Getting Started with Continuous Glucose Monitoring MEDTRONIC • CGM Getting Started Guide - X23 • MECHANICAL • Renie Design 1 / 29 / 10
Congratulations on your decision to use the MiniMed Paradigm® REAL-Time Revel™ System! A solid understanding of Continuous Glucose Monitoring (CGM) basics is essential to your success.
Let’s get started! Your CGM system includes 3 key items: 1 Glucose Sensor Measures glucose levels in the body. 2 MiniLink® transmitter The MiniLink transmitter connects to the glucose sensor and sends glucose readings to your insulin pump. It is recharged and stored in the MiniLink charger when not in use. 3 Insulin Pump Delivers insulin and receives and displays glucose readings.
1 Understanding CGM G L U C O S E R E A DI N G S Your BG meter measures glucose (sugar) levels in your blood, and your glucose sensor measures glucose levels in the fluid surrounding the cells in your tissue, which is called interstitial fluid. Most of the time, glucose travels first to your blood and then to your interstitial fluid. MiniLink ® Skin Glucose Sensor Because of how glucose travels, your BG meter readings and sensor readings will rarely match exactly. This is normal and should be expected.
C A L I B R AT ION Your MiniMed Paradigm® REAL-Time Revel™ System uses BG meter readings to make sure the glucose sensor maintains its accuracy over time. This is called calibration. To calibrate you must check your BG on your meter and enter the value into the pump. The two most common ways to calibrate are through the Bolus Wizard® and the sensor menu. The preferred method is the Bolus Wizard, which may help to prevent the stacking of insulin. When you calibrate is important.
Calibration is essential for optimal sensor performance. The glucose sensor performs best when calibrated 3–4 times per day. CGM does not eliminate the need for BG meter readings (fingersticks). You do not need to wait 6 hours (day one) and 12 hours to calibrate. You can calibrate early, as long as your glucose is stable. SET TINGS Your MiniMed Paradigm REAL-Time System allows you to customize alerts to help improve your glucose control.
2 Starting-Up CGM* S T E P 1 : G L U C O S E S E N S OR I N S E RT ION Site Selection Choose a place on your body at least: • 2 inches from your navel • 2 inches from your insulin pump infusion site • 3 inches from any manual insulin injection site For best glucose sensor performance, avoid: • Sites where clothing may rub or constrict (for example your beltline) • Sites where your body naturally bends a great deal • Sites that are scarred or have hardened tissue or stretch marks Note: clinical trials for
Insertion: 1 Place the glucose sensor in the Sen-serter® Insertion Device until it fits snugly. 2 Place your thumb on the back of the white tape and push the glucose sensor down until it locks. 3 While holding down the white tape, remove the clear tape. 4 Gently remove the needle guard. 6 Hold the skin taut. Place two fingers on the Sen-serter base to stabilize it for insertion. Press the white button on top of the Sen-serter Insertion Device.
S T E P 2 : PR O G R A M M I N G S E T T I N G S A good time to program your glucose sensor settings into your insulin pump is after glucose sensor insertion, while the glucose sensor is still wetting with interstitial fluid. Your healthcare provider will work with you and your trainer to determine your initial settings.
To turn your sensor setting on, go to: HOME Screen > MAIN MENU > SENSOR > EDIT SETTINGS > SENSOR: ON To turn your high and low glucose alert limits on, go to: HOME Screen > MAIN MENU > SENSOR > EDIT SETTINGS > GLUCOSE ALERTS: ON To set your high and low glucose alert limits, go to: HOME Screen >MAIN MENU > SENSOR > EDIT SETTINGS > GLUCOSE LIMITS Remember! Your High and Low glucose alerts are not the same as your target glucose ranges.
To set your rate of change alerts, go to: HOME Screen > MAIN MENU > SENSOR > EDIT SETTINGS > Rate Alerts You will be asked first to set a fall rate of 1.1 to 5.0 mg/dL/min, or select to turn it OFF. After your fall rate is selected, you will then be asked to set your rise rate. You may set a rise rate of 1.1 to 5.0 mg/dL/min, or turn it OFF. It’s often best to wait until you have adjusted to CGM to set these alerts.
Commonly Used Settings Setting What It Does High Repeat The amount of time until you are reminded that your sensor glucose is still above your high alert setting 2 hrs – 3 hrs Low Repeat The amount of time until you are reminded that your sensor glucose is still below your low alert setting 20 min – 30 min Cal Repeat The amount of time after you miss a calibration (Meter BG Now alert) before you are reminded 1 hr Cal Reminder The amount of time until your next calibration 30 min – 1 hr Weak Si
STEP 3: CONNECTING THE MINILINK® TRANSMITTER After the glucose sensor is inserted and your settings are entered, wait 10–15 minutes before connecting the MiniLink transmitter to the glucose sensor. Once 10–15 minutes have passed, remove the MiniLink transmitter from the charger. When you remove the MiniLink transmitter from the charger, a green light will flash on the transmitter. This indicates it has enough battery power to last at least 3 days and is ready to be connected to the glucose sensor.
S T E P 4 : C A L I B R AT I N G METER BG NOW alert will sound when the system is ready for you to enter a BG meter value for initial calibration. Remember, the preferred method is to use the Bolus Wizard.® Clear the alert and follow either of these steps to enter a BG meter value: > ENTER BG > BG to update Sensor : YES or MAIN MENU > SENSOR > CALIBRATE > Enter BG After you calibrate, it will take 10–15 minutes for sensor glucose readings to appear on your insulin pump screen.
S T E P 5 : R E A DI N G T H E DI S P L AY Your insulin pump screen displays 3-hour, 6-hour, 12-hour, and 24-hour glucose trend graphs. Press ESC once from the HOME Screen to display the most recently viewed trend graph. Press to display the other graphs.
3 Applying CGM in Your Life W H AT I S C A R E L I N K ™ S OF T WA R E ? CareLink software is a Web-based software that allows you to upload information from your MiniMed Paradigm® REAL-Time System to a secure online (internet) site for viewing. CareLink software organizes all of your insulin pump and glucose sensor information into reports (charts, tables and graphs) that help you track glucose levels, insulin usage and carbohydrate intake over time.
HOW DO CARELINK™ SOFTWARE REPORTS HELP ME? CareLink software provides you with information you’ve never had before about your glucose trends and patterns. Take action and make simple changes to optimize your glucose control.
CareLink™ Software Tips For best results using CareLink software, Medtronic Diabetes recommends: • Finding a consistent time once a week to review your CareLink reports. • Reviewing two CareLink reports to start: the Sensor Daily Overlay Report and the Daily Summary Report. • Picking one or two simple adjustments to work on at a time when you review the past week’s information in CareLink software. Always remember to review and discuss your CareLink reports when you visit your healthcare provider.
Appendix • M i n i L i n k® Tra n s m i t te r T i p s • C l e a n i n g Yo u r M i n i L i n k Tra n s m i t te r • O t h e r U s e f u l I n fo r m a t i o n Ta p e T i p s X - ray s , M R I s a n d C T s c a n s A i r Trave l • Alerts • No te s 18 | Appendix
MiniLink® Transmitter Tips Fully charge the MiniLink transmitter before each use. When the MiniLink transmitter is charging, a green light on the charger will flash. The green light on the charger will turn off when completely charged. When you remove the MiniLink transmitter from the charger, a green light should flash on the MiniLink transmitter. This indicates it has enough battery power to last at least 3 days and is ready to be connected to the sensor.
Cleaning Your MiniLink® Transmitter Medtronic Diabetes does not recommend cleaning the MiniLink transmitter after each sensor use. CAUTION: The MiniLink charger and test plug are not waterproof and should not be immersed in water. If you feel that the MiniLink transmitter needs cleaning, follow these steps: • Attach the test plug to the MiniLink transmitter to help prevent water, soap and sanitizer from damaging the connector pins inside the MiniLink transmitter. Do not expose the connector pins to liquids.
Other Useful Information Tape Tips It is highly recommended that you put a transparent dressing to secure the system in place and ensure that the sensor remains fully inserted underneath the skin. Seasonal climates, skin lotions/creams, trapped moisture or different clothing may affect your sensor tape adhesion or the way your body reacts to it.
Alerts To clear an alert screen, press ESC , then ACT . Alert What It Means How to Respond Weak Signal (WeakSn) The insulin pump and MiniLink® transmitter are not communicating. Re-position the insulin pump closer to the MiniLink transmitter. Lost Sensor (SenLos) Insulin pump has not received a signal from the MiniLink transmitter for more than 40 minutes. Ensure the MiniLink transmitter and sensor are connected. Place the insulin pump closer to the transmitter.
Alert What It Means How to Respond Sensor End (SenEnd) Sensor has been used for 72 hours. Remove sensor and follow guide for new sensor start. Sensor Error (SenErr) Sensor signals are either too high or too low. Clear the alert and ignore if this happens during initialization. If alert happens more than 3 times in 24 hours, replace the sensor Change Sensor (ChgSen) System has detected a sensor that isn’t working correctly.
Notes 24 | Understanding CGM
www.medtronicdiabetes.com Medtronic Diabetes 18000 Devonshire Street Northridge, CA 91325 1.800.646.4633 Band-Aid® is a registered trademark of Johnson & Johnson Companies. MiniLink, Sen-serter, Paradigm, and Bolus Wizard are registered trademarks of Medtronic MiniMed, Inc. Revel and CareLink are trademarks of Medtronic MiniMed, Inc. IV-3000 is a registered trademark of Smith & Nephew, Inc. 9403341-011 012810 ©Medtronic MiniMed, Inc. 2010. All rights reserved.
