Paradigm CGMS

[Subby]

I'm getting a few days use of a mm CGMS in a day, the type that integrates with my paradigm. I buy a sensor ($80 AU) and borrow the CGMS, the DE will get it up and running for me.

Having only been on CGMS once before, and an older system, I am an absolute newbie with this. A couple of questions to the CGMS pros:

- is it true I might be able to stretch the sensor to 4 or 5 days, of am I getting that mixed up with something else?

- Any hints or tips you think I really should know?

Thanks.

[Ray4Rick]

I've been on pump with CGM for a month now. I change my sensor every 6 days. But many folks on here have used the same one for 10-12 days. I'm trying to last as long as I can with the one I'm using now.

If the weather is hot, keep the sensors in the fridge. I had many problems last week, went through 4 sensors in a weekend because I was getting weak signals or loss signals. Again folks on here told me to keep them in the fridge and so I did. I'll see next change if I have an easier time.

Good luck to you mate,
:D

[JediSkipdogg]

I'm not sure the max time on a Minimed sensor but I'm on day 16 with my Dexcom sensor.

As for the temperature, I believe that 76-80 degrees is the max a sensor is allowed to get before being inserted. Not sure once inserted if there's a max. I've been leary of using a hot tub since starting because I'm not sure what that extra heat would do.

[Coppernob]

Subby, I am on the minimed system - 522 with CGM. I keep my sensor in for a week because it really suits me to change it on the same day every week. For the majority of the time, this works really well and the sensor could last a bit longer if needed. However, sometimes it starts to act up in the last 24 hours and the readings start bouncing all over the place, not coming close to a metered BG. I am very happy with the way this system works for me.

The only other thing I would say is that you have to try different locations in placing the sensor to decide what works best for you. Each of us has to find the place that gives the best readings without discomfort. For me that happens to be the outer part of my thighs - I just alternate legs each week. Other people prefer buttocks, abdomen etc.

Good luck Subby - hope it all goes well. :)

[poodlebone]

I'm getting a few days use of a mm CGMS in a day, the type that integrates with my paradigm. I buy a sensor ($80 AU) and borrow the CGMS, the DE will get it up and running for me.

Having only been on CGMS once before, and an older system, I am an absolute newbie with this. A couple of questions to the CGMS pros:

- is it true I might be able to stretch the sensor to 4 or 5 days, of am I getting that mixed up with something else?

- Any hints or tips you think I really should know?

Thanks.

Yikes! Is that AU$80 for just one sensor?! Here in the USA they're US$35 each if you buy a box of 10 and only very slightly more expensive per sensor if you buy a box of 4.

Yes, you can usually extend the life of a sensor well past three days. When you insert a sensor, Minimed says to wait X minutes (5? 15? Don't remember the actual number...) before attaching the transmitter. My CDE told me to wait at least 20 minutes. The longer the sensor sits and gets "wet", the better. The transmitter has a built-in 7 day timer and that starts as soon as you attach it to a sensor. The sensor has a 3 day cycle that starts counting down as soon as you do the first calibration. At the end of 72 hours, the pump will give a Sensor End alarm. You just go back into the Sensor menu and choose Start New Sensor. You don't have to turn it off first, you don't have to touch the sensor or transmitter. Just choose the Start New Sensor option. Within 5 minutes (usually less), it will ask for a calibration and you can start a 3 day cycle all over again. After another 72 hours, you'll get the Sensor End message again. You can restart it another time (Start New Sensor) but the following day you'll start to get Weak Signal messages, which means the transmitter needs to be recharged. You can carefully peel up the dressing (keep a finger pressed firmly on the plastic sensor hub to prevent it from pulling up), remove the transmitter and recharge it. Then reattach, tape it all down and wait for the 2 hour warmup period to calibrate. If you do remove/recharge the transmitter after 7 days, you can reattach it to the sensor as soon as it's charged. The sensor will already be good & wet since it's been in for a week.

Calibrations: Make sure your BG isn't moving much when you do them. Don't do it too soon after a bolus, eating food or exercise. When you do the very first calibration, the next one is due within 6 hours. You don't have to wait 6 hours and can do it earlier, when it's convenient for you. After that you'll need to calibrate every 12 hours but you can do it more often. I wouldn't do more than 3-4 calibrations per 24 hours, though. Just do them so the timing works out for you. You don't want to get a message asking for a calibration at 2:00am!

Taping: Keeping the sensor taped down so it doesn't move is important. When I insert a sensor I put a strip of tape (paper tape or some plastic-y cloth tape I have) over the plastic sensor hub, making sure I don't cover the two little prongs that snap into the transmitter. That keeps it stable while I'm waiting to attach the transmitter. When the transmitter is attached I usually use Opsite Flexifix to cover the whole thing. Since you're not going to beusing the CGMS full time, just use whatever you have as long as it will keep it all covered & stable. The transmitter/sensor connection is waterproof but if you do keep getting it wet the little adhesive will loosen and the whole thing can come out. So, better to keep it all covered up.

ISIG: The isig is the raw data the pump uses to calculate your interstitial glucose. As your BG goes up, so will the isig. As your BG falls, so will the isig. In order to calibrate your calibration factor should be between 2 - 20. To get the factor, divide your meter BG by the isig and it should be between 2 - 20. Of course, that's in mg/dl so you'll have to do the math to translate from mmol/l! When you first attach the transmitter and turn the system on, it will go through a 2 hour warmup period before asking for the first calibration. If you look at the sensor status screen you'll see the isig number changing a lot, going very high and very low and everything in between. That's normal and it will settle down. When a sensor is dying the isig will usually drop lower & lower. Eventually you'll get calibration errors because the isig is too low, and you'll see your sensor readings flatline at a low number.

Sometimes the MM sensors need extra time to get wet and the readings you get may not match your meter readings well. It can be frustrating, but they usually will pick up. I've had sensors that were not very good at all for a day or even two, then sudden;y fell in line and worked great. If you find that the readings don't match well fromm the start, just give it time. I will sometimes just turn the sensor off (in the pump menu) and leave it alone for several hours or overnight. When I restart it, the isig is almost always higher and the readings will track much better.

I've lost track of when I put my current sensor in. I've already recharged the transmitter once. I'm on either day 11 or 12 now and it's been working great. My record is 17 days, and that was in the same area as my current one (upper thigh, right near the top). Some have lasted only 5 days. Most average around 9-10 days.

[Subby]

Awesome replies, thanks a lot. As well as useful now, I have this info bookmarked for if I get a longer run with the CGMS. I am getting it on my Tuesday, it seems they usually run just for 3 days per "borrow". I will see if I can hedge to keep it over the weekend, make some excuse about hard to get it back Friday if need be... and try and extend the new sensor trick. I'm sure going to try that considering the cost...

Liz, yes, that's the price here for one sensor, as CGMS has not reached being covered by insurance in any shape or form yet. Obviously, fingers crossed it does soon. The accounts of how long the sensors can last make them even more tantalizing to think of them being affordable. For now, this is about the most exposure I'm going to get in the meantime...

As for the sites, considering I've only got one shot at this, am I best to go for a site I know works with the pump, or are the rules different? For example, while I occlude at many other sites, my upper butt is my all time best pump/injection site, should I just go for that?

[poodlebone]

A lot of people do use the upper butt. Just make sure that the sensor isn't inserted near an infusion set. Also remember that the pump has to be able to communicate with the transmitter so it needs to be worn fairly close to where you've inserted the sensor.

Are you sure that the transmitter they're letting you borrow will communicate with the pump? Minimed makes another system called the iPro (I think) that is used in doctor's offices and clinics. When patients wear that, they don't see the readings until the transmitter is returned to the doctor and they download it. I believe the sensors are exactly the same but the transmitter must be different somehow. The patient doesn't have to worry about doing any daily calibrations.

[Subby]

OK, butt it will be, away from set. My DE did suggest that my pump would display the results as per the paradigm "real time" system, but I guess I won't know for sure until my appointment.

[GretchO]

Subby...poodlebone has given you a great overview. I'd also add that MM suggests a 45 degree insertion angle...I'd go a bit steeper (closer to 60 degrees). I've had my current sensor in for 7 days so if you can finagle a few extra days I'd go for it.

[Coppernob]

As for the sites, considering I've only got one shot at this, am I best to go for a site I know works with the pump, or are the rules different? For example, while I occlude at many other sites, my upper butt is my all time best pump/injection site, should I just go for that?

Sorry Subby, I got so carried away with the idea of your getting a CGMS that I forgot it was a one shot deal! Hopefully it won't be too long before you have your own system.

Poodlebone's info is really good and I agree with Gretcho's comment about the angle - in fact the diabetes educator who started me out with the sensor said the same thing: insert at an angle of at least 60 degrees.

Good luck, Subby, hope it all goes well for you. :)

[Subby]

Hey no problem, and thanks for all the advice, it's all good.

You know, hearing that the sensor can last for quite a bit longer... means I am going to be thinking very carefully about seeing if I might buy a system and use it on an occasional, but consistent basis. I am by no means rich at all, but may have recourse to funding this... I am at a stage where the better I get my BG, the better the rest of my life is going to be, and if it helps me do things like go well at uni/hold down work (and any help with stability will definitely help with that)... Others might buy a new car... perhaps a CGMS will be my preference while I drive my old bomb around. We shall see how it goes. I have no doubt that the CGMS would not be worth a lot of money to some, but I really have had reactive BGs for years to those frustrating factors like stress, no matter what I seem to do, maybe it's worth some sacrifice to gain persistent insight into what is going on. Thanks for your enthusiasm - I share it!

[poodlebone]

OK, butt it will be, away from set. My DE did suggest that my pump would display the results as per the paradigm "real time" system, but I guess I won't know for sure until my appointment.

One thing about a butt site. If you don't have anyone to help you, it could be difficult. Unlike an infusion set which only has that little built-in adhesive to worry about, the whole sensor/transmitter must be taped down securely. Also, it can be tricky to attach the transmitter if the sensor is in an awkward place.

[Subby]

OK, well I've been running with it tracking for about 4 or so hours now. I was/am impressed at the size, and the on screen display. It has not been overly accurate yet. I had two mild hypos that it has just completely missed. (3.5 mmol/l each time = cgms not reading below 6 at any time, just passing over them with a slight dip). I will take a breath and wait for it to sort itself out a bit better as you suggest Liz.

Of course, it is when I have a hypo that I test, and it's quite different (3-4 mmol/l / 50-70 mg/dl difference) and I feel I should give it a meter reading to correct it... but I should suppress this instinct, right? Wait until I am over the hypo and stable, and it's a fair time for one of the few calibrations, before giving it a calibration reading?

A more general question. Since it has only had one calibration so far, lets just assume my BG meter was on the high side of things for that test, and the entry was say 1.5 - 2 mmol/l high. Does that mean the accuracy of the CGMS will be stuck relatively too high, until it gets more and more accurate readings? Or does it have its own ability to finetune actual readings? Is it worth taking a couple of tests during calibrations, to input a normalised/more accurate figure into the pump?

RE me buying a unit myself, I found out I can basically book in a session with this one whenever I want to buy a sensor... that's great! I thought they might need to ration it out more, I might have difficulty accessing it more regularly if I choose to.

[poodlebone]

The sensor does have a 15-20 minute lag time, behind your meter readings. This is especially true during times of a fast change, such as when you're dropping fast due to exercise, or if you just ate and your food is starting to hit your system. Since the best part of the CGMS for me is to avoid lows, I have my alarm set for 75. I am seriously thinking of making it a little higher, 80-85. Most times when I test and see I'm something like 62 but my sensor says 81, within 10-15 minutes the sensor will have dropped and the number will get close to my meter. Of course, if I didn't treat that 62 I may be dropping. I don't calibrate for something like that, only if the sensor is off by a lot more, especially if I haven't eaten or bolused within 3 hours or so. Never, ever calibrate if there's an arrow (or two, in either direction) on the screen. You will confuse the sensor, as I have learned. If the pump asks for a calibration and you realize that it's nortt really a good time you can ignore the alarm. It will stop showing readings, but once you're stable just go ahead and calibrate and they'll pick up again. This is why I keep an eye on my next calibration time. I don't want to eat lunch and then 40 minutes later it asks for the calibration that I forgot all about. It's happened!

When I calibrate I will sometimes do 2 or 3 meter BGs just to take sure I didn't have some kind of fluke reading the first time. Generally the numbers are all within a close enough range. If I've done 3 tests I'll just pick the # in the middle. If I do two and they're more than 10 points apart, I will often just average them and enter that. Usually I just do 2 meter tests before a calibration.

You will find that after the very first calibration, when you enter later calibrations the sensor will not change to meet that exact number so I guess it does do its own thing. Every so often the sensor is still too far off after a calibration and I will do another. The pump takes your past 4 calibrations into account somehow when it does its thing. I read a trick that if your BG is very stable, you can do 4 calibrations in a row (15 minutes apart) and that should give you a very accurate calibration, as long as there's nothing wrong with the sensor. I've done that twice, when a sensor was just all over the place. 4 in a row brought it back in line and it worked great after that. Minimed, of course, does not recommend this.

[Subby]

Liz, thanks for your invaluable help and ideas. As for my lows, the thing was - the sensor never made it down there at all, even with lag considered, so I guess it just hasn't been doing a great job this day. In fact, it's been showing rock trends and ignoring most of the movements. It was reading as 6 to 7 mmol/l for hours (and my own tests have been in that ballpark) but a few tests on my meter (two meters, actually) and I'm actually 11 mmol/l and not likely to have spiked there in the last 20 min. Sigh. Well, I will get some sleep and see if there is just a little more parity tomorrow. It's still exciting stuff.

[rak1978]

Wait until I am over the hypo and stable, and it's a fair time for one of the few calibrations, before giving it a calibration reading?


Subby,
Yay! I'm so happy for you that you're able to give it a test run!
That's exciting. Please forgive me if this is redundant. I don't have time to read through the previous posts on this thread (baby started walking and trouble is the name of his game!).
Regarding calibrations...I actually only calibrate when it has been many hours since my last meal &/or snack and bolus. Either the middle of the night or first thing in the morning is the best time for me. When I firsts got the cgms, this was the major mistake I made. I would calibrate within 1 or 2 hours of a meal and bolus when I was either on the rise or the fall and it produced terrible accuracy. Very frustrating!
I find with the cgms, there are many little quirks that you have to cater to or it will not run properly. The timing of the calibration is a major thing. Another one is when you are inserting it, don't pinch the insertion site and/or inject slowly. A swift and clean approach without hesitation works better so it gets in as deep and straight as possible.
Also, when I put a new sensor in, I just cover it up and wait a full night before connecting the transmitter to account for the wetting period. That way I don't have to deal with the initial inaccurate numbers with a new sensor. It works great from the start.
One more thing...keep hydrated. The more water the better.
Again, sorry if this is redundant. I didn't read the previous posts...just scanning though, it seems like you got some good advice.
Have fun with it! :)
Rachel

[Ark nana]

So far you guys have given so much good info, I can't even tell you how much I have learned from you. Here is my next question. You said the transmitter will time out after 7 days. and it will tell me that? Do I have to wait for my pump to tell me or can just do anytime on the seventh day? If it doesn't tell me anything, do I wait untill it does? Thanks!!:)

[GretchO]

when the transmitter battery starts dying (around 7 days) you'll begin getting "weak signal" errors. eventually, when the battery is too weak you'll get a "lost sensor" error. i wait until i start getting the errors to disconnect and recharge.

Subby...i really hope your sensor starts behaving.

[Ray4Rick]

.....After another 72 hours, you'll get the Sensor End message again. You can restart it another time (Start New Sensor) but the following day you'll start to get Weak Signal messages, which means the transmitter needs to be recharged. You can carefully peel up the dressing (keep a finger pressed firmly on the plastic sensor hub to prevent it from pulling up), remove the transmitter and recharge it. Then reattach, tape it all down and wait for the 2 hour warmup period to calibrate. If you do remove/recharge the transmitter after 7 days, you can reattach it to the sensor as soon as it's charged. The sensor will already be good & wet since it's been in for a week.


This happened to me yesterday, day 7, I got a weak signal then I got a lost signal. Are you telling me I could have only recharged the transmitter and it would have worked for a few more days?? I'll have to try that next time.

[Ark nana]

Yet another guestion about tape. Mini med. said to use the big sticky IV3000 to cover the whole transmitter and everything, is that a good idea? Yuo guys know more than they do. Keep in mind I'm new to the CGM. Only a week old.

[GretchO]

This happened to me yesterday, day 7, I got a weak signal then I got a lost signal. Are you telling me I could have only recharged the transmitter and it would have worked for a few more days?? I'll have to try that next time.

yup...just carefully remove any tape (or whatever) you have holding the transmitter/sensor down and detach the transmitter from the sensor. charge the transmitter, reattach it to the sensor and then from the pump go to Sensor > Sensor Start > Find Lost Sensor.

[Ark nana]

Hey guys I did exactly that today, and it worked!! Thank You, Thank You, I'm starting to feel more comphy about the whole thing, thanks to you guys. Ark Nana

[Subby]

Thanks Gretch and Rach. Not redundant info at all Rachel, very useful. I'm following your and Liz's recomendations on the calibration. I had a nice stable night/morning (I know this from my BG tests, not the cgms, which stayed unmoving and wildly optimistic ;) ) so hopefully my fasting calibration was helpful.

It's interesting I lost sensor signal a few times in the night, it's in my butt and I was on my back at times. Seems that the mattress/my body was enough to cut the signal out. No biggie, just interesting.

With the insertion, the DE used a serter and I have to say it was completely painless and seemed a neat insertion, as far as I can say on one insertion. Pretty different to set inserters which I only had grief with. Does anyone here use a sensor serter?

[poodlebone]

Yet another guestion about tape. Mini med. said to use the big sticky IV3000 to cover the whole transmitter and everything, is that a good idea? Yuo guys know more than they do. Keep in mind I'm new to the CGM. Only a week old.

I like to completely cover the sensor & transmitter. I started out with the IV3000, I think they're around 2" x 3" and I would use two, overlapping them in the middle. Same thing with Tegaderm. I then got a roll of Opsite Flexifix, 4" wide, and I just cut off a length of that and use the one piece to cover everything. For me, it holds much better than IV3000. It does sometimes irritate my skin, especially in hot weather when sweat collects underneath. It also peels up more easily then, so what I've been using now during the summer is Hypafix. It also comes on a roll, is NOT waterproof, and is more like a breathable cloth. The sensor & transmitter are waterproof once they're connected (you don't want to get them wet until the transmitter is snapped in place) so the tape not being waterproof isn't a problem. I do worry about it a little, so now I cut a strip of Opsite Flexifix about 1 1/2" wide and place that over the area where the sensor & transmitter connect. I then cover it all with Hypafix. I have not had an itchy site since I started doing this!

Another thing I do is put something on the transmitter before taping it all down. A piece of double sided removable tape works well. This allows the dressing to stick to it and keep everything in place, but when I peel it up to recharge the transmitter it comes off the transmitter easier. SOmetimes I just put a small piece of gauze down. I find that I sometimes had to really fight to get the dressing off without yanking the sensor out.

[poodlebone]

It's interesting I lost sensor signal a few times in the night, it's in my butt and I was on my back at times. Seems that the mattress/my body was enough to cut the signal out. No biggie, just interesting.

I've only gotten one Lost Sensor alarm during the night and that's when the pump came unclipped from my underwear and I rolled over so it stayed one one side of my body when the sensor was on the other side.

I did experience a new problem (for me) with my last sensor when I slept on it. The pressure caused the sensor readings to drop very fast. If you wake up and see that your graph has suddenly taken a nose dive but your meter does not validate a low BG, just make sure you're not putting pressure on the sensor. Leaving it alone for 15-20 minutes, massaging the area and drinking water will get it back in line. That happened to me 3 days in a row, but the first 7 days with the same sensor I had no problems.

With the insertion, the DE used a serter and I have to say it was completely painless and seemed a neat insertion, as far as I can say on one insertion. Pretty different to set inserters which I only had grief with. Does anyone here use a sensor serter?

I use the inserter every time for the sensors, and gave up on the SilSerter after just a few tries. You do want the sensor to go in fast so doing it manually isn't the best way to go. I have not had a painful insertion yet.

[Subby]

At mid afternoon I can say it's been much improved today. The error range has generally been within 1 to 2.5 mmol/l (18 to 45 mg/dl) once lag is factored in, which brings it into the range of excitingly useful. One of the best things I am finding is, once I get a feel it is being a little more accurate, seeing the trend of the last few hours is allowing me to relax and forget my diabetes a lot easier, it takes away a constant question mark in my head, worn deep by my BG's tendency to go off this or that way when least expected. If this level of accuracy was generally achievable, I think it would have a huge daily benefit on my daily control decisions, A1c, and mental relaxation from just not knowing if my BG is slipping away to levels wthat will adversely affect me, when I am not looking - and which way it is slipping, despite my attempts to keep on top with many BG tests.

There is a new level of feelings of confidence from having this window into what my body is doing, (when it comes to doing day to day things and if I am up for them) that is empowering and satisfying.

[rak1978]

There is a new level of feelings of confidence from having this window into what my body is doing, (when it comes to doing day to day things and if I am up for them) that is empowering and satisfying.

Subby,
Glad is starting to work for you! I felt this way too when I finally figured out how to get mine to work correctly. Before having the cgms, I would have TONS of anxiety....almost like panic attacks because I thought I was dropping and actually thought I was going to pass out multiple times a day. My blood sugars were lowish, but I definitely was not going to pass out from them. This anxiety started because I did have a few severe hypo's when I was on byetta. Weird what the mind can do. I have not once had that feeling since I've been on the cgms. It definitely brings confidence! I almost feel like it's someone else taking care of the numbers and I can relax and think about something else...well, not really, but close. Even if the numbers are not spot on, you can see the trends.
The good outweighs the bad on these things for sure.
It's great to that you can give it a test run and figure out all of these quirks before you have to put too much money into it. Mine weren't covered by insurance until recently and I have wasted many sensors/dollars trying to figure these things out. Hopefully, for your sake, your insurance will see the importance of these soon.


:)

[Ark nana]

I was thinking about the gauze over the transmitter just before I put the IV3000 on. Next time I will do that. Thanks.

[GretchO]

At mid afternoon I can say it's been much improved today. The error range has generally been within 1 to 2.5 mmol/l (18 to 45 mg/dl) once lag is factored in, which brings it into the range of excitingly useful. One of the best things I am finding is, once I get a feel it is being a little more accurate, seeing the trend of the last few hours is allowing me to relax and forget my diabetes a lot easier, it takes away a constant question mark in my head, worn deep by my BG's tendency to go off this or that way when least expected. If this level of accuracy was generally achievable, I think it would have a huge daily benefit on my daily control decisions, A1c, and mental relaxation from just not knowing if my BG is slipping away to levels wthat will adversely affect me, when I am not looking - and which way it is slipping, despite my attempts to keep on top with many BG tests.

There is a new level of feelings of confidence from having this window into what my body is doing, (when it comes to doing day to day things and if I am up for them) that is empowering and satisfying.

This is AWESOME news. I'm so glad it's helping you. I agree w/ the feelings of confidence. I still test a lot while wearing the sensor even though I've had a lot of luck w/ accuracy, but knowing what's going on between the tests is so very helpful and revealing. I love it for doing basal testing too.

[Ark nana]

Subby, I couldn't agree with you more. I wish I had the CGM for the last 4 years. I feel my confidence level is much higher. The feeling of being out of control is not a good feeling, as you all know. I'm still learning, but feel much better about my life. It's still not easy, but we can do it!! Right Girls!!

[Ark nana]

O.K. Guys, What's going on now. Everything was going great today, then after lunch, I get the alarm I'm doing low. I didnt feel low at all. My pump says 50 with the alarm still going off,so I did a BG and it said 90. Is my senser dying? It's only 8 days old. It's to young to die!! What next!!:eek:

[poodlebone]

O.K. Guys, What's going on now. Everything was going great today, then after lunch, I get the alarm I'm doing low. I didnt feel low at all. My pump says 50 with the alarm still going off,so I did a BG and it said 90. Is my senser dying? It's only 8 days old. It's to young to die!! What next!!:eek:

It is possible that it's dying. I've had plenty of sensors that only last a day or two after I recharged the transmitter for a second round. You can try to leave it alone and see if it comes back up. If the sensor is totally wrong and I decide I don't want all of the false data in my reports I'll turn it off, wait until my BG is more stable (after food is all digested and most of your bolus is out of your system), then I'll turn it on again and see if the isig has improved. If I can do a successful calibration I will. If my calibration factor will be too high (meter BG divided by isig) then I know it's dead and will give up. A calibration factor of 15 is the highest I'll attempt to use. Even then, I know there's not much life left in it.

[Ark nana]

I'll try that today, BUT will my pump not tell me my sencor is dead? Can I just click on New Sensor and get a little more time? Maybe I'm just trying to ask to much of my first sensor. They cost so much I want to squeeze as much time as I can. Thanks a bunch. Ark Nana

[poodlebone]

No, there is nothing specific to let you know a sensor is dead other than a very low isig and numbers that flatline or drop suddenly. You can try turning it off for awhile and the restarting. Check the isig when it asks for the first meter BG and if it's improved, then try to calibrate. I know the sensors contain some of the same stuff they use in test strips, so it's not an infinite supply and they will die eventually. 8 days is pretty good for your first sensor.

[Ark nana]

O.K. Now I know it's gone. Everthing you said, happened. So now I will wait until bed time, then put in a new sensor but don't hook up the transmitter or cal till morn. Right? Let it get good and wet. So do I put the transmitter on the charger, or on the sensor or where? This is Thurs. and I charged on Tues. So glad I found this forum. THANK YOU

[poodlebone]

O.K. Now I know it's gone. Everthing you said, happened. So now I will wait until bed time, then put in a new sensor but don't hook up the transmitter or cal till morn. Right? Let it get good and wet. So do I put the transmitter on the charger, or on the sensor or where? This is Thurs. and I charged on Tues. So glad I found this forum. THANK YOU

Pull the old ensor and charge the transmitter. You want it fully charged so it will go the full 7 days once you get the new sensor going. While the transmitter is charging, insert the new sensor. If you plan on waiting until morning to start it, go ahead and attach the charged transmitter and tape it down. By attaching the transmitter now, your sensor will still get wet overnight but in the morning you will be able to bypass that 2 hour startup period. Also, if you don't attach the transmitter and go to bed with just the sensor, there's a good chance the exposed end can get snagged on something and get ripped out. So, getting it all set up and taped down is best. Make sure your sensor option is turned OFF on the pump otherwise it will start to alarm during the night. In the morning, go back into the sensor menu and turn it on, then choose the Start New Sensor option. You'll see the message about it asking for a calibration in 2 hours but it will actually ask for one within 5 minutes. Do your first calibration and 15 minutes later the readings will start to appear. Remember that the second calibration will need to be done within 6 hours for a new sensor.

[rak1978]

Subby,
Did you have to give the cgms back yet?
If not, how is it working for you?

[Subby]

Hi Rachel, I reset it for another 3 days 7 hours ago. It's friday night here and I don't need to give it back til Monday... so depending on whether it holds, I might get a couple more days out of it.

Watching my Isig has been interesting. It dropped down to around 25 on the 2nd day and has been oscillating between 12 and 20 since. Just lately it's been hitting single figures as well. I don't have any way to guage, but I guess I would not be surprised if it conks out soon. Hoping to get another day at least. I keep guzzling water, and I found going for a jog really seemed to help it too.

I've been happy. the accuracy had continued to be ok, except not so adept at showing the extremities. It's as if it reflects my BG in a compressed way, if that makes sense. As such it has been no good for even remotely predicting lows, and it has not shown quite the extent of highs. However, for trends, it's been wonderful. I did some basal testing today which tells me that my already dynamic basal rates simply are not dynamic enough through my troublesome afternoon/evening which has been impossible lately (hitting 16+ mmol/l... crashing at about 6pm to repeated hypos... even with basals already tweaked to attempt to cater for the ups and downs). You can understand with such a hugely varying picture, it's hard not to suspect bolus mistakes and the like. However, the basal testing shows it is simply my crazy body doing it's "thing" - and appears to have changed from the last time I basal tested. Seeing the basal trends presented in such a strong way, I feel I have more confidence to make stronger changes I would perhaps have backed away from without it.

I'll make them tonight and hope to get a gauge tomorrow if my changes are a positive.

Physically it's been all fine. Barely noticed the CGMS. No pain, no hassle.

[poodlebone]

Gently massaging the area around the sensor also helps. I find that my numbers can get stuck if I'm inactive for too long, such as sitting in front of a computer for hours on end! Just getting up and moving around for a minute helps.

When you see the isig going high & low, do you do any meter tests at the same time? In general, the isig increases as your BG does, and falls as your BG falls. Many of my sensors have too much lag time for catching highs & lows and then I've had some that were nearly perfect. My last sensor (RIP after 12 days... I was so sad to see it go) stayed on track very well. The only time it really lagged was when I went for a walk after lunch every day, and even then it wasn't as behind as most usually are.

What do you have the low & high alarms set for? I have my low set for 75 and high for 160. I'm thinking of raising my low alarm to 80-90. That can be annoying during the daytime when my BG has more stable periods and my meter & sensor are close, but would be better during activity & nighttime. I still have too many lows, even with the CGMS.

[Subby]

Well, the Isig just seemed to do it's own thing really, seemed to increase with activity and highs as you mention Liz.

I got a good 5 days out of it (excluding the startup day, it didn't really count) and some great data. I really cracked a nut of the troublesome period through the day I get bad resistance and hard to predict basal needs. I have not completely solved it, but I feel I'm far more in the territory of really getting on top of it. It was very gratifying to see the evenness I am getting in between times of trouble. All up, a really useful tool.

[rak1978]

Hi Subby,
I'm glad you got some good use out of it. They are definitely great for identifying trends so that you can fine tune the pump settings. I love gadgets.
I hope your insurance will cover this soon.
Have a great day!

[Ark nana]

Just a update on how things are going. I'm on the third day of my second sensor. I'm gettihg a lot less alarms at night now. I don't go to the book they gave me for help, I go to you guys. I know you guys know what you're talking about. Not just trying to sell more product. It is a lot easier everyday. I guess you really can teach a old dog a new trick! Thanks again.;)

[poodlebone]

I'm glad that the data was helpful! Is your doctor's office going to download your pump to carelink? Sometimes it's useful being able to see hard copies of all of the days, rather than just what's on the pump screen.

[Ark nana]

Yes I am. My daughter helped me sign in yesterday. It was a little over my head, so I needed help. She is a high school teacher so it was a snap for her. I can't wait to see my endo next mo. with all this new info. She will be so proud of me. Hope you have a great day!!

[Subby]

Good for you Ark nana, I hope you have improvement in your control and health as you work with these tools.

Liz, I uploaded to carelink, my DE has access. I also put up a bit of a private online journal about my own observations and decisions and gave access to my DE. That way she can have a look at my notes, thoughts and conclusions if she likes, about what I thought was going on and why I made the changes I did. Or, not. It just felt like a good way to allow for finding out more about what I found as I used it, and why I did this, without me sending a whole heap of emails to sort through etc.

What I found really useful about the carelink program is that the overlaid CGMS data for the 5 days shows that issues that I was not quite sure if they were consistent or not with finger testing, are really quite consistent. When a spike might start up at 12pm one day, 12:20pm the next, and drop at 5:30 pm one day or 6:30 pm the next, and be different in height, a few single blood tests over that period can really mislead over time. The CGMS gave a much clearer picture.

[poodlebone]

Carelink really is a nice program. I just gave my CDE mu user name & password and she can look at it whenever she wants. At my appointments, she just logs in and can go over reports while I'm there. I have to admit that I'm lazy about uploading my pump and checking reports. I remember to do it once or tiwce a month (upload) but look at reports less frequently, only when I'm trying to figure out a new problem.

[Ark nana]

O.K. It's me again, Ark Nana. This time I have a question about something else. My BS really spikes in the mornings. I didn't notice it so much before the CGM unless I had a reason to check my BS. I would start to feel kinda dizzy and check. Now I can SEE my numbers spike. I went from a fasting BS of 104 to 172 with one arrow within 11/2 hrs. I eat the same thing every morn. and drink plenty of coffee, and give the same bolus. I will give a correction and then drop like a rock. Then I chase a low. Please don't tell me it's my coffee. I have switched to half calf already. Anyone else have this problem? and if so, how did you treat it. Thanks a Bunch!!

[rak1978]

O.K. It's me again, Ark Nana. This time I have a question about something else. My BS really spikes in the mornings. I didn't notice it so much before the CGM unless I had a reason to check my BS. I would start to feel kinda dizzy and check. Now I can SEE my numbers spike. I went from a fasting BS of 104 to 172 with one arrow within 11/2 hrs. I eat the same thing every morn. and drink plenty of coffee, and give the same bolus. I will give a correction and then drop like a rock. Then I chase a low. Please don't tell me it's my coffee. I have switched to half calf already. Anyone else have this problem? and if so, how did you treat it. Thanks a Bunch!!

Ark Nana,
Yes! I have this same problem in the morning. I attribute it partially to the dawn phenomenon. I have struggled with morning highs then drastic lows by 10:30am every day since diagnosis. My current solution is that I recently raised my basal rate significantly in the mid morning and cut my I:C ratio in half (was 1:10, now 1:20), and I mostly avoid carbs in the morning. My dr advised me once that if I want carbs in the morning, it should be maybe half a piece of ezekiel bread or something very minimal. That way there is less of a spike and less insulin required....therefore, less of a roller coaster effect. I know that everyone is different, but avoiding the carbs in the morning (as long as I raise my basal rate) works somewhat for me. The morning is so tricky!


Rachel

[Ark nana]

Thanks for a quick reply. I think I'll try to raise my basel rate like you said. If I tell you my rate right now you won't believe me. I'm very insulin sensitive. My basel rate is .1. At 2:00am it changes to .15, then back to .1 at 6:00. I know,sounds crazy. My carb ratio is 1-100. A little bite goes a long way with me. It makes it really hard to figure out. What works one day, won't work the next day. I.m a brittle diabetic. High one minute low the next. I'm hoping the CGM will help. Thanks for your help Rachel.

[Ark nana]

It's your friend from AR. with more questions. My second sensor is dying after only nine days, again just like the first one. I recharged after the seventh day after I got a weak signal. Only a day and a half and it's going crazy. What am I doing wrong? How do you guys get yours to last so much longer? I have a good site, my upper butt. I don't expect them to last forever, but for what we pay for them, I was hoping they would last a little longer than they do. Any advice? I'll try almost anything you guys say. I trust you. I've turned my sensor off now to see if that might help, just for a while.:eek:

[poodlebone]

9 days isn't too bad. Many of mine only last that long. Even many sensors that work great for the first week tend to go downhill after I recharge the transmitter. I think maybe the sensor gets moved a little when I remove the tape to get the transmitter off even though I try to be as careful as possible. The longest I've had one last is 17 days, and I had one go 15 days. I'm happy when I get 10-12 days from a sensor but not all of then last even that long.

[Ark nana]

Thanks once more for your help. I hope I'm not asking to many questions about the same thing, but I'm still so new to this whole thing (CGM). I want to do the right thing(OCD). anyway I called Mini Med this morn. and they weren't any help, they don't want you to get any more than 3 days out of a sensor. You can tell they don't have to pay for these things. anyway, they said maybe it could be I'm to close to a wireless phone that interrups the transmitter talking to the pump, or maybe a cell phone. Not sure about that. I'll try to be really careful when I disconnect to recharge. Maybe that will help. I'll keep trying. Thanks a bunch!! Ark. Nana

[Ark nana]

OUCH!! I put a new sensor in late on Sat. and this time tried a new site. I put it on my upper thigh. I pinched like I have done before, but this time I got into some muscle and it was not good. I tried to leave it alone for a couple hours, but finally I couldn't stand it any longer, so I removed it. I hated to waste it, but had no option. I'm thin so the only place I've used so far is my butt, plenty of fat there. Has that happened to you guys? Have a good day!! Ark. Nana

[poodlebone]

I've never had a cell phone or any home electronics interfere with the communication between the transmitter & pump. I have read stories of baby monitors causing a problem but I have no need for those!

I've had sore/painful sites when I've inserted into my arm a few times but I always put up with it since the readings were good. I insert in the muscular top area of the arm because it's all I can reach on my own and it is okay most of the time. I have no problem with my thighs - plenty of flesh to insert in there!

My current sensor took a nosedive this morning at work. My BG was high and it was reading much lower. When I calibrated the sensor did go up but not high enough, and the dropped right back down. I turned it off, thinking it was dead. I think it's been in for 6+ days so it might just be a weak transmitter battery. I'm going to recharge that later and see if it helps any. Otherwise I'll insert a new one tomorrow. I didn't get any Weak Signal alarms, which si what usually happens when I have to recharge the transmitter, so this sensor may be dead. It was working wonderfully, too, and I always hate to lose those.

[Ark nana]

Just a short Hello from Ar. Nana. I'm doing O.K. with the CGM but not as well as I would like to be. I still only get seven days out of a sensor. After I recharge on the second three day cycle, it dies by mid afternoon. Maybe the next one will be dif. I hope so. Anyway, just wanted to say Hi and hope all are well. Post again soon.:D

[poodlebone]

Do you put a piece of tape down over the plastic sensor hub as soon as it's inserted - before the transmitter is attached & the whole thing is taped down? That can help keep it stable. I know some people will put an entire IV3000/Tegaderm/other dressing over the sensor (making sure not to cover up the little connection prongs) and then another once the transmitter is attached so that the sensor is well taped down when they need to recharge. That's too much tape for me so I just try to be real careful when removing it. I keep a finger pressed down on the sensor the entire time I'm removing the tape and I go slowly.

You know, during those times when the sensor has lasted a long time and finally dies on its own I have a hard time yanking it out! Those are always the ones that seem to be Krazy Glued to my skin. When they're working great, they pull out when I go to remove the transmitter!

[Ark nana]

Good advice Poodlebone, as always. I'm on day ten!! So far, it is the longest live I've had out of a sensor. I think I was not being as careful as I should have been when I recharged . It seems to be working great. I guess with these things, you just take one day at a time. I'm taping it down a lot better too. I look like someone shot me in the butt!! Oh well, whatever works. Thanks again!!

[poodlebone]

I've been using Hypafix lately to tape down my sensors/transmitter because the other things just don't last in warm weather. Normally I use a piece of paper tape (medical paper tape, forget the brand) to tape the sensor down right after I insert it and while I'm waiting to attach the transmitter. I ran out so last time I cut a strip of Hypafix to place over the sensor. That worked great and didn't pull up at all when I removed the big piece of Hypafix that I had covering the whole setup. THe big piece came right off the small strip which surprised me. I figured it would rip it right off. I'm hoping the same thing happens when I need to recharge the transmitter in another few days. I think I'm on Day 4 of my current sensor (left thigh) and it has been amazing! I had inserted it late afternoon and turned it on before dinner one night. Isisg seemed good, did the calibration but then everything started dropping, telling me I was extremely low even right after I ate dinner. I turned it off and left it off overnight. Started it again the next morning and it's been great ever since. Except for one morning I have not had any big differences in the sensor & meter readings. I suspect that morning (the second morning of the sensor's life) was off because I slept on it or put pressure on it. The difference wasn't big enough to cause problems, I think it was 117 on the sensor and 150-something on the meter.

[issysmommy]

O.K. It's me again, Ark Nana. This time I have a question about something else. My BS really spikes in the mornings. I didn't notice it so much before the CGM unless I had a reason to check my BS. I would start to feel kinda dizzy and check. Now I can SEE my numbers spike. I went from a fasting BS of 104 to 172 with one arrow within 11/2 hrs. I eat the same thing every morn. and drink plenty of coffee, and give the same bolus. I will give a correction and then drop like a rock. Then I chase a low. Please don't tell me it's my coffee. I have switched to half calf already. Anyone else have this problem? and if so, how did you treat it. Thanks a Bunch!!

Just wanted to add (sorry if it's already been said), my CGMS really helped me see my morning mountains as I call them. I did a little experimenting and here is what I have found:

~I found that when I am asleep, I don't reach them at all.
~I found that coffee or no coffee doesn't change the highs.
~I found fasting I still get them.
~I found eating I get them a tad less (but I think that is because I bolused).

So...my main conclusion is that mornings cause stress. As much as I'd like to think I go with the flow, getting ready and out the door causes stress for me, so my adrenaline and stress requires an extra unit or two of insulin. If I'll bolus an extra unit (rather than raise my basal since it is only when I am awake which can change depending on when I get up), then I seem to be ok.

Hope that helps.

[Ark nana]

Hello Issysmommy, I have tried almost exactly what you did, and found almost the same thing except I can't eat any gluten in the morn. It seems fine any other time of the day. I know stress really plays a big part in my BS. I do take extra in the morn to combat the extra stress and it works pretty well. I didn't figure that out until I got my CGM in Aug. 09, just like you did. I see you haven't seen your endo sense you got your CGM. I haven't either. I will in two weeks. My last A1c was 7.4, so hoping for better numbers this time. It better be!! Anyway, thanks you for your input, it is greatly app. Have a grest day!!

[Ark nana]

Poodlebone, Guess what!! My last senser lasted 13 days!! I was so happy about that. The longest one so far. I think I wasn't being careful enough when I took the transmitter off to recharge. So your advice was right on the mark for me. Also I use a lot of tape now to keep everything in place. All good advice!! You Rock!!

[poodlebone]

I am using a sensor that I inserted on September 27th and it is still working great! This is the longest I have ever gotten one to last. The accuracy has been really amazing. One morning the sensor & my meter were pretty far off but I am 100% positive it was because I had slept on the sensor, and pressure on the sensor can cause the readings to suddenly drop. The sensor is in my right arm and since I'm comfortable sleeping on both my left & right sides I've been sleeping on my left. I can switch to my right if I position myself carefully and except for that one morning it hasn't been a problem.

I used to use paper tape to tapoe down my sensor after inserting it. I ran out and haven't remember to buy any more so I just cut a strip of Hypafix, 2" x 1/2", and used that to tape it down. The Hypafix has held tight even after peeling the dressing off multiple times to recharge the transmitter. I think that's one of the reasons why this sensor has lasted so long. The HYpafix is holding the sensor firmly in place so it doesn't budge when I remove the tape to get the transmitter off.

When I first inserted the sensor my calibration factor (metere BG divided by isig) was around 8. Not bad, but in the past my really good sensors started off with a calibration factor closer to 5. By the end of the first week it had gone up to 10 and I wasn't even going to recharge the transmitter, thinking that the sensor might only last another day or two. I did it anyway and the calibration factor remained a steady 10 all week. Near the end of the 3rd week it had crept up to 12. On Saturday afternoon (October 17th) I noticed my dressing was peeling up. I knew the transmitter would stop working Sunday afternoon (7 days since my last recharge) and I really wanted the sensor to last a full 3 weeks so I decided to change the dressing. My brain was on autopilot and I removed the transmitter automatically once I peeled the dressing off. D'oh! I recharged it, attached it and taped it all down again. My calibration fell back to 9-10 and has been there ever since.

My arm sites are usually good but even I'm amazed at the life I'm getting from this sensor. The site does not hurt, is not red and is only a little itchy around the edges of the dressing because I used IV3000. I have a bunch of them I want to use up. Lately I've been using Hypafix to cover everything and that causes no irritation at all.

[It Ain't Over]

I did not know about the significance of dividing the meter bg by the isig. Is that an indicator of a failing sensor?
I read the isig as 7.66 meter reading 94 = 12.27
So far for me this has been better than expected. First sensor is now n 17 days old. It has read within 5 pts of the meter reading everytime I have checked it, with the exception of those occasions where bg's are moving. Still usefull then. Just use the movement to signal something is about to go wrong.
Would like to see a signal there, instead of, or in addition to, the static alarm. That would work very well.
Of course the trouble would be more alarms going off...

[Ark nana]

That's great poodlebone!! That has to be some kinda record. My longest one so far is 13 days. I'm only on my 6th one. I skip a few days in between sometimes. There is only one area I can use (upper buttt area,right side) so I give it a rest every once in awhile. Anyway, good job!! Next time I start a new sencor I'm going to use so much tape I may never get the silly thing off!!

[poodlebone]

I did not know about the significance of dividing the meter bg by the isig. Is that an indicator of a failing sensor?


In order to calibrate a sensor successfully, the calibration factor has to fall between 2 & 20. You get the factor by dividing your meter BG by the isig. If it falls outside that range you'll get a calibration error. If you get 2 cal errors in a row, you'll get a Bad Sensor message. Doesn't mean it's really bad. You can always turn the sensor option off then turn it back on later and tell the pump to Start New Sensor.

As a sensor ages, the isig will gradually decrease and your calibration factor will start to increase. With a new sensor, your isig may be 18 while your BG is 100. As the sensor ages, when your BG is 100 your isig may be 14, then 11, then 9 etc. Eventually you won't be able to calibrate it because the factor will be out of range.

[poodlebone]

That's great poodlebone!! That has to be some kinda record. My longest one so far is 13 days. I'm only on my 6th one. I skip a few days in between sometimes. There is only one area I can use (upper buttt area,right side) so I give it a rest every once in awhile. Anyway, good job!! Next time I start a new sencor I'm going to use so much tape I may never get the silly thing off!!

13 days is very good. I'm always happy with anything over 10 days, and not every sensor even makes it that far. I've read stories of people getting more than a month from a sensor and I was always amazed. I don't know what the record is for keeping a sensor working properly.

I had to change the dressing again today because the IV3000 was peeling up in two places. I really hate that stuff! I replaced it with Opsite Flexifix which usually holds better. The strip of Hypafix stayed put as I peeled off the old IV3000. I highly recommend that stuff!

[It Ain't Over]

OK my senser failed last night. The meter ready /isig went to 24 and it would not calibrate. At 18 days I just replaced it. I am wondering if I should have just turned it off and then back on like you said.
But I figure 18 days to start with is great. It was starting to get a little red around the senser and felt a lot better after I removed and relocated the next one.

[Dalia]

Hi. I am new here.
How to prolong sensor life? Sometimes it helps gentle massage or warming -up around sensor insertion place.

[It Ain't Over]

Hi. I am new here.
How to prolong sensor life? Sometimes it helps gentle massage or warming -up around sensor insertion place.

I would think that would get the blood flowing in the area and that would contibute to a better start at least. Not bad, I will try that tonight with the next senser insertion.

[poodlebone]

Massaging the area can help when the sensor seems to have gotten "stuck", which usually happens during periods of inactivity. I guess the interstitial fluid just kind of sits there in a stagnant pool. Getting it moving around helps. Drinking water & staying hydrated also helps. I don't know if massaging the area before inserting would be a good idea, maybe that would cause more bleeding upon insertion?

Sometimes if I end up sleeping right on the sensor my sensor readings will suddenly drop. Removing the pressure from the sensor (shifting position so I'm not laying on it!) and massaging the area usually gets my sensor back to normal in a short time.

[It Ain't Over]

I have a question on the senser failure. So far everytime I have seen it read 'Bad Senser' it is preceded with one or two 'Calibraton Failed' notices.
The last time I saw that the isig was 5.8, but the pump was reading over 40 points off and had been right on the money just an hour before.
Is that the normal routine seen when a senser gives out? Does an out of whack reading and an attempt to calibrage tell it to quit?

[Ark nana]

Sometime when all else fails, I just turn the sencor off for a while. Last night it was waking me up with a high signal and I knew I wasn't so I just turned it off and went back to sleep. The next morn. I just hit reconnect old sencor and it was fine. Was that O.K.?? Sometimes it takes a couple of calibrations to get on track. Thanks always for the help. We are in this together.

[poodlebone]

I have a question on the senser failure. So far everytime I have seen it read 'Bad Senser' it is preceded with one or two 'Calibraton Failed' notices.
The last time I saw that the isig was 5.8, but the pump was reading over 40 points off and had been right on the money just an hour before.
Is that the normal routine seen when a senser gives out? Does an out of whack reading and an attempt to calibrage tell it to quit?

You can tell in advance if you'll get a CAL ERROR or not. When you check your BG to do a calibration, check the isig first. Then divide your meter BG by the isig. If that number does not fall between 2 - 20, you will get an error. You may still get an error if it's in that range but close to either end.

You will get a Bad Sensor after two Cal Errors. Do as Ark Nana suggested, and turn the sensor off for awhile. Turn it on and see if you can calibrate again later. Not 5 minutes later, give it a little time.

An isig of 5.8 is very low unless your BG was also very low but since you got a Cal Error I'm assuming your BG was over 100. The isig does decrease as the sensor ages. If turning the sensor off & then on again later doesn't do anything, just pull the sensor and insert a new one.

[It Ain't Over]

Ok, the BG at that time was 139, so the calibration factor would have been 24. Out of bounds.
Thanks for the information.