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.



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.

Giving Credit Where Credit Is Due

Earlier this month, I had sort of a breakdown.

bad tweets


bad tweets 2bad tweets 3


Maybe I need to backup a bit.

For two months, I had called numerous times to both Medtronic, my insurance company, as well as my endocrinologist’s office, about getting sensors and the transmitter kit from Medtronic to use with the 530G pump that I had put my name on the wait-list for. I knew that the Pathway2System had a 90-day wait on it, which would put me not receiving it until January. The only issue was that with a new year, I would have to meet a whole new higher deductible come January that I could not pay along with upgrade cost. I also knew that with December comes everyone else trying to meet their year-end cut off for met deductibles and Medtronic would be flooded with supply orders and the like. I wanted to avoid the hassle and start early.

Two whole months early.

I’ve never been one to wait until the last minute to order supplies, but I’ve never been two months early on trying to forgo a new insurance deductible either. But, either way, I was determined and thought I was being smart by starting so early. I knew that insurance should take about two weeks after waiting a week on getting my endo’s RX for the system itself. So, three weeks of wait, plus about a week of shipping would be one month… add in the year-end rush for the company, I thought I’d aimed it right and would be receiving the shipment by the end of the year.

On the morning of December 10th, I called for what seemed to be the 20th time to Medtronic to get an update. My representative was the only person who would talk to me, and it was hard to get hold of him, which was understandable with the new system coming out and the year-end stuff. Only I thought I had dialed a wrong extension when a lady answered. “No, I’m sorry. He’s no longer with us. I can try to help.”

Oh. My. Word.

My heart sank. Here it is, three weeks until the end of December, and I’ll have to deal with someone new and probably start all over. She was helped by her supervisor with the call (oh that poor girl! Being added into a new position right as all of this was going on!) but to make a long story short, what the prior rep had told me was wrong and because the Enlite sensors and CGM was sold as a system with the pump, I could not make the order until the pump was ready to ship, which would likely be in January or early February.

Two months of work and anticipation and high hopes… gone. It was then that I felt sick to my stomach. Hurt. Angry. Confused. Why, if it were not possible at all to begin with, did the rep not tell me when we started the process? I made a bad decision on my part and vented my frustration on Twitter. I didn’t tag Medtronic, but I did mention their name, which flagged their customer advocate team.

And I got a call at 9pm… that’s right PM. Night time. I missed the call but it went to voice mail. I still have that voice mail because it made me cry to listen to the voice on the other end. While he did not make any promises, the gentleman who spoke was very nice and caring. The mannerism in which he spoke was the sound of an invisible hug. I called back and left him a voice mail, as it was after his work hours, expecting a call the next day. Nope. He called me back THAT.NIGHT. He had worked over just to talk to me on the phone to find out what had happened.

He worked on my case for two days. He pulled and listened to the calls that I had with the prior rep. He heard the empty promises that were made, and apologized, though he wasn’t the one in the wrong. Without me asking, he spoke with supervisors and other departments and made things happen. He stepped up and not only spoke on my behalf and got the CGM kit and sensors sent to me, but the whole system including the 530G pump as well. They arrived this past Thursday. Within 2 days, he accomplished what I had been trying to do in two months.

During the whole process, through emails and phone calls, he kept a kind spirit about him that you could tell he was a person who loved his job and loved helping others. I even think he was more excited than I was when he called me with the news of the approval. But you know, even if it hadn’t been, just his attitude and the genuine care and concern that came through the phone and his actions in following up with my case was more than I could have ever asked for.

All too often people who work hard and do good things aren’t openly appreciated for it. Rueben is one who deeply deserves recognition. I didn’t get just a simple reply from Medtronic to say “We are sorry for your frustration. Please give us a call at…”. No. He took the time to call me to see if he could resolve the issue. That, my friends, is good customer service and being an excellent support advocate.

I never write letters to companies about their employees, but I felt this one was well deserved.

Confused? Me too.

“So wait… which pump are you on?”

PicFrame (2)

I get this a lot. Mainly because I switch up a lot.

So, to bring you up to speed, this is what’s going on. Back in October when my endo took me off of the Tandem t:slim and told me to stay on my Medtronic Revel pump, I submitted to Medtronic my request for a new CGM system with Enlite sensors in hopes that we would get approval by the end of the year so they could ship by the end of the year and fall under this year’s already-paid deductible and co-insurance. Why? Because otherwise, when the 530G upgrade actually does get shipped in January, I won’t be able to afford a new CGMS under the new deductible and all as well as pay the upgrade cost. Just can’t happen. Sorry. I was assured many times over by my rep at MedT that there shouldn’t be a problem. So, after two months of phone calls to both MedT and my insurance company, we got approval at the first of the month and I was told they would ship out in probably a week. Fast forward to today. I called to find out why I haven’t gotten a shipping notice. Come to find out, they hadn’t been shipped and won’t be shipped until the new pump is authorized by the higher-ups to be sent out… so which means my whole entire goal of getting everything handled as far as the CGMS goes by the end of this year was a crap-shoot and won’t happen. Which means I probably won’t be getting the system as I won’t be able to afford paying that much up-front next year. Which the Revel pump works just fine and so does my Dexcom, so that’s not a big issue, I just like to have all of my reports in one place. The upgrade is just a want, not a need. So if it doesn’t happen, I can’t get mad because I do have the Revel that works, and that’s all that matters.

Right now, I’m on my Tandem t:slim because they have put me in contact with a rep for my area to see if they can find out what’s going on and why I’m having so many issues with it. If they can fix whatever is going on, then fine. I’m cool with it. I’m doing this because 1) it’s still got 3 years of warranty left on it and 2) even though I’ve had major issues in the past with it, I still like it. I like the pump’s interface as well as the intuitive reports (Hello 21st century!) and 3) I have like, 3 months worth of supplies that need to be used so they don’t expire. The pump seems to be a picky one anyway, and I’m not going to chance what could happen using expired supplies with it. The only thing that absolutely bothers me about it and that I feel completely wrong about is how much insulin it hides. I can’t do anything to fix it, and I’m throwing out with each cartridge an amount of insulin that could keep some people alive up to 2 days. It just feels wrong. My main concern is that even though things are going okay right now, I’m constantly feeling on-edge about it. I keep waiting on the one day when all heck breaks loose and the pump decides to go whacko on me again and I go two weeks trying to fix something that can’t be fixed all the while I’m battling 300-500 BG readings. I don’t have this issue with MedT and I trust it because I’ve never had an issue with it like that.

And please, PLEASE don’t get me wrong – I’m very VERY grateful for all that I do have. And, yeah, I probably should just let this all go and let it ride and take it as a sign. I just know a lot of people are probably questioning what the heck I’m doing when I’m talk about either system at any given moment, and this is just the summary of it. In all honesty, I want my MedT pump. I like it and it’s dependable. I’m ready to use up the t:slim supplies and go back to it.

Lenny – FridayFind 5

One thing (person?) we were all introduced to when I attended the Diabetes Advocates Forum at Medtronic last month was Lenny.

Lenny the Lion, that is.

We all know Lenny from his Carb-counting game app for iPhone, iPad and Android, but now he comes to life for children (of ALL ages) everywhere!

Medtronic worked with Build-A-Bear to make these special bears to help give courage to kids when learning how to use an insulin pump and insert sites. Every child, 12 and under, who go onto the pump for the first time receives their very own Lenny from their trainer. He has special little spots on him – tummy, thighs, upper arms, and butt, for learning specific places that they can insert pump sites into. He even has one on his paw for testing blood sugar! The spots are made of a denser foamy material that make it feel like a real insertion, not just hold on to the site once it’s in. The idea behind Lenny is to help kids learn to have courage, and to not let diabetes hold them back.

Lenny came with his own material too:


{How to register YOUR Lenny to receive a birth certificate so you your child can go play with him in Bearville!}

{Tips on Site Rotation and how often to change them}

{A few more quick tips}

{I put some of BabyK’s 3-6 month clothes on him. Poor thing was “nakey”. 😉 }

And, from Medtronic themselves, here’s a fact sheet on Lenny:

{Click to see the full version - Used with permission}

One question that came up a lot on Facebook after a few of us posted the pictures was, “HEY! I want a Lenny! Where can I get one?” Well, my friends, he is available in the Medtronic Store, as well as a mini-version of himself that can hold an insulin pump inside (or Guardian CGM). I think this is great because there are those of us who are *slightly* over 12 (not pointing fingers at myself at ALL) who would want one but didn’t get one in pump training.

The only thing I wish he had (and actually it was mentioned to Medtronic during the forum) is his very own pump of somesort… and a CGM if the child is going to go on both. Some even mentioned Lenny having a sibling. I think Lenny needs to have a Lioness best friend – Lynn? Leona? Lenora? – who is diabetic too.. for the girls. Cause, come on… you know you would want to put a cute frilly outfit on her! (Possibly be a good way to show them how to “hide” their pumps? No?) This was actually brought up as a question in the forum – “would there be a girl version?”, and the answer was no. But I’m thinking that maybe, as with most companies, if the demand is high enough, they might consider it… so, would you like to have the choice of getting a Lenny or a Lenora? Let me know and I’ll pass it along!

Now, I’m off to shop for more clothes from Build-A-Bear for him, then snuggle and play with the app for a bit!

Suga-Rating for this FridayFind?


4 out of 5

Disclaimer! I did receive Lenny at no charge to me from Minimed. They did not ask me to blog about him, nor feature him in a Friday Find post. The kit that was sent to me had everything as shown above, and did not include 6 infusion sets as mentioned in the online product feature (I’m assuming this is because I’m already a pumper and the 6 would be for the child to practice with during training).

Continuing to Step in the Right Direction

This afternoon, I received an email that Medtronic has just sent out a press release regarding the ASPIRE study – the one where the worlds first insulin pump with LGS (Low-Glucose Suspend)! Results are awesome, too! According to the information, there was a 19% reduction in time spent below 70 when users were on this pump system. That is awesome, folks. A huge step in the right direction, in my opinion.

While it isn’t a cure, I do applaud these people who are working so hard to get better technology like this for us so that we can hopefully live longer, better lives, and maybe reduce the number of blue candles lit for lives lost due to hypoglycemia. And also, a huge thanks to those who are in the study, being human lab-rats for us.


If you’d like to read the release, you can find it HERE.

REVEL-ling In Disclosure Time Again!

20100101-DSCN0667Yep, it’s that time again! It’s time to update my disclosure for all of you happy readers of the IGTS Blog, and I am so excited to share this with you.

Last month, I was given the opportunity to be a part of Minimed’s blog, The LOOP Blog. After speaking with the PR department (They are some super nice people!), sharing several emails, and getting some other legal stuff squared away, we now have a formal contract in place that states I will post once a month for them. In exchange for these posts, I have been provided a Minimed Revel insulin pump as well as a box of sensors free of charge, and are mine to keep. (I went with the clear one if anyone is curious! LOL!)

They do not reserve any rights to what I post here on my blog about their product, but they do, however reserve that right to what I send in for their blog (which is only fair). The blog entries I write for them will post on the 15th of each month, and I’ll let you know when they are up by posting them to Twitter and Facebook. My training for the pump is scheduled for today, so I will post here Monday about how it all went.

I am super excited to be a part of their involvement with social media and outreach to the DOC, and hope to represent both Medtronic Minimed and the DOC in a way that will make you guys proud.

First Solo Guardian Sensor Change… Sort of.

MM SensorI had to do my first solo Minimed Guardian sensor change Friday, and I took the opportunity to take some pictures.

While I know there are ways to extend the sensor, my skin was getting itchy and sort of painful, so I decided it was best not to try my luck and go ahead and switch things out. After I got up and showered, I went ahead and placed the new sensor in my upper thigh, which, once again, gave me no trouble using the Sen-serter. (Shhh! I actually like the device! No gearing up to do a manual insertion – it does it for me!)  I made a make-shift Band-Aid to cover it using IV3000 and cutting a square to cover the sensor out of the paper and making a sensor sandwich to cover it (sensor, paper, then IV3000) but make it easy to remove and not pull the sensor out when I was ready to do the switch.

So, at around 1pm, I started to do the process of switching everything out. I was so used to Dexcom’s way of going into the menu to stop the old sensor and then start the new one when you were ready, that I went completely confused when I didn’t see a similar setup in the Guardian’s layout. I went back and referred to the manual and the online tutorial, but those ( I thought ) only applied to inserting your first sensor… not how to do a replacement “new” sensor. So what did I do? Yep – I called Minimed Customer Support and asked them to walk me through the process. I have to give them an A+++++ on this because the rep I spoke with was very understanding, patient, and very eager to help me and even double-checked with me to be sure I understood the process completely. He went above my expectations. He not only walked me through, but he made sure I understood the process well enough for the next change out as well. That’s what I call great customer service!

I knew that the area had been itching that night before and that morning, but I figured it was just about that time that I get rashes from glue adhesives and it would be fine as soon as I changed everything out. Well, when I took everything out and off, this is what I was left with:

Old MM Sensor Site

Not only did I have a rash from the glue, but somehow, my skin had been cut between where the clam-shell transmitter and the butt-end of the sensor meet. I’m hoping this won’t be a recurring thing with the sites and it was just that I had placed this one on my side. Granted, the user guide does state not to put the sensor in an area where your body moves a lot, so putting it on my side was not the best idea. But with being as pregnant as I am, we weren’t sure where to put the sensor during training since my stomach wouldn’t be safe right now, and I didn’t really want to strip down to put it in my leg either. So just a word of caution.. do what the book says… no insertion in “bending” areas!

BUT! On to the sensor itself. Setup went just as the first insertion. I recharged the transmitter, clipped it into the sensor that had been on my leg waiting for 5 hours by this time (I wanted to be sure to get it plenty “wet” and see if it helped with readings right off the bat), and tapped it down with IV3000. In the monitor, instead of having a menu option of “stop sensor” to stop the old one, you just go and tell the Guardian monitor to “start new sensor” and it begins the 2 hour warm-up period.

After the two hours, I calibrated and stayed pretty well on-track with no problems. I will say this though. Not only is it important to calibrate when your bg is steady and all that good stuff that they tell you, always clean your fingers. I know this should be a given, but I am very guilty of not making sure my hands are clean when testing. And how often do we fuss and complain about variability in CGMs verses meters when we’re probably testing with not-so-clean fingers? I know some of you out there are not as slack in that area as I used to be, but I have now made it a point to try to make sure I clean my fingers before testing, especially if that number is going to be used for calibration…. because what’s the point of calibrating if you’re going to give it a bad number anyway?

I’m scheduled for my second change out today. Debating on trying to extend it or change it. I’ll let you know on that one later.


And, just in case you wanted to see them, here’s some more pictures of what the sensor looks like (granted, this one is used, so please ignore the dried blood in places… I tried to clean it but some got left behind):

MM Sensor

If you look really closely at the sensor wire, you’ll see that it’s coated… I’m assuming that’s the difference between why you can take acetaminophen with their sensor and not with the Dexcom? Hmm.

MM Sensor