After Training: Continuous Glucose Monitoring MiniMed 630G System

After Training: Continuous Glucose Monitoring MiniMed 630G System
3
AFTER TRAINING
CONTINUOUS GLUCOSE
MONITORING
MINIMED 630G SYSTEM
®
3
TABLE OF CONTENTS
AFTER TRAINING
CONTINUOUS GLUCOSE MONITORING (CGM)
MINIMED® 630G SYSTEM
Section 1: The First Few Days . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Section 2: Frequently Asked Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Calibration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Sensor and Blood Glucose . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Sensor Glucose Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Sensor Alerts and Suspend . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Sensor Position and Taping . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
CareLink® Personal Software . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Charging the Guardian® Link Transmitter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Guardian Link Transmitter Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
X-ray, MRI or CT Scan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Traveling by Air . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Section 3: Help and Supply Ordering . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
1
3
THE FIRST FEW DAYS
Section 1: The First Few Days
Congratulations on starting CGM! What happens after training? In the next 6 days you will begin to
start seeing the value of using CGM to gain insights for better glucose control.
There are a few important things to remember over the next few days and beyond. You will want to
remember to:
1. Calibrate
You will need to test BG and enter it into the pump to receive sensor glucose values. This is called
calibration. Use the calibration schedule you made during training as a guide to help you get started.
You will start receiving sensor glucose data 10-15 minutes after you enter the first start up calibration.
After that, as long as you are entering calibrations as required, you will receive data. After 6 days of use,
you will start the process again.
Day 1: Insert and start
your sensor.
Day 6: Sensor expired alert.
Days 2-6: Calibrate every
12 hours.*
*Calibrating 3-4 times per day
before meals and bed is best.
Day 1: Calibrate in 2 hours
when Calibrate now message
is received. You will begin
to see SG readings in
10-15 minutes.
Day 1: Calibrate again within
6 hours and before bed.
Review the Calibration Quick Reference Guide in the back of Book 2, During Training
for ways to enter a calibration BG and important calibration tips.
2
3
THE FIRST FEW DAYS
2. Personalize Sensor Alerts
In the coming days, you will be receiving sensor alerts. This is one of the benefits of using CGM.
Knowing how to address alerts and personalizing them to meet your needs is important.
When a sensor alert is received, remember to clear it:
Read message on the
pump screen
Press and to
clear the alert
Take any action
needed
If a sensor alert is not cleared, the pump will begin to siren after 10 minutes. So it will be important to
address and clear each alert.
Are you receiving a lot of sensor alerts?
Don’t get frustrated. The sensor alert settings can be
changed so that you are alerted only when it is important to
you. Speak with your healthcare professional to change an
alert setting or possibly even turn a certain alert Off.
List of most commuorinng
alerts: Book 2 - D33.
Training page
See page 9 and 10 for more information about sensor alerts
and the Suspend on low feature.
3. Change your sensor
You will receive a Sensor expired alert at the end of six days. Inserting and taping a new sensor properly
are important for the sensor to work well.
You learned how to insert the sensor at your training, but that has been about a week ago. Therefore, it
is important to use one of the following to guide you through the steps.
ƒƒ Quick Reference Guide: see page 31 of Book 2, During Training
ƒƒ myLearning video: my.medtronicdiabetes.com/mylearning
ƒƒ Medtronic Diabetes website: www.medtronicdiabetes.com/changesensor
Remember the tips on the following pages to help ensure the best sensor use for all 6 days of wear.
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THE FIRST FEW DAYS
About the serter:
There is a small bump on each green button.
Have your fingers on these bumps when inserting the sensor.
When loading and removing the sensor:
ƒƒ Be sure the sensor is on a hard and even surface like a table or desk.
ƒƒ Be sure your thumb is on the thumbprint and not the green buttons.
ƒƒ Place the serter gently onto the sensor/pedestal to ensure it loads properly.
ƒƒ Keep your thumb on the thumbprint when removing the serter.
When inserting the sensor:
Hold the serter gently against your skin.
Light to
the touch
Place your fingers on the bumps on the green buttons.
Then press and RELEASE both buttons at the same time.
Continue to hold serter against body to allow the
adhesive time to stick to the skin
Slowly pull the serter away from the skin making sure the buttons are not
pressed.
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THE FIRST FEW DAYS
When removing the sensor needle:
Place fingers on the front and back of the sensor as
shown (not on the sensor arms).
Hold the needle on the ridges at the top of the needle
housing when removing it.
After sensor is inserted and the needle is removed:
Correct tape
placement
Attach the overtape to both the rounded part of the
sensor and the skin in front of the sensor.
When tape is placed onto the skin, press the adhesive against the skin to help ensure that it
sticks securely.
When connecting the Guardian Link transmitter to your sensor:
Avoid pulling the adhesive tab too tightly
when placing it over the transmitter.
Drawings throughout this document are only generic representations of the system components.
Is the sensor not staying attached to your body?
If you are having problems with the sensor staying in, or if the tape is coming loose, see page 10 for
additional taping information.
In addition to the information in this guide, you will find helpful information in many of the
Quick Reference Guides Found in the Handouts Section of Book 2, During Training.
5
FREQUENTLY ASKED QUESTIONS
Section 2: Frequently Asked Questions
The following pages provide answers to some of the most commonly asked questions and provides
additional information that you may find helpful as you are using CGM.
Calibration
How do I know when a calibration is due?
You can go to the Sensor status to see when your next calibration is due. You will also see other
information such as the time left before your sensor needs changed and the transmitter battery status.
To see this information, from the Home screen, select the
Status Bar. Then select Sensor.
When a Calibrate now alert, is received, you have the option to
change the Snooze time. This can be helpful if you are unable
to calibrate right away. Once you select Snooze, you are able to
test BG and calibrate.
LIFE WITH CGM
Using the Snooze…
Sid recently started a new sensor and receives the Calibrate now alert. He sees a two up
arrows next to the sensor value and knows he needs to wait to calibrate since arrows are
present. He sets the Snooze to 45 minutes to remind him to calibrate then if glucose is stable.
He remembers that he will not get sensor glucose readings until he enters a BG to calibrate.
6
3
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FREQUENTLY ASKED QUESTIONS
Sensor and Blood Glucose
The glucose value on my meter and the sensor glucose value do not match. Is there
something wrong?
Your meter readings and sensor glucose readings will be close, but will rarely match exactly because of
how glucose moves between the blood and the interstitial fluid. This difference is normal and should
be expected. Expect to see a larger difference between your meter and sensor reading when glucose
levels are rising or falling quickly.
If you have concerns about the differences between SG and BG, make sure you:
ƒƒ Wash hands before checking your BG.
ƒƒ Don’t wait to enter the BG value. If you plan to use a BG value to calibrate, enter it right away.
ƒƒ Calibrate before meals, before taking insulin, and before bedtime.
ƒƒ Do 3-4 but no more calibrations each day.
Can I use my sensor glucose values to make therapy decisions such as giving a bolus?
No. All therapy decisions, for example, giving a bolus for a high glucose or treating a low glucose, need
to be made based on a BG value. You will need to check your blood sugar on your meter and use the
fingerstick value to treat.
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3
FREQUENTLY ASKED QUESTIONS
Sensor Glucose Data
The Home screen shows the last 3 hours of sensor glucose values. Can I see values beyond
3 hours?
Yes. In addition to the 3-hour graph, you can also view 6-hour, 12-hour and 24-hour glucose
trend graphs.
To see this information, highlight the Home screen graph and
press select.
ƒƒ Press
to see the additional graphs
ƒƒ P
ress to scroll along the graphs and see SG values and
bolus information
What do the arrows on the sensor display mean?
These trend arrows indicate the rate that your glucose values have been moving up or down.
or
or
or
8
Glucose has been changing
(about 20-40 mg/dL over the last 20 minutes)
lucose has been changing quickly
G
(about 40-60 mg/dL over the last 20 minutes)
Glucose has been changing very quickly
(more than 60 mg/dL over the last 20 minutes)
e
Trend arrows showectmion
the speed and dsirbeen
my glucose ha
changing.
3
FREQUENTLY ASKED QUESTIONS
Sensor Alerts and Suspend
How does the Suspend on low feature work?
When Suspend on low occurs, all insulin delivery is stopped
immediately. Your pump will alarm and the screen will display
the message shown here:
Press
and
to clear the alarm.
Insulin will remain suspended after the alarm is cleared.
If the Suspend on low alarm is not cleared after 2 minutes:
ƒƒ the pump will begin to siren
ƒƒ an emergency message will appear on the pump screen
This will continue until the alarm is cleared.
If you clear the alarm within 2 hours:
ƒƒ insulin will stay suspended for a maximum
of 2 hours unless you manually resume
delivery
ƒƒ b
asal insulin will then resume and will not
suspend again for the duration of time
determined by your low snooze setting
ƒƒ a fter this time has passed, insulin
will then be suspended again if sensor
glucose is at or below low limit
!
If you do not clear the alarm:
ƒƒ insulin delivery will remain suspended
for 2 hours
ƒƒ basal insulin will then resume and not
suspend again for 4 hours regardless
of your sensor glucose value
ƒƒ if you clear the alarm during the 4 hours
period, the suspend feature is available
again once the duration of your low
snooze setting has passed
Warning: Suspend on low uses the sensor glucose value, not the blood glucose value, to
automatically suspend all insulin delivery. Be aware that insulin could be suspended while
your sensor glucose is at or below the low limit, but your blood glucose is above that limit.
This could result in hyperglycemia. Likewise, your pump may not suspend even when
your blood glucose is at or below the low limit. This could result in hypoglycemia. Always
confirm your blood glucose using your BG meter and treat as directed by your healthcare
professional.
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3
FREQUENTLY ASKED QUESTIONS
How is basal delivery resumed after Suspend on low occurs?
When a Suspend on low event occurs, basal insulin can be resumed either automatically or manually.
Automatic
Basal insulin will automatically resume if
insulin has been suspended for the maximum
of 2 hours. You will always receive a Basal
delivery resumed alert when this occurs.
Manual
There may be times when you choose to
resume basal insulin delivery yourself.
From the Home
screen, select
Suspend on low.
Then select
Resume Basal and
Yes to confirm.
Can I silence sensor alerts when I am, for example, in a meeting or class?
Yes. The Alert Silence feature allows you to temporarily silence sensor alerts for the period of time
that you set. 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. You would then go to
History and Alarm History to see what alert occurred. Alerts will automatically return to audio and/or
vibrate at the end of the duration that you set.
To temporarily silence sensor alerts, go to Sensor Settings and select
Alert Silence. Select the types of alerts you want to silence and the
Duration. Select Begin.
Alert on low is never silenced if Alert Silence is On. Insulin will be suspended if
Suspend on low is On and the low limit is reached.
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3
FREQUENTLY ASKED QUESTIONS
Sensor Position and Taping
Is there anything I can do if the sensor is not staying on my body for 6 days?
Yes. Consider these options when wearing the Enlite sensor to help keep the sensor from pulling
out of the skin:
Choose the right insertion site and orientation.
Avoid areas that might have too much bending
or constriction like the belt line and where there is
scarring or hardened tissue. Try a sensor position
where the sensor is lower than the transmitter.
You can also try one of these additional taping methods.
Above or below
belt line
Sensor lower
than transmitter
Enlite Overtape – Enhanced Taping Method
IV3000™
Tegaderm™ Film
Option 1
Option 2
Other tape products may be cut into strips and placed
over the transmitter*
Allows ventilation
around the back of
the transmitter.
Holds the back of the
transmitter secure
against the skin.
Extra pieces of Enlite overtape can be found in each
box of sensors. To order other tape products, call
1.800.646.4633 or visit my.medtronicdiabetes.com
*Always reference manufacturer IFU or user guide for appropriate application instructions.
How do I know if the sensor over tape has been applied correctly?
Correct Overtape is covering
both the rounded
part of the sensor
and the skin in front
of the sensor.
Not Correct
There is no overtape
covering the sensor.
The overtape is covering
the sensor connectors
and is not covering the
skin in front of the sensor.
11
FREQUENTLY ASKED QUESTIONS
CareLink® Personal Software
Why should I use CareLink Personal Software?
CareLink Personal software can help you better understand your glucose control. By looking at your reports,
you can see glucose patterns that are occurring, that is, highs and lows that may be happening at the
same times every day. You are then able to discuss this with your healthcare professional during your visit.
To learn more about the benefits of using CareLink Personal software, watch the short videos at
www.MedtronicDiabetes.com/CareLink-Info:
ƒƒ Why CareLink Personal Software is Helpful to Me
ƒƒ Looking at My Pump and Sensor Data
What reports are available when I download my pump?
Report
What does this report show me?
Therapy
Management
Dashboard
Provides a summary of your glucose, carbohydrate intake, and insulin
information. Helps to visually see glucose trends and high and low patterns
during the day, overnight, and at meal time using sensor glucose readings and
statistical information.
Episode
Summary
Provides a summary of glucose patterns and details including a description of
events preceding episodes of low and high glucose to help you see what may
have caused the event.
Adherence
Information about pump and sensor use such as BG measurements, sensor
wear, boluses, and other pump activities.
Sensor & Meter
Overview
A summary of sensor and meter glucose readings, carbohydrate intake and
insulin information. Provides an overview of glucose control during the day,
overnight, and at meal time using sensor glucose readings and statistical
information. Helps to identify the relationship between glucose, insulin, food,
and events for each day.
Logbook
Meter glucose readings, carbohydrate intake and insulin information in a report
that looks similar to a written log book.
Device Settings
Snapshot
Provides the current insulin pump and CGM settings.
Daily Detail
Each page presents detailed information from your pump, meter, and sensor
for one day. Provides insight into your glycemic control, including response to
carbohydrate intake and insulin use.
12
3
3
FREQUENTLY ASKED QUESTIONS
How do I use these reports to understand my glucose trends?
It can be helpful to focus on just one or two reports at first. Using the 1-2-3 approach and looking at specific
sections of the Therapy Management Dashboard and Sensor & Meter Overview reports can help
you and your healthcare professional better manage your diabetes. Before you look at your own reports,
go online to MedtronicDiabetes.com/TMD and to MedtronicDiabetes.com/sensor-meter3. The
example reports you find there will guide you as you answer the questions below.
Step 1: Look at the overnight period
Do you see a pattern of lows? Consider talking to your healthcare professional (HCP) about reducing your
overnight basal insulin/rates.
Was too much insulin given for your bedtime snack?
Did you exercise later in the day or in the evening hours?
Do you see a pattern of highs? C
onsider talking to your HCP about increasing your overnight basal insulin
rates.
Was there a bedtime snack that you did not bolus for?
Was your BG level already high before bed?
Step 2: Look at the period before meals
Do you see a pattern of lows?
Consider talking to your HCP about decreasing your basal insulin.
Do you see a pattern of highs? Consider talking to your HCP about increasing your basal insulin.
Step 3: Look at the period after meals
Do you see a pattern of lows?
Were you accurately carb counting?
Was insulin given at the right time?
Does your carb ratio need adjusting?
Consider using a Dual Wave® bolus if the meal was high in carbs and fat.
Do you see a pattern of highs?
Were you accurately carb counting?
Was insulin given at the appropriate time?
Does your carb ratio need adjusting?
Consider using a Dual Wave® bolus if the meal was high in carbs and fat.
Insulin sensitivity, carb ratios and active insulin may need adjusting. Exercise and physical
activity, stress or illness could also be affecting your glucose levels. Discuss these topics with
your healthcare professional.
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3
FREQUENTLY ASKED QUESTIONS
Charging the Guardian Link 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.
!
What do I need to know about charging my 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.
The lights on my charger are blinking. What does this mean?
ƒƒ I f you connect transmitter to charger and you see no lights on the charger: replace the battery in
the charger.
ƒƒ W
hile charging your transmitter you see a flashing red light on the charger: replace the battery in
the charger.
ƒƒ W
hile charging your transmitter you see a repeating pattern of quick red flashes followed
by a long single red flash: replace the battery in the charger and fully charge the transmitter.
14
3
FREQUENTLY ASKED QUESTIONS
Guardian Link Transmitter Care
How do I store my Guardian Link Transmitter?
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.
How do I clean the Guardian Link Transmitter?
1. Wash your hands thoroughly.
2. Attach the tester to the transmitter.
3. Dampen a clean cloth with mild liquid soap and warm water. Wipe the outside of the transmitter.
4. Rinse the transmitter under warm tap water.
5. U
sing an antibacterial hand sanitizer (available at a local drugstore) on a clean, dry cloth,
wipe the transmitter’s surface. Do NOT get any hand sanitizer inside the tester opening or
transmitter connector. Repeated exposure to hand sanitizer could damage the connectors
and affect the transmitter’s performance as a result. If you get hand-sanitizer inside the tester
or connector, allow them to air dry.
6. Disconnect the tester from the transmitter.
7. Place the transmitter on a clean, dry cloth and air dry for 2–3 minutes.
The charger and tester are only watertight when they are connected to each other. Do NOT immerse
in water or any other cleaning agent if not connected. If liquid gets inside the black connector of the
tester, shake the liquid out and allow to air dry.
X-ray, MRI or CT-Scan
I am having an X-ray, MRI or CPT scan. What do I need to know?
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.
X
15
FREQUENTLY ASKED QUESTIONS
Traveling by Air
I will be traveling by airplane. Is there anything I should know?
Going through Airport Security
Your pump should not go through the x-ray machine that is used for carry-on or checked luggage or
the fully body scanner. Request an alternative screening process that does not use x-ray. Your CGM
system can withstand exposure to metal detectors and wands used a security checkpoints.
Traveling by Air
Your transmitter, sensor and insulin pump are safe for use on U.S. Commercial airlines and can be worn
during flight. If airport security requests that you turn off your CGM device, you must comply. Check
with the Transportation Safety Administration (TSA) for updates. International travelers should consult
with their individual air carriers and international regulations.
Using Airplane Mode
If you need to temporarily stop wireless communication during a flight, you can use the Airplane Mode
feature. To turn Airplane Mode On, Select Utilities and then Airplane Mode. Select again to turn On
and select Save.
While Airplane Mode is On, the transmitter continues to collect glucose levels measured by the sensor.
Once the flight has ended, you can again select Utilities and Airplane Mode. Select again to turn Off
and select Save.
Once airplane mode has been turned off and communication resumes, the transmitter will send up
to 10 hours worth of sensor data to your pump.
If in airplane mode less than 6 hours, wait 15 minutes for sensor data to appear on pump screen.
If greater than 6 hours, disconnect transmitter, reconnect it, and select Reconnect Sensor when it
appears on the Home screen to begin warm up.
16
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3
HELP AND SUPPLY ORDERING
Section 3: Help and Supply Ordering
The information on this page is important as you continue using CGM.
Who can I contact for assistance?
Starting continuous glucose monitoring is exciting, but it can also sometimes feel like a lot to learn.
If you need answers, there are a few places you can go:
ƒƒ Quick Reference Guides on a variety of topics can be found in Book 2, During Training
ƒƒ To find additional information on many topics go to www.medtronicdiabetes.com/support
ƒƒ F
or classes to review information and help you learn more, go to
my.medtronicdiabetes.com/mylearning
ƒƒ The 24-Hour HelpLine is there for you 24 hours a day, 365 days a year to help with any technical
questions: 1.800.646.4633
How do I order supplies?
There are several ways to order your CGM supplies. Choose the way that works best for you.
ƒƒ mySupplyConnection™ Automatic Reorder Program: Call 1.800.646.4633, Option 2 to have
your supplies automatically sent to you on a regular basis.
ƒƒ Online Store: Create an account at my.medtronicdiabetes.com and order online. If you have
already gone onto myLearning, you will use that username and password.
ƒƒ myMedtronic Connect: This app lets you order supplies right form your phone. Go to iTunes tor
Google Play Store to download.
ƒƒ Automated Phone System: Place an order 24 hours a day, 7 days a week by calling
1.800.646.4633, Option 2.
ƒƒ Live Representative: Call the Supply Order Team at 1.800.646.4633, Option 2, Monday through
Friday from 8:00 am to 6:00 pm CST.
If we haven’t heard from you, watch for an email, text, or call from the supply team to be sure
your supplies are ordered. Please always keep your email and cell number updated with us.
17
NOTES
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NOTES
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NOTES
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Toll-free: 1.800.328.2518
(24-hour technical support for
physicians and medical professionals)
www.medtronicdiabetes.com
Guardian, CareLink, MiniMed are registered trademarks and mySupplyConnection is a trademark of
Medtronic MiniMed, Inc.
M968828A001_A
950M14678-011 20160311 © 2016 Medtronic MiniMed, Inc. All Rights Reserved.
18000 Devonshire Street
Northridge, CA 91325
USA
1.800.646.4633
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