Can someone who’s had success with this CGM please give some advice on how to insert the damn thing? I’ve been on it for a couple of months, and the last month or so has plagued me with problems.
I’ve used my abdomen without too many problems, but I tend to “flatline” (i.e. dead sensor) rather quickly. It’s not a good choice for me as it makes it nearly impossible to rotate CGM sites along with pump sites. Also, in the summer, when I’m swimming, I like to have my pump site and CGM concealed under a bathing suit: usually the pump at my hip/rear-end, and the CGM on the inside of my thigh. My thigh is really my favorite place for the CGM – when it works.
I’m not particularly muscular, but I’m also quite lean, so it’s hard to find a spot that won’t hit a muscle, giving me a painful bruise and a sensor that lasts a day, if that.
My specific questions:
Where, other than abdomen, do you use the CGM?
If you use your legs, where and HOW do you insert it? i.e. seated in a chair (leg bent at the knee), seated on a bed (legs straight), standing? Different muscles in the legs contract at different times, so it’s really difficult to get in a position where I’m not striking a muscle, and then moving to another position without then feeling pain.
Do you pull off the back-half of the adhesive before or after removing the introducer needle? Any tricks to pulling the needle out without flailing it about underneath the skin?
What on earth is the “Reconnect old sensor” menu option for? How is it different than “Find lost sensor”?
I hate the IV3000, and hate pulling out body hair when removing it. I usually cover the transmitter and sensor each with a piece of breathable clear medical tape. Could this be a problem?
I know somebody is going to chime in and say I should get a Dexcom. And when I see the pictures online of the tiny little Dexcom on someone’s arm, I wonder if I went the correct route in getting what I’ve got. (I also watched to Kerri’s (SixUntilMe.com) video about ‘A day at the beach’; where she wears her pump in the ocean, and I wonder if I even went the correct route getting another Medtronic pump. But this is what I have, it’ll be at least three years before I can get another one, so I’ll need to make it work. Any advice?
I had a lot of trouble with my CGM at first, and they ended up sending me a new one. This was after calling the troubleshooting line several times. The new one worked like a charm! You may check to see if yours is really working properly.
It is important to use the inserter when putting your sensor. If you are lean, you can rock the inserter backward a bit (so the needle is pointing a bit farther out than usual). If you do that, you will be decrease the angle and not go so far in. Keeping it taped is another important part of making sure it stays working. I tape the sensor and transmittor seperately. I am active and tend to sweat, and this helps the moisture not to get trapped beneath the tape.
I use the back of my arm sometimes for the sensor. I also use my outer leg (just below the hip). I put it in standing up. I try to never use my abdomen for the catheter that the insulin goes in. That way, it stays pretty open for the sensor, but it is nice to have those other sites as well. Hope this helps.
I had issues in the beginning as well but found two things that greatly improved my results.
I use the top of my thigh about 8 inches above the knee and that gives me the best readings for the longest time. those sites usually last 7 to 10 days!! I know medtronic does not make it to last that long but it works for me and saves my insurance company money so it works.
I do the insertion the night before I switch it so it has time to get accustom to the area and that makes all the difference in the world. just insert and don’t connect till morning. I leave both in the working one and new one then switch it over after the 15 min charge and bam I am up and running with great readings closely matching my meter.
answering your tape question It should not be an issue but I keep mine all covered with a tagaderm to prevent wetness and what not.
I hope this helps a bit. ohh I like to use my arms and flanks as sites as well they work well when I follow my insertion way.
Thanks for your help Med464. So you are doing it directly above the knee, not off to either side? Are you standing or sitting when you do that? I always find that I think it goes in OK, but when the muscles move, it hurts. (I had a sensor in my leg for about 6 hours today before ripping it out. It hurt when I walked, and it said my blood sugar was 136 the whole time with no variation whatsoever – obviously not a good insertion).
You can switch it over from one site to another and not lose any monitoring time? I thought the transmitter needed to be connected for two hours before it started the readings (regardless of when you “Start New Sensor”), and the sensor sitting there without the transmitter didn’t really do anything.
I’m already on my second inserter. After finding that the sensor didn’t go in all the way, I called Medtronic and they sent me a second one. I know it’s important to use it (not sure why), unlike the regular infusion sets which I do manually. Everyone always said to tip the sensor forward to get more of an angle… I’ve been really trying to do that, thinking that it wasn’t deep enough and that’s why my results were bad. (Once, when it wasn’t tipped forward, after half a day or so of working fine, I kept getting LOW alarms – CGM read below 40 mg/dL, Isig was 4, but my OneTouch was 114!). I’ll try tipping backwards next time. Do you pinch the skin to get a good insertion spot, or do you do the opposite and stretch it out?
When you say you got “a new one”, are you referring to the transmitter? Because of the pain and difficulties in inserting it, I’m pretty sure that’s the problem. On the few times I get a good insertion, the CGM works really well.
Thanks for the advice. I know I’m asking lots of questions. I really like the CGM, but it bugs me that I can’t get it to work and I keep wasting sensors! I want it to work!!
I usually put the sensor in the night before (let it “marinate”) and start first thing in the morning. It leaves me with a night of no sensor but the sensor works so much better for me if it has time to sit before starting. When you actually do start the sensor you will get the signal to add a blood sugar almost right away.
I can’t really help with where to put it as I usually do not put my pump sites in my abdomen because I use that mostly for the sensors.
Yes I insert it above the knee but higher up where the fat is and not off to the side. I insert it while sitting because I can feel the fatty area needed.
As for the sensor it is posed to have the two hr start up but when you let it sit like that for a while and get accustom to its place the cgm will prompt you within 5 mins to give the bg number and then you are set. I run with mine and do lots of walking and heavy lifting and not to mention I am exposed to high temps and my cgm seems to do well despite all of that when it is on my thigh.
Sorry to hear you are having trouble with the MM CGM. I have been using them (mostly) successfully since February. Maybe something I do can help.
First, I always insert the sensor into my leg. This frees up more room for my infusion set (stomach usually). I aim to put the senor in my inner thigh. Describing the location may be a little tough. I aim for 2-5 inches below my hip the area that is meatier (or fattier). If you take a cross-section of your leg where 12 is straight up and 6 is straight down (when sitting in a chair) I aim for 1 to 2 o'clock on my inner thigh.
When inserting I sit down and keep my leg as loose as possible. I try to insert at a 60 degree angle (although I am unclear if a deeper angle helps). I have inserted the sensor too far down my leg and hit muscle and it is no fun, but readings were decently accurate. I was stuborn and kept it in for over 24 hours. It ached with every step and left a huge bruise when I removed it. I do not pinch the skin, but I do push the sensertor slightly into my skin. Next hit the button and insert (often the worst part of my week). Then, I carefully remove the bigger sticker cover and the large needle. I pull the needle out slow and steady and hate how it feels coming out. I have a hand on the sensor to make sure it does not move while removing the needle. I lost a sensor from it comming partly out due to movement when taking out the needle.
Next, I charge the transmitter for 20-30 minutes (allows sensor to marinate). After it is charged I carefully attach the transmitter to the senor and cover it with tagaderm and try to forget it is even there.
I think the "reconnect to old sensor" feature can be used when you time out and no readings are tranfered from your transmitter to pump in the 40 minute time frame. I recently got some new sensors that are only lasting 5 to 5.5 days. My previous batch was lasting 6-9 days.
I only use my abdomen so I won’t really be much help w/ the leg issues.
I have been having really inconsistent results lately, particularly after longer runs (10+miles, long for me anyway!), it just reads 40. I talked to MM just yesterday (only 7 miles, same problem…) and they suggested using “reconnect old sensor” when the CGM is not in line with my BG, to keep it from getting “overcalibrated”? They are sending me a couple of new sensors tomorrow, just bicycling today (heh heh heh) and short run tomorrow, 7 on Thursday and then 18 on Saturday so we’ll see if it’s the sensor?
I use this stuff called Flexfix Opsite tape to stick the things on. It will fill up a “bubble” with sweat sometimes and I’ll poke it w/ a lancet to drain the sucker.
Capin, I remember you giving me this advice previously. I used my legs for awhile and it was great, but then I ran into the problems. Thanks for the advice, again. I think I may need to do a better job holding the sensor down with one hand while pulling out the needle. I also realized that I should be holding the “feet” of the serter with my other hand, otherwise it might not go in all the way. (I held the Serter against my skin without a sensor and hit the button, and even then the white plastic hit my skin with a painful amount of force, so I can see how it may have a tendency to pull away if not held down).
I still need to find the best spot on my legs though… either that or gain a ton of weight. It’s tough to find the right spot, and once it’s found, even tougher to rotate!
Interesting interpretation on the “Reconnect old” menu option. When I thought I’ve had a really bad calibration throw off my results, I’ve often selected “Start new”, thinking my seed calibration would take effect immediately. I’ll bet the two options do the same thing - except the “Start new” option restarts the 3-day clock, whereas the “Reconnect old” does not.
Strange that this even happens though. I’ve been told that the CGM only looks at the most recent calibration, not a combination of the last several calibrations. I’m a math guy, I’d love to know the algorithm they use. Thanks for the input!
Are you doing the cal factor (calibration factor)? A tech told me about it, a few weeks ago. For a calibration to be good, formula is: meter bg divided by isig = cal factor. If that resulting number is between 1.5 and 20, it will be a good calibration.
Regarding the reconnect old sensor, my CDE told me not to do that, but to use the new sensor option instead.
One thing I learned yesterday afternoon, is when I insert a new sensor and then start it, I check the isig number right off the bat. Mine was well over 100.??, and it has been tracking much better. So I’m assuming that the higher the isig is in the beginning, the better the sensor is going to be. I’ve had them in the 200’s before right off, and those were good. I’ve had them start off in the double digits, and those have not been good. However, none of this registered until today (still Thursday for me).
One other thing I’ve learned this week…is that discovering I’m highly sensitive to an antibiotic I’ve taken off and on through the years, is that it has greatly increased my insulin sensitivity. NOT good in this respect. Doc had me D/C the RX, and pharmacy has told me, that it will take 2 full days to get out of my system. So you might want to keep that in mind as well - RX’s can screw with the interstitial fluid big time, even if fingerpokes appear to be fine.
I do only my abdomen, so no help with the legs. I have noticed though, that there are some areas better than others. My usual spot is just below the breast about 2 inches, but I don’t think that you want want to try that area. The next best area, for me, is just above the waistline.
Your # 3…I pull the back half of the adhesive off, before pulling the needle out. Try holding the sides of the clear plastic (?) part, and pull the needle out at the same angle in which you inserted it. What angle are you inserting at? I usually do 60 - 65 degrees insertion, but have started doing 70 degree insertion. If you are inserting at 45 degrees or less, is when you will have the most difficulty.
Your # 5… the tape you are using should be just fine, as long as it holds the transmitter firmly in place.
It’s been a few days since I’ve gotten to read this entire thread, but someone (you?) sounded like they were trying to insert with the rubber needle guard still on. If so, take it off before attempting to insert. I forgot to do it on one insertion, and it hurt like hell. I usually have no pain whatsoever when inserting, and have had only one or two small bleeders.
I started on the Guardian cgm in April (no pump), but had used the Navigator for 1-1/2 years prior. I will say that I much prefer the 90 degree straight in insertion, over the angled insertions.
I have read on another website that the calibration factor can be used to gage how well your sensor is performing like Thrisha is describing. The sensor contains a gel or glue substance that reacts/changes in the presence of glucose (your SG). The sensor then transmits this raw data number to the pump as an ISIG number. As the sensor ages the gel reactive substance decreases how well it changes in the presence of glucose (your SG). This leads to a reduction in you calibration factor. Therefore your pump can extrapolate and predict what your SG is based off of the sensor’s ISIG value. Also, if your calibration factor drops (too) low, then your sensor will not be as reactive to BG changes and will die soon. I believe that I higher calibration factor correlates to a more accurate sensor with an longer life.
The other useful news that I learned while talking to tech support is that your pump uses your last 4 calibrations to help determine your SG. The pump puts slightly more weight on the newer values (likely due to the aging sensor and decreasing calibration factor values). I have been using this to my advantage. If I calibrate with a poorer number (like when my BG is not flatlining), I can wait until my BG is where I will get better calibrations and do a few calibrations (every 15 minutes) to remove the bad calibration from use.
That is good to know Capin. It certainly explains the “flatlining” I see when a sensor dies… I had always though it was due to the sensor not being inserted properly and not being able to “touch” the interstitial fluid (what does SG stand for, by the way?). Based on my observations, and those from others (yourself included), it seems like there is a large variance in the quality of the sensors. Perhaps it has to do with the shipping (I found a cardboard box full of sensors left by UPS at my front door on an 80-degree day once), the packaging (the plastic bag doesn’t protect it as well as the harder plastic used with infusion sets) or just the production quality overall.
Also, thanks for the calibration info. I’ve given plenty of poor calibrations before, because after testing my BG (fingerstick) and the number appears on the pump screen, I don’t see the arrows and know if I’m stable or not… so I suppose it takes an hour (four 15-minute intervals) to rid itself of that bad calibration.
Thanks Trisha. I am definitely taking the plastic guard off first! First I remove the “clear” parts (guard and tape on the front, then insert the needle. Then: sometimes I remove the needle before pulling off the tape on the back, sometimes pull the back (white) tape before removing the needle. That is where my question really lies. I certainly don’t take all the tape off before inserting, or I’ll end up with a crumpled mess.
I don’t have much fat on my body, so I’ve been trying to do a bit more than 45 degrees, but I think that’s where I’ve been hitting muscle, so I’ve relaxed back to 45. As I mentioned earlier, the last time I used my fingers on my other hand to hold down the feet of the Serter when inserting and it seemed to have helped. At least that one time. I also use the Silhouette (angled) infusion sets.
No Dexcom push here–I LOVE my Medtronic CGM (most of the time)!
I wear the sensor in my abdomen and the pump connection in my stomach. Makes rotation really easy: keep them both on the same side and move around, then switch sides. I have had problems when placing the sensor in obscure places. I lose the sensor constantly.
Never use legs. Have trouble laying on it, so keep away from legs, sides, etc. Plus above lost sensor comment.
Always insert with the back half attached so it doesn’t jam up the works.
I do not have a lot of luck with these, so I tend to do new sensor. Thing to remember is it resets your “time.” If you have had the sensor in for two days, then “find new,” it starts counting again. That is why “find” (if it has a weak sensor) and “reconnect” (if you turn it off while swimming, for example) are features.
Am a girl, so do not have those problems. Anything you use to hold it down will be sticky!
Couple of tips. I wear a sensor for a week. Insert Saturday night with the existing sensor attached. In the morning, charge transmitterr and connect new sensor. Sometimes it starts really fast, but usually takes the normal time–which belies the whole idea of “wetting” a ensor. I think it has more to do with connection to the pump and getting it to syncronize. It will ask for the first reading when the ISIGs are in the correct range and stable. I have never found any difference in a sensor with ISIGs above or below 100 at the beginning. On Wednesday (3 days) I start new again, and then on Saturday once more. I get better readings Wed-Sat. I never calibrate when I am below 70 or above 170.
That said, I generally (not always) range about 10 points difference from a blood reading. If my BG is really high it can take a while to get resyncrhonized. Low is kind of the same.
It takes time to find what works for you. There will be lots of tips to try here. Some will work for you, and some won’t. One of the reasons D is an individual sport!
Keep at it–you just need to experiment and learn some more!
Thanks for the long, descriptive response T1F! I’ve generally found that my site (whether infusion site or CGM site) gets irritating at different times - and I tend to keep them for as long as they will go - so I really can’t keep the two in the same rotation pattern. (Also, on days like yesterday when my infusion site was a bit painful, I replaced it but kept the same reservoir/tubing, throwing synchronization off even further!).
Right now I’ve got the sensor in my left leg (on the inside, so I don’t lie down on it) - figured I’d give it another shot and it seems to be working so far. Sometimes the pump loses the signal, but it gets it back before timing-out.
As far as #3, I guess I wasn’t too clear. I definitely keep the tape on when I insert it, but after it’s inserted, do you remove the tape or the needle first? There’s a YouTube video (here) where the girl in the video starts to pull off the back half of the tape, then changes her mind and pulls out the needle first. (I also have the same hesitation before pushing the inserter button as she does!).
My trainer told me nothing about ISIGs. I’ve learned all of what I know about it on Tu. Are there any basic directions/rules that I should know aout it? (I know that there is a multiplier which converts it to BG, but that’s more informational and not directional).
Scott,
The girl in the video, should have went ahead and pulled it off, before pulling the needle out. However, I don’t pull it from the end that she was going to do so. I lift it just a bit, and pull from the end closest to insertion. Hope this helps.
Trisha
