Conflicted

I am one of MANY people who choose to use the Medtronic pump system with the the Dexcom CGM system. Since my endo took me off of my t:slim, the biggest thing I have been irritated by is how I cannot get all of my information into one report. I was finally SO happy to have that ability with Diasend for the t:slim and the Dexcom, and now I don’t. I know Medtronic has their own CGM system and I do have the 530G that will work with the Enlite sensors, but I had a bad run of luck (about 3 months worth) with it when I used it last year and I am hesitant to go down that path again, especially right now.

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Plus, now that Dexcom has Share built into the receiver, it has been SUCH a valuable tool for me and my family. I even contemplated using my old, out of warranty Animas Ping system so I could have all of my data in one place, but after one day of all of the irritating quick-scrolling and constantly missing my intended mark, I got irritated and used my Medtronic pump again. Not to mention, logging everything into the Medtronic through the Capture option so I could keep complete records was just irritating in itself (not that anyone else should have to do that, but I was just for my own sanity’s sake).

It really baffles me how Medtronic, being the big business that it is, and knowing that not everyone can wear their sensor, wouldn’t work with Dexcom to have a Dexcom version of their pump. Of course, I don’t know if maybe the feeling is mutual between companies and they just don’t want to be friends or what, but it would seem that if a company wanted to reach a HUGE customer base for their combination product, it would offer options that would fit almost everyone’s needs.

Anyway, that’s where I am right now. I have had a good experience over the past month and a half with my Medtronic pump and it’s made handling diabetes with pregnancy since switching a lot easier. I just wish I could have my reports all in one place, instead of two. It helps me make better decisions about my care. Sort of like what having access to Medtronic Pro reports would probably do too, but that’s another beef I have with them ( I mean, seriously?? Why can’t we have access to the more comprehensive stuff if our endo’s trust our judgement? And why have TWO systems anyway – other companies don’t [I don’t think, anyway].)

Bottom line is I know Dexcom works very well for me. I know that I like the Medtronic pump. I just want my world to be perfect and have the option of having those two combined.

*clicking my ruby slippers*

3 Weeks

Three weeks ago, I began what I thought would be just a break from my Minimed pump / CGM combo. I was constantly getting frustrated with CGM sensors not lasting the full 6 days (usually only about 4 days) and knowing that my records were going to be all messed up. I have to hand it to Medtronic though, they stuck it out with me the entire time and without hassle replaced boxes of sensors and even my serter. But with all of the trying and trying and trying, I just couldn’t get them to work. So, I wanted to take a break. Being overwhelmed with that and just everything else, I just didn’t feel like I could troubleshoot anymore. Now, I’m not saying their product isn’t good, because I know a LOT of people who use it and have had a lot of success too, but I’ve learned one thing – there is a lot of truth in the fact that not every device “fits” everyone, and no, they don’t all work the same. Thus, my theory that everyone should get to “date” pump systems before locking in needs to be a must. And I don’t mean just over the weekend. I mean like, for a whole month or two.  I just think with all the scar tissue I have and the sensitivity to the tape the Enlite has, it’s just not worth trying to make it work right now. So yes, in essence, it’s me, not them.

When I got frustrated, I switched back to using my Dexcom. Granted, it’s a pain in the butt to keep up with, but for me? The accuracy over the duration of wear time is much better. It wasn’t until everything happened with my eye that I realized just how important it was. I’m not saying it is super accurate, but I’ve been able to depend on it more than the pump CGM, and right now that matters a heck of a lot more than whether it’s integrated or not. Plus, I have no tape rashes or burns from the Dexcom, so that’s a huge plus for me.

IMG_5503Also, at the time, I had a fling. No, not that kind of fling… a pump fling. Knowing how I am about wanting to switch up pumps between the Medtronic and my t:slim, I had actually planned on going through maybe two cartridges in my t:slim pump at the end of March. I don’t know if the battery works the same as most computer batteries, but with those, if you don’t use them, the batteries mess up, so every now and then I wanted to be able to use it so that just the lack of use didn’t mess up the battery. So, when the eye thing happened, I was on the t:slim. I was not having any issue at all with the pump like I had before, so I am not attributing what happened to that, but I am telling you that because when I spoke with my endo, he told me to “keep everything to the same” until I went for my appointment… which will be next week. So, for 3 weeks now, I’ve been using my t:slim pump. Much longer than I expected, but I have to say, I haven’t had the issues with random, uncontrollable highs that I did before. In fact, it’s been quite the opposite. My control has improved. I still wonder if the cartridges I had were affected by the recall, but that the lot numbers were too “young” to be considered in it (my lot numbers were in the 300’s, the recalls started in the 800’s). I’m not going to lie, I’m sort of hopeful that maybe that was the case and now the pump will work just fine.

And, as an update to the whole eye thing, I have good days and bad ones. For the most part, if I can keep my blood sugar as steady as possible and without any major swings (like, no arrows on the dex, and no BG’s above 180-200 for a period of time), my vision is pretty well clear. But if I have a period of time were my BG has run high for a while or if I have major swings (like when I went from 220’s to 70’s within an hour and a half), my eye is pretty well good for nothing for a while. It’s amazing me how things work and affect us all. If anything, this has taught me, as I said before, it’s not about what you use to control your diabetes, as long as you’re using it the best you can and doing the best you can.

Anyway, that’s sort of a rundown of what’s been going on. I know it’s probably confusing when I just throw stuff out there at random without any true point or purpose other than to just get stuff out of my head, but that’s sorta what I started blogging for anyway.

Learning.

It’s been two months since I started on the #Medtronic 530G pump and #Enlite CGM. I have to say, it was something I fully expected to just be able to just jump into and use with no issue at all. Go ahead.. laugh… I understand.  While the pump’s operations are relatively the same (as far as bolus, basal, etc), the CGM is actually a very different thing than I remember the CGM being like with the old SofSensors.

Coming from the Dexcom and reading how the literature in the manual for the 530G’s Enlite was supposed to work, I thought it would be a simple transition, but there are some things that still hold true I’ve learned with the Enlite system. You do still need to have a schedule that you can stick to throughout the day to calibrate 4 times. For me, I find the best results come when I calibrate first thing in the morning, about an hour after that (so, when I wake up and then before I drive for work), at lunch, and then supper or bedtime. That, and making sure I don’t see ANY arrows ( I know the book allows for one, but I still don’t calibrate then) when I calibrate have helped tremendously.

One thing that Medtronic won’t… well… can’t (due to FDA) tell you is to explore other site locations. For me, my Dexcom was always a happy camper in my thigh. I never had issue there and it was out of the way. While my thigh would still be a good place for the Enlite, I have a very active (almost) 3 year old (GAH!) that I play with and he will inevitably knock the sensor in a way that would jar it and I would lose that sensor. For me, I’ve learned that my arms are my sweet spot for those. The problem is that it’s not always easy to insert there, and my hubby has to help me with it sometimes. Which, that’s okay because I’m finally getting full use out of the sensor and not having it zonk out after only a few days. For the past week and a half, I’ve had almost spot-on readings. Most of the sensor glucose values on my pump will be within 10mg/dL of my meter. And honestly, the amount even within 2 or 3 mg/dL have been uncanny. I’m hoping the trend continues and it’s not just because I’ve found a “sweet” spot for now.

Another hurdle I had to overcome was the taping issue. I’m allergic to the tape that they send so I had to find an alternative way to tape it. I know how to use Opsite pretty well and I don’t react to it, so I wanted to find a way to make it work. After trying various ways by myself and with the clinical nurse for Medtronic in my area, I think I have a solution… which is honestly nothing more than just buying the smaller 2″ width of Opsite (I had 4″ for my Dexcom sensors.. which was too wide) and cutting a piece the size of the Medtronic overtape, and cutting a hole in it similar to how the MedT overtape looks. By using that the same way you would use the supplied overtape and a thin long strip of the 4″ over the shell to hold it in place (since your arm isn’t flat, you sort of need something to keep the sides from catching on door ways, etc), It’s a pretty good system that has worked so far.

Most of all, I’ve learned to have patience with this system. If you take the time to learn it and don’t rush it, it can be used to your advantage. I’ve also learned that you can’t always follow everything exactly by the book. The instructions are meant to be there for the greater good of all of the customers as most are universal, but some things – like sensor placement and tape options – may have to be individualized…

and that’s okay.

🙂

Maybe It’s In The Design

I’ve been trying to wear the new Enlite sensors from Medtronic for a month now and have only had success with two of them. I’ve also been trying to find out what is going wrong with them when I wear them to throw them off so much. The only thing I can come up with is the same as everyone is telling me (trainers, helpline people, etc) – the head of the sensor is just moving too much or it’s getting jostled.

While I thoroughly tape my sensors down and I don’t see how they could have any room whatsoever to move, I guess there is a remote possibility. But what puzzles me is why they went with the design that they did. If the key to success with the sensors is to not have it move, then why not create a head to the sensor to be more secure by making a more stable plastic base for the head of it and a wider tape area?

This is my thought process: Take for instance the Dexcom sensors. If you’ve ever seen one, they are made in a plastic base that is attached to a larger tape that goes all the way around the sensor. Also, the sensor is inserted at about a 1/3 or 2/3 position of the sensor base (imagine two lines equally spaced on top of the sensor base… it would fall on one of those lines.. like, almost where the G is on the Dexcom transmitter shown in the picture), and so it is surrounded by lots of tape as well as a wide plastic base on top that prevents it from moving or being jostled. That sensor is so protected, it’s hard to say that anything could knock it and cause the filament to break or bend. (Not to mention, it’s inserted at an angle, so you don’t have to worry about pressure directly on it causing the sensor to go deeper and possibly hit muscle or something and bend from that.)

I think Medtronic (FINALLY) has a good *comfortable* sensor, but that it’s design and base design doesn’t help it be the best it could possibly be. There’s not much tape there on the bottom. And considering the transmitter connects on the side of it and not on top, one would think that the head of it would need more security anyway due to the possibility of the transmitter being knocked, causing pressure on the head of the sensor to move. So, maybe if they created a more solid base for the sensor head. If it were sitting on a flat, thin “sheet” of plastic with a bed and possibly a 1/4 – 1/2 inch rim of tape going all the way around it, it would help to anchor it a bit better and keep that fragile sensor from moving.

I don’t think we should have to worry about taping the darn thing so much just to keep the head of it steady. I think the design needs to be centered around the optimum stability of the sensor head.

But what do I know, I’m not a rocket scientist or anything. Just a (successful) Dexcom user for 4 years who is trying to make these Enlite sensors work and not fail.

Progress With The Enlite

On the 6th of this month, I wrote a post about how I was doing on the new Medtronic 530G system, and how things were going with the Enlite. I’m not going to lie, at the time of the writing, I was pretty upset that I had already used as many sensors as I had just trying to get one to last.

In that post though, I had one inserted at the time that had lasted successfully for 5 days by then. Well, I actually got a full 10 or 11 days out of it (shh!! don’t tell!) and was ever more excited to do so. The accuracy I had compared to my meter checks was almost spot on, and if not, it was within 10% or so. It wasn’t until the last day that I knew it was conking out on me and I had t pull it because the readings were terribly off and the ISIG value was very very low. Either way, I was able to get that one to last and get back the time I lost in the one sensor that got terribly kinked, so I’m happy with that. I hope to be able to get at least 10 days out of all of them if I can so I can extend them as much as possible. Granted, I knew going in that I probably wouldn’t be able to extend them as long as a Dexcom sensor, so I’m not terribly upset if I can’t. It’s probably healthier for my skin that way anyway.

It seems, though, that a lot of people have trouble with even the Enlite sensors, so I thought I’d offer a few things I’ve learned in hopes that it helps someone else.

1. Try to get your basal and bolus ratios worked out as fine-tuned as possible. If you’re someone who swings a lot (and I mean, like, a LOT), the sensors can’t be calibrated properly enough to give you good information. Granted, they’ve loosened up the calibration requirements (you can now calibrate at any time unless you have two arrows showing. I don’t recommend it, but you can if you have to)

2. Try other insertion spots. Yes, the Enlite is only FDA approved for your abdomen, but if you’re like me, you simply can’t wear them there. I have found my best spot is in my upper thigh area. It doesn’t get pressed on or knocked around at all, and the sensor stays pretty stable there.

3. Try inserting manually. I know, crazy, right? But it’s weird that the last sensor and this current sensor have been working so well, and yet I’ve manually inserted both of them. And really, it doesn’t feel any different than inserting a shot needle because of how thin the sensors are now. There are some videos on YouTube that show you how, so if you want to know how to do one, go watch those. I might do one later with the next insertion, I’m not sure yet.

4cartoon-clock-17420458. This has got to be the most important thing. Develop a routine for calibrating within your schedule. The calibrations you give is what it goes on to calculate your sensor glucose overtime in relation to the electrical current the ISIG signal is reading. So, for me, I found the most stable parts of my day, which happen to be as soon as I wake up, before breakfast (there’s usually a 1-2hr gap there), afternoon around 4-5pm, and then at bedtime. If I stick to this routine, I have better results. If it gets off during that time, I can still calibrate again in 20 minute intervals (usually takes about 3 to get it back in line at the most). Yes, this goes over the recommended 4 times max per day, but hey, if it works, go with it.

5. Never calibrate right when you test your BG and the pump asks you if you want to use it to calibrate your CGM. Always say “no” and then go look at your graph. See how you’re trending. That way you can make sure you’re not showing double arrows that could throw things off.

BG: 202 ISIG:27.28 (202 / 27.28 = 7.4) Technically I could calibrate, but I don't want to right now. SG is close enough to BG anyway.
BG: 202 ISIG:27.28 (202 / 27.28 = 7.4) Technically I could calibrate, but I don’t want to right now. SG is close enough to BG anyway.

6. Take some time to research what the ISIG is, beyond what the manual tells you. For me, it was learning how it relates to your trend over time. If your CGM is reading far off from what your fingerstick is telling you, you can do a simple math (yeah, I know, more math!) equation to see if it’s okay to calibrate or if your sensor is just being wonky at the time. (Of course, always wash your hands though if you get a wonky reading, since sugars and stuff from food can throw it off too.) If after washing your hands and retesting, the sensor is still off, take your BG and divide it by your ISIG value. If the value is between 1.5 and 20, then you should be okay to calibrate, though having a result that is closer to the middle of that range – between 8 and 13 – is probably even better. That means that more than likely the value you calibrate it by won’t be seen as erroneous and won’t throw a Cal Error at you. If it’s out of this range, try a few things like drinking some water, moving around or massaging the area (not directly ON the sensor, just around it – the fluid may not be moving around the sensor enough) for a minute or two and see if the ISIG changes in about 10 minutes. Also, if your ISIG is getting low, like around 4-7, it may be time to change the sensor out as no amount of calibrating will probably work.

7. Tape that sucker down. I know they’ve vastly improved the sensor taping this time around, and yes, you could go without using an over-tape, but I still use one piece over it just for security sake. It helps the sensor not to move or get jostled by accident.

8. I insert my sensor at night after the transmitter has charged (which I let it charge about 2 hours – no matter if the little light has stopped flashing), connect the two, tape everything down, and leave it alone until morning. When I wake up the next day, I tell my pump I have a new sensor in, and it usually asks for a calibration within a few minutes instead of two hours. This way, the sensor has soaked over-night and has settled in and has allowed any site trauma or irritation from a newly-made hole to calm down before giving it information. Also, this lets your first calibration come when you’re usually most stable, so you know you’re giving it a pretty good starting reference point.

9. Lastly, if I do choose to restart my sensor (if the ISIG is still “strong”… like, in the 20’s or higher), I carefully take off the tape while holding the sensor “head” still and then disconnect and recharge the sensor. After recharging, reconnect it and retape it. I do this at night so that I can calibrate in the morning just as if it were a new sensor. Then, just start the “new” sensor, calibrate and go. If you choose to restart the sensor, keep a closer eye on the ISIG as usually after a restart is when the sensor will start losing life. Some have made it a whole other 6 days with it, some only get a few more days (like myself). But if readings start going really wonky, check the ISIG (just the one on the pump, not the math equation thing). As I said earlier, if it’s getting low, like, 7-ish or below, you’re probably losing the sensor, so toss it and insert a new one.

I hope these help and not have your mind blown. I will say though, I’ve been very satisfied with their new system. In fact, I’ve not missed my Dexcom at all, and that’s pretty huge for me to say (which I’ll go into that stuff in another post.. this one is already a novel.) If you have any questions, feel free to ask in a comment and let me know.

First Impressions of the 530G

While I’m not officially using the pump and CGM to it’s full ability, I wanted to shed some light on how things are going so far in the 530G pumping world.

As far as the pump functions go, I really don’t see much difference between the 530G system and the Revel. There are some minor changes throughout the system, but overall, if you’re used to the Revel system, then the pump side of the 530G will be no surprise to you. I’ve been using it since I got it as a pump system, and haven’t had any issues, save for a motor error, which after a long trouble-shooting call with Medtronic, deemed it unsafe to use and I had a replacement by the next morning (and a Saturday morning at that, too!). Transferring information over from the Revel to the 530G was super easy to do, and once I did, I packed up my Revel and sent it in for the credit on the upgrade cost.

IMG_6853The biggest upgrade with the pump is the CGM component along with the Threshold Suspend feature (which I will refer to as TS from here on out). The new sensors have a new device that hides the needle, and it inserts at 90 degrees instead of a 45 degree angle. The sensors are much thinner and honestly, feel no different than an infusion set going in. That was my biggest complaint with the SofSensors was that they hurt like the Dickens (what does that mean, anyway?) and out of the three day wear, I would only get one good day. The new sensors are touted to be much more accurate than the SofSensors anyway, but time will tell. I know there are studies out there that prove they aren’t as accurate as the Dexcom G4, and I have to agree – but only on the basis that getting one to actually last 6 days has been troublesome.

I have used 4 sensors so far, and three of them have failed. One was inserted into my abdomen because, you know, that’s the FDA approved place… but what wearing a 35 pound toddler on my hip/stomach sort of throws that out of the window because, honestly, you have to be sensitive with these sensors. When I pulled it out, it looked like an accordion. IMG_6854The next sensor looked great, but it died after 4 days. The third one died after one day. No amount of calibrating, not calibrating, protecting it, restarting it, nothing, kept that sensor alive. When I called in to see if I could have at least two of them replaced, they went through and troubleshooted (troubleshot?) a few things with me, and basically, the sensor is delicate, and needs to be worn where it won’t get knocked or pressed. And really? Who thought that would be a good idea? People are active and we don’t want to have to worry about babying a sensor device. I could be all sorts of rough and tumble with my Dexcom and didn’t have much issue at all. Finding such an area on my body that won’t be knocked by my son or pressed on when I sleep or sit is hard. But, with this last one, I may have found a good one because I don’t sleep on it and I can be more conscious about my son hitting/sitting on it. It’s on my upper thigh, right were my pocket is. I also learned (from YouTube) how to manually insert a sensor (hence the ability to take the picture of the contraption, less the pedestal in the above paragraph), so I’m not sure if that had anything to do with it or not, but so far, this one has lasted just over 5 days, and with incredible accuracy. My only wish is that they had kept the idea of a slanted angle insertion verses the straight in. I think it causes the sensor to be more vulnerable to kinking and accordion-ing, which makes me nervous.

As far a the new CGM insertion device goes, it was relatively simple to use, but you had to pay close attention to how you used it. My advice here is to just play with it a bit and watch it from the underside so you know what happens when and how you press the green button on the side. A VERY good video on how to use the inserter and insert an Enlite sensor is on YouTube as well. The nurse explains it very nicely and in an easy to understand manner.

I’m honestly not ready to use the TS feature yet. I did try it out and it did seem to work okay, but I quickly turned the feature off. As I haven’t been trained on it (nor the sensors, but inserting and using a sensor is a lot different in my mind than using a function on a device that could cut off my life liquid) and I have a lot of questions about it.

I am excited about this pump/CGM upgrade, even if I don’t use it for what they are calling it to be (Artificial pancreas? nope. But we won’t go there). It’s been nice not to have to carry around my Dexcom with me. Granted, the alarms on the Medtronic pump is irritating to say the least, but I’m glad they are because I won’t ignore them.

IMG_6855

 

I may come back later after I’ve used it and give a more in-depth view of it, and if things are going successfully, I’ll leave some tips that have helped me.