INSULIN PUMP AND CONTINUOUS GLUCOSE MONITORING SYSTEM Insulin Pump User Guide
Paradigm® 522 and 722 Insulin Pumps User Guide
© 2006, Medtronic MiniMed. All rights reserved. This product is covered by U.S. Patent Nos. 6,551,276; 6,554,798; 6,872,200; 6,936,029; 6,979,326; 6,997,920 and 7,025,743. Other U.S. and/or foreign patents may be pending. Bolus Wizard®, Dual Wave®, Paradigm®, Quick-serter®, Quick-set®, Silhouette®, Sof-set®, and Square Wave® are registered trademarks of Medtronic MiniMed. Easy Bolus™ is a trademark of Medtronic MiniMed. Energizer® is a registered trademark of Eveready Battery Company.
Important Safety Information Regarding Your Paradigm Insulin Infusion Pump (includes all models) Avoid Immersing Your Pump In Water Although it is unlikely that water damage will occur if your pump is splashed or briefly dunked, you should avoid immersing your Paradigm infusion pump in water. To swim or participate in other water activities, always disconnect from your Paradigm pump and reconnect after water play.
Contents Your personal information ............................................. xi Basal rate .................................................................................................. xi Carb ratios (meal bolus information) ............................................................... xii Chapter 1 Introduction .................................................1 Availability ................................................................................................. 1 Assistance ...........
Time display .......................................................................................14 Reservoir volume .................................................................................14 Alert and alarm icons ............................................................................14 Sensor icons .......................................................................................14 Scroll bar .............................................................................................
Changing your infusion set ............................................................................ 44 Removing the reservoir .............................................................................44 Rewinding your pump ...............................................................................45 Inserting the reservoir in your pump .............................................................46 Manual prime ......................................................................................
Add, delete, review meter IDs .....................................................................69 Normal bolus using Bolus Wizard feature .......................................................... 71 Bolus Wizard feature examples ...................................................................... 73 Chapter 6 Optimizing pump therapy ................................. 77 Square Wave and Dual Wave bolus ..................................................................
Alarm details ....................................................................................... 103 Setting your alert type ...............................................................................103 Auto-off ..................................................................................................104 Low resv alert (Low reservoir warning) ...........................................................104 Review daily insulin totals ..........................................................
I cannot get to the User Settings menu ........................................................ 125 Alert conditions ........................................................................................126 What to do .......................................................................................... 126 Low reservoir alert ............................................................................. 126 Low Battery alert .............................................................................
Bolus history ............................................................................................135 Bolus Wizard feature ..................................................................................136 Carb ratios ..............................................................................................136 Carb units ...............................................................................................136 Daily totals ..............................................................
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Practice lessons and examples Bolus examples Meal bolus Normal meal bolus using the exchange system ..................................................23 Bolus practice .........................................................................................24 Normal meal bolus practice using exchanges ....................................................24 Normal meal bolus using carbohydrate counting ................................................
Example 1: BG on target (normal BG) and no active insulin ...................................73 Example 2: BG above target (high BG) and no active insulin ..................................74 Example 3: Blood glucose below target (low BG) and no active insulin .....................74 Example 4: Blood glucose above target (high BG) with active insulin .......................75 Example 5: Blood glucose below target (low BG) with active insulin ........................
Your personal information You may need the following information from your healthcare professional before going to your pump start appointment. If you are unsure, contact your healthcare professional or pump trainer for instructions. NOTE - This information is not for the Bolus Wizard® feature. Refer to chapter 5 for Bolus Wizard feature settings. Basal rate Basal insulin is required to maintain your target glucose values when you are not eating.
Pattern B Pattern A Basal rate Start time number #1 midnight #2 #3 (additional basal rates) #4 #5 #6 #7 #8 Basal rate (units per hour) Carb ratios (meal bolus information) Your carb ratios are used to calculate your meal boluses. If you count grams: this ratio is the number of carb grams covered by one (1) unit of insulin. If you count exchanges: this ratio is the number of insulin units you need to cover one carb exchange.
Chapter 1 Introduction Thank you for choosing Medtronic MiniMed as your partner in helping you gain better control of your diabetes. Whether you are beginning pump therapy for the first time or upgrading from a previous model, we believe that the combination of state-of-the-art technology and the simple, menu-driven programming of the pump will provide many benefits. This user guide is designed to help you to understand pump therapy and the operation of your pump.
Emergency kit Keep an emergency kit with you at all times to make sure that you always have necessary supplies. Inform a family member, co-worker, and/or friend where this emergency kit is kept. Please refer to the “User safety” section in this chapter for more information on pump safety.
Disposables The pumps use disposable reservoirs and infusion sets for insulin delivery. Installation instructions for Paradigm reservoir and infusion sets are provided in chapter 4, “Starting on insulin.” ➠ Reservoirs: The 522 pump is intended for use with a 176-unit Paradigm reservoir (MMT-326). The 722 pump is intended for use with a 300-unit Paradigm reservoir (MMT-332), however it can also use the MMT-326 as well.
➠ ➠ Sensor: The sensor continuously converts tiny amounts of glucose from your fatty layer under the skin into an electronic signal. ComLink: The Medtronic MiniMed ComLink is used to download the Paradigm 522 or 722 pump data to the diabetes management software using a serial communications interface cable installed on your computer. To order supplies, call 800-646-4633 (1-800-MiniMed) 818-362-5958 (outside U.S.) www.minimed.com How to wear your pump There are different ways to wear your pump.
How to use this guide NOTE - This user guide shows sample screens only. Your pump screens may be slightly different. For step-by-step instructions, refer to the appropriate sections in this guide. Refer to the Glossary for definitions of terms and functions. The terms and symbols used in this guide are in the table below.
User safety Indications Pump The Paradigm 522/722 pump is indicated for the continuous delivery of insulin, at set and variable rates, for the management of diabetes mellitus in persons requiring insulin. Sensor and transmitter The sensor and transmitter components are indicated for continuous or periodic monitoring of glucose levels in the fluid under the skin, and possible low and high blood glucose episodes in adults (ages 18 and older).
Precautions Although the pump has multiple safety alarms, it cannot notify you if the set is leaking or the insulin has lost its potency. It is essential, therefore, that you test your blood glucose levels at least four times per day. If your BG is out of range, check the pump and the infusion set to ensure that the necessary amount of insulin is being delivered. Avoid extreme temperatures 1 Avoid exposure of your pump and remote control to temperatures above 108°F (42°C) or below 34°F (1°C).
Notice CAUTION: Any changes or modifications to the devices not expressly approved by Medtronic MiniMed could void your ability to operate the equipment. Insulin pump and RF accessories The pump, meter, transmitter and remote control comply with the United States Federal Communications Commission and international standards for electromagnetic compatibility. Do not use the RF meter to send your BG reading to the pump while on an aircraft. Manually enter your BG.
Chapter 2 The basics Your pump CAUTION: Never use sharp objects to press the buttons on your Paradigm pump as this can damage the buttons or compromise the seal of the pump. Some examples of sharp objects that may damage your keypad are fingernail files, pens or pencils, paper clips, knives, scissors, and keys. Take a look at your pump. The reservoir window allows you to view the insulin in the reservoir.
Install battery CAUTION: Do not use a rechargeable or carbon zinc battery in your pump. For best results, a new AAA Energizer alkaline battery is recommended. Medtronic MiniMed designed the pump to only accept a NEW battery. As a safety measure, if you install a battery that does not have full power, the “weak battery” or “failed batt test” alarm may sound. If you receive a “weak battery” alarm, respond to the alarm and continue. The pump will still operate normally, but with a decreased battery life.
5 While the pump turns on, it will show various screens until the HOME screen appears. 7 Ver X.XX HOME screen NOTE - If you are replacing a battery for a pump that has recently been in use, the only screen you will see before the HOME screen is the one displaying the version number. If the HOME screen does not appear, do these steps: a. Check that the battery is inserted correctly. If the battery has been installed backwards, remove the battery and install it properly. b.
Pump buttons The buttons on the pump are used to navigate through the menus and screens, and to program the features of the pump. UP button (From the HOME screen, this is the EASY BOLUS button.) EXPRESS BOLUS button DOWN button ESC button From the HOME screen EASY BOLUS™ button—Shortcut to set and deliver an Easy Bolus. Turns the backlight on/off from the HOME screen. Opens the MAIN MENU. If Sensor is off: Opens the pump STATUS screen.
The pump screen The screen shows five lines of text at one time. The first is the operating mode. The second is the current open menu or function. The last three lines show either information or text that you can select for the current function. NOTE - The screen text in the examples used in this guide might not exactly match the text on your pump screen. Please follow your pump screen instructions. If you have any questions, call the Medtronic MiniMed 24 Hour HelpLine.
Time display The current time of day is displayed across the top of the pump screen in the format you select—12-hour or 24-hour. The AM or PM is only displayed for the 12-hour format. For instructions on setting the time on your pump, see“Setting the time and date” on page 21. 12-Hr Time Display Reservoir volume The reservoir volume icon tells you how much insulin is in your pump. This icon is also divided into four segments.
Scroll bar If there is more text than the screen can show, a scroll bar appears in the right side of the screen. Press view any additional text. to scroll bar Screen backlight When you press from the HOME screen, the light on the screen turns on or off. During programming, the backlight can be turned on by pressing the and the together. The light will stay on while you are pressing any of the pump buttons. It will stay on as long as the current screen is active.
Operating modes The screen lets you know when a special feature is active or if there is a condition that needs your attention. The active features and pump status will determine the operating mode. The screens for the three modes are shown below. WARNING: When the pump is in “Attention mode,” all insulin deliveries are stopped. Normal - mode for standard pump operations for normal basal and bolus delivery. No special features are active (i.e., basal patterns, temp basal, etc.). No alarms or alerts exist.
Attention - indicates insulin delivery has stopped. This can mean that the pump is in Suspend mode. It can also mean an alarm is active or an alarm condition exists that needs immediate attention for insulin delivery to resume. A solid circle appears at the top of the screen and the pump will beep periodically until either the pump is taken out of Suspend mode or the condition is cleared. The screen will show text describing the condition that put the pump in Attention mode.
SENSOR - Contains the functions to setup the interface between the sensor and the pump and has access to the pump’s sensor features. Refer to the sensor user guide that came with you pump, “Paradigm 522 and 722 Sensor features,” for more information. BASAL MENU - Contains the functions to setup and deliver your basal insulin. Refer to chapter 3, “Basal” for more information. PRIME MENU - Contains the functions required to change your reservoir and fill the infusion set with insulin.
STATUS screen The STATUS screen shows information about what your pump is doing. The information that shows on the STATUS screen depends on the current activities and conditions of your pump. ➠ To open the STATUS screen, press ESC until the STATUS screen appears ➠ To view more text on STATUS screen, press / to scroll and view all of the information. To exit the STATUS screen, press ESC until the STATUS screen disappears.
If you remove your pump Pump settings You may have an occasion when you need or want to remove your pump. If you have to remove and store your pump, it is recommended that you store it with the battery in place. Keep a record of your current basal rates. To preserve battery life, reset the basal rates to 0 (zero), turn off the RF options (meter, remote), and set Auto-off to dashes or zeroes. NOTE - Your pump keeps a record of the basal and bolus insulin it delivers. Setting your basal to 0.
Chapter 3 Basic programming Setting the time and date Setting the correct time and date in your pump is necessary for accurate basal insulin delivery and allows you to keep an accurate record of your insulin delivery and other pump functions. You can select a 12-hour or 24-hour clock. You must reset the time and date if you receive a CHECK SETTINGS alarm or you clear your settings (Clear Settings function). 1 Go to the TIME/DATE SETUP screen.
5 The TIME SET AT screen will show the settings that you programmed. Press ACT and exit the menus. Your time/date settings are complete. TIME SET AT 8:33 AM 26FEB2004 Bolus There are three bolus types: Normal, Square Wave®, and Dual Wave®. This section gives instructions for a Normal bolus using the express bolus button and navigating through the menus. (For information about Square Wave and Dual Wave boluses, refer to chapter 6, “Optimizing pump therapy.
NOTE - If you have BG Reminder turned on, a screen displays allowing you to accept or modify the length of time after this bolus before you are reminded to check your blood glucose. See the section, “BG reminder” for information about this feature. 4 Press ACT to accept and deliver the bolus. The Normal bolus will start. As the bolus delivers, the amount shown on the screen will increase until the entire bolus has been delivered. BOLUS DELIVERY 11:53A Normal 0.1 U BOLUS DELIVERY 11:53A Normal 2.
Bolus practice: Going through the menus, program a 2.0 unit Normal bolus now. Check here if you were able to program it. Using the EXPRESS BOLUS button , program a 2.0 unit Normal bolus now. NOTE - Make sure that you are not connected to your pump while practicing. Check here if you were able to program it. Normal meal bolus practice using exchanges: Choose a meal you might eat and fill in the blanks.
Choose a meal you might eat and fill in the blanks. Food: ________ grams of carbohydrate: ______________ ________ grams of carbohydrate: ______________ ________ grams of carbohydrate: ______________ total grams of carbohydrate: ________________ Your insulin to carbohydrate ratio: 1 unit of insulin for _______ grams carbohydrate. Divide your total carbohydrates by your insulin to carbohydrate ratio and take _____units of insulin for your meal.
Practice: Meal bolus You have determined your meal bolus as: _______ units. Your target blood glucose range is: _______ to _______ (average is _______ ). Your current blood glucose level is: _________. Your correction factor is: 1 unit of insulin will drop your BG _________. You will take ________ unit(s) of insulin to correct your high BG level. Your total bolus (meal bolus plus correction bolus) is _________.
Review your bolus deliveries You can view a list of your bolus deliveries in the BOLUS HISTORY screen. This screen shows a list of the dates, times, units, and types for your last 24 boluses. This feature is helpful for record keeping or to check if you bolused for your last meal. If a bolus was stopped before delivery was complete, the BOLUS HISTORY screen will show only the amount actually delivered. Refer to the next section “Bolus details” for instructions about viewing bolus details.
Bolus details You can view the details for any of the deliveries in the BOLUS HISTORY screen. The details include: Bolus types: Normal, Square, and Dual ➠ Programmed bolus amount ➠ Delivered bolus amount ➠ Bolus Wizard feature information (if used) To see the details for any bolus, do these steps: ➠ 1 In the BOLUS HISTORY screen, select the bolus that you want to review and press ACT. 2 The details for that bolus will appear on the screen. Scroll through the details. 3 Exit when you are done.
Maximum bolus limit The maximum bolus (max bolus) is a safety feature that limits the amount of insulin that can be delivered in a single bolus. The factory setting is 10.0 units. You can specify the limit from 0.0 to 25.0 units. It is important to discuss this feature with your healthcare professional to determine your maximum bolus amount. To set the maximum bolus limit, do these steps: 1 Go to the MAX BOLUS SETUP screen. 2 Set your maximum bolus limit and press ACT. 3 Your maximum bolus is set.
BG reminder When you deliver a bolus, you may want to check your BG afterwards. The BG Reminder is an optional feature that makes your pump beep or vibrate to remind you to check your BG after a bolus. Your pump is set at the factory with this feature turned off. If the BG Reminder is on, during bolus programming your pump will ask for the amount of time you want to be reminded after your bolus delivers. This time can be from 30 minutes to 5 hours, or NONE.
Basal Basal insulin is required to maintain your target glucose values when you are not eating. Your healthcare professional will calculate this rate for you. Your basal insulin should account for approximately one half of the body’s total daily insulin requirements. Your pump mimics your pancreas by delivering insulin continuously over 24-hours. You can set your insulin pump to change rates during the day to match your needs. Your needs depend on your lifestyle and insulin requirements.
Your basal settings You must program your basal settings before you can deliver basal insulin. Keep a written record of your basal settings. It is recommended that you set your basal rates with the assistance of your healthcare professional. If you plan to take off your pump for an extended period of time, i.e. more than a day, set the basal rate to 0.0U/H. This will ensure that the insulin delivery records in your pump are accurate.
If you need to program more than one basal rate for the day, do these steps: a. In the SET START TIME 2 screen, enter the start time for the next rate and press ACT. b. The SET BASAL RATE 2 screen will appear. Enter the rate and press ACT. c. Repeat steps a and b for each additional basal rate. Each rate will have a different number (i.e. Basal Rate 1, Rate 2, Rate 3, etc.). SET START TIME 2 --:-- _.__ U H ACT Start time 2 (flashing) Press / _.
Basal review Temporary basal information is only available in the STATUS screen. Current basal delivery The STATUS screen shows your current basal information. standard basal is the current basal STATUS U100 Last Bolus N 3.8U 9.07A 11 JAN Basal 1: 0.80 U/H Units Left: 128.0U Battery: Normal Remote: On Tue 11 JAN 2004 S/N #000000 Paradigm 522 Ver X.XX X.X Daily basal rate(s) The BASAL REVIEW screen shows your daily basal rates programmed for delivery from midnight to midnight (12:00A to 12:00A).
2 If you do not use patterns: The delivery details for your standard basal will appear. STANDARD 16.80 U 0.60U/H 1.00U/H 0.80U/H 1) 12:00A 2) 11:30A 3) 12:00P basal rate start times If you use patterns: The screen will show the basal patterns. The current basal pattern will be highlighted. Select the pattern you want to view. Press ACT. (24-hour total) The start time and basal insulin from 12:00A units for each delivery rate in that to 12:00A basal delivery rates pattern will appear.
Max basal rate Maximum (Max) basal rate is a safety limit for the amount of basal insulin that is able to be delivered per hour. This maximum rate will apply to every basal rate that is set, including a temporary basal. It is important to discuss what your Max basal rate should be with your healthcare professional.
Stopping your pump You can stop your pump with the Suspend function. Suspend stops all insulin delivery including the current basal and any bolus or prime deliveries that are in progress. While suspended, your pump will not deliver insulin until you Resume your pump. When basal is resumed, the pump is taken out of the Suspend mode. The pump will beep or vibrate about every 15 minutes on the hour to remind you that it is not delivering insulin. Example: You suspend your pump at 11:20AM.
Example: Suspend function 1 Josh has been on a Medtronic MiniMed pump for several months. He is very active in soccer and basketball. He and his healthcare professional have determined that he does not need his basal insulin during his games, and that he is able to take the pump off for these short amounts of time. Josh uses the “Suspend” feature on his pump to stop the basal insulin during the time that he is disconnected from his pump. He will “Resume” delivery when he reconnects the pump.
Resume pump delivery When the pump is suspended, it defaults to the HOME screen with a solid circle. Do these steps to resume your pump and basal delivery: 1. From any screen, press ACT until the RESUME screen appears. Press ACT again. 2. Your pump will beep once, then the HOME screen will appear (with no circle). ACT Stopped at 1:05P RESUME NOTE - A bolus or fixed prime that was stopped by Suspend will NOT restart when you resume your pump. You must reprogram and activate it to finish delivery.
40 Chapter 3
Chapter 4 Starting on insulin Prepare your pump for use Before continuing with the steps in this chapter, we recommend that you watch your pump training CD-ROM and complete your pump start training.
Filling the reservoir WARNING: When filling the reservoir, take care to remove air bubbles. 1 Remove reservoir from package. Make sure plunger rod is fully extended. plunger rod 2 Swab vial with alcohol. 3 Making sure you do not push down on the plunger, press the transfer guard onto the vial. reservoir transfer guard 4 Push down on the plunger to pressurize the vial.
5 While still holding the plunger rod, flip the vial over so the vial is up, slowly pull down on the plunger to fill the reservoir. 6 Gently tap the side of the reservoir to make any air bubbles rise to the top of the reservoir. 9 With the vial down, hold the transfer guard. Turn the reservoir counter-clockwise then pull straight up to remove it from the transfer guard. 7 Slowly push up on the plunger just enough to remove any air bubbles from the reservoir.
11 Tap the side of the reservoir to remove any air bubbles. 12 To purge air bubbles that have risen to the top of the reservoir, push up on the plunger until you see insulin in the tubing. 13 Without pulling, turn the plunger rod counter-clockwise to remove it from the reservoir. Changing your infusion set Removing the reservoir Each time you remove and replace a reservoir in your pump, you have to rewind and prime your pump. Priming requires insulin. 1 Remove the entire infusion set from your body.
Rewinding your pump Before you continue, make sure the pump is NOT connected to your body. WARNING: Make sure the infusion set is disconnected from your body before you rewind or prime the pump. Never insert the reservoir into the pump while the tubing is connected to your body. Doing so could result in an accidental infusion of insulin. 1 If you removed your reservoir and are replacing it, go to the REWIND screen. Main > Prime > Rewind 2 In the REWIND screen, press ACT to start the rewind process.
Inserting the reservoir in your pump If your reservoir is already inserted in your pump, continue to the next section, “Manual prime.” You must do these steps in the order described. Your pump screen will show instructions to help you with these steps. If you are practicing, do NOT insert the reservoir in your pump. CAUTION: You must rewind your pump before installing a new reservoir. As part of the pump’s function, it measures the reservoir volume.
Manual prime Manual prime fills the infusion set tubing with insulin before you attach it to the infusion site. Manual prime is only available after you rewind your pump. WARNING: Make sure the infusion set is disconnected from your body before you press ACT to prime the pump. Never insert the reservoir into the pump while the tubing is connected to your body. Doing so could result in an accidental infusion of insulin. 1 After you rewind your pump, the PREPARING TO PRIME screen will appear.
IS PRIMING COMPLETE? Disconnect from body See user guide for instruction. ESC, ACT to clear If your manual prime uses more than 30U insulin, the pump will ask you, “is priming complete?” If you get this message, do these steps: a. Make sure you are not connected to the pump. b. Read the message on the screen, then press ESC, ACT to clear. c. If your manual prime is complete (you see droplets on the tip of the infusion set needle), press ESC and continue to step 5.
Quick-set infusion set (with Quick-serter®) Always refer to the instructions that shipped with your infusion set. 1 Wash your hands. 2 Clean and dry the infusion site.
10 11 12 13 Disconnecting Quick-set The Quick-set allows you the freedom to temporarily disconnect from your pump without removing the infusion set from your body. Hold the side grips of the connector part with your fingers. 50 Chapter 4 Twist the connector counterclockwise. Remove the connector from the site.
Reconnecting Quick-set A fixed prime is used before reconnecting the Quick-set to ensure that all air is removed from the tubing. Refer to the section, “Fixed prime” on the next page for instructions. Place the connector part (flat-side facing down) on the infusion set until it is fully seated. Do not grip the connector part by the flat side-grips.
Fixed prime A fixed prime fills the soft cannula with insulin and is required after the infusion set is inserted into your body and the introducer needle is pulled out. Additionally, a fixed prime is required prior to reconnecting the tubing to the infusion set to ensure that all air is removed from the tubing. NOTE - Prime amounts depend on the type of infusion set you are using. Refer to your infusion set instructions for your fixed prime amount. 1 Go to the PRIME MENU.
Record keeping for diabetes management Now that you are using the pump with insulin, we will be asking you to test your blood glucose regularly. The information from your blood glucose journal is your healthcare professional's only method of making adjustments in your pump settings. It is important to test often and write down your blood glucose readings, the food you eat, any exercise you perform and any other notes to explain your blood glucose results.
Using your daily journal To use the daily journal that came with your pump, follow these easy steps: 1 Write the day and date in the spaces provided on the top of the page. 2 Find the time of the entry you are making. Test your blood glucose and enter the value in the space labeled “blood glucose.” 3 If you are eating at this time, write the grams of carbohydrates in the space labeled “carbohydrates.
Chapter 5 Using the Bolus Wizard feature What is it? A feature that calculates an estimated bolus: ➠ To support your food intake AND/OR ➠ To correct high blood glucose Information you need Food entry You need to know how many exchanges or grams of carbohydrates you are going to eat. (You need to know what foods contain carbohydrate and understand carbohydrate counting.) Your blood glucose reading You need to know your blood glucose, BG, reading.
Get this information from your healthcare professional, and, for best results, talk to your healthcare professional before making any changes. Keep a record of your settings in the “Bolus Wizard feature settings” table on this page and the next page. Bolus Wizard feature settings Information Carb units: Carb ratios: Bolus Wizard feature uses this for your food bolus calculations. If you count carbs: this ratio is the amount of carbohydrate grams covered by one (1) unit of insulin.
Bolus Wizard feature settings Information BG target range: If your current BG is above the BG Target Range, the Bolus Wizard feature will calculate a correction dose. If your current BG is below the BG Target Range, the Bolus Wizard feature will calculate a negative correction and subtract it from your food bolus. Range: 60 – 250 mg/dL or 3.9 - 13.9 mmol/L NOTE - Your pump will allow you to program up to eight (8) different BG target ranges.
How the Bolus Wizard feature works 1 If you want your current blood glucose to be factored in, enter your BG reading. ➠ Automatically from your linked meter (refer to the section “Meter option”) or ➠ Manually by selecting . 2 If you are going to eat, enter your food amount in carbs or exchanges. 3 The Bolus Wizard feature will calculate a bolus for you. An ESTIMATE DETAILS screen will appear with your estimated total bolus amount.
More about the Bolus Wizard feature About high or low BG levels If your BG is less than 70 mg/dL (3.9 mmol/L) or more than 250 mg/dL (13.9 mmol/L), the Bolus Wizard feature screen will notify you and give instructions. Read the instructions and press ACT or ESC to clear the message. You can continue programming and deliver your bolus. LOW BG DO NOT BOLUS UNTIL BG IS NORMAL. Treat low BG. Monitor BG. HIGH BG Check for occlusion Check ketones. Consider insulin injection. Monitor BG.
About active insulin Active insulin is the bolus insulin that has already been delivered to your body, but has not yet been used. The Bolus Wizard feature considers your active insulin time setting in determining any active insulin still in your body from prior boluses. This may help prevent hypoglycemia caused by over correcting for high blood glucose.
How to program the Bolus Wizard feature You need your personal settings from the Bolus Wizard feature settings table to setup the Bolus Wizard feature. Your Bolus Wizard feature settings are programmed in the EDIT SETTINGS screen. Main > Bolus > Bolus Wizard Setup > Edit Settings Once the settings are programmed, you do not have to program them again unless the values change. After you program one setting, the screen will automatically go to the next required setting.
Carb units The carb unit setting lets the pump know which way to count your carbohydrates (grams or exchanges). Refer to the “Bolus Wizard feature settings” table for your carb ratio settings. NOTE - Any time you make changes to the carb units, you must also reprogram the carb ratios. 1 In the EDIT SETTINGS screen, select Carb Units and press ACT. EDIT SETTINGS Wizard: On Carb Units: Carb Units:- - BG Units: --- 2 Select Grams or Exchanges and press ACT.
WARNING A carb ratio of XX is valid but outside the usual range of 5-50.* ESC to correct, ACT to continue NOTE - Carb ratio values are normally between 5–50 grams/u or 0.3– 3.0 u/exch. If your ratio value is outside the range, this warning message will appear on the screen. Press ESC to correct or ACT to continue. (* 0.3 - 3.0 for exch) To set just one ratio: a. Press ESC.
BG units You can select mg/dL or mmol/L as your Blood Glucose Unit (measurement type). NOTE - If you make changes to your BG units setting, you must reprogram your insulin sensitivity and BG targets. 7 In the EDIT SETTINGS screen, select BG Units and press ACT. EDIT SETTINGS Carb Units: grams Carb Ratios:- > BG Units:- - - 8 Select mg/dL or mmol/L and press ACT. BLOOD GLUCOSE UNITS mg/dL mmol/L 9 The screen will return to the EDIT SETTINGS screen to set your insulin sensitivity next.
3 The SET START TIME 2 screen will appear. 4 To set just one insulin sensitivity: To set more than one insulin sensitivity: Press ESC. SET START TIME 2 _:_ ___ mg/dL per unit insulin a. Set the start time for the next insulin sensitivity and press ACT. SET START TIME 2* 7:30A ___ mg/dL per unit insulin (flashing) set, then press ACT (flashing) b. Set the value for the next insulin sensitivity and press ACT. c. Repeat steps a and b to set more values. d. Press ESC when you are done.
1 In the EDIT SETTINGS screen, select BG Target and press ACT. 2 Enter the low end of your BG target range and press ACT.Then enter the high end of your BG target range and press ACT. EDIT SETTINGS mg/dL BG Units: Sensitivity: -> BG Target: --- ACT TARGET RANGE 1 12:00A mg/dL 100 - 100 first BG Target Range (flashing) NOTE - The start time for your first BG target range is midnight (12:00A or 00:00) and cannot be changed. 3 The screen will display one of these messages: 4 To set just one BG Target: a.
Active insulin time The active insulin time setting lets the pump know which active insulin time to use in calculating the amount of active insulin to subtract before estimating a bolus. Refer to “About active insulin” on page 60 for more information about this setting. Your healthcare professional should determine the active insulin time that is best for you. To set the time, take the following steps: 1 In the EDIT SETTINGS screen, select Active Ins Time and press ACT.
Review your Bolus Wizard feature settings Check your Bolus Wizard feature settings in the REVIEW SETTINGS screen. If necessary, compare this information with your information in the Bolus Wizard feature settings table. Bolus > Bolus Wizard Setup > Review Settings 1 In the REVIEW SETTINGS screen, scroll through the text to view your Bolus Wizard settings. 2 Exit the menus when you are done.
Meter rules If you want your pump to communicate with the meter, the following conditions must apply: 1 The meter option must be turned on and programmed. Refer to the instructions in this section. 2 Your pump must be within 4 feet (1.2 meters) of your meter to receive the BG reading. 3 The pump cannot have a Low Battery alert condition. 4 When programming a bolus, the BG measurement from the meter will appear as the default BG value on the ENTER BG screen.
2 Add, delete or review your meter ID(s) as desired. Add Delete Review a. Select Add ID and press ACT. a. Select Delete ID and press ACT. a. Select Review ID and press ACT. b. Use the up and down arrow buttons to enter each of the six ID numbers. Press ACT after each entry. b. Select the meter ID that you want to delete and press ACT. b. The programmed IDs will show in the REVIEW METER ID screen. ADD METER ID - - - - - - (flashing) c.
Normal bolus using Bolus Wizard feature After the Bolus Wizard feature is turned on and programmed, this feature can calculate an estimate of insulin you need for your correction bolus and/or your food bolus. You have the option of using the estimate or changing it as necessary. Additionally, your pump can receive your BG reading from the meter, if they are linked. Use to deliver a Normal bolus at any time except during another Normal bolus.
4 In the ENTER FOOD screen, If this is a food bolus: If this is a correction bolus: Enter the food value you will Select 0 (zero) as the value and eat and press ACT. press ACT. ENTER FOOD 45 ENTER FOOD grams* 0 * or exch (flashing) 5 Review the information in the ESTIMATE DETAILS screen. Press ACT to continue to step 6. If you need to make any changes, press ESC to return to the ENTER BG screen (step 3) and make changes as necessary. ESTIMATE DETAILS Est total: 4.
Bolus Wizard feature examples For the scenarios that follow, Michael has his Bolus Wizard feature turned on with the following settings: Carb ratio: 15 grams per unit of insulin Insulin Sensitivity: 40 mg/dL per unit of insulin BG Target: 90-120 mg/dL Active Insulin Time: 6 hours NOTE - If you want to see details of the formulas the Bolus Wizard feature uses to calculate estimate boluses like the ones in the following examples, see “Bolus Wizard feature specifications” on page 141.
Example 2: BG above target (high BG) and no active insulin The next day, Michael wakes up before school. Before eating the same breakfast, he tests his BG with his linked meter and finds it to be 200 mg/dL, which is above his target of 120 mg/dL. His BG reading is automatically sent to his pump. When prompted by the Bolus Wizard feature, he enters his carbohydrate amount of 60 grams in the ENTER FOOD screen. Based on his settings, the pump will suggest that he take 6.0 units of insulin.
Example 4: BG above target (high BG) with active insulin Michael is at school and wants to eat a snack in the late morning. He tests his BG with his linked meter and finds it to be at 200 mg/dL, which is above his target of 120 mg/dL. He estimates that his snack contains 60 grams of carbohydrate, so he enters 60 into the pump when prompted by the Bolus Wizard feature. Based on his settings, and as a result of 1.5 units of active insulin, his pump will suggest that he take 4.5 units.
Example 5: BG below target (low BG) with active insulin Another day at school, Michael is getting ready to eat lunch. He tests his BG with his linked meter and finds it at 70 mg/dL (3.9 mmol/L), which is below his Low BG target of 90 mg/dL (4.9 mmol/L). His reading is automatically sent to his pump. When prompted by the Bolus Wizard feature, he enters his carbohydrate amount of 60 grams in the ENTER FOOD screen. Based on his settings, and despite 1.
Chapter 6 Optimizing pump therapy Square Wave and Dual Wave bolus Square Wave bolus delivers a bolus evenly over a period of time (30 minutes to 8-hours). This bolus can be used for insulin delivery when you have eaten a long meal with extended snacking. It can also be useful if you have delayed food digestion due to gastroparesis or meals high in fat. A Square Wave bolus can be useful if a Normal bolus drops your BG too rapidly.
Dual Wave/Square Wave bolus On/Off NOTE - It is important that you consult with your healthcare professional before using a Square Wave or Dual Wave bolus. You should be familiar with the basic functions of your pump before exploring these options. To set up a Dual Wave or Square Wave bolus, you must first turn on the Dual/Square bolus option. If the option is off, a Dual Wave or Square Wave bolus cannot be programmed or delivered. 1 Go to the DUAL/SQUARE OPTION screen.
For a Square Wave bolus do these steps: For a Dual Wave bolus do these steps: a. Select Square Wave Bolus. Press ACT. The SET SQUARE BOLUS screen will appear. a. Select Dual Wave Bolus and press ACT. The SET DUAL BOLUS TOTAL screen will appear. b. Enter the desired amount for the Square Wave bolus units and press ACT. b. Enter the desired amount for the total dual bolus units. Press ACT. c. Continue to step 5. SET SQUARE BOLUS 1.2U SET DUAL BOLUS TOTAL 1.
Square Wave bolus practice Your target pre-meal blood glucose range is ______ to _______. Check your pre-meal blood glucose. Are you within your target? _____ If yes, continue. If no, wait to try the following test until your pre-meal blood glucose is within your target range: TEST: Choose a meal that is high in fat (e.g. hot dogs, pizza, cheese enchiladas). Determine your meal bolus amount. Set the Square Wave bolus to deliver the determined amount of insulin over 2-hours1.
Dual Wave bolus practice Can you think of any meals where this feature would help you with blood glucose control? Your target pre-meal blood glucose range is ______ to _______ Check your pre-meal blood glucose. Are you within your target? _____ If yes, continue. If no, try this test when your pre-meal blood glucose is within your target range: TEST: Choose a meal that has a combination of both rapidly absorbed and slowly absorbed carbohydrates. Determine your meal bolus amount.
Using the Bolus Wizard feature for a Square Wave or Dual Wave bolus If you are using the Bolus Wizard feature to calculate your Square Wave or Dual Wave bolus amounts, you will be prompted to enter your BG reading and/or the carb/exchange units you will eat. The Bolus Wizard feature will use this input to calculate your suggested correction and/or food bolus amount. If you do not want to use the Bolus Wizard feature estimate, you can change it, if desired.
4 For a Square Wave bolus do these steps: For a Dual Wave bolus do these steps: The SET SQUARE BOLUS screen will appear. NOTE - The number of units you program for the Change the amount if desired. Press ACT to SET DUAL BOLUS TOTAL is a total of both the accept. Normal and Square Wave bolus units. SET SQUARE BOLUS Estimate 4.0U ACT a. The SET DUAL BOLUS TOTAL screen will appear. Change the amount if desired. Press ACT to accept. SET DUAL BOLUS TOTAL Estimate 4.0U ACT b.
NOTE - If you have BG Reminder turned on, a screen displays allowing you to accept or modify the length of time after this bolus before you are reminded to check your BG. 6 Press ACT to accept and deliver the bolus. The BOLUS DELIVERY screen appears.The pump beeps or vibrates at the start and end of the bolus. Shortly after bolus delivery begins, the screen defaults to the HOME screen. An open circle will appear indicating that your pump is in Special mode.
Step value setup You can set the step value from 0.1 to 2.0 units (factory setting: 0.1). Set the step to a number that is convenient to use and easy to multiply. Example: 2.0 unit Easy bolus with a step amount set at 0.5 units Total # Steps = 4 Total # Button Presses = 4 4 1 Step = 0.5 units 3 1 Step = 0.5 units 2 1 Step = 0.5 units 1 0 1 Step = 0.5 units 0 0.5 1.0 1.5 2 Total # Units 2 In the EASY BOLUS ENTRY screen, the “step” value will appear flashing.
2 Press the number of times needed for your bolus amount. Watch the amount change on the screen with each press. The pump will vibrate or sound a different tone for each press. When your total bolus amount appears on the screen, press ACT. Listen/feel to count the steps without looking at the screen. SET EASY BOLUS x 10 1.0 U ACT For example: You need to deliver a 1.0 unit bolus, and your step size is set to 0.1. Each time you press , the units increase by the “step” amount. To deliver 1.
Example 1: Easy bolus Alexander is a busy executive with an accounting firm. He wears his Paradigm pump on his belt and does not want to take it off to give himself a bolus. Alex can easily reach down and feel for the Easy Bolus button to give a bolus. He previously programmed his pump to deliver an Easy Bolus in steps of 0.5 unit increments. From the HOME screen, with each press of the track of the number of button presses. , the pump will sound a different tone so he can keep He wants to give himself 2.
Basal patterns The Basal Patterns feature is optional for pump users. You can set your pump to deliver a standard basal and two additional basal patterns to meet your individual daily, weekly, or monthly needs. Keep a paper copy of your programmed patterns with you at all times in case you need to reprogram your pump. To select and use pattern A or pattern B, the patterns option must be on and programmed.
Program a pattern Your pump will keep your pattern settings even when the Patterns option is turned off. The patterns feature must be on to program a basal pattern. NOTE - When you make changes to a pattern, the pump will use that pattern as the current basal. Make sure the basal you want is selected in the SELECT PATTERNS screen. Do these steps to program your patterns: 1 Go to the EDIT BASAL screen. EDIT BASAL Main > Basal > Set/Edit Basal 2 Select the basal pattern you want to program and press ACT.
5 After you press ESC, the BASAL RATE screen appears. The screen will show: ➠ Current ➠ Time basal pattern and basal rate it started ➠ 24-hour indicates Pattern A is the active pattern BASAL RATE A Current Rate 0.80 U/H Started #1 - 12:00A 24 Hr. Total 19.20 basal total Select a pattern Before you try to select a pattern to be active, make sure the Patterns feature is on.
Example 1: Basal patterns Ken has had his insulin pump for about a month. He tests his blood glucose 4 - 6 times a day and records his results in his logbook. He is happy with his glucose control during the week but on the weekends, he noticed that he has to eat more food to prevent his blood glucose from running too low. Ken has realized that during the week while he is at work, he is very inactive and sits at a desk most of the time.
Temp basal rates The temp basal rate feature is useful to manage BG levels during unusual short-term activities or conditions. These conditions could be an illness or unplanned physical activity that is not part of your daily routine. A temporary basal rate allows an immediate short-term change to your basal insulin for a specified period of time (30 minutes to 24-hours). This rate can be up to your maximum basal rate setting.
Temp basal types Based on your preference, you can select either Percent of Basal or Insulin Rate. Insulin rate Insulin rate is a fixed basal in units per hour (U/H). This temp basal type is independent of your current basal. When you select Insulin rate (U/H) for your temp basal type, your pump will deliver the fixed amount you have set for the duration as set. The amount of your temp basal insulin rate can be set up to your maximum basal rate setting.
Percent of basal The temp basal type is dependent on your current basal rates. Percent temp basal is a percentage increase or decrease of your current basal (0 - 200 percent limited to your maximum basal rate setting). The maximum percent limit is based on the largest basal rate segment with your programmed temp basal rate time. For example: It is 6:00AM and your current basal rate is 1.50 U/H. You want to set a temp basal rate of 130 percent for seven (7) hours.
NOTE - The pump delivers basal amounts in 0.05 U/H increments. Because of this, your temp basal amount will be rounded down to the next 0.05 U/H increment. temp basal settings temp basal type: Percent of basal duration: 4 hours (1:05p - 5:05p) rate: 120 percent (%) (120% x rate 2 = 3.06) 3.06 rounded down to the next 0.05 increment is 3.05 U/H 1.50 U/H (rate 1) 7:00a.m. (07:00) temp basal start time 3.05 U/H 2.55 U/H (rate 2) (120% x rate 3 = 2.34) 2.34 rounded down to the next 0.05 increment is 2.
Selecting temp basal type Your pump will remember the temp basal type setting. Once the type is set, you do not have to set it again. To select a temp basal type, do these steps: 1 Go to the BASAL MENU. Main > Basal > Temp Basal Type Select Temp Basal Type and press ACT. BASAL MENU Max Basal Rate Patterns Temp Basal Type ACT 2 The SET TEMP BASAL AS screen will appear. Select Insulin Rate or Percent of Basal and press ACT.
3 In the SET TEMP BASAL screen, the temporary basal rate will flash. Enter your temp basal rate, then press ACT. OR SET TEMP BASAL U/H 3:00P 0.05 U 60% H appears if Temp Basal Type is set to “Insulin rate (U/H)” 4 The BASAL MENU will appear. Your temp basal is now set and delivering. Exit the menus.
Canceling a temp basal Use the cancel temp basal function in the BASAL MENU to cancel a temporary basal. This function immediately stops the temp basal and resumes the regular programmed basal delivery. To cancel a temp basal, do these steps: 1 Go to the BASAL MENU. Main > Basal > Cancel Temp Basal 2 Select Cancel Temp Basal and press ACT to accept.
Example 2: Temp Basal for an increased temporary basal rate Gail has had a cold with a cough for a couple of days. Because she is not feeling well, she tests her blood glucose more frequently. She finds that her blood glucose levels are running above target range before meals and she has needed several correction boluses to keep her blood glucose levels within her normal limits. Gail decides to use the Temporary Basal Rate to increase her basal rate during the day today.
100 Chapter 6
Chapter 7 Insulin pump therapy follow-up We hope that you are now comfortable using the pump and your blood glucose values have improved through insulin pump therapy. Diabetes management requires much more than blood glucose control. You need to take care of your complete physical and mental health. This includes seeking treatment for any condition both directly related to and not related to diabetes. The following recommendations apply to general diabetes as well as insulin pump therapy follow-up.
➠ Test for microalbuminuria yearly Every visit ➠ ➠ ➠ Blood pressure check Foot exam Review goals for BG, meal plan and exercise Annually ➠ ➠ ➠ ➠ ➠ ➠ ➠ ➠ Dilated eye exam by a qualified ophthalmologist Annual flu shot Regular dental visits Nerve function tests EKG test over age 35 Prostate exam for men, breast exam for women Diabetes education review Replace Glucagon Emergency Kit (new prescription from healthcare professional) 102 Chapter 7
Chapter 8 Utilities Alarm review You can review alarms in the ALARM HISTORY screen. This screen shows up to 36 past alarms and/or errors. You can also review the details for each alarm when you are in the ALARM HISTORY screen. 1 Go to the ALARM HISTORY screen. Main > Utilities > Alarm > Alarm History 2 Scroll through your past alarms. ALARM HISTORY 11OCT 10:35P LoRes 08OCT 04:08P ChkSet 05OCT 11:35A LoBat 3 If you want to review the details for an alarm, continue to the next section, “Alarm details.
1 Go to the ALERT TYPE screen. Main > Utilities > Alarm > Alert Type 2 Select your alert type and press ACT. That alert type is now active. Exit the menus. ALERT TYPE Beep Long Beep Medium Beep Short Vibrate Auto-off The factory setting for this feature is off (set to 0 hours). This is a safety feature that stops insulin delivery after a defined time period (from 1 to 24-hours).
For “Insulin units”: For “Time”: Enter the number of units you want remaining when the first warning will go off. Press ACT. Enter the amount of remaining time you want for the first warning. Press ACT. WARNING UNITS 20 U (flashing) can be 5.0 – 50.0 The pump will alarm first when the specified units remain, then again when half that remaining amount is used.
Review daily insulin totals The DAILY TOTALS screen provides a day by day history of the total amount of insulin that delivered for the past 31 days. This screen includes all bolus and basal amounts delivered midnight to midnight for each of the past 31 days. The “Today” line in the DAILY TOTALS screen shows the amount of insulin you delivered so far that day. NOTE - The insulin used to prime your pump is not included in the DAILY TOTALS screen.
Pump data management The pump data management feature allows you and your healthcare professional to view and manage your basal and bolus insulin delivery, BG data, and food intake with averages up to 31 days. You can view the details of each day individually. You can also average the data over a specified time period that you have selected up to (up to 31 days). This is done in the DAYS TO AVERAGE screen as explained in the next section. To view the details of one day: 1 Select a date and press ACT.
➠ Total carbohydrates entered into the pump for the day (entered into the Bolus Wizard feature). To view more data, press . 5 The BOLUS screen is displayed.
Days to average The DAYS TO AVERAGE screen allows you to choose the number of days to average. This example shows the previous 12 days as the number of days to be averaged. 1 Select Daily Average and press ACT. DAILY TOTALS Daily Average Today 26.5U 27Feb 48.5U 26Feb 54.5U ACT DAYS TO AVERAGE Main > Utilities > Daily Totals > Daily Average 2 The DAYS TO AVERAGE screen is displayed. Select the number of days you want to average by pressing and . Press ACT. 3 The AVG BG screen is displayed.
5 The AVG INSULIN (average insulin) screen is displayed. This screen shows: ➠ The average total insulin delivered per day for the previous 12 days. ➠ The average total basal and bolus insulin delivered and total percentage of basal and bolus insulin delivered per day for the AVG INS 112.30U previous 12 days. Basal 60.20/ 54% ➠ The average total carbs entered into the pump per day (entered into the Bolus Wizard feature) for the previous 12 days. To view more data, press . Bolus Carbs 52.
Personal reminders Alarm clock The alarm clock is a feature that allows you to set daily reminders for various events (8 max). The factory setting for this feature is off. The alarm clock can be useful to remind you when to check your blood glucose, eat, bolus, etc. When the alarm clock goes off, the message, “ALARM CLOCK” will appear. 12:40P ALARM CLOCK 1 Go to the ALARM OPTION screen. Main > Utilities > Alarm Clock 2 Select On/Set. Press ACT. 3 Select Add Alarm. Press ACT.
Turn on remote control option WARNING: If there is a Low Battery condition, the pump will not receive signals from the remote. To ensure the pump communicates with the remote control, make sure the pump does not have a low battery. (Replacing the low battery with a new battery will restore remote control function.) 1 Go to the REMOTE OPTION screen. Select On and press ACT.
Add Delete Select Add ID and press ACT. Enter each of the six ID numbers. Press ACT after each. ADD REMOTE ID (flashing) Review Select Review ID and press Select Delete ID and press ACT. ACT. Select the remote ID that you The programmed IDs will show want to delete and press ACT. in the REVIEW REMOTE ID screen. DELETE REMOTE ID 1 111111 2 222222 3 ------ ______ After you set the last number of the ID, the screen will return to the REMOTE ID MENU. The selected ID is now deleted.
Example 1: Block Nicholas is a very active toddler who wears a Paradigm pump. His parents don't want to worry that he will play with the pump and accidentally change his programmed settings. They simply activated the Block feature, and now, except for the Suspend and Selftest, no other features are active when using the pump buttons. When Nicholas needs a bolus, his parents and caregivers simply program it with the Remote Control.
Lock keypad feature Lock keypad prevents accidental pump keypad presses. The only button you can press is to view the STATUS screen. The remote control can be used to give a bolus or put the pump into Suspend. A locked kepad is automatically unlocked during the following: Battery insertion Alarms Alerts ➠ ➠ ➠ To lock keypad 1 Go to the Lock Keypad screen Main > Utilities > Lock Keypad 2 Select Utilities Press ACT. MAIN MENU 3 Select Lock Keypad Press ACT.
Selftest Selftest is a safety utility that allows you to check if your pump is operating properly. This selfdiagnostic feature can be used for maintenance or to check your pump if it operates unusually. During selftest, your pump will automatically run internal tests, including a check for proper operation of the beep and vibrate modes. The selftest is additional to the routine tests that run independently while the pump operates.
User settings WARNING: Do not clear your pump settings while it is connected to your body. The user settings function allows you to save, restore, and clear all pump settings. You can also view a listing of the dates and times of all recent user settings operations you have done. The Save Settings feature lets you keep a set of pump settings that you can restore to your pump if it is cleared or you need to go back to these settings for any reason.
3 If this is the first time you have saved pump settings, go to step 4. If you have previously saved pump settings, a message displays, indicating the date of your last pump settings save. Read the instructions on the screen then press ACT to save your current settings (or press ESC to cancel the save). 4 The SETTINGS SAVED message displays to confirm that your current pump settings have been saved. Exit the menus.
Clear settings Take the following steps only if you want to clear your pump to factory default settings. WARNING: Do not clear your pump settings while it is connected to your body. CAUTION: Do not clear your pump settings unless directed by your healthcare professional or a Medtronic MiniMed representative. If you clear your pump settings, it will be necessary to reprogram all your personal pump settings as directed by your healthcare professional. Additionally, you will have to rewind your pump.
History If you want to view a listing of the dates and times of all recent User Settings operations you have done on your pump, such as saves and restores, take the following steps: 1 Go to the UTILITIES screen and select User Settings. Then, hold down and press ACT. Main > Utilities > User Settings UTILITIES MENU Selftest User Settings Language ACT 2 The USER SETTINGS screen is displayed. Select History and press ACT.
Chapter 9 Troubleshooting This Troubleshooting chapter is designed to help you understand the messages that your pump is giving you when you get an alarm or an alert message. The procedures in the beginning of this chapter are to be used when you get specific alarms or cover a likely condition that might happen. A list of alarms is provided at the end of this chapter.
8 If you followed these steps and you are still receiving a No Delivery alarm, call the 24 Hour HelpLine. What happens if I leave the battery out too long? If you leave the battery out too long (more than five minutes), you may receive a BATT OUT LIMIT alarm message when you install the new battery. Do the following steps: 1 Set your pump clock to the correct time, date, and year. 2 Check to make sure that all your settings, such as basal rate, are set as desired.
What is a CHECK SETTINGS alarm? This alarm occurs after an E alarm or after you clear your pump. It is advising you to make sure that all your settings are correct. A CHECK SETTINGS alarm occurs after any of these actions: ➠ All user settings were cleared (set back to their defaults) because there was an E-error alarm. ➠ The “Clear Settings” function was performed. ➠ After you rewind when practicing without a reservoir when your first get your pump.
The pump is asking me to rewind This is normal after any of the following: 1 Any E-alarms 2 Clear Settings function 3 No Delivery Alarm (during the Prime sequence) My bolus stopped The Bolus Stopped error can occur if the battery cap is loose or the pump was bumped or dropped during a bolus. It can also happen if the pump receives a static shock. As a safety measure, the pump stops the bolus when this happens. 1 If you dropped your pump, visually inspect it to make sure that it is not damaged in any way.
8 If your pump still does not receive your BG reading from the linked meter, use the up/down buttons to manually enter your BG (in the ENTER BG screen). I dropped my pump Take care to protect your pump from being dropped. 1 Check that all connections are still tightly in place. 2 Check the LCD, keypad and pump case for cracks or damage. 3 Check infusion set, including the tubing connector and tubing for cracks or damage. 4 Review the status screen, basal rates and other pump settings.
Alert conditions Your pump has a sophisticated network of safety checks and systems. If it detects an unusual condition that requires your immediate attention, it will beep or vibrate periodically to alert you. The pump will go into Special mode (an open circle will display), and the backlight will illuminate.
Low Battery alert If you get this alert, DO NOT go to sleep without replacing the battery. The backlight, Remote control and meter functions are disabled during a Low Battery condition. If the alert type is set to “vibrate,” the pump will change to the audio alert “beep-medium.” Clear (ESC, ACT) this alert before you replace your battery. 10:09A LOW BATTERY Replace battery now Use 1 AAA ESC, ACT to clear Alarms Your pump has a sophisticated network of safety checks and systems.
What to do When an alarm is triggered, the pump goes into Attention mode and an alarm message shows on the screen. The pump then defaults to the HOME screen. Do these steps when you get an alarm: 1 View the alarm: From the HOME screen, press any button to see the alarm message. (any button) 2 Read all of the alarm text. There are instructions on how to fix the alarm condition. (Press to read more text, if available.
Alarm conditions Alarms put the pump in “Attention” mode. A (Alarm) This alarm shows an “A” followed by two numbers. A-alarms cause all insulin delivery to stop. Your pump settings are retained. If this alarm repeats often, call the Medtronic MiniMed 24 Hour HelpLine for assistance.
Check settings When this alarm is active, you should check and/or reprogram your pump settings, including the time/date. CHECK SETTINGS 8:35A Delivery stopped Reprogram settings ESC, ACT to clear E (Error) After receiving this alarm, note the error number then call the Medtronic MiniMed 24 Hour HelpLine for assistance. An error alarm will show an “E” followed by two numbers. E-alarms cause all insulin delivery to stop, the pump resets, and all your settings are cleared.
Max delivery This alarm alerts you when you have taken more insulin than expected based on maximum bolus and maximum basal rates. Motor error Insulin delivery has stopped. This alarm occurs if your pump detects a motor error. 3:25P MAX DELIVERY Exceeded 1 hour max delivery Check BG ESC, ACT to clear MOTOR ERROR Delivery stopped 3:25P Disconnect set ESC, ACT to clear No delivery Insulin delivery has stopped. This alarm occurs if your pump detects a blockage.
Reset The Reset alarm triggers when pump settings are cleared because of one of these reasons: ➠ ➠ Pump settings were cleared (Clear Settings function) and settings have not been reprogrammed. 8:35A RESET Settings cleared by user Reprogram settings ESC, ACT to clear A download attempt from the PC is incomplete. (The download function is applicable to the optional software feature. Refer to the software user guide for more information.) Weak Battery The pump tests the voltage of each battery installed.
Chapter 10 Pump maintenance It is recommended that you read your warranty statement included with your pump for information about what is covered during your warranty period. Battery The Paradigm pump uses a AAA battery. As a safety measure, Medtronic MiniMed has designed the pump to only accept a NEW battery. If you insert a used battery, the “Failed batt test” alarm may be triggered. Refer to the section “Install battery” in chapter 2 for instructions.
Cleaning your pump 1 Use only a damp cloth and mild detergent mixed with water to clean the outside of your pump. 2 Rinse the pump with a clean cloth, dampened with clean water. 3 Dry with a clean cloth. 4 Never use organic solvents, such as lighter fluid, nail polish remover, or paint thinner to clean your pump. 5 Keep the reservoir compartment and battery compartment dry and away from moisture. 6 Do not use any lubricants with your pump. 7 Use a 70 percent alcohol wipe to disinfect your pump.
Chapter 11 Pump specifications This section provides detailed information on specifications related to your pump. The safety features of your pump are individually listed and described. Alarms and error messages Indicators: audible tone (beep) or vibration (silent) All alarms and errors show messages on the pump’s screen and provide instructions on what to do. Unresolved alarms will escalate to siren mode for added safety.
Bolus units Increments: 0.1 units Bolus Wizard feature (see end of this section for information) Carb ratios Maximum ratio settings: range: warning limits: 8 3 – 150 grams/u 0.1 – 5.0 u/exch less than 5 or greater than 50 grams/u less than 0.3 or greater than 3.0 u/exch Carb units The food entry when using Bolus Wizard feature grams: 0 – 300 (increments: 1 gram) exchanges: 0.0 – 20 (increments: 0.5 exch) Daily totals Maximum records shown: 31 days of data, maximum display: 999.95 units/day.
Easy bolus Features programming using audible tones (or vibrate pulses) in user-determined increments. Beep mode range: 0 to maximum bolus; Vibrate mode range: 0 to 20 steps or maximum bolus, whichever comes first. Default step increment: 0.1 unit Step size < maximum bolus. Adjustable step size: 0.1 to 2.0 units per step. Accessible from the remote control or pump buttons. Infusion pressure Maximum infusion pressure and occlusion pressure: 13.7 PSI (94,46 kPa).
Occlusion detection When occlusion is detected, the “no delivery alarm” will occur. The occlusion alarm is triggered by an average of 2.77 units of “missed” insulin. This table shows occlusion detection for 3 different situations when using U100 insulin. 522/722 Rate Minimum time before alarm Typical time before alarm Maximum time before alarm bolus delivery (1.5 u/minute) 92 seconds 116 seconds 162 seconds basal delivery (1.0 u/h) 2.2 hours 3.09 hours 4.47 hours basal delivery (0.05 u/h) 37.
Pump size The dimensions of the pump are approximately: 522 Pump: 2.0 x 3.0 (2.8 at the battery cap) x 0.75 inches [5.1 x 7.6 (7.1 at the battery cap) x 2.0 cm] 722 Pump: 2.0 x 3.7 (3.5 at the battery cap) x 0.75 inches [5.1 x 9.4 (8.9 at the battery cap) x 2.0 cm.] Pump weight 522 and 722 pump: 522 pump approximately 100 grams (with battery installed), 722 pump approximately 108 grams (with battery installed).
Status screen Item When What ➠ Alarm Clock:* Appears if scheduled to alarm Time set is displayed ➠ Auto-off: Appears if enabled X HR ➠ Basal pattern information: If active Pattern A or B ➠ Battery Status: Always appears Normal, Low, Off Appears if BG meter is enabled XX.
Bolus Wizard feature specifications There are three different formulas the Bolus Wizard feature uses to estimate a bolus, depending on your current BG: 1 If current BG is greater than your High Target BG correction estimate food estimate = food carb ratio + = food carb ratio food estimate 3 If current BG is between or = High or Low food = Target BG carb ratio insulin sensitivity + current BG - Low BG Target insulin sensitivity correction estimate + 0 Notes: If a Dual Wave bolus is less than t
Active Insulin Insulin Curve Curve 100% 90% 88 Hour Hour 77 Hour Hour 66 Hour Hour 80% 55 Hour Hour 44 Hour Hour 33 Hour Hour %%Insulin Remaining Insulin Remaining 70% 60% 22 Hour Hour 50% 40% 30% 20% 10% 0% 0 1 2 3 4 5 6 7 8 9 Time Time(hours) (hours) Graph adapted from Mudaliar and colleagues, Diabetes Care, Volume 22, Number 9 September 1999, page 1501 Active insulin only reduces the correction portion of the estimate, not the food portion.
Bolus Wizard feature examples Settings: ➠ Carb ratio: 30 grams/unit ➠ Insulin Sensitivity: 40 mg/dL/unit ➠ BG Target: 90-120 mg/dL ➠ Active Insulin Time: 6 Hours #1: No active insulin from previous bolus delivery. User inputs 60 grams of carbs and does not enter BG. (food estimate) 60g 30g/u = 2 units estimate = 2 units #2: No active insulin from previous bolus delivery. User inputs 60 grams of carbs and a BG of 200.
#5: Previous bolus activity results in a calculation of 1.5 units unabsorbed (active) insulin. User inputs 60 grams of carbs and a BG of 200. (correction) (food estimate) 60g 30g/u = 2 units + 200mg/dL - 120mg/dL - 1.5 units (active insulin) 40mg/dL/u = 2 - 1.5 = 0.5 units = 2 + 0.5 = 2.5 unit estimate = 2.5 unit #6: Previous bolus activity results in a calculation of 3.5 units unabsorbed (active) insulin. User inputs 60 grams of carbs and a BG of 200.
Default settings Menu Bolus Menu: Item Default Setting Bolus Wizard feature: Off Easy bolus: On Easy bolus step: Dual/Square bolus: Maximum bolus: Basal Menu: 0.1 u/h Increments maximum bolus setting Off 10.0 u/h 0 - 25 u (per single bolus) BG reminder: Off 0:00 - 5:00 0:30 Patterns: Off 0.00 - 35.00 u/h 0.05u Maximum basal rate: 2.0 u/h Basal rate: 0.0 u/h Temp basal type: Lock Keypad: U/H (no defaults) Alert type: audio, beepmed max basal rate setting 0.
Menu Item Default Setting Bolus Wizard feature Settings carb units: ins to carb (or exch) ratio: Limits Increments Warning Limits grams or exchanges none none none 15 grams/u or 1 units/exch 3 - 150g/u or 0.1 - 5.0 u/exch 1 g/u or 0.1 u/exch 5 - 50 g/u or 0.3 - 3.0 u/exch 50 mg/dL or 2.8 mmol/L 10 - 400 mg/dL or 0.5 - 22.2 mmol/L 1 mg/dL or 0.1 mmol/L 20 - 100 mg/dL or 1.1 - 5.6 mmol/L 100- 100 mg/dL or 5.6-5.6 mmol/L 60 - 250 mg/dL or 3.3- 13.9 mmol/L 1 mg/dL or 0.
Icon table Do not reuse: Attention: See Instructions for Use w Date of manufacture (year - month): Batch code: LOT Use by: (year - month) Catalogue number: REF Device serial number: SN Storage temperature range: Fragile product: Type BF equipment: (Protection from electrical shock) Conforms to IEC60601-1 sub-clause 44.6 and IEC60529 standard.
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Glossary A Accept - Pressing the ACT button to approve the selection or setting. Active insulin - Bolus insulin that has been delivered to your body, but has not yet been used. Alarm - Audible or vibrating (silent) notice that indicates the pump is in Attention mode and immediate attention is required. Alarms are prefixed in the alarm history with the letter A. Alarm clock - Feature you can set to go off at specified times of the day.
Bolus - A dose of insulin given to cover an expected rise in blood glucose (such as the rise after a meal) or to lower a high blood glucose down to target range. BOLUS HISTORY - This screen displays the last twenty-four (24) boluses delivered by your pump. Bolus Wizard feature - Calculates the bolus amount based on personal information of the pump user. C Carb ratio - (Carbohydrate ratio). Used when counting carbohydrates in grams. The amount of carbohydrates covered by one unit of insulin.
Food bolus - A dose of insulin given to cover the expected rise in blood glucose that occurs after eating. G Gastroparesis - A condition of the digestive system that slows down the emptying of food from the stomach. H HbA1c - Glycosylated hemoglobin HDL - High-density lipoprotein A complex of lipids and proteins in approximately equal amounts that functions as a transporter of cholesterol in the blood. Hold - Press and continue to press a pump button. I Idle - The pump is at the HOME screen.
Max basal rate - The maximum amount of basal insulin that the pump will deliver at one time. (set by the user) Meter - The Paradigm Link Blood Glucose Monitor Powered by BD Logic™ Technology (Paradigm Link meter). Your pump can be programmed to receive your BG readings from this meter. Meter option - Feature that allows the pump to receive BG readings from the Paradigm Link meter. N Press - To push and release a button.
Status screen - Displays the current operations of the pump, including active functions, the most recent basal and bolus deliveries, reservoir information, and battery condition. Step - Measurement of insulin that you set and use for Easy Bolus delivery. Suspend - Function that stops all insulin delivery. Any current bolus and/or prime deliveries are cancelled. The basal delivery is paused until restarted.
154 Glossary
Index A accessories 3 accessories, activity guard 4 holster 4 meter 3 pump clip 4 remote control 3 active insulin 60 Active insulin time, setting 67 alarm clock 111 Alarm conditions 129 ALARM HISTORY screen 103 Alarm types, A- alarm 129 auto off 129 batt out limit 129 bolus stopped 129 check settings 123, 130 E- (error) 130 empty reservoir 130 failed batt test 130 max delivery 131 no delivery 121 Alarms, Alarm details 103 responding to 127 review 103 alert type, Setting your 103 alerts, for alert condition
your BG reading 55 your personal settings 55 Bolus Wizard, How it works 58 buttons, pump 9, 12 C Carb ratios xii Carb ratios, exchanges 62 grams 62 Carb units 62 Charger 3 CHECK BG message 30 Child block 113 cleaning the pump 134 Clear settings 119 correction bolus 22, 71, 72 D DAILY TOTALS screen, Review 106 default settings 145 disposables 3 Dual Wave bolus programming, with Bolus Wizard 82 without Bolus Wizard 78 dual/square option, on-off 78 E Easy 84 Easy bolus 84 Easy bolus, cancel 86 deliver an 85
P Patterns, basal 88 on/off 88 pattern A, B 88 Program a basal pattern 89 Select a basal pattern 90 standard basal pattern 88 Personal reminders 111 personal settings 55 practicing 45 PRIME MENU 18 prime, fixed 52 history 52 manual 47 pump, battery compartment 9 buttons 9, 12 if you remove your 20 screen 9, 13 using in water 125 R Reminder, alarm clock 111 remote control 3 remote control IDs, add, delete, review 112 Remote control option, turn on 112 removing your pump 20 reservoir, filling the 42 Insertin
158 Index
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