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CGM on its way!

Discussion in 'Continuous Glucose Sensing' started by TheLegoRef, Jun 20, 2012.

  1. TheLegoRef

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    I just got an email from UPS, stating that Medtronic is sending a package. I know it's the cgm, and I know it will get here tomorrow, but...

    Do you know what should be in the package when it gets here? (I'd like to know what to expect, and to know if I am missing something, or need to get something else.)

    What will I have to ask the doctor to fill out a script for?

    What do you use to "hold it down"? We don't even use IV prep for his sites. When we had the blind test done, the lady used a rather large square. I've also seen a youtube clip with someone using two of the smaller ones. What do you use? (I'd like to know what to ask our endo to fill out a script for.)

    How do you get the tape off? It was really stuck to him after the blind test. There was a lot of it, and he finally just had to take it off in the shower, and even then he said he had trouble. Was it just too much sticky on it?

    Do you use the sensor all the time? Or do you do it sometimes? I'm not sure if my ds would want to wear it if we're at a public beach. Do you take a few days off sometimes?

    Where do you use have your sites? The blind test site was on his tummy. But he uses his pump sites rotating between his legs and his tummy.

    Any advice for my son or I? We have no prior experience to CGM's other than the one blind test.

    I've read the answers to a lot of these questions already on the forums, in the past few weeks. But maybe you might have some new or updated advice?

    Thank you!!
     
  2. momof2marchboys

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    Are you getting the Guardian?
    We just got one the beginning of May - and the box from Medtronics had 4 boxes in it - 3 boxes were sensors and 1 box was the Guardian. It had 2 clips for the what I call the beeper our son keeps in his pocket, the shell looking transmitter thing, a sample package of IV3000 adhesive, a charger, carelink cables, a big direction book and a blue thing to use for putting the sensors in with.
    Our trainer called me prior to getting the box and told me just to open the box and start reading the manual and get familiar with the CGM and to not do anything else until training.

    We tried the IV3000 samples they sent us and I have requested more but have also ordered off amazon.com a roll of Opsite Flexifit to try and see if that will hold better for us as my son is pulling the sensors out at night when he goes to bed. Medtronics also has sent us a sample package of various different adhesives to try to see what we like too - I requested this when I went to order more IV3000 b/c i have an allergy to certain adhesives and didn't know if my son would react the same way or not.

    Good Luck with your CGM - I have loved ours when he has left it in for more than a day as it caught some lows before we would have noticed them and some highs during the nights
     
  3. PixieStix

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    1. The pkg will have the Mini Link box that contains the transmitter, charger, test plug, extra battery and 10 pieces of IV 3000. You should also get 1-3 boxes of sensors (10/box), a Carelink device, maybe additional IV 3000, AAA batteries and alcohol pads depending on how your insurance covers.

    2. The scripts for CGM supplies are already in place with the initial order--you will just need to know who your insurance allows you to get your supplies from on an ongoing basis. Some allow direct procurement from Medtronic, some insurances only let you get sensors, etc from secondary supplier like Liberty, Edgepark, CCS, etc.

    3. IV 3000 is the medical tape sent, but there are lots of other choices ie Tegaderm, Opsite, Hypafix. Some even use regular first aid tape in an "X" across the sensor/transmitter. Start out w/ the IV 3000 and see how well it sticks. They don't usually send tapes beyond the 10 pieces w/ the initial shipment, so will need to procure more pretty fast after starting. Best tapes are the ones that will stick to your particular skin w/o irritation, and ones that your insurance will cover. We use Tegaderm HP here--two pieces/sensor. You want a tape that sticks, but to get off might either need adhesive remover (call helpline to ask if they can send some) or just use baby oil on the tape for a few minutes before removing.

    4. My DS wears CGM 24/7, has never gone w/o it since starting in 2006. Wouldn't give it up for anything, would stop using pump long before considering going w/o CGM. Most often put sensors in the arms, but also use belly, butt, hips when skin on arms need a break. DS really doesn't care what shows at the pool, Sometimes I try to convince he to put in a spot under swimsuit, etc--then realize it is me who has the issue about it, not him. Go with what works for your son.

    5. Advice--stick with it during the frustrations you might have at the start. Takes a bit to figure out when/when not to calibrate, which is key to having accurate CGM. Don't react to every number, look for the trends to adjust basal/bolus settings. Use Carelink reports to identify trends.

    Hope this helps!
     
  4. MomofSweetOne

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    We use it 24/7. It relieves lots of stress and helps with sleep quality. You won't necessarily get MORE sleep but better.

    We prep with alcohol wipes and tape with Hypafix. We've been getting about 7 days out of a sensor.

    If you have problems with losing signal, it's your transmitter. Call Help-line every time to document, ask your rep for more training, but don't give up. Once you get a new transmitter that works properly, the thing is so helpful. Unfortunately, it sounds like lots of us have had transmitter problems at some point.

    Sites go into her butt. Not enough fat other places.

    We found that clipping her pump to the back of her pjs prevents weak signal alarms during the night because of her body being between the receiver and transmitter. Also, pressure on the sensor/transmitter will give false low alarms. I bought her a great big body pillow to cuddle, and it solved most of those issues.
     
  5. TheLegoRef

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    Thanks for the replies!

    He keeps his pump in a pump wrap on his thigh, so that hopefully that keeps things steady. He can rotate it around so that the pump is on whatever side of his body the sensor is on. I'll tell him to make sure it's on the same side. Thanks for the heads up.

    It's not the Guardian, because we already have the Revel. So I guess his pump will just start receiving the info after we set it up. (If I do it correctly!)

    If you're getting more than the suggested time from the sensor, when do you decide to change it? Do you just see a difference in the numbers, similar to when you know a pump site's going bad, and the numbers aren't right? Pump sites you're not supposed to leave in for too long, or (from what I've heard), it's more likely to leave worse scar tissue. Is that different with the sensors? I never see anyone saying "I got 10 days from my pump site!" but I've seen several posts about getting a long time from a sensor.

    Thanks again for the answers. I have no idea what D people do without CWD. :confused:
     
  6. MomofSweetOne

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    We start seeing lots of false lows and an inconsistent BG/ISIG ratio when it's dying. Sometimes the readings start to resemble rabbit hops. We got 9 days from our last one.:eek:

    Sensor sites aren't supposed to create scar tissue like pump sites since nothing is being infused. We haven't had any infection issues with them, either. They do leave a bigger hole than sensor sites that take longer to fade.

    The sensor site and the infusion site need to be 3" apart minimum.

    Inserting the sensor with the muscle (straight down, not angled or side ways) can help prevent the sensor from "wicking in and out of the interstatial fluid" (an excuse often given for all lost sensor issues by Helpline).

    We're careful with the calibrations (no arrows, no eating starting within 15 minutes), but we have found if we calibrate under 100, the accuracy is less accurate than if her BG is a bit higher. We've even had good accuracy calibrating in the 200s. Sometimes ideal numbers aren't happening, and you especially want CGM monitoring as you try to break through the highs with assertive temp basals.

    Good luck - don't give up with problems. The system is great when it's working properly. Like another poster said, I'd hate to give it up.
     
  7. emm142

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    I'd look into getting some tape other than the IV3000 which is provided. In my experience (and that of a lot of people on here) IV3000 is utterly useless. It just drops off as soon as it is exposed to water or sweat. :rolleyes: I'm a huge proponent of Hypafix (a white, material tape like the sort on a pump site) but others love Flexifix, which is a clear plasticky kind of tape.

    As for keeping the sensor in, I do it for 7 days. The transmitter I have (I'm not sure if this has now changed) needs to be removed and placed on the charger after 7 days. This means peeling off the tape to disconnect the transmitter, and doing another 2 hour start afterwards. Peeling off the tape seems to disturb the sensor placement, and when I've tried reconnecting to the same sensor after that point I haven't had good results. So I just change sensor at 7 days.

    I do have a lot of little scars from the sensors, as the needle is quite big, but because there is not a substance infusing in and out I've heard that sensor scars are less problematic for lipohypertrophy etc. I place sensors on my upper arms (outside or back) or thighs (outside or front). I save my abdomen for pump sites, and also sensors don't seem to work as well there for me.

    Otherwise, you should be set to go. I hope you love it!
     
  8. TheLegoRef

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    The UPS man just dropped off our box. :) Looks like we have everything we need to get started. We got 3 boxes of sensors, plus the original "kit", and one package of the IV3000. We do have one piece of Tegaderm - I think the lady that put the blind site on him gave us it as a back up to the one she put on him. But the one she put on was a big rectangle - the Tegaderm is an oval. I guess we'll give that a try, and if it works out, I'll see if we can get that.

    I can't wait for him to get home from camp! :) I'll try to remember to post an update after he gets home, and after we try it out. I'll definitely let him know about the site options. :)

    Thanks!
     
  9. hawkeyegirl

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    One tip, be sure to put a piece of tape UNDER the transmitter too. Otherwise it causes some nasty skin irritation in many people.
     
  10. TheLegoRef

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    We thought of another question. (We haven't started yet.) There's a paper in the box that says something about the wireless communication between the meter and the pump. Yes, we know that feature, that's how when he tests, his BG *magically* ;) shows up in his pump. The paper says when using the glucose sensor, turn OFF the wireless feature, to manually type in the BG. Do you all do that? (If you have a Medtronic Paradigm Revel and a OneTouch UltraLink meter.) I thought that's how it calibrates. Also, if we don't have that on, his BG's from his meter won't show up in the CareLink data that gets downloaded from his pump. Why do we have to turn that off, and is there anyone that doesn't? When we did the blind testing, we weren't told to turn that off. That's how we calibrated it.
     
  11. PixieStix

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    As long as you have the 523/723 pump model you can have the link turned on, but you will only calibrate with the linked BG number 3-4 times/day, when the BG is stable. If you have a 522/722 model, you have to turn the link off or it will calibrate the sensor every time a BG is checked and your sensor will be extremely inaccurate. If you aren't sure what model you have, look on the label on the back of your pump.
     
  12. TheLegoRef

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    I looked at the back of his pump, and it says 723. So we can leave the link on.
    I think we'll try to do it tomorrow morning before breakfast, since it says you have to calibrate it the first time at 2 hrs, 6 hrs, and 12 hrs. So before breakfast sounds like a good time to do it the first time?
     
  13. MomofSweetOne

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    I can't help with your question as we use the Aviva meter., but I wanted to mention that Medtronic sends out a sample package of the various tapes they carry for free. It doesn't have Hypafix, but it does have IV 3000, Tegaderm, etc.
     
  14. hawkeyegirl

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    Yes, before breakfast is a good time to calibrate. :)
     
  15. TheLegoRef

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    We had a great first day with the cgm. :) DS and I got it all figured out, and is in a good site I guess, because all of the times he tested with his meter today, he was within 10 points of the sensor. We're loving it already. :)

    A few more questions! (Of course...)

    1) Is it "bad" to calibrate too often? Every time he tests with his meter, his pump asks him if he wants to calibrate the sensor. He said yes each time. (It was only at mid morning, lunch, afternoon snack, dinner, bedtime.) I know the manual says at least once every 12 hours, and 3-4 times is good. But is more than that bad? Like if he tests and calibrates 8-9 times? I wouldn't think it would be, and I feel silly asking, but I figure I'd ask anyway.

    2) I couldn't find what margin of error / points difference, between the meter and the sensor is acceptable range. If his meter says 150, what range should the sensor say?

    3) I think I know the answer to this, but maybe there's something I'm not thinking of, that someone else has. :) DS has the Medtronic Revel 723. We don't have the MySentry. When I would normally test him during the night, if I'm trusting my sensor, I have to wake him up to have him show me his pump, don't I? I mean, if his pump is wrapped in his pocket wrapped in his sheets, I can't unravel him probably. If I can see his pump, I can just check it myself. But without the MySentry... Rambling. Does anyone do anything differently so they can see their kid's pump without waking the kid?
     
  16. hawkeyegirl

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    1. Yes, it can be bad to calibrate too often. You want to do your best to only calibrate at times when BG is steady and when food will not be consumed for at least 10 minutes. We also try to only calibrate between 80-200. We usually only cal 3 times a day (wakeup, mid-afternoon, bedtime).

    2. Mmmmmm. Hard to say. For me, I like the sensor to be close enough that it wouldn't affect the action I would take if I knew the actual BG reading. What I mean by that is that I'm fine with the sensor reading 100 and BG being 87, because it wouldn't change what I do. I'm also fine with it being off more at higher numbers than lower numbers. So if it's reading 220 and he's really 270, I don't care much, because I'm going to check and correct either way. But if it says he's 90 and he's really 50, that is not acceptable.

    3. We solved this problem by ordering the Guardian unit. It's a little stand-alone receiver that can sit on his nightstand (not fancy like MySentry - it's the receiver that you order if you're on MDI or another pump.). We mute the alarms on his pump at night so we only have to deal with the Guardian. When your transmitter goes out of warranty and you order a new one, tell them you want the Guardian too. If your insurance covers CGM, it will cover the Guardian too.
     
  17. TheLegoRef

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    Things are going well. :) After 3 days, the sensor said it was time to be changed, but after reading a lot about people getting more time out of their sensors here, we kept it. We just chose "new sensor" in his pump. Is that the option that you chose? What do you tell your endo? Sorry, we're doing this our way, and we think 6 days is fine?

    Also, we seem to be having trouble at bedtime with calibrating. My son often seems to have a down arrow at bedtime snack. Dinner is at 6ish, snack is at 9ish. He's not going low, but he is going down. The manual said don't calibrate if there are arrows. So far, we've just sent him to bed, and we wake him up and test and calibrate right before we (Mom and Dad) go to bed. Is that what you do?
     
  18. hawkeyegirl

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    Yes, you restarted the sensor exactly the right way. Our endo has never said anything about it. Endos know that everyone restarts the MM sensor.

    We also usually calibrate at our bedtime. We don't do a bedtime snack, but often times, supper is too close to his bedtime for us to get a good calibration in. So our last calibration of the day is often between 11pm and midnight, when I go to bed. :)
     
  19. TheLegoRef

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    Awesome. :) Thanks. :)
     
  20. TheLegoRef

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    Okay, so we're 6 days in. We switched out our sensor when it asked us for a new sensor today. We obviously are doing it correctly, but I'm not sure if we're doing it the best way. We're unsure about when to put the new sensor in, since you need to calibrate 2 hours later, then within 6, then within 12. Also going back to before that, if we're in the store, and it asks for a new sensor, can we tell it "hold on, keep going for a few more hours until we get home"? Today, we just ended it, I'm not sure of the exact wording in the option that he picked, then when we got home, we put in a new sensor. But that was right before lunch. So he put in the transmitter after lunch (to wait the 15 mins between sensor and transmitter), but then 2 hours after that is lunch peak. Hm. So should we have waited until 2 hours before dinner, so that it could calibrate before dinner? Sorry, that was a long paragraph!!
     

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