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MiniLink, Armed.

MiniLink sensor in my arm.My Minimed rep was meeting me at the dLife offices after work to hook me up with the Medtronic Minilink and I joked in an email that he should hoot like an owl upon arriving so that I would know he was there.

Around 6 pm, my cell phone buzzed.  The message left was not someone saying, "Hi, Kerri.  [RepName] from Medtronic calling," but instead, "Whoooooooo!  I'm here."

That's the mark of someone who's on my level, that's for damn sure.

After exchanging grins, we settled ourselves at a table at a local coffee shop and laid out our drug paraphernalia on the table.  The box of CGM sensors, the MiniLink transmitter, the insertion device, and our respective glucose meters (my rep is also type 1) littered the table.  Conversation flowed easily as he set me up with the MiniLink.

"Okay, so now we're ready to place the sensor."  He loaded up the inserter with my first MiniLink sensor.

"Great.  Let's pop that in on my arm."

He paused. 

"Inserting a sensor at a coffee shop is a first, that's for sure.  But in the arm?  This is a series of firsts for me." 

With a little help and almost no pain at all, the sensor was inserted and the transmitter connected.  (I didn't have the opportunity to take pictures of the actual insertion, but I will do a photojournal for the next sensor I use.) 

After the first three hours, the pros and cons were beginning to show themselves. 

PROS:  The sensor is small - about the diameter of a quarter (maybe a small bit bigger) and about three stacked quarters high.  It's on the back of my arm and is pretty low-profile.  It's also water-proof, so no crazy-sticky shower patches that leave red rings on my skin for days.  The MiniLink transmitter, like the Dexcom, takes two hours to fully calibrate when you first put the sensor on.  (This term is called "wetting," which I think is revolting.  My rep and I called it "percolating."  Much less icky.  And hearkens to coffee, which I need desperately.  I'll explain why in the "cons" section.)

This sensor also works in tandem with my Medtronic 522 insulin pump, so I'm toting around one device instead of a receiver and an insulin pump.  It also is able to calibrate using any glucose meter, so I could continue on testing as usual, using my One Touch Ultra2.   One hub device is a huge selling point for me. 

CONS:  The transmitter is floppy and needs to be secured against my skin with a bandaid to keep it from coming loose or dislodging the wire.  This is the biggest con for this transmitter so far.

HOWEVER:  This frigging thing kept me up all night long.  After being instructed that the CGM results are about 15 - 20 minutes behind my actual blood glucose (i.e. the CGM says 100 mg/dl, my sugar is actually 80 mg/dl or thereabouts), I set my low glucose alarm for 80 mg/dl, assuming my number would actually be close to 60 mg/dl once the alarm sounded. 

Thanks to my vigilance with my overnight basals and the fact that they're set with precision, my numbers run close to 90 mg/dl all night long.  Due to this tight control on my overnights, the low glucose alarm went off eight million times last night.  That was issue one.

Issue two involved another alarm - this one reading "Bad Sensor."  Unfortunately, this alarm went off at 2:53 in the morning and I was not going to wake up again just to reinstall a new sensor.  So, against the advisement of my Minimed rep, I manually told the pump that I had installed a new sensor and recalibrated it.  It reset its timer for the two hour calibration, thus waking me up again at almost 5 am. 

Then the low glucose alarm went off again at 6:15, because I was 79 mg/dl.MiniLink - ha ha ha ha ha!

(Note to self:  Kerri, set the low glucose threshold at 65 mg/dl, for crying out loud.  Or you may never sleep again.  Seriously.  Every time the thing went off, you groaned, the cats howled, and Shoes most likely plotted revenge.  Raise the threshold.  Do it now, you silly girl.)

I have not slept well, but it's obvious that my numbers hold tight and steady throughout the night.  I'm hoping last night's escapades were a fluke thing and that a little tweaking will have me living in relative harmony.  

I'll have more on the technical aspects of this device throughout the week, but for now I'm going to check my number - ah, 113 mg/dl on the Link, 99 mg/dl on my OneTouch - and get another cup of coffee.

I am MiniLink.  :)

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Comments

Ack! Sorry the first night was so eventful.

(And I can just imagine how that freaked out the kitties.)

Kerri,
I have the mini link too, and I stopped using it consistently because the alarms were driving me crazy at night! However, I did have to change my low BG warning level to around 80 because I would tend to be 60 on my meter and my mini link would read me at about 75 or 80. Typically if I caught a low around 80 on my minilink I had enough time to head off a real low. I loved having that security at night, but the random alarms for bad sensors or sensor errors at night were enough for me to chuck the sensor into oblivion! haha I definitely need my sleep, I guess.

Best of luck with the mini link!

Laura
laurasventings@wordpress.com

Hi Kerri,
When I first started with the CGM, I had my low set at 80 and my high at 120 because I was pregnant. My pump is set on vibrate so it would take three alarms before I got an audio alarm which I also ignored. My husband was ready to throw it out the window after two nights. What I want to know is how you got the sensor in your arm. I don't think I could do that so I would love a blow by blow or pictures to see how it is done.
Thanks.

I see nights like that too. And also many nights where I float through at around 90, which is most satisfying.

Note that the Dexcom is now also waterproof, so you don't need that terrible shower patch for it. And it doesn't flop around, so you don't need a bandaid either.

I'm curious, would you be able by yourself to insert the Minimed transmitter on your arm?

I know I couldn't with the Dexcom and I'd need to enroll my darling wife. She's been know to jab me with glucagon and various infusion sets over the years!

Mine was set at 80 originally and went off all freaking night long too. I found changing it to 75 worked. Typically a 74 is about a 65 I find when I actually test.

Unfortunately, I really never got the accuracy to a point where I found it helpful.

Right now I'm 79 and it says I'm 110. Big difference.

I change the low threshold overnight; I keep it at 90 during the day and 70 @ night.

And I use Tagaderm patches (clear tape) + Skin Tac to cover the sensor/transmitter, as I'm quite a sweater (not the fuzzy kind) and I need somethin' sticky to keep the sensors in place (esp. when I work out).

You're right, the first night i used the sensor - i was awake listening to the alarms all night long too. Since the sensors haven't worked for me lately, and i just got a new box of them last week, I will definately be looking forward to reading your blog about your experiences. :]

does it feel weird to have it in your arm though? i can't imagine that one right now. :]

hope to talk to you soon, have a great day! :)

-Mollie

I am so excited to read more about this Kerri. I am really planning on doing this very thing soon.

My 722 is ready to go!

Sorry you had such a terrible night. The first thing that struck me though is how sensitive you must be to noise. I'm sure my CGM couldn't disturb me that often if it tried!

I have my low threshold set at the equivalent of 70 overnight, higher during the day. I also lengthen out the low snooze to its maximum of 1 hour to minimise how often I'm disturbed, since I don't go back to sleep until a fingerstick has me back at a good number anyway. The time taken for the CGM to come back up after a true low can sometimes show quite a lag.

As for the Bad Sensor, that is exactly what I would have done. I think I've only ever had two truly bad sensors and they cost too much to ditch just because the calibration has gone a bit screwy.

Funnily enough I put my first ever sensor in my arm too. Hope you get more sleep tonight!

I had a 3 day study on one of the old models, same size sensor it just connected to this huge beeper thing with a cable. It wasn't real time so it didn't have the low alerts etc. It did however beep a lot during the calibration period. It was very very annoying. I would also suggest something like tegaderm or iv 3000 instead of the band-aid, it did the trick for my sensor. Good luck.

Hey Kerri

The Guardian starter kit includes some tapes that cover the entire unit - sensor and transmitter. Walgreens also sells medical tape rolls. I just rip it like duct tape and slap it across the whole thing (tx and sensor,) about an inch an each side. I wouldn't continue using a bandaid, (especially in the summer.) With good tape it won't be "floppy," it'll just be a bump on you. Plus protect against ripping off from clothes.

I never start new sensors in the evening. Always in the morning as you need to enter BGs and 2 and 5 hours - plus if there are sensor problems it won't bug me at night.

Yeah I sleep through the alarms until they become "siren" alarms - much to my partners annoyance as well.

I've been using for a month now and it's taken me that long to get used to the kinks and tailor it to myself.

good luck james...

Looking forward to the updates! Very cool.

Would love to know if MiniMed is giving any updates on how they're doing w/ getting insurance companies to cover these.

My is being shipped today! I am interested to see the outcome on both of our sensors!

Mine is being shipped today, whoops, don't type while you are low ;).

That 15-20 minute lag would confuse the hell out of me. I hope it works well for you especially with those lousy overnight lows you get.

I was up late due to diabetes too, but mine was a bad site with 400s. Hope tonight is less eventful and more restful.

Question: did you get your insurance to cover the CGM? if so, how? if not, did they deny it or did you just not apply?

Thanks!!

Hilarious to read but so sympathetic for you. Sleep is a hot commodity; no one likes to lose it. I also had first night challenges. Here are a few tips or pointers. The first sensor day is the worst. You only have at max three "GOOD" calibrations in the device so it's points of blood glucose reference are limited (calibrations at 2, 6 and 12 hours). That doesn't mean you should calibrate more. Calibrating more increases the chance of using a "BAD" calibration. Just make sure when you calibrate that your bg is not traveling significantly up or down(best times are when you first wake up and before each meal). Good calibrations are the only time when we would want a medical monitor to be flatlined... CLEAR?

Also, Chelle's suggestion of dropping the low threshold down during the night is a good solution too. I do the same because I also have bg's that dance around the 85-75 range at night...

Lastly, when you get a sensor alarm for a sensor that is not newly inserted - don't reinitiate using "new sensor." Try "find lost sensor" first. It is the third choice on the sensor menu. This will take the calibration period from 2 hours down to 15 minutes giving you back one hour and 45 minutes to organize your shoes. Didn't we cover this on the 10 commandments?

Hoot Hoot!

From - The Percolator...

Sorry Kerri, for hijacking your comments, but "Find Lost Sensor" will only work following a "Lost Sensor" alarm (And then not if you've reached Day 7 of continuous wear when it needs disconnecting and re-initializing to continue giving data. Not that I'd use a single sensor for that long... *ahem*)

What has occurred to me as being strange though is that whenever I've had "Bad sensor" alarms (which have only ever followed 2 "Cal Error" alarms) hitting Start New Sensor has been followed by a Meter BG request and new data within 15 minutes. I'm using up old-stock sensors (the ones that have to be refrigerated) and my MiniLink is over 9 months old. Wondering if things, and specifically the ease of restarts, have changed?

Hi Kerri,

I'm a long time "lurker" of your blog and first time poster. I have a 12 year old daughter using the CGM. One other idea that works for us with the Bad Sensor error - turn off the sensor from the sensor menu on your pump for a couple hours and let it percolate a bit more and then turn it back on. We get a bad sensor almost every other time we insert a new one. Also, just for the record, we HATED the CGM at first because of the alarms at night. As you adjust your settings, it gets easier and now it's hard for us to imagine living without it.

I need that MiniMed rep. That's hilarious.
Did your insurance pay for the CGMS? I am still fighting with my insurance for approval. It's annoying.

Thanks so much for these posts. I know a new pump will be in my future soon, and it'll probably be another Minimed, so CGM is also on my mind, but I'm feeling a bit apprehensive about it. These posts are really helpful in letting me straighten out my thoughts!! :)

Ditto using Tegaderm to keep the transmitter in place, plus it will help prevent those "Bad Sensor" alarms as the sensor will stay firmly in place.

And yes, Minimed will TELL you not to restart an old sensor as a new one, but trust me, they're plenty good for at least 6 days. We've gotten as many as 11 days out of one. When it finally does go bad you'll know because it will be way off or it won't restart, or it will give you cal errors, etc.

Hey Kerri-

Were you saying the floppiness was before you put on a bandaid? Reason I ask is I am a pro bandaid kinda guy and here's why. My bandaids stop flopping and with less hassle. Tegaderm or IV 3000 covers a large area. For folks with skin irritations (like me) that can cause more trouble than it's worth. If I skin flake away why would I need better bg control?

Also, if you are wearing the sensor for periods greater then, um lets say, 6 days, the tape can get funky (think sweating/showering) regardless of your bandaid/tegaderm preference. Using a bandaid allows you to rip off the old one while holding the transmitter in place and put on a new one. I found that when I tried to do that with a patch that covers the whole sensor/transmitter, I would also pull the sensor out of the site. And most importantly, Tegaderm doesn't come in Spiderman or Sponge Bob patterns...

Love the blog and the ideas. THANKS!

Oh, by the way. Nice camera.

Thanks for blogging about this. IT helps me as someone who wants to go on a CGMS in the future. Sorry you didn't sleep well. Hope that stops! I'm kinda glad that Shoes might have been awoken by your diabetes gadgets, though! :)

hey Kerri,

congrats on becoming a "The Best Patient's Weblog" finalist for Medgadgets's Medical Blog Award!

I had the same experience when I got mine late last fall and eventually "paused" using it but am meeting with the trainer this month...Also, 24hr fitness was ready to call Homeland Security when I unhooked and left it in the locker for an intense workout without turning off the "alarm"...vibrate....VIBRATE...beep/vibrate...BEEP/VIBRATE...Car Alarm.....FIRE ALARM...;p
Also, because I had to check it so often that I was worried tugging my shirt up so much would invite a visit from HR...lol

I have been giving the Paradigm REAL-Time Insulin Pump a trial run for the past 2 months. I gave up after a month of using the CGM - as it was causing me to lose sleep (and almost made me lose my job - but I quit it in the end due to not being allowed to inject/test BG's in classroom at school). Anyway, I find it's just as easy keeping BG's in control with finger letting - and adjusting insulin requirments/food intake from there. It may work for others - but for me - 2-3 days was the longest the sensor would work - and that is with making the pump think I had a new sensor, etc. etc. At $45/shot - too expensive for my tastes - despite having insurance covering it.

I may now having to relinquish the loaner pump back to Medtronic - due to them not allowing me to take it on my holidays down south in a few weeks. I will miss the little bugger - but with all the pump training from my diabetes educator (Anne Royer - also a Type 1) - I will be using the knowledge obtained from her to manage on multiple shots (e.g. Poor Man's pump) - until I get another loaner pump from a different manufacturer (want to make sure I purchase the pump I want - rather then being pressured by Medtronic to buy their pump NOW!).

Good luck!

Oh man - do I miss the days of wasting my weekends with the solid gold Zelda cartridge... Sigh...

I never noticed the SUM logo or CGM connection on him before... Oh Yeah - those were back before he was pumping and all.

:-)

I was a lapsed CGM user too- and to the relief of my bery supportive husband who hates the beeping at night. I have it set at 80 and will consider lowering it to 70 during the 11-7 hours. I hated that it beeped incessantly in office meetings -even though noone said anything- I was still embarrassed, but now I keep it on vibrate and find that works best for me. Ditto with the 1 hour delay. What I have noticed is that post prandial blood sugar readings are sometimes high even though they go down- anyone else have this problem?

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