 So those are the things that actually if the Dexcom does not give you a tandem pump a signal for 20 minutes or more, which can happen sometimes after a shower, some people say that the water gets in there, there's some lip of a signal loss, you may be kicked out. But from my experience, it is not that easy to be kicked out as Metronik. So I think tandem has advantage here in terms of getting kicked out. So guys, as a result, if you're sick and your body is telling you that your blood sugars are running high, your pump and CGM is not able to keep up with you, I would suggest to turn the control IQ off or the auto mode off in the Metronik and do it yourself, because these pumps are not designed for bad days, the closed lip systems are designed when you're relatively stable on a day-to-day basis. But if you're sick, your ketones are high, don't expect the pump to take care of you. That is not designed for that purpose. There's an important clinical pearl for you. If you're sick, call your endocrinologist, call your diabetes specialist, call your diabetes educator, get help before you end up in the hospital. So now we are going to talk about the different feature which, again, educational parts out of all these differences. What is important for you doesn't matter if you're a Metronik pump or a tandem pump, there's certain things that you always have to do. So if you're on a Metronik pump, here are some educational points for you. Now, if you're treating hyperglycemia, try to treat these low blood sugars with more caution. Since your insulin pump is going to reduce your basal insulin, just try to eat less of a carb. If you're eating 20-30 grams of carbs normally to fix it, just eat 10-15 grams. It's just going to be a lot easier to correct those relatively mild low blood sugars. On the other hand, that's true for both Metronik and the tandem, but for Metronik, it is also very important to enter your blood sugar calibrations or when it says blood sugar required or BG required. Not every time the pump asks you, BG required doesn't mean that you have to calibrate the sensor, so it is just sometimes a requirement that the pump company came up with for the safety feature. So if you do not enter the BG, you're just not going to be able to stay in the Oda mode, and once you're in the outside Oda mode, you're not as safe in terms of keeping your blood sugars under control. And you guys really should also remember that you cannot really put a temporary basal, so when you're in the Oda mode, the pump is in charge, you cannot really modify much of anything. You can always, for both pumps, you always have to enter your carbs so you can get a bolus. Again, you know, this feature is valid. It has to be done for both pumps. But if you want to do a dual bolus or a square wave bolus, that is not going to be possible when you're in the Oda mode. So if you're going to go partying, if you're going to do something crazy, just probably, I'll tell you, just get out of Oda mode, do your own thing with the personal settings, and hopefully you know how to handle different situations. But in crazy situations like that, like in a sickness or in a super crazy vacation or something like that, you may not be able to rely on your pump. So you know, let's say you're in a party, you're not going to be able to do a dual wave or a square wave, but if you're not in the Oda mode, you should be able to do that. And you can adjust your basal rates when you're not in a regular situation. Let's say you go out on a vacation where you're super physically active, you may just want to reduce your basal dose quite a bit in consultation with your diabetes specialist or a necronologist. On the other hand, with the tandem, there are a couple things that are different from an educational standpoint. When you have tandem, you can actually do an extended bolus, but that's only up to two hours, so be mindful of that. It's still possible, but it is not as free. On the other hand, with the tandem insulin pumps, you should not be overriding your boluses because remember, tandem insulin pump will give you a bolus already. If you are going to hit 180, if it is predicted to be 180, you will get a 60% of calculated bolus. So if you are trying to overdo it, it may cause a stacking and that may not be to your best advantage. On the other hand, the pump parameters can be adjusted with the tandem pump, so if you need to adjust your insulin carb settings, you can do that, but sensitivity in terms of the active insulin time, I'm sorry, in terms of the active insulin time, you're basically stuck with the five hours. So if you need to make an adjustment there, you should in consultation with your necronologist. Again, giving a bolus is a requirement without overdoing. Again, treating low blood sugar with tandem also, you'd have to be less aggressive and just keep those all in mind. Also remember with the tandem insulin pump, if you're exercising, you can put it in an exercise mode or if you're on a vacation where you are actually physically much more active then you can set your exercise mode frequently and the sleep mode also can help you to keep a tighter blood sugar control and wake up with a nicer blood sugar bag. Lastly, let's talk about the sensor differences. So that is important because DEXCOM is really a good sensor. It allows you to make clinical decisions, so you can basically go with the numbers of the DEXCOM. The only time, because you don't really follow the DEXCOM is if you feel different. If you feel low, but DEXCOM is saying that, oh, you're 100, these devices are not perfect. They're getting there close to be perfect, but again, if you feel like different than what the pump is telling you, I mean, the DEXCOM is telling you, then you should definitely do a finger stick check. DEXCOM will allow you to do calibrations if you want to improve the sensitivity factor. If you just started the DEXCOM, you may want to give a couple of hours for it to warm up. So in the first couple of hours of starting your sensor, you also need to do a finger stick if you need to check your blood sugars during the warm up period. Again, the DEXCOM can be remotely monitored. It's usable for both Android and the iPhone on the cell phone. The sensor for the Metronik, unfortunately, cannot be used on an Android right now, so you have to have an iPhone. But if you have a pump which uses the closed-loop system, then you actually see the blood sugar number with the shield sign on the pump, so you don't necessarily have to use actually a phone. On the other hand, for a guardian sensor to keep going and to help with the closed-loop systems, you have to do two to four calibrations at least a day. And you cannot really make clinical decisions in terms of your calculating your correction insulin. You have to do a finger stick and enter to the pump in order to get a correction insulin. So you cannot just take the sensor value and put in the pump and then just use that. The pump will not just allow you to do that. And if you do not do that, then you will be kicked out of the OTA mode. So it's very important to do your calibrations to stay in the OTA mode. For Metronik, if you stay in the OTA mode 80-90% of the time, you will be very, very successful. It just takes a little bit more effort and we just talk about differences. So it is up to you how you want to proceed between the different two pumps. With a tandem, ALAK DEXCOM has a sensor a little bit more. Bottom line though, it's not always the car, it's most of the time the driver. So as a patient, you are in the driver's seat and you are operating these pumps. So if you are not a very adherent or motivated to get things done and keep your sugar under control, these pumps are not really miraculous, so it's not going to really help you much. It helps mostly to motivated individuals. On the other hand, I will also applaud Metronik for their clinical support team. Their educators, their nurses are very supportive, they are very available. So as a result, Metronik wins the clinical part of it. And tandem and DEXCOM, they are great companies technologically. They have a few features that I like more than Metronik. But when it comes to the clinical service, providing educators, being very helpful on the phone, etc. I think they have a long way to go. They are newer companies, they are doing great things for the patients. But again, I think in my practice what I typically end up doing is if they are asking my opinion between the two pumps, if you are a young individual, tech savvy, you don't really need a lot of support from the educators or from the technical people, then I think you are good to go with tandem and DEXCOM. I have a lot of elderly patients who are really good technologically, but overall speaking, my older patients tend to need more help with the education, understanding the carbohydrate counting, how the pumps work, and the technical parts. And I'm glad that the Metronik nurses are really helpful. They are very genuine and sincere, help patients all the time, anytime we need them. So for those patients, I tell them, hey, you know, you may have to do a few more finger sticks, but I think it's worth it because you have a great educator and you have to really understand that you need a lot of support. Somebody who is 25-year-old, they just don't want to deal with the finger sticks. They are too busy and they just know how to download things on the computer and they can set things up themselves technically and they are quick learners in terms of how to operate the machine and how to count carbs. For those patients, I think in my practice I prefer tandem and DEXCOM combination. Another important fact that guys live in a real world, the tandem and DEXCOM together is right now covered by Medicare. Metronik, on the other hand, could not get their sensor covered by Medicare. So if you're a Medicare patient, you're not going to be able to get that closed loop system at least for a while. And they're working to get their system going. They're coming with a new sensor that will not require finger sticks or maybe require just one or two finger sticks at the beginning and nothing after. And they're getting there. So the competition is good. But as I said guys, if you are as of February, we are actually in March now, as of March 2020, Metronik and DEXCOM together will be more covered by Medicare versus Metronik, not as of this time. So if you have any questions guys, if you want to be seen by us remotely, again, we are not a typical diabetes practice. We basically see patients remotely. So we can see your DEXCOM data remotely. We can see your POM data remotely. We can help you 24-7. Every week you can send us your data. We can sit down and review your data, make some adjustments and get you to become a perfect diabetic patient. And if you control your diabetes, guess what? You're not going to suffer from the consequences or complications of diabetes. So again, I'm Dr. Ergin. I'm an endocrinologist from sugarmds.com. If you have any questions, concerns, please let us know. You can email me at ahmet at sugarmds.com. Or you can just call us, text us at 1-800-644-3963. I hope that helped you and have a wonderful day.