A Practical Guide to Continuous Glucose Monitoring Innovating for life. www.medtronic-diabetes.com.
Contents Introduction • • • • The Medtronic Continuous Glucose Monitoring (CGM) System How does CGM Work? Starting-up CGM Frequently Asked Questions About Alarms Living with A Continuous Glucose Monitor • • • • • • • • Using Medtronic Bolus Wizard Calculator and REAL-Time Glucose Values Wearing the System at Night Bathing, Showering, and Swimming Personal Situations X-rays, MRIs, and CT Scans Air Travel Care of the Insertion Site Tape Tips Troubleshooting Basics • • • • • • • • • • • Blood Glucose Mete
To get started If you are using an insulin pump, you need to identify which model you have first. There are two places where you can find it: Status Screen Your Continuous Glucose Monitoring (CGM) System consists of 3 key items 1 An Insulin Pump or CGM Monitor From the Home screen, press ESC on the pump. Use the down arrow button to scroll down the Status screen.
How Does CGM Work? Calibration Calibration is like buying a watch and setting it for the first time and then checking the time during the day to make sure it’s right. Calibrating is essential for your system to work. 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.
Alarms and Alerts settings Your CGM system allows you to customise alerts to help you improve glucose control. Your healthcare provider will work with you to determine your initial alert settings. The pump or monitor will sound an alarm to alert you that something is going on – you may be going high or low, or maybe you’ve forgotten to do a calibration. You will see a message on the screen. If you scroll down, you will see what action to take.
Starting Up CGM To insert the Medtronic Enlite™ glucose sensor. . . 1. Open the Enlite sensor package. 1 Glucose sensor insertion 6. To insert the Enlite sensor: 6-A Press the green button in, and then release it. Keep holding the serter in its place.
9. While holding the sensor in place, gently lift the adhesive tab. Carefully remove the bottom piece of white paper from under the adhesive pad. Press the adhesive against the skin. To start the Medtronic Enlite™ glucose sensor. . . 10. OPTIONAL Before connecting the MiniLink transmitter, apply overtape. NOTE! Overtape is not shown in steps 12 - 17. Do not cover the adhesive tab (1) or sensor connectors (2) with overtape (3). 3 3 12.
6 Turn the sensor on Check which pump you are using, or if you are using the Guardian monitor.
7 Reading the display Reading the Trend Graphs • The most recent sensor glucose measurement or the reason that one is not displayed • The historical sensor glucose measurements or the reason that one is not displayed for the last 3, 6, 12, or 24 hours • Arrows that show the relative rate at which the most recent sensor glucose levels have risen or fallen Once again, check if you are using a pump (and which model) or the Guardian monitor.
Sensor Definition Icon shows normal signal between glucose sensor and insulin pump/monitor Icon shows no signal from glucose sensor Arrow One up arrow shows that your SG has been rising at a rate of 1 mmol/L over the previous 20 minutes “When I checked my blood glucose with my meter, it was high, but I did not get a HIGH alarm….
• Wearing your glucose sensor and insulin pump/monitor at night is very simple. You might want to try clipping the insulin pump to your pyjamas, or you can place it in bed next to you or on your pillowcase. With experience, you will find the best place to put your insulin pump at night • Sometimes the insulin pump and transmitter may stop ‘talking’ to each other at night. This can cause a LOST SENSOR or WEAK SIGNAL alarm.
Care of the Insertion Site Airlines require that all devices with radio frequency capabilities should not be used on an aircraft. l i v i n g w i t h a co n t i n u o u s g lu co s e m o n i to r • Clean hands and proper glucose sensor insertion will help reduce the risk of bleeding, swelling, and infection.
A basic level of understanding of troubleshooting should be achieved during the training on the system. This guide will help you understand and incorporate solutions to the most common issues related to this new technology.
Sensor vs. Meter BG Calibration Error Discrepancy between sensor and meter BG. Possible causes: What is a CAL ERROR Alarm? A new sensor has to settle into the tissue, and requires 2 calibrations within the first 6 hours • Sensor placed late in the day/evening and not calibrated till morning • Meter variance – make sure you don’t use different meters • Rapidly rising blood glucose. ‘Sensor Lag’ between fluid compartments • Unrealistic expectations • Sensor value is an average over 5 minutes.
Sensor Alarms and What to Do Sensor Alarms and What to Do (continued) To be used with… The MiniMed Paradigm Veo Insulin Pump and the MiniMed Guardian Continuous Glucose Monitor To be used with… The MiniMed Paradigm Veo Insulin Pump and the MiniMed Guardian Continuous Glucose Monitor WEAK SIGNAL Occurs when the pump/monitor does not receive data from the transmitter for a period of time.
Sensor Alarms and What to Do (continued) Sensor Alarms and What to Do (continued) To be used with… The MiniMed Paradigm REAL-Time Insulin Pump To be used with… The MiniMed Paradigm REAL-Time Insulin Pump WEAK SIGNAL Sensor is too far away from pump. See User Guide. t r o u b l e s h o ot i n g b a s i c s LOST SENSOR Pump is no longer getting sensor data. See User Guide. DO NOT DISCONNECT THE TRANSMITTER FROM THE SENSOR. LOW XXmmol/L Glucose is lower than user specified limit.
You should discuss skin care, taping and adhesion with your educator. Actual skin allergy is rare. Most skin issue reports are related to irritation and lack of adhesion. Some key points are: t r o u b l e s h o ot i n g b a s i c s • After contact with water, most adhesives will loosen. It is very common that the edges ‘peel’ up from the IV 3000® dressing after a bath, shower, or swimming.
a) Take the glucose sensor out and start again b) Turn the glucose sensor feature off and on again r e a l - l i f e s to r i e s o f g lu co s e s e n s o r u s e c) Check that she has entered the Transmitter ID correctly, started a new sensor, and that the sensor and transmitter are connected properly According to the user guide, the first thing to do is: c) Check the connection. It can take up to 30 minutes for the antenna icon to change to black. The icon now turns black after a few minutes.
Gary has been using the MiniMed Paradigm REAL-Time System. He complains of night sweats, but • The sensor glucose levels were a little behind her fingerstick BG levels. This difference led to the CAL ERROR alarm. r e a l - l i f e s to r i e s o f g lu co s e s e n s o r u s e without any LOW GLUCOSE alarms. His wife woke him one night to perform a fingerstick, which identified a low glucose. The alarms are sometimes annoying, but Debbie knows how important they are.
m e dt r o n i c c a r e l i n k® p e r s o n a l s o f t wa r e Medtronic CareLink® Personal Software is designed to make it easier to track your blood glucose and sensor glucose levels, and to compare any changes in those levels with your daily activities, such as meals and exercise routines. Charts and graphs allow you to see the changes graphically, while tables provide the actual numeric values.
• One day selected with three graphs • Meter and sensor glucose readings m e dt r o n i c c a r e l i n k® p e r s o n a l s o f t wa r e • Insulin usage • The carbohydrates you have eaten (taken from your entries into the Bolus Wizard calculator) and your exercise routines, if you recorded these Report Management Generating Reports Reports are displayed in PDF format. They can be viewed online, saved, printed and/or emailed.
Viewing Reports Select a report from the menu on the left-hand side of the screen. Select the date or date range for the report and click the Go button. Your report is displayed as a PDF file in a separate window. m e dt r o n i c c a r e l i n k® p e r s o n a l s o f t wa r e Saving Reports To save your report, click Save a Copy on the Adobe® Acrobat® toolbar, as shown below. Type a name for the report in the file name field and click Save.
Safety Information Medtronic Diabetes Continuous Glucose Monitoring System www.medtronic-diabetes.com.au Medtronic Diabetes 24-Hour HelpLine T: 1800 777 808 Medtronic Australasia Pty Ltd • Diabetes 97 Waterloo Road, North Ryde NSW 2113 Australia T: 02 9857 9000 • F: 02 9887 1829 www.medtronic.com.au Paradigm, Veo, Guardian, MiniLink, Bolus Wizard and Enlite are trademarks and Medtronic CareLink is registered trademark of Medtronic MiniMed, Inc.
