor Shut-off Troubleshooting).

• After starting a new sensor session, you will not receive sensor glucose
readings or alerts until your 2-hour startup period has ended and you

have completed your initial calibrations. See Chapter 4, Section 4.3,
Startup Calibration.

Dexcom G4 User’s Guide | 43

3.8 SENSOR STARTUP PERIOD

The sensor needs a 2-hour startup period to adjust to being under the skin.

When you press the SELECT button during the
startup period to turn the receiver display on, your

trend graph will include a 2-hour countdown symbol

in the upper right hand corner.

Over time, the countdown symbol will ll to indicate
that you are getting closer to initial calibration time. See the pictures below for
an example of what this looks like. During the countdown period, you will not get
sensor glucose readings, alerts and alarms.

Throughout the 2-hour startup period if you see the out of range symbol at
the top of the screen review the following troubleshooting tips.

• Make sure your receiver and transmitter are within 6 meters of each other.

Check in 10 minutes to see if the antenna symbol reappears in the upper left
corner of the receiver screen.

•

If the receiver and transmitter are still not communicating, check the device
information screen to make sure the correct transmitter ID is entered into your
receiver (see Chapter 2, Section 2.3, Checking Information About Your Receiver).

•

If the correct transmitter ID has been entered into your receiver and the receiver
and transmitter are still not communicating, then contact your local distributor.

At the end of the 2-hour startup period the receiver will let you know that it is time

to calibrate your sensor. Chapter 4, Calibrating Your Dexcom G4 System, tells
you how to calibrate your sensor.

[0-24]

minutes

[24-48]

minutes

[72-96]

minutes

Ready for

calibration

[48-72]

minutes

Start

44 | Dexcom G4 Continuous Glucose Monitoring System

3

3. To turn the receiver back on and resume communication with the transmitter,
press the SELECT button. It may take up to 20 seconds for the display to turn
back on.

2. Conrm that you want to shutdown your receiver.

a. If you want to shutdown, press the LEFT button

to highlight “OK” and then press the SELECT

button.

b. If you want to cancel the shutdown, press the

SELECT button (with “Cancel” highlighted) to

return to the main menu.

3.10 TEMPORARY RECEIVER SHUTDOWN

There may be times when you want to temporarily shut down your receiver.
Shutdown will stop all communication between the transmitter and receiver, and
will turn the receiver off. You will not receive sensor glucose readings or any
alerts or alarms while the receiver is shut down, but your current sensor session
will continue. Follow these steps to shut down your receiver:

1. From the main menu, scroll to and highlight

“Shutdown.” Press the SELECT button.

3.9 TAPING THE SENSOR POD

The sensor pod should stay securely attached to
your skin using its own adhesive. But, if the patch
is peeling up, you can use medical tape (such as
Blenderm, Tegaderm, IV 3000, 3M tape) for extra
support. If you use tape, only tape over the white
adhesive patch on all sides for even support. Do
not tape over the transmitter or any of the plastic
parts of the sensor pod. Do not tape under the
sensor pod or leave any substance on the skin where you insert the sensor.

Dexcom G4 User’s Guide | 45

HEL P F U L HI N T:

• If your receiver gets wet you need to make sure the speakers and vibrate

mode are still working. You can do this by using the Try It option in the

proles menu. See Chapter 6, Section 6.3, Alert Proles.

3.11 THE DEXCOM G4 SYSTEM AND WATER

Your sensor is water resistant when showering, bathing, or swimming if the
transmitter is fully snapped in. The sensor has been tested to be water resistant
when submerged for up to 2.44 meters for a maximum of 24 hours. The receiver

is rain resistant, but you should try to keep it dry. Do not spill uids on it or drop
it into uids. Keep the micro USB port cover closed to help prevent uid

from getting inside the receiver. Wireless communication does not work well
through water so the range is much less if you are in a pool, bathtub, water bed,
etc.

HELPFUL HINTS:

• Remember that your alerts and low glucose alarm will not work when the

receiver is shut down.

• Shutting down the receiver does not extend the sensor life beyond 7
days. Your sensor session will stop 7 days after you started the sensor
session.

46 | Dexcom G4 Continuous Glucose Monitoring System

THIS PAGE LEFT INTENTIONALLY BLANK

Dexcom G4 User’s Guide | 47

chapter four

CALIBRATING YOUR DEXCOM G4 SYSTEM

48 | Dexcom G4 Continuous Glucose Monitoring System

Dexcom G4 User’s Guide | 49

The Dexcom G4 System requires you to calibrate the sensor
glucose readings to your blood glucose meter.

4.1 CALIBRATION OVERVIEW

There are important times when you must calibrate:

1. Initial startup: 2 hours after you insert your sensor

2. 12 hour update: every 12 hours after the initial startup calibration

3. More information needed or other reasons

When calibrating, you need to manually enter your blood glucose values into the
receiver. You can use any commercially available blood glucose meter.

On the rst day of your sensor session, you will need to enter 2 blood glucose

values into your receiver as your 2 hour startup calibration. After your 2 hour
startup calibration has been entered, you will need to enter 1 blood glucose
value as your calibration at 12 hours after your startup calibration. From that
point on you will need to enter 1 blood glucose value every 12 hours. The
receiver will remind you when these calibrations are needed. You may also be
prompted to enter additional blood glucose values as needed. An example of
your minimum calibration schedule during a seven day sensor session is shown
below:

Example Minimum Calibration Schedule During Seven-Day Sensor Session

Monday (Day One of Sensor Session):

Tuesday - Sunday (Days 2-7 Sensor Session):

8:00

10:00

22:00

22:00

12-hr update

calibration

10:00

2-hr startup

calibration

Sensor

Insertion

12-hr update

calibration

12-hr update

calibration

Taking acetaminophen (paracetamol) containing products (such

as Tylenol) while wearing the sensor may falsely raise your sensor
glucose readings. The level of inaccuracy depends on the amount
of acetaminophen (paracetamol) active in your body.

50 | Dexcom G4 Continuous Glucose Monitoring System

4.2 HOW TO CALIBRATE

For calibration, you must enter the exact blood glucose value from your meter.

Blood glucose values must be between 2.2-22.2 mmol/L and must have been

taken within the past 5 minutes.

The steps below show you how to enter your blood glucose values for
calibration:

1. Take a blood glucose measurement using your meter.

2. From any trend graph, press the SELECT button to display the main menu.

3. Use the Up or DOWN button to scroll until you

highlight “Enter BG.”

4. Press the SELECT button to choose this option.
You will see a screen with a blood drop and a
number in mmol/L units.

4

HELPFUL HINTS:

• Do not use alternative blood glucose site testing (blood from your palm or

forearm, etc.) for calibration as alternate site blood glucose values may

be different than those obtained from a ngerstick blood glucose value.

Use a blood glucose value obtained only from a blood glucose meter for
calibration.

• In order to obtain accurate sensor glucose readings proper calibration is

required using accurate blood glucose values.

Entering incorrect blood glucose values, or blood glucose values

that occurred more than 5 minutes ago may cause inaccurate
sensor glucose readings.

HEL P F U L HI N T:

• Only blood glucose values between 2.2-22.2 mmol/L can be used for

calibration. If the blood glucose value(s) you entered was outside of this
range, the receiver will not calibrate. You will have to wait until your blood
glucose is in this range to calibrate.

Dexcom G4 User’s Guide | 51

a. When the receiver does not have a recent

sensor glucose reading the default is 6.7

mmol/L.

b. If there has been a sensor glucose reading in

the past 15 minutes, the “Enter BG” screen will

display your current sensor glucose reading
as your starting point. Do not use the current
sensor glucose reading for calibration. Use
only blood glucose values from your meter.

c. Before you take a blood glucose measurement to be used for calibration,

wash your hands, make sure your glucose test strips are not expired
and have been stored properly, and that your meter is properly coded (if
required).

Carefully apply the blood sample to the test strip following the instructions
provided with your meter or test strips.

5. To enter the blood glucose value, use the UP or DOWN button to scroll until
you see the correct value and then press the SELECT button.

6. Conrm that the blood glucose value you entered is correct. Entering
incorrect values may affect the sensor accuracy.

a. If the blood glucose value displayed is correct,

press the SELECT button.

b. If the blood glucose value displayed is incorrect,

press the RIGHT button to highlight “Cancel”
then press the SELECT button to return to the

“Enter BG” screen. Repeat the steps for re-

entering the correct blood glucose value.

c. If you do not press the SELECT button, the

receiver will “time out” and no blood glucose

value will be recorded for calibration.

7. The “Enter BG” processing screen will appear

to let you know the blood glucose value is being
processed for calibration.

HEL P F U L HI N T:

• “Enter BG” will be the second main menu option when you are in the

middle of a sensor session.

52 | Dexcom G4 Continuous Glucose Monitoring System

4

HELPFUL HINTS:

• Before calibration make sure a sensor glucose reading or a blood drop
symbol is displayed at the top of the trend graph.

• Due to the potential for confusion from low glucose, you may want to treat

low blood glucose prior to calibrating.

• Always make sure the antenna symbol is displayed in the upper left
corner of the trend graph before you enter blood glucose values for
calibration.

• You should always use the same meter you routinely use to measure

your blood glucose to calibrate. Do not switch your meter in the middle
of a sensor session. Blood glucose meter and strip accuracy may vary
between blood glucose meter brands.

• The accuracy of the blood glucose meter measurement used for

calibration may affect the accuracy of sensor glucose readings.

• Do not calibrate your Dexcom G4 System when you have acetaminophen

(paracetamol) active in your body. Taking acetaminophen (paracetamol)
containing products (such as Tylenol) while wearing the sensor may
falsely raise your sensor glucose readings. The level of inaccuracy
depends on the amount of acetaminophen (paracetamol) active in your
body.

Your sensor glucose readings may be inaccurate if you calibrate
less than every 12 hours.

You must enter the exact blood glucose value that your blood

glucose meter displays. Enter all blood glucose values for
calibration within 5 minutes. Entering incorrect blood glucose
values, or blood glucose values that occurred more than 5 minutes
ago, will affect device performance and may cause inaccurate
sensor glucose readings.

8. For startup calibration, repeat these steps for the second blood glucose value.

9. A sensor glucose reading will appear on the receiver right away, and sensor
glucose readings will be updated every 5 minutes.

10. If readings do not appear immediately, see Chapter 9, Section 9.2,

Calibration Troubleshooting.

Dexcom G4 User’s Guide | 53

4.3 STARTUP CALIBRATION

Two hours after you start the sensor session (see
Chapter 3, Section 3.7, Starting a Sensor Session)
the receiver will tell you that you need to calibrate by
displaying the startup calibration prompt. This prompt
means you need to calibrate with 2 separate blood
glucose values from your meter. You will not see
sensor glucose readings until the receiver accepts the
blood glucose values.

1. When you see this screen, press the SELECT button
to clear the display.

2. Take 2 separate blood glucose measurements with your meter and enter the
blood glucose values into the receiver (see Chapter 4, Section 4.2, How to
Calibrate).

3. You can clear the prompt by pushing the SELECT button. The blood drop
symbol will remain at the top of the trend graph until you calibrate. The system

will re-alert you every 15 minutes until you enter the blood glucose values. You

will not receive sensor glucose readings until the receiver accepts the blood
glucose values.

If you do not clear the prompt, the system will re-alert you every 5 minutes.

Startup calibration prompt

4.4 12 HOUR CALIBRATION UPDATE

Calibrate your system every 12 hours after your initial calibration (performed at 2
hours after sensor insertion) to make sure your sensor glucose readings remain
accurate and are close to your blood glucose meter values. You can enter any
blood glucose values you take during a sensor session. If you have not entered
any blood glucose values in the past 12 hours, the receiver will ask you to enter
a blood glucose value to update its calibration. The following steps show you
how to enter this calibration.

Your sensor glucose readings may be inaccurate if you calibrate
less than every 12 hours.

54 | Dexcom G4 Continuous Glucose Monitoring System

1. When you see this calibration prompt it means
it is time to calibrate with a single blood glucose
value. You can clear the prompt by pushing the

SELECT button. The system will re-alert you every

15 minutes until the receiver accepts the blood
glucose value.

2. Take 1 blood glucose measurement with your meter
and enter the blood glucose value into the receiver.
If this screen reappears shortly after you have entered a new blood glucose
value see Chapter 9, Section 9.2, Calibration Troubleshooting.

4

Calibration prompt

4.5 OTHER REASONS YOU MAY NEED TO CALIBRATE

• When your system did not accept the last calibration.

• When your blood glucose value is very different from the sensor glucose

reading.

1. When you see this calibration prompt it means it is
time to calibrate with a single blood glucose value.

2. Take 1 blood glucose measurement with your meter
and enter the blood glucose into the receiver. If this
screen reappears shortly after you have entered a
new blood glucose value see Chapter 9, Section

9.2.1, Types of Calibration Prompts.

HEL P F U L HI N T:

If you see these screens they are indicating calibration errors (see Chapter
9, Section 9.3, Calibration Error Troubleshooting).

15 minute calibration

error screen

1 hour calibration

error screen

Calibration prompt

Dexcom G4 User’s Guide | 55

chapter ve

SENSOR GLUCOSE READINGS AND

TRENDS

56 | Dexcom G4 Continuous Glucose Monitoring System

Dexcom G4 User’s Guide | 57

This chapter will teach you how to view your sensor glucose
readings and trend information. The trend graph will provide
additional information that your blood glucose meter does not.
It shows your current glucose value, the direction it is changing
and how fast it is changing. The trend graph can also show you
where your glucose has been over time.

Your blood glucose meter and sensor measure your glucose from two different

types of body uids: blood and interstitial uid. Therefore, your readings from

your blood glucose meter and sensor may not match.

HELPFUL HINTS:

• The greatest benet you receive from using your Dexcom G4 System will

come from the trending information. It is important that you focus on the
trends and rate of change on your receiver, rather than the exact glucose
reading.

• If you have difculty reading your receiver in bright sunlight, you may

need to seek a shady location.

Taking acetaminophen (paracetamol) containing products (such

as Tylenol) while wearing the sensor may falsely raise your sensor
glucose readings. The level of inaccuracy depends on the amount
of acetaminophen (paracetamol) active in your body.

The blood glucose value from your blood glucose meter should
be used for treatment decisions, such as how much insulin you
should take. The Dexcom G4 System does not replace a blood
glucose meter. Blood glucose values may differ from sensor glucose
readings. The direction, rate of glucose change, and trend graph on
your Dexcom G4 System provide additional information to help with
your diabetes management decisions.

58 | Dexcom G4 Continuous Glucose Monitoring System

5

5.1 Sensor Glucose Readings

Press the SELECT button to wake up the receiver screen. You will see the home

screen, which is the 3-hour trend graph. The 3-hour trend graph will show the

following:

• Each “dot” on the trend graph is a sensor glucose reading reported every 5

minutes.

• The trend graph shows the current time.

• The display light is activated with a press of any button.

• The status area shows needed calibration updates, calibration errors and

sensor glucose reading issues.

• Your high alert setting will be displayed as a yellow line across the trend graph.

• Your low alert will be displayed as a red line across the trend graph.

• The gray zone highlights your target glucose range based on your

individualized settings for high and low glucose alerts.

• Your current glucose reading will be red if it is low and yellow if it is high, based

on your high and low glucose alert settings.

• The dots on your trend graph will also change colors based on your high and

low alert settings.

• If your low glucose alert is not set and your glucose is 3.1 mmol/L or lower,

your glucose value will be red.

• If your sensor glucose readings are in between your high and low glucose alert

settings, the glucose value will be white.

High glucose
alert setting

Low glucose
alert setting

Antenna

Battery status

Most recent 5-minute

glucose reading

Glucose
target range

Glucose
value

Current time

Status area

Trend arrow

Dexcom G4 User’s Guide | 59

You can view your past glucose information

through the 1, 3, 6, 12, and 24 hour trend graphs

by pressing the UP or DOWN button.

• Your system only reports glucose information
between 2.2-22.2 mmol/L. Your trend graph will
show a at line or dots at 22.2 or 2.2 mmol/L

when your glucose is outside this range.

The sensor glucose reading is in
millimoles per liter (mmol/L) unit

(Scroll up from the 3-hour graph to reach the 1-hour graph)

1-Hour Trend Graph: The 1-hour trend graph shows your

current glucose reading and the last 1 hour of sensor glucose
readings.

3-Hour Trend Graph: The 3-hour trend graph shows your

current glucose reading and the last 3 hours of sensor glucose
readings.

(Scroll down from the 3-hour graph to reach the 6-hour graph)

6-Hour Trend Graph: The 6-hour trend graph shows your
current glucose reading and the last 6 hours of sensor glucose

readings.

(Scroll down from the 6-hour graph to reach the 12-hour graph)

12-Hour Trend Graph: The 12-hour trend graph shows

your current glucose reading and the last 12 hours of sensor
glucose readings.

60 | Dexcom G4 Continuous Glucose Monitoring System

The receiver displays “LOW” when the most recent glucose reading is less than

2.2 mmol/L and “HIGH” when the most recent glucose reading is greater than

22.2 mmol/L.

5

5.2 RATE OF CHANGE ARROWS

Your rate of change arrows add detail about the
direction and speed your glucose is changing.

The trend arrows appear to the right of your current
glucose reading.

HEL P F U L HI N T:

• Do not overreact to the rate of change arrows. Consider recent insulin

dosing, activity, food intake, your overall trend graph and your blood
glucose value before taking action.

(Scroll down from the 12-hour graph to reach the 24-hour graph)

24-Hour Trend Graph: The 24-hour trend graph shows

your current glucose reading and the last 24 hours of sensor
glucose readings.

Dexcom G4 User’s Guide | 61

This table shows the different trend arrows your receiver will display:

Constant: Your glucose is steady (not increasing/decreasing more

than 0.06 mmol/L each minute). Your glucose could increase or

decrease by up to 0.8 mmol/L in 15 minutes.

Slowly rising: Your glucose is rising 0.06-0.11 mmol/L each minute.

If it continued rising at this rate, your glucose could increase up to 1.7
mmol/L in 15 minutes.

Rising: Your glucose is rising 0.11-0.17 mmol/L each minute. If it

continued rising at this rate, your glucose could increase up to 2.5
mmol/L in 15 minutes.

Rapidly rising: Your glucose is rising more than 0.17 mmol/L each
minute. If it continued rising at this rate, your glucose could increase
more than 2.5 mmol/L in 15 minutes.

Slowly falling: Your glucose is falling 0.06- 0.11 mmol/L each minute.

If it continued falling at this rate, your glucose could decrease up to

1.7 mmol/L in 15 minutes.

Falling: Your glucose is falling 0.11-0.17 mmol/L each minute. If it

continued falling at this rate, your glucose could decrease up to 2.5
mmol/L in 15 minutes.

Rapidly falling: Your glucose is falling more than 0.17 mmol/L each
minute. If it continued falling at this rate, your glucose could decrease
more than 2.5 mmol/L in 15 minutes.

No

arrow

No rate of change information: The receiver cannot calculate how

fast your glucose is rising or falling at this time.

62 | Dexcom G4 Continuous Glucose Monitoring System

5

5.3 GLUCOSE STATUS AREA SYMBOLS

During your sensor session the “status area” at the top of the trend graph may

display any of the status symbols below. You will not receive sensor glucose
readings during the time the status symbol is displayed except during the regular
12 hour calibration prompt.

Calibration

Needed

This icon means you need to enter a calibration. This prompt will appear
when it is time for your 12 hour calibration update or any other time an
additional calibration is needed (see Chapter 4, Section 4.2, How to
Calibrate).

Additional

Calibration

Needed

This icon means you need to enter one more blood glucose value in order
to calibrate the system and start receiving sensor glucose readings.

HELPFUL HINTS:

• Trend arrows do not appear when there are

glucose data gaps (see Chapter 9, Section 9.4,
System Glucose Error). If the glucose reading

error symbol , the wait symbol , the out of
range symbol , or the blood drop symbol

appear at the top of the trend graph, the trend
arrows will not appear.

• If the trend arrow is missing, but you are concerned that your blood

glucose level may be rising or falling, take a blood glucose measurement
test on your blood glucose meter.

Symptoms related to low or high blood glucose levels should not

be ignored. If you have symptoms of low or high glucose obtain a
blood glucose measurement from your meter.

Dexcom G4 User’s Guide | 63

Glucose
Reading

Error

This icon means the receiver does not understand the sensor signal
temporarily. This icon is related to the sensor only. You should wait for
more prompts and do not enter any blood glucose values when you see
this symbol.

Out of Range

This icon means the receiver and sensor/transmitter are not
communicating. Make sure the receiver and sensor/transmitter are

within 6 meters of each other (see Chapter 1, Section 1.2, Transmitter

Overview).

15 Minute

Calibration

Error

This icon means the sensor cannot calibrate right now. If you see this
screen, enter at least one more calibration blood glucose value after about

10-15 minutes. If the sensor still cannot calibrate after that, the sensor

needs to be removed and a new sensor needs to be inserted.

1 Hour

Calibration

Error

This icon means the sensor is not calibrating correctly. If you see this
screen, wait a minimum of one hour and then enter one more blood
glucose value. If no readings display on the receiver after this, the sensor
needs to be removed and a new sensor needs to be inserted.

Wait

This icon means the receiver has detected a potential problem with the
sensor signal. You should wait about 30 minutes for more prompts. Do not
enter any blood glucose values when you see this symbol.

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THIS PAGE LEFT INTENTIONALLY BLANK

5

Dexcom G4 User’s Guide | 65

chapter six

ALERTS, ALARMS AND ALERT PROFILES

66 | Dexcom G4 Continuous Glucose Monitoring System

Dexcom G4 User’s Guide | 67

6.1 SETTING YOUR ALERTS

6.1.1 DEFAULT ALERT/ALARM SETTINGS

When you receive your Dexcom G4 CGM System the following alerts and
alarms are preset on your receiver (see table below).

What will I see
on the receiver
screen?

What does this
mean?

What
is the
default
setting?

How will the
receiver notify
me?

Will the
receiver
re-notify
me?

High Glucose
Alert

Your most recent
sensor glucose
reading is at or
above the high
alert setting.

On at

11.1 mmol/L

Vibrates twice
then vibrates/
beeps twice every
5 minutes until

conrmed or your

glucose value
drops below the
alert level.

No, unless you
have turned
on the high
alert snooze
feature.

Low Glucose
Alert
Your most recent
sensor glucose
reading is at or
below the low alert
setting.

On at

4.4 mmol/L

Vibrates three
times then
vibrates/beeps
three times every
5 minutes until

conrmed or your

glucose value
goes above the
alert level.

No, unless you
have turned
on the low
alert snooze
feature.

Fixed Low Alarm
Your most recent
sensor glucose
reading is at or
below 3.1 mmol/L.

On Vibrates four

times then
vibrates/beeps
four times every

ve minutes until
conrmed or your

glucose value
goes above 3.1
mmol/L.

Yes, every
30 minutes
after each

conrmation

until your
blood glucose
value comes
back into
range.

This chapter will teach you about your Dexcom G4 CGM
System’s many alerts and alarms and how to customize them.

68 | Dexcom G4 Continuous Glucose Monitoring System

What will I see
on the receiver
screen?

What does this
mean?

What
is the
default
setting?

How will the
receiver notify
me?

Will the
receiver
re-notify
me?

Out of Range
Alert

The
Sensor/Transmitter
and Receiver are
not communicating
to each other.

Off Off No

Rise/Fall Alert
Single Arrow

Your glucose
is rising/falling
at or above
a rate of 0.11
mmol/L/min (at
least 1.7 mmol/L in
15 minutes).

Off Off No

Rise/Fall Alert
Double Arrow

Your glucose
is rising/falling
at or above a
rate of 0.17
mmol/L/min (at
least 2.5 mmol/L in
15 minutes).

Off Off No

6

HEL P F U L HI N T:

• Your receiver may alert you at other times you need to take action

such as low battery, failed sensor, etc. See Chapter 12, Appendix, for a
detailed list of these other alerts.

Dexcom G4 User’s Guide | 69

6.1.2 GLUCOSE ALERTS

The Dexcom G4 System lets you create your own personal settings for how you
want the receiver to tell you what is going on. The low and high glucose alerts
will tell you when your sensor glucose readings are outside your target glucose
range. Rise and fall (rate of change) alerts let you know when your glucose

levels are changing fast (see Chapter 6, Section 6.2, Advanced Alerts). The

Dexcom G4 System also features a low glucose alarm that cannot be adjusted
or turned off and is set at 3.1 mmol/L. This is a safety feature telling you your
glucose level may be dangerously low. In addition to the alert screens that
appear on your receiver display, you can also set high and low glucose alerts
to notify you with vibrations and beeps. This feature can be helpful during times
such as sleeping, driving, exercising, or during meetings.

6.1.3 HIGH GLUCOSE ALERT

When your sensor glucose readings are at or above
your high alert level, this screen will appear with your
high glucose alert value displayed. Your receiver will

vibrate and/or beep depending on your prole setting
(see Chapter 6, Section 6.3, Alert Proles).

When you set the high glucose alert, this level is
indicated by a yellow line on the trend graph.

The receiver will continue to alert you until you press
the SELECT button to clear the alert, or until your
sensor glucose readings drop below your high glucose
alert level. You can choose to have the receiver

re-alert you after clearing the alert by changing
your snooze settings (see Chapter 6, Section 6.2,

Advanced Alerts).

High glucose alert set

at 11.1 mmol/L

High glucose

alert setting

70 | Dexcom G4 Continuous Glucose Monitoring System

6.1.4 LOW GLUCOSE ALERT

When your sensor glucose readings are at or below
your low alert level, this screen will appear with your
low glucose alert value displayed. Your receiver will

vibrate and/or beep depending on your prole setting.

When you set the low glucose alert, this level is
indicated by a red line on the trend graph.

The receiver will continue to alert you until you press
the SELECT button to clear the alert, or until your
sensor glucose readings rise above your low glucose
alert level. You can choose to have the receiver

re-alert you after clearing the alert, by changing
your snooze settings (see Chapter 6, Section 6.2,

Advanced Alerts).

Low glucose alert set

at 4.4 mmol/L

Low glucose alert setting

6

HELPFUL HINTS:

• When you have both your high and low alerts turned on there will be a

gray zone on your trend graphs indicating your target range.

• If your high or low alert is turned off this gray zone will not appear.

Dexcom G4 User’s Guide | 71

6.1.6 GETTING TO THE ALERTS MENU

1. Press the SELECT button to turn on the receiver. The 3-hour trend graph will

appear.

2. Press the SELECT button to display the main menu.

3. From the main menu, press the UP or DOWN button to scroll to “Alerts” and

press the SELECT button. The alerts menu will appear.

6.1.5 LOW GLUCOSE ALARM

The Dexcom G4 System also has a xed low alarm set at 3.1 mmol/L. This

alarm is a feature in addition to your personal low and high glucose alerts. You

cannot change or turn off this alarm or its re-alarm settings.

• For the low glucose alarm the receiver will display

the screen to the right.

• Re-alarm: The receiver will automatically notify you

again in 30 minutes after you press the SELECT
button to clear it, if your sensor glucose readings are
still at or below 3.1 mmol/L.

HELPFUL HINT:

• Your receiver will not alert you if you have calibrated in the last 5 minutes

and received a sensor glucose reading outside your target range. The
receiver will alert you if your sensor glucose reading remains outside

your target range after ve minutes.

72 | Dexcom G4 Continuous Glucose Monitoring System

6.1.7 HIGH AND LOW GLUCOSE ALERTS

The following steps show you how to change your high and low alert settings.

1. From the alerts menu, press the UP or DOWN

button to select “High Alert” or “Low Alert” and

press the SELECT button.

2. Press the UP or DOWN button to highlight “On/Off”
then press the SELECT button to set this option. A
check mark will appear next to the current setting.

3. Press the LEFT button to return to the previous
screen.

4. Press the DOWN button to highlight “Level.” The
number displayed is your current high glucose alert
value setting. To change this number press the

SELECT button and then press the UP or DOWN

button until your desired high glucose alert value is
displayed, then press the SELECT button.

• Your high glucose alert value can be set between

6.7 and 22.2 mmol/L in 0.1 mmol/L increments.

• Your low glucose alert value can be set between

3.3 and 5.5 mmol/L in 0.1 mmol/L increments.

6

HELPFUL HINT:

• The steps for setting both the high alert and the low alert are the same.

Dexcom G4 User’s Guide | 73

6.2 ADVANCED ALERTS

In addition to your high and low alerts and alarm, the high and low snooze, rise
and fall rate and out of range alerts may be set. For any of these advanced
alerts follow the steps below.

1. Turn the receiver on by pressing the SELECT button.

2. Press the SELECT button to enter the main menu.

3. Press the UP or DOWN button to highlight “Alerts” and press the SELECT
button.

4. From the alerts menu, press the UP or DOWN

button to select “Advanced” and press the SELECT

button.

HELPFUL HINT:

• Alerts must be acknowledged by pressing the SELECT button on the

receiver.

74 | Dexcom G4 Continuous Glucose Monitoring System

6

6. 2.1 SETTING A SNOOZE TIME FOR YOUR HIGH AND LOW

GLUCOSE ALERTS

You have the option to set a snooze time, every 15 minutes for up to 5 hours, in

between your high and low glucose re-alerts.

1. Press the UP or DOWN button to choose “High

Snooze” or “Low Snooze” and press the SELECT

button.

2. Press the UP or DOWN button to select the
amount of time (in 15 minute increments) in

between the rst alert and re-alerts. Press the

SELECT button. If you set the amount of time to

zero there will be no re-alerts.

3. When nished, press the LEFT button to return to

the alerts menu.

Dexcom G4 User’s Guide | 75

6.2.2 RISE AND FALL GLUCOSE RATE ALERTS

Rate alerts notify you when your glucose levels are rising (rise alert) or falling
(fall alert), and by how much. You can choose whether your receiver alerts you
when your sensor glucose value is either rising or falling 0.11 mmol/L or more
per minute, or 0.17 mmol/L or more per minute.

If you set your fall rate to 0.11 mmol/L per minute and
your sensor glucose readings fall at this rate or faster,

the “FALLING single arrow” screen will appear and

the receiver will vibrate or beep according to your

prole settings.

If you set your rise rate to 0.17 mmol/L per minute and
your sensor glucose readings rise at this rate or faster,

the “RISING double arrow” screen will appear and the
receiver will vibrate or beep according to your prole

settings.

Fall alert

Rapid rise alert

76 | Dexcom G4 Continuous Glucose Monitoring System

6

The following steps show you how to change your rise or fall rate alert settings.

1. Press the UP or DOWN button to choose “Rise

Rate” or “Fall Rate” and press the SELECT button.

2. Press the UP or DOWN button to highlight

“On/Off,” then press the SELECT button.

3. Press the UP or DOWN button to choose “On”
or “Off.” Then, press the SELECT button to select
“On” or “Off.”

4. Press the LEFT button to go back to the previous
screen. Press the UP or DOWN button to select

“Level” then press the SELECT button. Choose

whether the alerts should be delivered when

your glucose levels are rising/falling either “0.11
mmol/L/min” (0.11 mmol/L or more per minute)
or “0.16 mmol/L/min” (0.16 mmol/L or more per

minute). Press the SELECT button.

5. When nished, press the LEFT button to return to

the alerts menu.

Dexcom G4 User’s Guide | 77

6.2.3 SETTING THE OUT OF RANGE ALERT

The out of range alert lets you know when the sensor/transmitter and receiver
are not communicating with each other. Typically, you should keep the sensor/

transmitter and receiver within 6 meters of each other. When the sensor/

transmitter and receiver are too far apart and are not communicating, you will not
receive sensor glucose readings from the sensor.

When this happens, the out of range symbol will
appear in the upper right corner of the trend graph
and the screen to the right will appear. The amount of
time the devices are out of range will appear on the
out of range alert screen.

1. Press the UP or DOWN button to choose “Out of

Range” and press the SELECT button.

2. On the out of range menu, press the UP or DOWN

button to choose “On/Off.” Then, press the SELECT
button to select “On.” If you do not want to receive

out of range alerts press the SELECT button to

choose “Off.”

3. Next, on the out of range menu, press the UP or

DOWN button to choose “Time” and press the
SELECT button.

HELPFUL HINT:

• You conrm alerts by pressing the SELECT button on the receiver.

78 | Dexcom G4 Continuous Glucose Monitoring System

6

4. Press the UP or DOWN button to choose the
elapsed time, after which the receiver will alert you

and continue to re-alert you until you are back in

range. Press the SELECT button.

5. When nished, press the LEFT button to return to

the alerts menu.

6.3 ALERT PROFILES

The Dexcom G4 System allows you to set proles

to choose the way you want your alerts to behave.

This customizable feature is found under the Proles

option on the Main Menu shown to the right.

You can set your prole to the sound pattern and
the volume level that best ts your lifestyle needs.

Depending on your daily activities, you can quickly
and easily change the way your system alerts you by

changing your prole settings.

Your prole options are:

1. Vibrate

2. Soft

3. Normal

4. Attentive

5. HypoRepeat

For each prole option you will rst be alerted by a vibration.

When you choose your prole setting it is important to know this setting will
apply to all alerts, alarms and prompts. Within each prole setting each specic

alert will have its own unique sound pattern, tone and volume level. This allows
you to easily identify each alert and alarm and its meaning.

Dexcom G4 User’s Guide | 79

HELPFUL HINTS:

• On the rst alert notication the receiver will vibrate only (no beep).
Regardless of the specic alert prole you chose, if you conrm the initial

vibrate alert, you will not receive an additional audible alert.

• The xed low alarm at 3.1 mmol/L cannot be turned off or adjusted.

• For the soft, normal, attentive and hyporepeat proles the following alert

sequence will occur:

• The rst alert is vibrate only.

• If the alert is not conrmed in ve minutes, the system will

vibrate and beep.

• If the alert is not conrmed in ve more minutes, the system

will vibrate and beep louder and this will continue at the same

volume level every ve minutes until conrmed.

For the hyporepeat prole only:

• If the alert is conrmed and your sensor glucose readings

continue to be at or below 3.1 mmol/L your system will repeat
the alert sequence above in 30 minutes.

To conrm any alert press the SELECT button.

80 | Dexcom G4 Continuous Glucose Monitoring System

6

The vibrate prole can be used when you want to silence the

receiver and be alerted by vibration. The only exception to this will

be with the xed low alarm at 3.1 mmol/L, which will alert you as
a vibration rst, followed by audible beeps 5 minutes later if not
conrmed.

The soft prole can be used when you need your alert to be
discreet. This prole sets all the alerts and alarms to lower volume

beeps, which is intended to be less noticeable by people around
you.

This normal prole is the default prole when you receive your
system. This prole sets all the alerts and alarms to higher volume

beeps.

The attentive prole can be used when you need your alert to be
the most noticeable. This prole sets all the alerts and alarms to

loud and highly distinctive melodies.

The hyporepeat prole is very similar to the normal prole. The
difference with this prole is it will continuously repeat the xed low

alarm every 5 seconds until your sensor glucose value rises above

3.1 mmol/L or if it is conrmed. This prole can be helpful if you

want an additional level of awareness when you have severe low
sensor glucose readings.

6.3.1 ALERT PROFILE OPTIONS

HEL P F U L HI N T:

The “Try It” feature is available under the proles menu and

allows you to hear an example of the alert sequence and
sound for each individual alert and alarm. Once you hear the

sounds, it is easier to understand the alert prole options.

Dexcom G4 User’s Guide | 81

PROFILE

TYPE

VIBRATE SOFT NORMAL

ATTENTIVE HYPOREPEAT

High Alert

2 long
vibrates

2 long
vibrates + 2
low beeps

2 long
vibrates +
2 medium
beeps

2 long
vibrates +
ascending
melody

2 long vibrates +
2 medium beeps

Low Alert

3 short
vibrates

3 short
vibrates + 3
low beeps

3 short
vibrates +
3 medium
beeps

3 short
vibrates +
descending
melody

3 short vibrates +
3 medium beeps

Rise Alert

2 long
vibrates

2 long
vibrates + 2
low beeps

2 long
vibrates +
2 medium
beeps

2 long
vibrates
+ 1 short
ascending
melody

2 long vibrates +
2 medium beeps

Fall Alert

3 short
vibrates

3 short
vibrates + 3
low beep

3 short
vibrates +
3 medium
beeps

3 short
vibrates
+ 2 short
descending
melodies

3 short
vibrates + 3
medium beeps

Out of

Range

Alert

1 long vibrate 1 long

vibrate + 1
low beep

1 long
vibrate +
1 medium
beep

1 long vibrate
+ 3 short
repeating
melodies

1 long vibrate + 1
medium beep

Fixed Low

4 short
vibrates

4 short
vibrates +
4 medium
tone beeps

4 short
vibrate +
4 medium
tone beeps

4 short
vibrates
+ 2 long
descending
melodies +
pause + 4
low beeps

4 short vibrates
+ 4 low beeps +
pause + repeat
sequence

All Other

Alerts

1 long vibrate 1 long

vibrate + 1
low beep

1 long
vibrate +
1 medium
beep

1 long vibrate
+ 1 short
melody

1 long vibrate + 1
medium beep

6.3.2 ALERT PROFILE DETAILS

82 | Dexcom G4 Continuous Glucose Monitoring System

The following steps show you how to access and choose the prole you want to

set.

1. Press the SELECT button to turn on the receiver.

The 3-hour trend graph will appear.

2. Press the SELECT button to display the main
menu.

3. From the main menu, press the UP or DOWN

button to scroll to “Proles” and press the SELECT
button. The proles menu will appear.

4. Press the UP or DOWN button to scroll to the

prole you want to set and press the SELECT

button.

5. When nished, press the LEFT button to return to
the main menu.

6

Dexcom G4 User’s Guide | 83

chapter seven

EVENTS

84 | Dexcom G4 Continuous Glucose Monitoring System

Dexcom G4 User’s Guide | 85

The Events feature allows you to record information about your
diabetes management that may help you and your healthcare
professionals better understand your glucose patterns and
trends. You can enter details about carbohydrate intake, insulin
intake, exercise, and issues related to your health. You can then
view your trends and track your patterns using the Dexcom
Studio software.

7.1 EVENTS

7.1.1 SELECTING AN EVENT

1. Press the SELECT button to turn on the receiver.

The 3-hour trend graph will appear.

2. Press the SELECT button to display the main
menu.

3. From the main menu, press the UP or DOWN

button to scroll to “Events” and press the SELECT

button. The events menu will appear.

HEL P F U L HI N T:

• Event markers can be downloaded and viewed in the Dexcom Studio

software but cannot be viewed on your receiver.

86 | Dexcom G4 Continuous Glucose Monitoring System

7

4. Press the UP or DOWN button to choose the event

you want, “Carbs,” “Insulin,” “Exercise” or “Health”

and press the SELECT button.

7.1.2 SETTING THE DATE AND TIME FOR AN EVENT

When you enter an event you will be prompted to check that the date and time
for that event are correct. The default date and time for events you enter is the
current date and time stored in the receiver. The date format is YYYY/MM/DD.

1. To change the date and time for an event, press
the RIGHT button to highlight each value in the
date and time. Then, press the UP or DOWN
button to make any adjustments and then press
the RIGHT button to move to the next value. After
adjusting the time, press the SELECT button.

2. You will advance to the event conrmation screen.

Press the SELECT button to conrm the entry.

HELPFUL HINT:

• If you change the date or time for any event, it only applies to that event

and will not change the current date and time in your receiver.

Dexcom G4 User’s Guide | 87

7.1.3 CARBOHYDRATES

The carbs event lets you enter the amount of carbohydrates you have
consumed, up to 250 grams.

1. From the events menu press the UP or DOWN

button to choose “Carbs” and press the SELECT

button.

2. Press the UP or DOWN button to enter your carb

amount (0-250 grams), and press the SELECT
button. The number that rst appears on this

screen will be the last number you entered or the
default amount of 50 grams.

3. Check that the date and time for this entry are correct. Press the SELECT

button to conrm the entry.

4. You will advance to the event conrmation screen.

Press the LEFT or RIGHT button to choose either

“OK” to conrm or “Cancel” to discard this entry,

and then press the SELECT button. You will return
to the Events menu.

88 | Dexcom G4 Continuous Glucose Monitoring System

7

7.1.4 INSULIN

The insulin event lets you enter the amount of insulin you have taken, up to 250
units. You can only enter an insulin amount, not the type of insulin taken.

1. From the events menu press the UP or DOWN

button to choose “Insulin” and press the SELECT

button.

2. Press the UP or DOWN button to enter your insulin

amount (0-250 units), and press the SELECT
button. The number that rst appears on this

screen will be the last number you entered or the
default amount of 10 units.

3. Check that the date and time for this entry are correct. Press the SELECT

button to conrm the entry.

4. You will advance to the event conrmation screen.

Press the LEFT or RIGHT button to choose either

“OK” to conrm this entry or “Cancel” to discard

this entry, and then press the SELECT but ton. You
will return to the Events menu.

Dexcom G4 User’s Guide | 89

7.1.5 EXERCISE

The exercise event lets you enter the intensity (light, medium, or heavy) and

duration (up to 360 minutes), for any particular date and time.

1. From the events menu press the UP or DOWN

button to choose “Exercise”, and press the

SELECT button.

2. Press the UP or DOWN button to choose your
exercise intensity level, and press the SELECT
button.

3. Press the UP or DOWN button to enter your

exercise duration (0-360 minutes), and press the

SELECT button. The number that rst appears on

this screen is the default amount of 30 minutes.

4. Check that the date and time for this entry are correct. Press the SELECT

button to conrm the entry.

5. You will advance to the event conrmation screen.

Press the LEFT or RIGHT button to choose either

“OK” to conrm this entry or “Cancel” to discard

this entry, and then press the SELECT but ton. You
will return to the events menu.

90 | Dexcom G4 Continuous Glucose Monitoring System

7

7.1.6 HE ALTH

The health event lets you enter episodes of illness, stress, high symptoms, low
symptoms, cycle (menstrual) or alcohol consumption, for any particular date
and time.

1. From the events menu press the UP or DOWN

button to choose “Health,” and press the SELECT

button.

2. Press the UP or DOWN button to choose your
health event, and press the SELECT button.

3. Check that the date and time for this entry are
correct. Press the SELECT button to conrm the
entry.

4. You will advance to the event conrmation screen.

Press the LEFT or RIGHT button to choose either

“OK” to conrm this entry or “Cancel” to discard

this entry, and then press the SELECT but ton. You
will return to the events menu.

7.2 DEXCOM STUDIO SOFTWARE

The Dexcom Studio software is an optional component of your system. This
software allows you to view trends, track patterns and create customizable
charts to display your glucose trends.

You can change the date ranges to view long or short term patterns and trends.
You can use data from current and previous system downloads and save or

print les that you and your healthcare professionals can review.

For system requirements refer to the Dexcom website (www.dexcom.com). The
Dexcom Studio Software User’s Guide gives you more information on how to
use this software.

chapter eight

COMPLETING A SENSOR SESSION

Dexcom G4 User’s Guide | 93

Your sensor will continue to give you sensor glucose readings
for up to seven days. The performance of a sensor has not been
tested beyond seven days.

HELPFUL HINTS:

• Do not remove the transmitter from the sensor pod while the pod is
attached to your skin.

• Do not dispose of your transmitter. It is reusable. The same transmitter is
used for each session until you have reached the end of the transmitter
battery life.

• Consult your local waste management authorities for appropriate
procedures for disposal of blood contacting components (sensor and
applicator).

• In some cases your sensor session may end before you have completed
a full 7-day period. If this happens, see Chapter 9, Section 9.6, Sensor
Shut-Off Troubleshooting.

94 | Dexcom G4 Continuous Glucose Monitoring System

You can set the receiver to alert you with these displays using the proles setting
(see Chapter 6, Section 6.3, Alert Prole Details, “All Other Alerts”). After the
6-hour, 2-hour, and 30-minute reminders, you will continue to receive sensor

glucose readings. You can clear these screens by pressing SELECT on the

receiver. You must remove your sensor after the nal sensor expiration screen

(00:00:00) appears.

Once your sensor session has ended, sensor glucose
readings will no longer be shown on the receiver. The
trend graphs will indicate that the sensor session has
ended by displaying a red stoplight symbol at the top
as shown in the screen to the right.

You will need to remove your sensor and insert a new
sensor.

Sensor expiration notication

end of session screen

30-minute sensor expiration

notication screen

8.1 AUTOMATIC SENSOR SHUT-OFF

The receiver will tell you how much time you have remaining until your sensor

session is complete. The sensor expiration screen will appear at 6 hours, 2
hours and 30 minutes before your 7-day sensor session ends.

6-hour sensor expiration

notication screen

2-hour sensor expiration

notication screen

8

Dexcom G4 User’s Guide | 95

8.2 REMOVING A SENSOR

When you are ready to remove the sensor, make sure to pull out the
sensor pod while the transmitter is still attached.

1. Gently peel up the sensor pod adhesive patch from your skin, this will pull out
your sensor.

8.3 TRANSMITTER REMOVAL

Once the sensor pod is off your body, you will need to remove the transmitter (do
not dispose of the transmitter). To remove the transmitter you can use either

of the two methods below:

Method 1

The safety lock, once removed from the applicator (see Chapter 3, Section 3.4
Placing the Sensor), can be used as a tool to remove the transmitter.

1. Place the sensor pod on a table.

2. Hold the rounded edge of the safety lock.

3. Make sure the jagged edge of the safety lock is facing down (the direction
away from the removal arrow) as shown below:

Sensors may fracture on rare occasions. If a sensor breaks and no

portion of it is visible above the skin, do not attempt to remove it.
Seek professional medical help if you have symptoms of infection

or inammation—redness, swelling or pain—at the insertion site.

If you experience a broken sensor, please report this to your local
distributor.

HEL P F U L HI N T:

• Glucose level alerts and alarms will not function after the sensor session

has ended.

96 | Dexcom G4 Continuous Glucose Monitoring System

8

4. Insert the jagged edges so that they “hug” the wide end of the transmitter

in the sensor pod. Press the safety lock down until you cannot press down

anymore, and the transmitter will “pop” out of the sensor pod.

5. Remove the transmitter, clean it (see Chapter 10, Section 10.1, Maintenance)
and store it in a cool, dry place until your next glucose monitoring session.

Method 2

If you did not save the safety lock, you can simply use your ngers to spread out

the tabs at the back of the sensor pod (end closest to the sensor pod tab wings).

The transmitter will “pop” out of the sensor pod.

Safety lock
(from applicator)

Sensor pod with
safety lock
snapped in

Sensor pod
tabs

Sensor pod
tab wings

Removal
arrow

Dexcom G4 User’s Guide | 97

9

chapter nine

TROUBLESHOOTING

98 | Dexcom G4 Continuous Glucose Monitoring System

Dexcom G4 User’s Guide | 99

9.1 SENSOR INSERTION TROUBLESHOOTING

Sensor insertion difculties

• I am having trouble taking out the safety lock:

- Make sure to pull the safety lock straight out away from your body. Use the

arrows on the safety lock as a guide.

- Do not wiggle back and forth.

• I am not able to pull the collar up:

- Make sure the plunger is completely pressed down before pulling the collar

up.

- When pulling the collar up you should hear 2 “clicks.”

- Try using more force when pulling the collar up.

• I am not able to remove the applicator barrel from the sensor pod:

- Make sure the collar is pulled all the way

up. You may need to use extra force to
pull the collar as close to the top of the
applicator as possible.

- Make sure the transmitter latch is at

against the adhesive on your body before
squeezing the release tabs.

- Then squeeze the ribbed release tabs on

the sides of the sensor pod, and lift the
applicator away from your body in an arc
motion.

• I am not able to remove the transmitter latch:

- Hold the sensor pod with one hand and twist the transmitter latch with the

other hand to remove it.

- Do not try to snap it straight off.

Release the applicator barrel

HEL P F U L HI N T:

• If the troubleshooting steps in this chapter do not x your issue, contact

your local distributor.

This chapter provides helpful tips and instructions to resolve
issues you may experience while using your Dexcom G4 CGM
System.

100 | Dexcom G4 Continuous Glucose Monitoring System

Sensor pod is not sticking long enough

• Make sure your skin is clear of any cream or lotion before you attach the

sensor pod.

• Clean the area rst with an alcohol wipe. Make sure the area is clean and

completely dry before you insert the sensor. Do not leave any substance on the
skin where the needle inserts.

• You may use medical tape (such as Blenderm, Tegaderm, IV 3000, 3M tape)

over the white adhesive patch of the sensor pod, but do not place the tape
over the transmitter or the plastic parts of the sensor pod or where the needle
inserts the sensor.

9.2 CALIBRATION TROUBLESHOOTING

Calibration prompts may appear during your sensor session. Review the
following troubleshooting tips to have a successful calibration.

HELPFUL HINTS:

•

Make sure the receiver and transmitter are communicating when you

calibrate. The icon should not appear in the status area.

•

Make sure the icon does not appear in the status area when you
calibrate.

•

Make sure your blood glucose values are between 2.2 and 22.2 mmol/L
before you calibrate.

• Prior to obtaining a blood glucose value to be used for calibration, wash

your hands, make sure your glucose test strips are not expired and have
been stored properly and that your meter is properly coded (if required).
Carefully apply the blood sample to the test strip following the instructions
provided with your meter or test strips.

• Make sure you have not taken any medications containing

acetaminophen (paracetamol) (such as Tylenol).

• Make sure your transmitter is fully snapped in to your sensor pod.

• See Chapter 4, Calibration, for further information.

9