MiniMed™ 640G System - Medtronic Diabetes UK
Getting Started with the MiniMed 640G System ™ Intelligent for Better Control Table Of Contents Introducing the MiniMed 640G System MiniMed Care............................................................................................................................................................3 Welcome .....................................................................................................................................................................4 The Delivery of Insulin ...........................................................................................................................................7 Menu Map ..................................................................................................................................................................8 Getting Started with the MiniMed 640G Insulin Pump Section 1: Pump Basics ..................................................................................................................................... 10 Section 2: Home Screen ................................................................................................................................... 12 Section 3: Basal Patterns .................................................................................................................................. 14 Section 4: Giving Boluses................................................................................................................................. 18 Section 5: Contour® Next LINK 2.4 Meter ..................................................................................................... 22 Section 6: Infusion Set & Reservoir (changing the Quick-set Infusion Set) ................................... 25 Section 7: Alerts and Alarms........................................................................................................................... 32 Section 8: Suspend Delivery ........................................................................................................................... 34 Getting Started with Continuous Glucose Monitoring Section 9: Introduction to Continuous Glucose Monitoring .............................................................. 35 Section 10: Sensor Glucose (SG) and Blood Glucose (BG) ................................................................... 36 Section11: Trends ............................................................................................................................................... 37 Section 12: Personalised Alerts ..................................................................................................................... 38 Section 13: Reading the Sensor Display ..................................................................................................... 48 Section 14: Connecting your Pump and Transmitter ............................................................................ 50 Section 15: Inserting and Starting the Sensor ......................................................................................... 52 Section 16: Calibrating ..................................................................................................................................... 58 Section 17: Other Sensor Alerts .................................................................................................................... 62 Appendix Charging and storing your transmitter ........................................................................................................ 63 CareLink™ Personal Therapy Management Software.............................................................................. 64 X-Rays and Traveling By Air ............................................................................................................................... 65 SmartGuard™ Suspend by Sensor Features ................................................................................................ 66 2 Introduction I MiniMed Care Register today At Medtronic we are not just committed to developing new and innovative products to help improve the lives of people with diabetes. We also provide you with ongoing support and customer service to help you make the most of your pump therapy and continuous glucose monitoring. By registering for MiniMed Care, you can benefit from the following: Updates about our latest research and breakthrough technologies Regular tips and tricks for easier diabetes management Access to free interactive learning modules and tailored content for pump users Register for MiniMed Care today at www.medtronic-diabetes.co.uk/minimedcare/registration 3 Introduction I Welcome MiniMed™ 640G System Benefit from the unique MiniMed connection for secure insulin delivery, with an infusion set for every lifestyle. With the accurate1 Contour® next LINK 2.4 by Bayer, you can wirelessly send blood glucose results to your MiniMed 640G and deliver an insulin bolus discreetly. With our most responsive sensor system yet, you can continuously monitor your glucose levels with superior comfort* and accuracy**. Upload your pump to CareLink™ to conveniently track your glucose control and remotely share this information with your healthcare professional. www.medtronicdiabetes.com/carelink *The size of the new generation Enlite sensor has been reduced by 80%. **When combined with the MiniMed 640G system and Guardian 2 Link transmitter. 1. Bailey T, et al. Accuracy and user performance evaluation of the Contour® Next Link 2.4 blood glucose monitoring system. Clin Chim Acta. 2015; 448:139-45. Intelligent for Better Control 4 Introduction I Welcome Getting Started with the MiniMed™ 640G System Welcome! We are glad that you have chosen insulin pump therapy and are excited for you to begin using your MiniMed™ 640G. The MiniMed™ 640G system features innovative technology to more closely mimic the way a healthy pancreas delivers basal insulin to the body and help you achieve better glucose control. The MiniMed 640G system has been designed to provide you with: Advanced protection from dangerous high and lows Personalised convenience to help you manage daily diabetes tasks The MiniMed 640G insulin pump also has a new, improved design for consistent ease of use. Whether you are just starting pump therapy or upgrading from a previous pump model, this guide provides you step-by-step instructions on the basic operation and programming of your MiniMed 640G system, including Continuous Glucose Monitoring. Did You Know? A complete explanation of the technical and operational aspects of your pump can be found in the MiniMed 640G System User Guide. During your in-person training, your trainer will build on this information and help ensure you are confident to begin using your MiniMed 640G. We hope you enjoy learning about your new insulin pump. Information contained herein does not replace the recommendations of your healthcare professional. Please refer to the User Guide and your HCP for more information. When using an insulin pump, check your blood glucose minimum 4 times a day. IMPORTANT: Do NOT attach the insulin pump to your body or attempt to use insulin in your pump as you use this guide to practice and learn. Attaching and using must only be done when you receive formal training with your healthcare professional or a certified product trainer. 5 let’s get started! 6 This document does not replace the Instructions for Use. For a listing of indications, contraindications, precautions, warnings, and potential adverse events, please refer to the Instructions for Use. Introduction I The Delivery of insulin 1 The Delivery of Insulin 3 5 2 4 Infusion Set* 1 Tubing: carries insulin from the pump to you 2 Reservoir Connector: end of the tubing that attaches the reservoir which holds the insulin 3 Insertion Site Section: other end of the tubing that attaches to you 4 Cannula: tiny flexible tube placed into your body** by the insertion needle included in the insertion site section 5 Adhesive: holds the infusion set in place 6 Reservoir Compartment: part of the pump where the reservoir fits Reservoir 6 You should replace both the infusion set and the reservoir every 2 to 3 days. *Quick-set® infusion set shown in illustration. **Some infusion sets do not use a cannula but have a small needle that remains inserted in the body. Pump 7 Introduction I Menu Map Menu Map Suspend Delivery Audio Options History Reservoir & Tubing Insulin Settings Sensor Settings Event Markers Press Reminders Utilities Home Screen History Summary Daily History Alarm History Sensor Glucose Review* Suspend Delivery ISIG History* 8 Audio Options Reservoir & Tubing Audio Audio & Vibrate Vibrate Volume New Reservoir Fill Cannula Introduction I Menu Map Navigation Press from any screen to open the Menu. Press and Press on the desired menu item to open. to scroll through the menu items. The scroll bar appears on menus to indicate when additional text is available. Press Press to scroll down to view additional items. Press to scroll back up. to return to the Home screen. to go to previous screen. Hold Sensor Settings Reminders Sensor Sensor Connections* Alert Silence* High Settings* Low Settings* Calibrate Sensor* Auto Calibration* Personal Bolus BG Check Missed Meal Bolus Low Reservoir Set Change Calibration* Insulin Settings Utilities Bolus Wizard Setup Basal Pattern Setup Preset Temp Setup Preset Bolus Setup Dual/Square Wave Bolus Increment Max Basal/Bolus Easy Bolus Auto Suspend Bolus Speed Airplane Mode Display Options Time & Date Remote Bolus Block Self Test Carb Unit Manage Settings Sensor Demo Device Options Language *Only available when Sensor feature is on. Event Markers BG Injections Food Exercise Other 9 Insulin Pump I Pump Basics Section 1: Pump Basics Before inserting the battery or pressing any buttons, let’s take a closer look at your pump. The Front of Your Pump Up, Down, Left, and Right • Press to scroll up or down through a menu or list • Press to move to desired area on the screen • Press to change the value in an area Back Up Back Left • Press to return to a previous screen • Press and hold to return to the starting screen, called the Home screen Notification Light • Right Select Down Menu Select • Menu Press to select or confirm a value or menu option that is highlighted • Press to get to the Menu • Press and hold to put pump into sleep mode Press when directions say ‘select ’ Notification Light • Flashes when an Alert or an Alarm is occurring The Bottom and Back of Your Pump Pump Serial and Model Number 10 Medtronic Diabetes HelpLine Telephone Number You may need to provide this information if you call for assistance. Insulin Pump I Pump Basics Inserting the Battery Your insulin pump is powered by a AA battery. A lithium, alkaline, or rechargeable AA battery can be used. The battery you place into your pump should always be new or fully charged. To insert the battery and get started, you will need: • The battery cap found with the pump • The belt clip found with the accessories • The AA battery found with the accessories Step 1. Place the battery into the battery compartment with the negative (flat) end going in first. Step 2. Place the battery cap onto the pump. Use the edge of the belt clip to turn the cap to the right (clockwise) and tighten until the slot is horizontal to the pump. See image below. Note: Do not undertighten or try to overtighten the battery cap. It should be aligned horizontally with the pump case as shown here. Once the battery is inserted, the pump will power on and the Startup Wizard will begin. You will need to follow it step-by-step to set up your language, time format, time and date. 11 Insulin Pump I Home Screen Section 2: Home Screen The Home Screen will be your starting place to access all features in the pump. Status bar: provides a quick look at the pump’s status Current time Bolus: gives you access to the bolus delivery screen and other bolus insulin options Active insulin: displays any insulin still active from a previous bolus BG reading: displays a BG taken in the last 12 minutes Basal: gives you access to basal insulin options Backlight When you are not pressing buttons on your pump, you will notice that the Backlight will soon turn off. The pump is still on; it is just saving battery life. You can simply press any button to make the screen reappear. Unlocking the Pump After the Backlight has been off for a few minutes, the pump goes into Sleep mode and the pump is locked. When you begin using your pump again, you will see a screen like the one shown here when you leave the Home screen. You will need to press the arrow key that is highlighted to unlock the pump. This confirms you are reading the screen and the button presses are not accidental. If the wrong key is pressed, you will see the screen here. Select OK to return to the Home screen and try again. You can press and hold if you wish to put the pump into Sleep mode and keep it locked when you are not using it. Doing this can also help save battery life. 12 Insulin Pump I Home Screen Status Bar The Status Bar displays the following icons so you can quickly view important information. Battery icon: Shows the level of charge your battery has. As the battery charge decreases, the icon will become less full and change to yellow and then red. Reservoir icon: Shows the approximate amount of insulin left in your reservoir. As insulin is used, the icon will become less full and change to yellow and then red. Audio icon: Shows the audio mode you are using: audio Note: , vibrate or audio and vibrate . If you are using a 1.8mL insulin reservoir, the range of reservoir icons will start with the second green icon. Not displayed with a 1.8mL reservoir If starting with a full 1.8mL reservoir and using the minimum amount of insulin recommended to fill the shortest tubing (45 cm) and a steel cannula, the pump will display the second green (not full) reservoir icon after the reservoir and infusion set change is complete. Status Screens There will be times when you need additional status information such as the number of insulin units left in your reservoir, the last BG entered or your current basal rate. To access the Status Screens, press to highlight the Status Bar and press . Remember: You can go back to the previous screen by pressing . 13 Insulin Pump I Basal Patterns Section 3: Basal Patterns Basal insulin is delivered throughout the day and night to cover insulin needs between meals and during the night. The pump supplies basal insulin by delivering small amounts of short-acting insulin throughout each hour, every hour of the day and night. This allows for insulin to be increased and decreased to adjust for your body’s needs. Basal insulin amounts must be programmed into your pump. This is done by setting a basal pattern. A basal pattern consists of one or more basal rates being delivered over the course of 24 hours. Basal Patterns Set up - Multiple Basal Rates It is likely when you start on pump therapy, that you will need more than one basal rate throughout the day and night to meet your body’s insulin needs. For example, a Basal Pattern may look like this: 1.000 03:00 – 08:00 U/hr 00:00 – 03:00 0.500 0.700 U/hr 00:00 0.800 U/hr 08:00-15:00 0.650 U/hr 06:00 12:00 24 Hours 15:00-19:00 0.550 U/hr 19:00-24:00 0.600 U/hr 18:00 In this example, the basal pattern includes 5 different basal rates over 24 hours. Note: The basal rates shown are for illustration purposes only – your basal settings will be different. 14 24:00 Insulin Pump I Basal Patterns Setting Multiple Basal Rates 1. From the Home screen, select Basal > Insulin Settings > Basal Pattern Setup. 2. Select Basal 1 > Options > Edit. 3. Press on the time segment. The End time will be flashing. to change End time to 03:00 4. Press and press . 5. Press to 0.700 U/hr and press . You can see you are automatically asked to enter the end time of the second basal rate. This basal rate will need to end at 8:00 and will need to be changed to 0.800 U/hr. 15 Insulin Pump I Basal Patterns 6. Change End time to 08:00 and basal rate to 0.800 U/hr using and press . You can now enter the next end time. 7. Repeat steps 3 to 6 to enter the 3 next time segments and basal rates. For the last time segment, you will need to enter 24:00 as the end time to complete the full 24 hours. 8. Select Done. 9. Verify that Basal 1 is entered correctly. Press to view all basal rates. 10. If NO changes need to be made: Select Save. 11. If changes need to be made: Press . This basal pattern delivers 15.85 U over 24 hours. Press and press . Repeat steps 7 to 9. 12. Select Save. Temporary (Temp) Basal Rate This feature lets you immediately increase or decrease your basal insulin for the period of time (duration) that you set. It is the easiest way to immediately adapt your basal rate according to your daily life and is often used for exercise and sick days. A Temp Basal can be set in either Percent (delivers a percent of the current basal rate) or by Rate (delivers the amount that you enter). 16 Insulin Pump I Basal Patterns Set Temp Basal Rate 1. From the Home screen, select Basal > Temp Basal. 2. Press to set duration and press . 3. Select Next. 4. Select Percent. Note: If you choose to use Rate, select Type, and you can then enter the U/hr desired. 5. Press or to enter the percent of current basal rate desired . 6. Select Begin. Note: The Home screen reads Basal (T) since Cancel Temp Basal Rate you have a Temp Basal active. Select Basal (T) to review the details of the active Temp Basal. When the Temp Basal is complete, the basal will automatically If you ever set a Temp Basal and decide you do not need it, it can be canceled. 1. From the Home screen, select Basal (T). return to the regularly programmed basal rate. 2. Select Cancel Temp Basal. Note: Basal rate has now returned to the currently programmed rate. 17 Insulin Pump I Giving Boluses Section 4: Giving Boluses A bolus is given to cover food that contains carbohydrate and/or to correct glucose levels that are above your target range. Bolus Wizard Calculating how much bolus insulin to give can be challenging. When using the Bolus Wizard, all you will need to do is enter your current BG reading along with the amount of carbs you are about to eat. Once you do this, the Bolus Wizard uses the individual settings provided by your health care professional to estimate your bolus amount. Because these settings are specific to you, you can use it to calculate the precise amount of bolus insulin you need for your food and BG. This can help you better control your glucose levels. Note: Before using the Bolus Wizard, you need to program your individual settings with the help of your health care professional. Turning the Bolus Wizard On and Setup 1. From the Menu, select Insulin Settings > Bolus Wizard Setup > Bolus Wizard. 18 2. Press to continue reading text and select Next. Insulin Pump I Giving Boluses 3. Follow the instructions to program the following settings: Carb Ratio, Insulin Sensitivity Factor (Sensitivity), BG Target and Active Insulin Time. Each setting will include a short description: you need to select Next and enter the requested data. Carb Ratio Insulin Sensitivity Factor BG Target Active Insulin Time 4. Select Save. The Bolus Wizard setup is now complete. Using the Bolus Wizard Here you can see the Bolus Wizard calculation screen and a short description of the steps below: If you have tested your glucose using your compatible Bayer meter, the BG and correction dose will already be showing. You will first test and enter your current BG. You will then enter grams of carbohydrates to be eaten. The pump displays estimated amount of insulin to be delivered. Note: The boluses shown are for illustration purposes only – your settings and bolus results will be different. 19 Insulin Pump I Giving Boluses Giving a Manual Bolus When giving a manual bolus, you simply enter the amount of bolus insulin that you think you need for the carbohydrates you are eating, or to lower your BG if it is high. 1. From the Home screen, select Bolus. 2. Press 3. Select Deliver Bolus. 4. Confirmation that Bolus has started will appear. The Home screen will show the amount as it is being delivered. to 1.0 u and press . Once the bolus has finished delivering, the pump will return to the normal Home screen. Notice that Stop Bolus also now appears. Notice there is Active Insulin now displayed. Active insulin is insulin from boluses that are still working to lower your blood glucose level and/or to cover your carbohydrate intake that is still not absorbed. Each time you give a bolus, it is added to the active insulin amount. As time passes, the amount will decrease. You will learn more about active insulin during your training. 20 Insulin Pump I Giving Boluses Stopping a Bolus To stop a bolus while it is delivering: 1. From the Home screen, select Stop Bolus. 2. Press and select Yes. 3. Select Done. The Bolus Stopped screen will show you how much of the bolus insulin was delivered before it was actually stopped. Checking Last Bolus Checking Bolus History There may be times when you need to see the time or amount of the last bolus that was given. You can see the last bolus delivered in the Quick Status screen. From the Home screen, select the Status Bar > Quick Status (see page 13). You may also want to review the last several boluses that were delivered. You can see the last several boluses delivered in Daily History. Press Menu button > History > Daily History. The (N) behind the Last bolus amount means the bolus was delivered as a normal bolus. There are additional ways to give a bolus which you will learn about later. 21 Insulin Pump I C ontour ® n ext LINK 2.4 Meter Section 5: C ontour ® n ext LINK 2.4 Meter The Contour Next LINK 2.4 meter from Bayer is the only blood glucose meter able to communicate wirelessly with your MiniMed 640G insulin pump. With the Contour next LINK 2.4 meter, you can: • Wirelessly send glucose readings to your pump • Deliver a bolus remotely • Upload your pump data to CareLink™ Personal Review the parts of your meter here: Menu and Power Button 5.2 10:24 l 11.10 Test Strip Port* and Port Light mmol L Before Meal Display Screen USB Connector Bolus Reminder Notes Protective USB Cap Selection/Scrolling Buttons Contour next LINK 2.4 Meter Charging your meter Your meter has a permanent rechargeable battery. It is important that the meter be charged prior to your in-person training. To charge your meter: 1. Plug the USB connector into a computer.** The computer must be ON and not in sleep, hibernate or power save mode. 2. The meter will briefly display Do Not Test-charging and the test strip port light will flash. You cannot do a blood glucose test while the battery is charging. 3. When charging is complete, the test strip port light will turn off. You can then unplug your meter. * The Contour Next Link 2.4 meter only works with Contour® Next glucose testing strips. ** If you would prefer not to charge your meter using your computer, you can purchase a compatible outlet charger by calling Bayer Customer Service. 22 Insulin Pump I C ontour ® n ext LINK 2.4 Meter Connecting your Pump and Meter You will connect your pump and meter at your in-person training. For more information on using your meter, see the User Guide found in the meter box. 1. Press OK when asked Connect to a MiniMed Pump? CONNECT TO PUMP Connect to a MiniMed Pump? 2. Press OK. CONNECT TO PUMP Select "Connect Device" on your Pump. OK Skip 3. Press Auto Connect. CONNECT TO PUMP Manual Connect Auto Connect 4. Press OK Go Back on your pump. Put the meter down and pick up your pump. 5. Select Utilities. 6. Select Device Options. 7. Select Connect Device. 8. Select Auto Connect. 9. Press 10. Select Continue. . Place the meter and pump next to each other. 23 Insulin Pump I C ontour ® n ext LINK 2.4 Meter 11. Select Search on your pump. 12. Select Search on your meter. The search may take up to 2 minutes. CONNECT TO PUMP Select “Search” on Your Pump and meter. 13. Check to see that the Device SN (serial number) on the pump screen matches the Device SN on the meter. Search Cancel 14. If they match, select Confirm on the pump. CONNECT TO PUMP Use Pump to confirm Device SN: BGJ133333F 15. Check to see that the SN on the back of the pump matches the SN now on the meter screen. 16. Select Next on the meter. PUMP CONNECTED MiniMed Pump connected: AA1234567B Next Delete Uploading your pump to CareLink™ Personal CareLink Personal software is a web-based program that is provided free of charge. This software allows you to upload the data from your pump and glucose meter and review it on easy-to-read reports. This enables you to conveniently track your glucose control and remotely share this information with your healthcare professional. To upload information from your pump to CareLink Personal, you will use the Contour next LINK 2.4 meter as the communication device from the pump to your computer, through the USB connector of the meter. To set up your CareLink Personal account, go to www.medtronicdiabetes.com/carelink 24 Insulin Pump I Infusion set and Reservoir Section 6: Infusion Set and Reservoir The following is a step-by-step guide to changing the Quick-set® Infusion set. START HERE: 1. Wash your hands. Press . 2. 3. Select Reservoir & Tubing. Select New Reservoir. 4. 5. Remove the infusion set you have been using by loosening the adhesive and pulling away from body. Remove the used reservoir from the pump. 6. Select Rewind. 25 Continued on next page Insulin Pump I Infusion set and Reservoir FILL RESERVOIR & CONNECT TO THE INFUSION SET TUBING Follow the next steps to fill reservoir with insulin and connect to the infusion set tubing. 3. 1. Plunger rod Reservoir Plunger Transfer guard Remove from package. Make sure insulin vial is at room temperature to reduce the risk of air bubbles. 4. Transfer guard 2. Plunger 5. Pull plunger down to the amount that you plan to fill with insulin. Insulin vial Plunger Insulin vial Wipe vial with alcohol. Place vial on table. Firmly press the blue transfer guard onto vial. Push and hold plunger down. 6. With your thumb still on the plunger, flip over so vial is on top. Release thumb and pull plunger down to fill with insulin. 7. 8. Reservoir Transfer guard Tap the reservoir to move air bubbles to top of reservoir. Push plunger up to move air into vial. If needed, pull plunger back down to amount of insulin needed for 2-3 days. To avoid getting insulin on top of the reservoir, turn vial over so it is upright. Hold transfer guard and turn reservoir counter-clockwise and remove from transfer guard. IMPORTANT: If insulin or any other liquid gets inside the tubing connector, it can temporarily block the vents that allow the pump to properly fill the infusion set. This may result in the delivery of too little or too much insulin, which could cause hypoglycemia or hyperglycemia. 26 Insulin Pump I Infusion set and Reservoir CONNECT RESERVOIR TO INFUSION SET 1. 2. Connector You will place the reservoir connector onto the end of the infusion set to the filled reservoir. Remove infusion set from package. Remove the paper that holds the tubing together. Gently push connector onto reservoir. Turn clockwise until locked. You will hear a click. IMPORTANT: Do not touch the top of the reservoir before connecting it to the infusion set. Please make sure that the connector and the top of the reservoir are dry. 3. 4. If you see air bubbles, tap reservoir to move them to top. Push plunger just a bit to move them into tubing. Twist plunger counterclockwise to loosen and remove. Plunger THE BACKLIGHT MAY HAVE TURNED OFF Press any button to turn the screen back on Select Load Reservoir and unlock the pump if necessary. Select Next. 27 Continued on next page Insulin Pump I Infusion set and Reservoir 1. PLACE RESERVOIR INTO PUMP Now place the filled reservoir into the reservoir compartment of the pump. Place reservoir into pump. 2. 3. Turn clockwise, until you feel reservoir lock into place. Select Next. LOAD RESERVOIR AND FILL TUBING 1. 2. Follow these steps to load the reservoir and fill the tubing. Select Load and keep holding When you see this screen, select Next. 4. 3. Drops at end of tubing Select Fill and keep holding until you see drops at the end of tubing, then let go. 28 . After you see drops, press and select Next. Insulin Pump I Infusion set and Reservoir 1. Blue hub INSERT INFUSION SET Next, follow the steps to insert the infusion set into your body. Tubing slot Place blue hub into quick-serter, placing the handle in the tubing slot. 2. 3. Needle guard Be careful not to push or hold blue button. Holding the serter with one hand, gently press infusion set to secure. Be careful not to push all the way into serter. Do not hold or press on the blue button. 4. Blue button Pull blue button down until you hear it click. Adhesive Holding needle guard, pull off the paper that covers the adhesive. 5. Choose an insertion site from the shaded areas shown here. Wipe with alcohol or antiseptic. 6. Needle guard Turn to loosen needle guard and pull. 29 Continued on next page Insulin Pump I Infusion set and Reservoir 7. 8. 9. Hold serter against cleaned site. Press the two white buttons at the same time. Press the blue button to unlock. 10. 11. 12. Blue button White Buttons Blue handle 1 2 Pull serter away from body. Press adhesive against skin. Hold infusion set. Pull blue handle straight out to remove needle. Fold blue handle until locked. Note: Alternative infusion sets offered are Mio™, Silhouette®and Sure-T®. Most of the steps described in this section will be different for each infusion set. Please refer to the instructions for insertion included in the infusion set box. 30 Insulin Pump I Infusion set and Reservoir FILL CANNULA 1. 2. Select Fill. Select Fill amount and enter: - 0.300 if using 6mm cannula - 0.500 if using 9mm cannula Then press . You will now fill the cannula, the little tube under your skin, with insulin. Note: Your pump will remember the Fill amount that you used last. Always verify that the Fill amount is correct. • If it is correct, press and press . 3. to Fill Now . Change to • If it is incorrect, press correct amount and. Press . Fill Now. Select Fill Now. 4. Note: Select Stop Filling if you need to stop, for example, if you notice the Total amount is incorrect. This should rarely happen if you have verified the Fill amount on the previous screen. The Home screen displays the insulin as it fills the cannula. Your infusion set change is now complete! 31 Insulin Pump I Alerts and Alarms Section 7: Alerts and Alarms Alerts An alert makes you aware of a situation that may need your attention. When an alert occurs, you should check to see what your pump is telling you. Examples of alerts include Low reservoir or Low battery. Alarm When an alarm occurs, something has been detected that is preventing insulin from being delivered. You are not getting insulin. It is important that you address an alarm right away. Examples of alarms are Insulin flow blocked and Replace battery now. When an alert or alarm occurs: Notification Light ALERT ALARM The red light on the pump will blink once followed by a pause. This sequence continues until the alert is cleared. The red light on the pump will blink twice followed by a pause. This sequence continues until the alarm is cleared. The flashing pattern is shown here: The flashing pattern is shown here: Audio Depending on your Audio Option settings, the pump emits a repeated alert tone, a continuous three-pulse vibration, or both. Display The pump will display a notification with a yellow icon and instructions on what to do. Notification light 32 The pump will display a notification with a red icon and instructions on what to do. Insulin Pump I Alerts and Alarms To address and clear the alert or alarm: 1. Read the text on the screen to understand the alert or alarm and the steps that should be taken 2. Press 3. Press . on the desired option. Example of alarm: Press • Alert: the audio/vibration pattern repeats every 5 minutes or every 15 minutes (depending on the alert) until the alert is cleared. • Alarm: the audio/vibration pattern repeats every minute for 10 minutes if the alarm is not cleared. After 10 minutes, the alarm begins to siren. IMPORTANT: It is important that you are able to address an Insulin flow blocked alarm. This alarm means that insulin is not able to get through the tubing or cannula. If this alarm occurs, check your blood glucose and check to see if your infusion set has become dislodged or if your tubing is kinked. • If you don’t detect an issue and are unable to change your reservoir and infusion set right away, you might choose to select Resume Basal. If an Insulin flow blocked alarm occurs again, follow the steps on the screen. Select Rewind and change your reservoir and infusion set. • If you detect an issue or if your reservoir has run out of insulin, follow the steps on the screen. Select Rewind to change your reservoir and infusion set. You can call the Product helpline if you have questions about your pump, alerts or alarms. 33 Insulin Pump I Suspend Delivery Section 8: Suspend Delivery Remember your pump is delivering basal insulin throughout every hour of the day. Although you should never stop this insulin delivery for more than an hour or so, there will be times when you will want to manually suspend, or stop delivery, and disconnect from your pump. This is done using the Suspend Delivery feature. Using Suspend Delivery stops all insulin delivery. The most common reasons to manually suspend delivery might include bathing and water activities. Infusion sets are designed so you can easily disconnect from your pump and leave it in a safe place. When the pump is manually suspended, all insulin delivery stops. All insulin delivery will remain stopped until you resume delivery. When the delivery is resumed, basal insulin will begin to deliver again. The pump will not deliver any of the basal insulin you missed while the pump was suspended. If you manually suspend delivery while a bolus is delivering, the bolus delivery will stop. When you resume delivery, the remainder of the bolus will not be delivered. To place the pump in Manual Suspend: from the Menu, select Suspend Delivery > and select Yes. Press Notice that the Home screen has changed. To resume Basal Insulin Delivery, select Resume from the Home screen. 34 CGM I Introduction to Continuous Glucose Monitoring Section 9: Introduction to Continuous Glucose Monitoring Continuous glucose monitoring (CGM) gives you a more complete picture of your glucose control: • Using a sensor allows you to receive up to 288 sensor glucose readings every 24 hours, filling the gaps between your BG tests. • Graphs and trend arrows show the speed and direction your glucose levels are moving. • CGM alerts notify you of high and low glucose values. MiniMed 640G also includes SmartGuardTM, Medtronic’s exclusive closed loop technology. SmartGuard mimics some functions of a healthy pancreas, to provide you with advanced protection from hypoglycemia1: SmartGuard can: • PREDICT when you are approaching low glucose levels 30 minutes in advance • Automatically STOP insulin delivery before you go hypoglycemic • And automatically RESUME it when your glucose levels recover*. Your Continuous Glucose Monitoring (CGM) system includes 3 key items: 1 Glucose sensor The Enlite™ sensor measures glucose levels in the body. 2 Transmitter** The Guardian™ 2 Link transmitter connects to the glucose sensor and sends glucose readings to your insulin pump. 3 Insulin pump The MiniMed™ 640G insulin pump displays glucose readings. Other items include: Enlite serter, Enlite overtape, Guardian 2 Link charger and watertight tester. Always use the components that were sent with your MiniMed 640G System. 2 3 1 Drawings throughout this document are only generic representations of the system components. 1. Conget I., Choudhary P., Olsen B., et al. Prevention of hypoglycemia by the predictive low glucose management feature in a user evaluation study. Diabetologia. 2015, 58 (Suppl 1), p 416. * See Appendix pages 66-67 for further details on how SmartGuard works. ** The transmitter must be within 1.8 meters of the insulin pump in order to communicate sensor readings. The MiniMed 640G insulin pump will not communicate with MiniLink transmitters. 35 CGM I Sensor Glucose (SG) and Blood Glucose (BG) Section10: Sensor Glucose (SG) and Blood Glucose (BG) Your BG meter measures glucose levels in your blood. The glucose sensor measures glucose in the fluid surrounding the cells of your tissue called interstitial fluid. Transmitter Skin Glucose Sensor Interstitial Fluid Cell Glucose Blood Vessel Glucose travels between these two areas (blood and interstitial fluid). Most of the time, it travels to your blood first, and then to your interstitial fluid. Because of how glucose moves, your BG meter readings (BG) and sensor glucose readings (SG) will be close, but will rarely match exactly. This difference is normal and should be expected. When glucose levels are rising or falling quickly, you should expect to see an even larger difference between your BG meter readings and the sensor glucose readings. Examples of times when this larger difference may occur include: • After meals or taking a bolus of insulin • During exercise • When arrows appear on your pump screen as explained in the next section IMPORTANT: Sensor glucose is not the same as blood glucose. Your SG and BG readings will be close to one another, but will rarely match exactly. Sensor glucose values should not be used to make diabetes treatment decisions. Always confirm your glucose value with a BG meter first. 36 CGM I Trends Section 11: Trends Sensor glucose trends give insight into the direction and the speed that your glucose is changing. The sensor graph and trend arrows are used to show your trend information. IMPORTANT: When using CGM, focus less on each individual glucose number and more on the direction and speed that your glucose is changing. Example of Sensor information on the Home Screen Trend Arrows Sensor Glucose Graph Sensor Glucose Reading By looking at the sensor information above, you can see that your current glucose reading is 5.6 mmol/L. When you look at the graph, you can see that you are trending downward. Furthermore, you see arrows above the number. These arrows indicate the rate that your glucose values are moving up or down: or - SG has been rising or falling by about 1-2 mmol/L over the last 20 minutes or or - SG has been rising or falling by about 2-3 mmol/L over the last 20 minutes - SG has been rising or falling by about 3 mmol/L over the last 20 minutes Note: You may be likely to notice your glucose trending up or down after eating, giving a bolus, or when exercising. 37 CGM I Personalised Alerts Section 12: Personalised Alerts Your CGM alert and suspend settings are most beneficial if they are personalised for your needs. Your healthcare professional will work with you to determine your initial settings and help with adjustments that need to be made, as you learn more from the information that CGM provides. The graph below shows an example of the different settings that can be personalised for both High and Low sensor glucose readings. Personalised Alerts 13.9 Alert on High Alert before High Rise Rate ( 4.0 High Snooze) Sensor Glucose Readings ( Low Snooze) Suspend before Low Alert before Low Suspend on Low Alert on Low CGM Alert Setting Turning Sensor Feature On Before setting any of these sensor alerts, you must first turn the sensor feature on. To turn the sensor feature on, go to the Menu > Sensor Settings and select Sensor. 38 High Limit CGM I Personalised Alerts Low Settings The Low Settings include alerts, as well as the SmartGuard™ suspend by sensor features. You can choose to be alerted if your sensor glucose: • is approaching your low limit (Alert before low) • has reached your low limit (Alert on low) The SmartGuard suspend by sensor features can automatically suspend insulin if your sensor glucose: • is approaching your low limit (Suspend before low) • has reached your low limit (Suspend on low) This will keep you from getting additional insulin that would continue to lower your sensor glucose level. 22.2 mmol/L Alert on High Alert Before High Rise Alert ( High Snooze) Snooze ( Suspend before Low Alert before Low Suspend on Low Alert on Low A Low Snooze) Sensor Glucose Readings 2.2 mmol/L Your low (Lo) limit can be set from 2.8 to 5.0 mmol/L. This is the value on which the other low settings described below are based. You can set up to eight low limits for different periods of the day or night. Alert Reason Alert before low If Suspend before low is on, you will be alerted when insulin is suspended. If Suspend before low is off, you will be alerted when the sensor predicts you will reach your low limit in 30 minutes. Alert on low Sensor glucose value is equal to or lower than your low limit. Steps to take Do not treat your glucose based on SG. Confirm it using your BG meter. Treat if necessary based on instructions from your healthcare professional and continue to monitor. 39 CGM I Personalised Alerts Note: If either Suspend on low or Suspend before low is turned on, Alert on low will automatically be set to on so you know that your glucose is at or below your low limit. SmartGuard Suspend features Suspend before low Suspend on low Impact on insulin delivery if suspend feature is turned on Insulin delivery is temporarily stopped if sensor glucose value is approaching your low limit. Information displayed by the pump You will receive this alert message and need to check your BG. Insulin delivery will remain suspended after the alert is cleared. After the alert or alarm message is cleared and insulin delivery has stopped, the Home screen will display: • Suspended before low or Suspended on low at the bottom of the screen If the alert is not cleared in 10 minutes, the pump will begin to siren. • a shaded area to You will receive this alarm message and need to check your BG. Insulin will remain suspended after the alarm is cleared. • a flashing SmartGuard represent the time when insulin has been suspended suspend by sensor icon. Insulin delivery is temporarily stopped if sensor glucose value has reached or fallen below your low limit. If the alarm is not cleared after 10 minutes, the pump will begin to siren and an emergency message will appear on the pump screen. Notes: • Only one suspend feature can be used during each time segment; you cannot turn both Suspend before low and Suspend on low on. • Insulin delivery will not be suspended if you are more than 3.9 mmol/L above your low limit. 40 CGM I Personalised Alerts Resuming Basal Insulin Automatic Basal Resume In addition to suspending insulin delivery, the pump can also automatically resume delivery of basal insulin. If insulin has been suspended by either Suspend before low or Suspend on low, insulin delivery will automatically be resumed: • if SG values are above the low limit and are trending upward. If you have the Resume basal alert on, you will be alerted when this occurs. • after a maximum suspend time of 2 hours. You will always be alerted (even if the Resume basal alert is off ) when this occurs. It is important that you check your BG and ensure your glucose is at a safe level. Manual Basal Resume You can choose to resume basal insulin delivery yourself at any time. You simply need to select Suspended before/on low on the Home screen and follow the instructions on the screen. Setting up your Low Settings: In this example, we will set up multiple time segments with different alert and suspend settings. on the time segment. 1. From the Menu, go to Sensor Settings > Low Settings and select Low Settings to turn On. 2. Press to set Lo limit 3. Press or and press . 4. Press to continue onto the next screen. 41 CGM I Personalised Alerts 5. Select each feature you wish to turn on. In this example, Suspend before low has been turned on. Notice that Alert on low is automatically turned on. 6. Once settings are selected, select Next. on the time segment. Repeat steps 3 to 7 to enter the next time segment 7. Press and select the features you want to turn on for this segment. In this example, Alert before low, Suspend on low, and Resume basal alert have been turned on. 8. Select Done. 42 9. Verify that settings are correct and select Save. CGM I Personalised Alerts 10. If snooze time needs to be changed, press to Snooze and press . The low snooze time can be set from 5 minutes to 1 hour. 11. Press or and press to the correct time . Your Low Settings setup is now complete. Time that you want to wait to be reminded that an alert condition still exists. Remember: Sensor glucose values must be confirmed with a BG meter reading before diabetes treatment decisions can be made. High Settings The High Settings allow you to be alerted if your sensor glucose: • is rising rapidly (Rise Alert) • is approaching your high limit (Alert before high) • has reached your high limit (Alert on high) Personalized Alerts 22.2 mmol/L High Limit Alert A ert on High ( Low Snooz Alert Before High Sensor Glucose Readings Suspend before Low Alert before Low Rise Alert ( High Snooze) Suspend on Low Alert on Low 2.2 mmol/L CGM Alert Setting 43 CGM I Personalised Alerts Your high (Hi) limit can be set from 5.6 to 22.2 mmol/L. This is the value on which other high settings described below are based. Remember: Your high limit is not the same as your glucose target. Your healthcare professional will help you determine the best setting so that you are alerted when needed while preventing unnecessary or inconvenient alerts. Reason Alert Alert before high Sensor glucose reading is expected to reach the high glucose limit in the length of time that you set for the Time before high*. Alert on high Sensor glucose value is equal to or higher to the high limit you set. Sensor glucose reading is increasing at a rate that is equal to or faster than the Rate Limit that you set. The Rise Alert can be set to alert if glucose is rising as follows: Rise Alert • • • • - SG is rising at a rate of 0.056 mmol/L per minute or more - SG is rising at a rate of 0.111 mmol/L per minute or more - SG is rising at a rate of 0.167 mmol/L per minute or more Custom - SG is rising at the rate that you set. This can be set from 0.050 to 0.275 mmol/L per minute Steps to take Do not treat your glucose based on SG. Confirm it using your BG meter. Treat if necessary based on instructions from your healthcare professional and continue to monitor. *Time before high determines how many minutes before reaching the high limit that you will receive an Alert before high. This can be set from 5 to 30 minutes. Remember: You can set up to 8 different time segments throughout the day and night. Each time segment can have different high limits and high alerts that work best for you during that time of day or night. 44 CGM I Personalised Alerts Setting up your High Settings: 1. From the Menu, go to Sensor Settings > High Settings and select High Settings to turn On. If you are changing settings that are already entered, press to Setup and press . 3. Press or to set Hi limit and press . In this example, the limit is set to 13.8 mmol/L. 2. Press on the time segment. If you are setting multiple time segments with different high limits and alerts, press to set the first End time and press . In this example, only one time segment is set. to continue onto the 4. Press next screen and select each alert you wish to turn on. 45 CGM I Personalised Alerts 5. Once settings are selected, select Next. In this example, the Alert on high has been turned on. 6. Select Done. 7. Verify that settings are correct and select Save. 8. If snooze time needs to be changed, press to Snooze and press . The high snooze time can be set from 5 min to 3 hours. 9. Press or to the correct time and press . Your High Settings setup is now complete. Changing High and Low Settings To make changes to your existing High or Low settings, go to Sensor Settings > High Settings or Low Settings > Setup and select Edit. 46 CGM I Personalised Alerts Alert Silence If a sensor alert occurs when Alert Silence is on, a Sensor alert occurred message is displayed and the notification light flashes, but there is no beep or vibration during the set period of time. To set Alert Silence: from the Menu, go to Sensor Settings > Alert Silence. You can select which alerts you would like to silence and set the time you want these alerts to be silent for. Alerts will automatically return to audio and/or vibrate at the end of the duration that you set. Note: If an alert is received during Alert Silence, go to the Menu > History and select Alarm History to see the alerts that occurred. 47 CGM I Sensor Display Section 13: Reading the Sensor Display Once the sensor has started giving you sensor glucose readings, the Home screen will display them similar to what you see here. Additional Sensor Icons Trend Arrows High Alert Limit Most recent Sensor Glucose (SG) Reading 3-hour Sensor Glucose Graph SmartGuard Suspend by Sensor Icon Low Alert Limit Bolus Marker The Sensor Glucose reading is updated every 5 minutes. Status Bar In addition to the pump icons, you will see additional sensor icons on the Status Bar when using CGM. Connection icon: shows radio frequency (RF) communication between the pump and sensor. Calibration icon: represents the time left until next calibration is due. The icon empties as time decreases. Down arrow means calibration is needed. Sensor Life icon: represents the number of days before sensor needs to be changed. Additional icons: appear when the sensor is in warm up, pump and transmitter are out of range, system cannot be calibrated, or calibration or sensor age are unknown. 48 CGM I Sensor Display SmartGuard Suspend by Sensor Icon During any time segment when either Suspend before low or Suspend on low is set to on, you will see the Suspend by sensor icon on the Home screen : Suspend before low or Suspend on low is on and ready. If either suspend becomes active, the icon will flash while insulin delivery is stopped. Suspend before low or Suspend on low is on but is unavailable. This can be due to a recent suspend or when no SG values are available. Sensor Status You can go to the Sensor status menu to see, for example, when your next calibration is due, time left on your sensor, and battery life remaining on your transmitter. From the Home screen, select the Status Bar and select Sensor. You will also see additional sensor status information in Notifications, Quick Status, and Settings Review screens. Sensor Graph A graph that shows the last 3 hours of sensor glucose readings will always display on the Home screen. Your high and low glucose limits entered in your sensor settings will be shown in red. You can also view 6-hour, 12-hour and 24-hour glucose trend graphs by selecting the sensor graph. Blue squares at the bottom of the graph represent a bolus. A gold shaded area represents time when insulin was suspended by sensor. 49 CGM I Connecting your Pump and Transmitter Section 14: Connecting your Pump and Transmitter Before using the sensor for the first time, you will need to wirelessly connect the pump and transmitter so that they can communicate with each other. This allows the sensor information to be displayed on the pump screen. To wirelessly connect your pump and transmitter: 1. Attach your transmitter to the charger and make sure it is fully charged. charger transmitter 3. Select Auto Connect > Press > Select Continue. Steps for Manual Connect can be found in the MiniMed 640G User Guide. 50 and select Utilities > Device 2. Press Options > Connect Device. Only one transmitter can be connected to the pump at one time. When you need to connect a new transmitter, you must first select Manage Devices, select the transmitter number and select Delete. 4. Make sure the transmitter is on the charger before proceeding. Now start the search processes on both devices. CGM I Connecting your Pump and Transmitter 4b. Immediately select Search on the pump. The search can take up to 2 minutes. ! 4a. Remove transmitter from charger. If green light on transmitter does not flash, reconnect to charger until fully charged. 5. Once device is found, confirm that the serial number (SN) shown on the pump is the serial number on the back of your transmitter and select Confirm. If you receive the No devices found message, place the transmitter back onto the charger. Then remove the transmitter from the charger and immediately select Retry on the pump. 6. Connection is now complete. The transmitter serial number will be displayed on the pump screen. Note: These steps only need to be done as a first time set-up. You will not have to repeat with each new sensor you start. Note: If you stop using CGM for a period of time and need to store your transmitter, please make sure to leave it connected to the charger during the storage period. This will help ensure you get the most life out of your transmitter battery. 51 CGM I Inserting and Starting the Sensor Section 15: Inserting and Starting the Sensor*** Before you insert your sensor, gather all of your supplies: Enlite™ System Components* Thumb print A B C A D Bump on button One-press Serter Enlite Sensor & Pedestal A – Pedestal B – Needle Housing C – Sensor D – Clear Liner Sensor Overtape Guardian 2 Link A – Pre-cut Hole *For more details on the Enlite system components, consult the User Guides One-press serter is required in order to insert the sensor properly Enlite sensor is individually packaged and comes attached to a plastic pedestal which is necessary for proper loading into the serter Sensor overtape is required to keep the sensor securely in place Guardian™ 2 Link transmitter is connected after the sensor is inserted and covered with the overtape ***Please refer to the One-press serter user Guide and your HCP for more information. 52 CGM I Inserting and Starting the Sensor Selecting Your Site Your sensor can be inserted in any of the shaded areas shown here**. The sensor insertion site should be at least: • 5 centimeters from your navel • 2.5 centimeters from your insulin pump infusion site • 2.5 centimeters from any manual insulin injection site **Clinical trials for glucose sensors were performed on sensors inserted in these areas. For good sensor glucose performance, avoid sites: • Where clothing may rub or constrict (for example, your beltline) • Where your body naturally bends a great deal which may cause the sensor to pull out • That are scarred or have hardened tissue or stretch marks • Where there is a great deal of motion or friction Preparing Your Site • Wash your hands with soap and water. • Clean the selected site with an alcohol swab and allow the alcohol to dry. Do not use IV prep or the sensor may not work properly. 53 CGM I Inserting and Starting the Sensor Inserting Your Sensor The instructions below only refer to the One-press Serter. If you have a different serter model, please refer to your serter User Guide for instructions on how to insert the sensor. 1a. Hold sensor by plastic pedestal. Remove sensor with attached pedestal by holding pedestal only. Place sensor/ pedestal on a clean, flat surface (such as a table). 4a. Place serter on body. Hold serter steadily against your cleaned insertion site, without pushing serter too deeply into skin. Note: Failing to hold serter securely flat against body may allow serter to spring back after pressing buttons and result in improper insertion of sensor. 1b. Tuck adhesive tab. Make sure that sensor’s adhesive tab is tucked under sensor connector and snaps. X Correct 2. Load sensor into serter. Grip serter exactly as shown with thumb on thumbprint marking on serter. Do not hold side buttons. Push serter down onto pedestal until base of serter sits flat on table. X Correct Incorrect 3. Detach serter from pedestal. To detach serter from pedestal, grip serter as shown, with thumb on thumb print on serter. With other hand, place two fingers on pedestal arms, and slowly pull serter straight up. Note: Make sure that pedestal is firmly on table before pulling serter away. Warning: Do not detach pedestal from serter in mid-air as this may damage sensor. NOTE: The sensor remains inside the serter after removing the pedestal. The arrow on both sides of serter indicate location of the sensor needle. 54 Incorrect 4b. Insert sensor. Press and release bump on both buttons at same time. 4c. Hold serter against body. Continue holding serter against body to allow adhesive time to stick to skin. 4d. Remove serter from body. Slowly pull serter away from skin, making sure buttons are not pressed. 5. Remove needle housing. Gently hold base of sensor against skin with one hand. With other hand, hold needle housing at top and slowly pull it straight, away from sensor. Dispose of needle housing in a sharps container. Warning: Watch for bleeding at the insertion site. If bleeding occurs under, around, or on top of the sensor, apply steady pressure using sterile gauze or a clean cloth placed on top of the sensor for up to three minutes. The use of non-sterile gauze can cause an infection. If bleeding does not stop, remove the sensor and apply steady pressure until the bleeding stops. 6a. Remove adhesive pad liner. Hold sensor in place and gently remove liner from under adhesive pad. Do not remove the adhesive liner from the rectangular adhesive tab. 6b. Press entire adhesive pad to skin. Firmly press adhesive against skin and smooth entire adhesive pad so it sticks to skin. NOTE: Enlite adhesive is pressure-sensitive. Continue applying pressure to ensure sensor remains inserted in skin for whole 6 days of wear. 7a. Untuck adhesive tab. Untuck adhesive tab from under sensor connector. 7b. Straighten adhesive tab. Straighten adhesive tab so it lies flat against your skin, but do not remove adhesive liner yet. CGM I Inserting and Starting the Sensor Taping Your Sensor Before you connect the Guardian 2 Link transmitter to your Enlite sensor it is very important that you properly secure the sensor against your skin using the sensor overtape. 1. Remove large paper backing from overtape. Do not remove two smaller paper tabs on sides of overtape. 2. Attach the overtape to both the rounded part of the sensor and the skin in front of the sensor. Important: Make sure there is overtape on both the rounded part of the sensor and the skin. 3. Apply rest of overtape, but do not block sensor connector with overtape. Press overtape to your skin for several seconds. 4. Remove two paper tabs from sides of overtape. Press overtape against skin. 5. These images show overtape applied correctly. IMPORTANT: All Enlite tapes and adhesives stick best when you apply pressure for several seconds after putting them on your skin. Doing so helps the Enlite sensor stay securely placed and fully inserted. Properly applying the overtape is key to ensuring your success with the Enlite sensor. Due to the sensor’s small size and flexible nature, the overtape helps to secure it from body motion or physical activity that can cause it to be pulled out. 55 CGM I Inserting and Starting the Sensor Connecting your transmitter to your sensor Before connecting the transmitter, make sure the Sensor feature is On. See page 38 if you need help with these steps. 1. With one hand, hold sensor in place. With other hand, connect transmitter to sensor. 2. You will hear a faint “click” when the two components are connected. Check for green light to flash on transmitter. 3. Remove the paper on adhesive tab. 4. Fold adhesive tab over transmitter. Be careful not to pull the adhesive tab too tightly or it may cause the transmitter to pull from the sensor connection. 5. Press adhesive onto transmitter. Apply additional tape over transmitter as needed. IMPORTANT: If you do not see a green light flashing on the transmitter after it is connected to the sensor, then disconnect the transmitter and place it back on the charger to ensure that it is fully charged. Then reconnect the transmitter to the sensor. If for any reason you disconnect the transmitter from the sensor, wait 5 seconds before reconnecting it to the sensor. It is very helpful to remember the order of these three steps when changing your sensor: 1. Insert the sensor. 2. Tape the sensor in place. 3. Connect the transmitter. 56 Strongly Suggested: Applying an additional piece of tape over the sensor as shown here helps to ensure the transmitter and sensor stay secure and connected during wear. The Enlite overtape or any other medical tape can be used. Enlite overtape Medical tape* *A piece of Tegaderm™ cut in half is shown in this image. Note: When your transmitter is connected to your sensor they form a water-tight seal to a depth of 2.4 meters for up to 30 minutes. You can shower and swim without removing them. CGM I Inserting and Starting the Sensor Starting the Sensor Once you have inserted the sensor and connected the transmitter, the pump and transmitter will begin to communicate. Make sure your pump is on the Home screen so that the message below (in step 1) will be displayed when the sensor is ready to be started. This typically takes less than a minute, but may take up to 10 minutes. 1. Select Start New Sensor. 2. The Sensor warm-up started message will appear. 3. Press and then to clear. Warm up… will appear on the Home screen until sensor is ready for the first calibration. If 15 minutes have passed and the Warm up bar does not appear or it looks like it is not progressing, look in the Quick Status screen, if you see the time of Next cal listed, the sensor is in Warm up. Note: The next time you connect a transmitter, you will see these screens. Select Start New Sensor if you have just inserted a new sensor. Select Reconnect Sensor if you have only disconnected and reconnected the transmitter. 57 CGM I Calibrating Section 16: Calibrating Your continuous glucose monitoring system requires blood glucose meter readings in order to provide you with sensor glucose readings. These BG meter readings are entered into the pump and are for sensor calibrations. Calibration is essential for optimal CGM performance. CGM does not eliminate the need for BG meter tests. To calibrate, you must test your blood glucose on your meter and then enter that value into your pump. The pump will accept BG meter readings between 2.2 mmol/L and 22.2 mmol/L. After inserting a new sensor, a calibration is needed: • Within 2 hours after you connect the transmitter to your sensor and start the Warm up period. Your pump will notify you with a Calibrate now alert when it is ready for its first calibration. • Again within 6 hours (first day of inserting sensor only) • Again every 12 hours (when a calibration is necessary you will receive a Calibrate now alert). Important: After the first day, the minimum number of calibrations required is one every 12 hours. However, calibrating 3-4 times a day is optimal and these can be done when it is convenient for you. To help you remember to calibrate, think “before is best” - typically the best times to calibrate are before meals, before taking insulin, and before bedtime. Also check for arrows - calibrating when there are 2 or 3 arrows may decrease sensor accuracy until the next calibration. 58 CGM I Calibrating Example of optimal calibration times Glucose level (mmol/L) Blood glucose reading Target range Low limit Sensor glucose 16.7 11.1 3 5.6 1 4 2 0 0 2 4 6 8 10 12 14 16 18 20 22 Time Optimal calibration time Optimal calibration time Not optimal for calibration Optimal calibration time When receiving a Calibrate now alert, if you cannot calibrate right away, you can set the Snooze to remind you to calibrate in the time that you set. If you plan to test BG and calibrate right away, simply select Snooze. Once you select Snooze, Calibration required will appear on the Home screen until you enter a BG to calibrate. Remember: Calibrations are necessary in order to continue to receive sensor glucose readings, alerts and alarms. 59 CGM I Calibrating Calibrating the Sensor There are 5 different ways that you can enter a BG reading to calibrate the sensor. Calibrating by using the Contour® next LINK 2.4 Meter When you use the compatible Bayer meter, you will see the meter value automatically displayed on the home screen, as shown here. 1. Select Calibrate Sensor or if you plan to give a bolus using Bolus Wizard, select Bolus. 2. If you have selected Bolus, select Yes to Calibrate Sensor? after bolus is delivered. Calibrating through the Bolus Wizard In the Bolus Wizard: 1. Select Deliver Bolus. 2. Select Yes to calibrate sensor. Calibrating through Home Screen Graph 1. Select press 60 to the sensor graph, and hold. 2. Press press or to enter BG value, and select Calibrate. CGM I Calibrating Other ways to calibrate The 2 other ways to calibrate your sensor are through: • Sensor Settings: from the Menu, go to Sensor Settings > Calibrate Sensor, select BG and press or to enter BG value > press and select Calibrate. • Event Markers: from the Menu, go to Event Markers > BG > Enter BG > press > select Save > select Yes to calibrate sensor. Once you have entered a calibration BG, the Home screen will show you that the system is calibrating. You will start seeing sensor glucose readings again in 5-15 minutes. IMPORTANT: If you notice a large difference between your BG meter reading and sensor glucose readings, wash your hands and do another BG fingerstick test to help ensure a more accurate reading. Check the sensor site to ensure the sensor overtape is still holding the sensor in place. If there is still a large difference in glucose readings, another calibration may be needed to bring the readings closer together again. You can use the Calibration Reminder to give you notice before the next calibration is necessary. The Calibration Reminder defaults On with a reminder time of 1:00 hour and you can change it by going to the Reminders menu option. 61 CGM I Other Sensor Alerts Section 17: Other Sensor Alerts We discussed personalised alerts earlier in Section 12. There are other sensor alerts that you will receive as well. The most common alerts that you can expect to receive when using CGM can be found in the table below. Alert Reason Steps to take A calibration is needed in order to receive sensor glucose readings. Enter BG value into your pump to calibrate. Communication between pump and transmitter has been lost for 30 minutes during or after warm-up. Check that the sensor is still inserted in the skin and the transmitter and sensor are still connected. Move your pump closer to your transmitter. Calibration not accepted The BG meter value could not be used to calibrate; it was too different from the SG value. Wait at least 15 minutes for BG to stabilise. Wash your hands and repeat the BG test. Use this value to calibrate again. BG not received The transmitter was unable to receive the calibration BG reading from the pump. Move your pump closer to your transmitter and select OK. The pump will try sending the BG again. Sensor expired Sensor has reached its maximum usage of 6 full days. Remove the sensor and follow the instructions for inserting and starting a new sensor. Change sensor You have received two Calibration not accepted alerts in a row. Remove the sensor and follow the instructions for inserting and starting a new sensor. Cannot find sensor signal The pump has not received a signal from the transmitter. Disconnect and reconnect your transmitter and sensor and select OK. Calibrate now Lost sensor signal For a complete list of Alerts and Alarms, refer to the MiniMed 640G System User Guide. 62 Appendix I Charging and Storing your transmitter Charge the transmitter before each use. When the transmitter is charging, a green light will flash on the charger. This green light will turn off when the transmitter is completely charged. You will need to charge the transmitter after each sensor use. A fully charged transmitter can be used for a maximum of six days without recharging. It can take up to an hour to fully recharge. ! Charging and Storing the Guardian™ 2 Link Transmitter When you remove the transmitter from the charger, a green light should flash on the transmitter. This indicates that it has enough battery power to be connected to the sensor. If you do not see the green flashing light on the transmitter place it back on the charger until it is fully charged. Store the transmitter, charger, and test plug in a clean, dry location at room temperature. Although not required, you may store the transmitter on the charger. If the transmitter is not in use, you must charge it at least once every 60 days. If you connect transmitter to charger and you see no lights on the charger: replace the battery in the charger. While charging your transmitter you see a flashing red light on the charger: replace the battery in the charger. While charging your transmitter you see a mix of short and long flashing red lights on the charger: replace the battery in the charger and fully charge the transmitter. Refer to your Guardian 2 Link transmitter and charger User Guides for more information. 63 Appendix I CareLink™ CareLink™ Personal Software What is CareLink™ software? CareLink™ Personal software is a web-based software that allows you to upload information from your MiniMed™ 640G system to a secure online (internet) site for viewing. CareLink software organises all of your insulin pump, sensor glucose and blood glucose meter information into reports (charts, tables and graphs) that can help you track glucose levels, insulin usage and carbohydrate intake over time. With CareLink software, you can grant your healthcare provider online access, so that your information can be discussed at your next appointment. Benefits of CareLink software CareLink Personal software makes it easier to track your glucose levels and see how they are affected by your insulin delivery, meals and exercise routines. CareLink Personal provides a secure place to store your information and uncover patterns in your glucose control that meter and logbooks alone cannot reveal. Information from CareLink software can help you and your healthcare provider make more informed therapy decisions aimed at improving your glucose control. CareLink reports can help you and your healthcare provider make decisions that improve your control and fit your lifestyle. The combination of insulin pump therapy, continuous glucose monitoring and CareLink software provides you with the tools and information you may need to optimise your therapy. For more information on how to upload information to CareLink Personal software using the Contour® Next LINK 2.4 glucose meter from Bayer, see page 24. 64 Appendix I X-rays and Traveling by Air X-rays, MRI, or CT Scan If you are going to have an X-ray, MRI, CT scan, or other type of diagnostic imaging involving radiation exposure, remove your insulin pump, transmitter, and glucose sensor and place them outside of the testing area. Traveling by Air If you wear a CGM device, you may need to stop the wireless communication between the transmitter and the pump during the flight. To temporarily stop wireless communication, turn Airplane Mode on. From the Menu, go to Utilities > Airplane Mode, select Airplane Mode to turn On and Save. The transmitter continues to measure glucose levels when in Airplane Mode. To resume wireless communication, turn Airplane Mode off: When Airplane Mode is turned off and communication resumes, the transmitter will send up to 10 hours of sensor data to your pump. If Airplane Mode was on for <6 hours: 1) Wait 15 minutes for sensor data to appear on pump screen If Airplane Mode was on for >6 hours: 1) Disconnect transmitter from sensor and then reconnect it. 2) Select Reconnect Sensor when it appears on the pump screen to begin sensor warm-up. 3) The sensor data (up to 10 hours) will appear on the pump. 4) You will be asked to calibrate in 2 hours to resume sensor readings. Always remember that it is important when traveling to be extra attentive to monitoring your glucose and prepared to respond if needed. 65 Appendix I SmartGuard ™ Suspend by Sensor Features The images below show additional detail about using the Smartguard suspend by sensor features of your MiniMed 640G System. Sensor glucose trend Estimated sensor glucose trend Sensor glucose trend during suspend 1) Suspend on low event: If sensor glucose (SG) reaches your low limit, insulin delivery will be stopped. You will always receive a message and alarm when this occurs. Low Limit You will have 10 minutes to respond before the pump begins to siren and emergency message appears. 2) Suspend before low event: To help keep sensor glucose (SG) from reaching your low limit, insulin delivery will be stopped if SG is: • at or within 3.9 mmol/L above the low limit 30 min • predicted to be approaching the low limit in 30 minutes Low Limit If Alert before low is on, you will receive an alert when insulin is suspended. 3) Alert on low during Suspend before low: If insulin delivery has stopped due to Suspend before low, SG may still reach your low limit. You will always be alerted when this occurs. Low Limit 66 You will have 10 minutes to respond before the pump begins to siren. Appendix I SmartGuard™ Suspend by Sensor Features 4) Automatic basal resume based on sensor glucose (SG) value: During Suspend before low or Suspend on low, basal insulin will automatically resume if: • SG is above the low limit and trending upward Low Limit 30 min • insulin has been suspended by sensor for at least 30 minutes If Resume basal alert is on, you will receive an alert when this occurs. Remember you can manually resume basal insulin at any time. 5) Automatic basal resume due to 2 hour maximum suspend: During either Suspend before low or Suspend on low, if basal insulin is not resumed due to SG values, it will automatically resume after 2 hours. Low Limit 2 hours You will always receive an alert when you reach the 2 hour maximum suspend time, even if the Resume basal alert is set to off. Remember you can manually resume basal insulin at any time. 6) Suspend by sensor unavailable: Once basal insulin resumes following either a Suspend before low or a Suspend on low, there will be a period of time when suspend by sensor is unavailable. 30 min Low Limit This will most often be 30 minutes if you respond to the suspend alarm, but can be up to 4 hours. See the User Guide for more specific information about this unavailable period. 67 Who to contact and when? CONTACT MEDTRONIC Please contact Medtronic for further guidance and technical advice on using your MiniMed pump. • If you have any concerns that your pump isn’t functioning correctly. • If your pump displays a warning sign or alarm which you cannot switch off. • For more information about a certain pump function. • For guidance when adjusting your basal insulin dose, as instructed by your doctor. Visit our website at: www.medtronic-diabetes.co.uk Alternatively call our customer support helpline 01923 205167 CONTACT YOUR HEALTHCARE PROFESSIONAL Europe Medtronic International Trading Sàrl Route du Molliau 31 Case postale CH-1131 Tolochenaz www.medtronic.eu Tel: +41 (0) 21 802 70 00 Fax: +41 (0) 21 802 79 00 United Kingdom Medtronic UK Ltd. Building 9 Croxley Green Business Park Watford, Hertfordshire WD18 8WW. UK www.medtronic.co.uk www.medtronic-diabetes.co.uk Tel: +44 (0)1923 212 213 Fax: +44 (0)1923 241 004 Republic of Ireland & Northern Ireland Medtronic Ireland Ltd Unit GA Swords Business Campus Balheary Road Swords Co Dublin. www.medtronic.ie www.medtronic-diabetes.ie UC201500095aEEREVB ©2015 Medtronic MiniMed, Inc. All rights reserved. For all other inquiries regarding your health and continuing care please contact your healthcare professional.
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