Paradigm RT CGMS - Tips & Tricks, FAQ's and Tips for using the Paradigm Real Time System Rating Options

[Tiffany]

June 2, 2009 was my three year anniversary with the Paradigm RT TGMS system. (TGMS = telemetered glucose monitoring system, as Medtronic calls it) When I first started using the Gen 1 transmitter with my 522, there was nobody else using it...nobody that I could seek help from or even just bounce ideas off of. I was all by myself and had to learn almost everything by trial and error - I didn't even have any previous training and inserted my very first sensor on my own. It was, in large part, the reason I started this forum (that, and LindaZ and a few others who also had nobody to talk to). I compiled a list of tips and tricks that I've learned over the years and finally remembered to post it (thanks to Liz, who inadvertently reminded me in another thread!).

I encourage everyone to add any tips/tricks that they might have here in this thread, but please don't use this thread for a general discussion

So, without further ado:

Insertion

• When inserting, try a deeper insertion angle. I find I only have to go slightly deeper (about 50 degree angle) but sometimes an even deeper angle can be beneficial. It can also help to place two fingers on either side of the sen-serter's 'feet' and pull the skin taught slightly. When I insert on my upper abdomen, I sometimes have to go at a shallower degree, about 35.
• The sensor can be inserted pretty much anywhere you'd put an insertion set. Arms, legs, abdomen, hips - just remember to adjust the insertion angle as necessary.
• If the sensor isn't in all the way after using the sen-serter, you can finish pushing it in manually. I find that pinching the skin or alternately pulling it taught helps.
• To help prevent excessive bleeding, leave the introducer needle in for a few minutes after insertion. If the site bleeds after you've pulled the needle out, put a tissue over the sensor (where the needle was) and apply light pressure.
• You can hook a transmitter up to a bleeding site, after doing the above. In fact, many of us have noticed that a site that continually or occasionally bleeds throughout the sensor life is a Very Good Thing.

After insertion, a lot of people wait to initialize the sensor in order to allow for "wetting". For people who find that the first several hours of their sensor life is not as accurate as it might be, this can be an extremely helpful practice (I do not do this). It is common practice to insert the sensor and night and initialize it the following morning.

Taping

• From day one I've known that taping the sensor/transmitter down extremely well is one of the most important factors for success. The more stable your sensor, the more stable your readings.
• Opsite Flexifix. I can't recommend it enough.
• Some people place a strip of paper tape over the sensor prior to placing an adhesive coverage (like Opsite) over the whole works - the theory being that paper tape will absorb any excess moisture that may collect under the adhesive. (I've personally never tried this)

Calibrating
If you're new to this system, it's not a bad idea to calibrate only when your BG's are absolutely stable. No arrows on the graph screen, and never during a hypo/hyper episode. Minimed now recommends that users do no more than 3 calibrations / day - I believe that it's not the quantity, it's the quality. I average about five calibrations per day successfully. You have to find what works for you.

• Base post-meal calibrations on your active insulin time. If that time is four hours, don't do a postprandial calibration two hours after a meal; instead, wait four.
• For preprandial (before meal) calibrations, wait at least fifteen minutes to eat after calibrating so that the system has time to accept your calibration without any subsequent fluctuations.
• I calibrate successfully during fluctuations; however, only if there is one arrow on my graph screen (showing a slower rate of change) and only if my BG isn't a high high or a low low (i.e. over 12 and under 3.0).

Restarting a Sensor
By far, the most common question I see regarding the RT system is how long the sensors can be used for. The longest I've gone is three weeks; we had another member, Drea, who wore one for a month. YMMV applies, of course. To coax your sensor past three days:

• At the first "Sensor End" message, 72 hours after you plugged the Minilink into the Sensor, restart the sensor by going into the Sensor menu on your pump and if you have a 522 or 722 selecting "Sensor Start" and then "New Sensor". If you have a Revel or Veo, go to the Sensor menu, then select "Link to Sensor" then select "New Sensor". The pump will ask you for a BG calibration about five to fifteen minutes after this, preventing the two hour initialization time.
• On day six, the Minilink must be disconnected from the sensor and recharged in order to reset the timer. Leave the old sensor in, let the Minilink charge up (about twenty minutes) and reconnect it to the old sensor. Tape it up again (remember, tape tape tape!) and use the "Sensor Start" --> "New Sensor" or "Link to Sensor" --> "New Sensor" (depending on your pump model) options to reinitialize the sensor. This will result in the two hour initialization time.
• After another 72 hours, start back at step one by simply telling the pump that you've inserted a new sensor. Rinse, lather and repeat!

ISIG
There are many informative discussions here on Insulin Pump Forums about the ISIG value and it's importance to the success of a sensor. Rather than repeating all of that, I'll simply say that the most important things I look for in my ISIG value are:

• I know my sensor is doing well if my ISIG value is at least 1.5 times the value of my BG. NOTE: my BG is registered in mmol/L
• If my ISIG value drops below my manual BG value in the first three (or so) days of a new sensor, it isn't a big deal; I just don't calibrate until the ISIG rises to at least equal my BG. If the ISIG is below after day three, it is a good indication that the sensor needs to be pulled.
• ISIG values over 200 (on the pump or with the test transmitter) are a pretty good indication that the transmitter is dying.

I never just pull a sensor without trying at least a few restarts - sometimes it's a guaranteed fix-all.

And that's all I can think of right now. (IMG:style_emoticons/default/smile.gif)

Please do not use this thread to post general questions. It is meant to be a concise guide of Tips and Techniques.

[GA Hiker]

[*]On day six, the Minilink must be disconnected from the sensor and recharged in order to reset the timer. Leave the old sensor in, let the Minilink charge up (about twenty minutes) and reconnect it to the old sensor. Tape it up again (remember, tape tape tape!) and use the "Sensor Start" --> "New Sensor" options to reinitialize the sensor. This will result in the two hour initialization time.

Actually, on day six the sensor can be restarted just like at 72 hours. However, it will only last another day at most and then must be disconnected and recharged. So I restart on day six, then recharge and insert another sensor on day 7. I tried a couple of times to go longer than a week but could never get to 2 weeks and I didn't like the way the site looked.

Barbara

[Tiffany]

Thanks for pointing that out Barbara. I should've clarified; there is an important point on day 7 at which the pump starts blaring out "Weak Sensor" errors. If the sensor hasn't been recharged prior to that, I can't get it to work again even if I disconnect it. So that's why I do it on Day 6 - it simplifies things so that I can completely avoid the Day 7 error.

[GA Hiker]

Thanks for pointing that out Barbara. I should've clarified; there is an important point on day 7 at which the pump starts blaring out "Weak Sensor" errors. If the sensor hasn't been recharged prior to that, I can't get it to work again even if I disconnect it. So that's why I do it on Day 6 - it simplifies things so that I can completely avoid the Day 7 error.

Thank you, I didn't realize that. Maybe next time I will recharge on day 6 and will try to go nine days. That would be nice if the site doesn't get too bad.

[anderfo]

Thank you, I didn't realize that. Maybe next time I will recharge on day 6 and will try to go nine days. That would be nice if the site doesn't get too bad.

It should be no problem - I run my sensors for (in average) 11 days.
My personal best is 28 days, but it's usually somewhere between 8 and 14 days.

[Mary0126]

I am bigger around the middle and find it hard sometimes to keep the sensor in around the tummy area. Where else would you suggest wearing the CGM?

[Arlene S.]

I am bigger around the middle and find it hard sometimes to keep the sensor in around the tummy area. Where else would you suggest wearing the CGM?

Do you tape your sensor down?

You could try using your thighs.

[Linda B]

PLEASE DO NOT POST ANY QUESTIONS HERE.
THIS IS A SPECIAL POST CREATED TO GIVE ALL OF THE IMPORTANT INFORMATION ABOUT THE MM CGMS IN ONE PLACE.

Instead, find the appropriate topic in the forum topic list or create your own topic and post your question.

THANKS!

THE MODERATING TEAM