New Enhanced Enlite

About a month ago Medtronic sent out a News Release about their "Enhanced Enlite" that would be available to consumers in Canada in October.


It sounds like it's got some pretty sweet improvements. The site talks about reduced sensor size (80% reduction in the size of what sits under the skin), new sensor design that will allow it to give better daily performance, new adhesive that's less likely to irritate skin, and changes to the connection between the sensor and transmitter.

I originally saw the news because I subscribe to Medtronic Canada on twitter. They tweeted about it, so I replied and asked whether customers on their Automatic Supply Agreement would be automatically switched to the new sensors in October.

Medtronic Canada's reply

Medtronic Canada's reply

They replied that no, users would have to call in and request the switch, since customers can decide whether they want to switch.

Very cool! I haven't called yet, but my next Automatic Supply order isn't due til the end of October, so I've got a bit of time to get it done :).


Sensor Bruise

I inserted a new sensor this afternoon. It bled a bit, but not much. I waited a few minutes, and after noticing no new blood, I attached the transmitter. I started a new transmitter on my pump then hopped in the car to do some shopping.

The sensor hurt. It was sore and hurt every time the fabric of my jeans stretched over it.  I started walking carefully to avoid jarring it, since it was aching more the more I moved.

I picked up groceries and noticed something odd as I got back in the car: a tiny red spot on my jeans. I checked it out when I got home, and not only had it kept bleeding badly enough to soak through my jeans, but it also left one huge mofo of a bruise on either side.

ow ow ow.

Sensor bruise in my leg

Ow ow ow.

Accuracy has thus far been crap, although the sensor has only been in for around 6 hours so I know I'll need to wait until tomorrow (and calibrate a few more times) before I can expect my sensor graph to be any good.


Still: Ow.


Alllllmost 6...


...Well, 5 days 23 hours isn't bad?

Such a good sensor, right up until around 5am...

Such a good sensor, right up until around 5am...


I suppose that's not completely accurate though. I probably only got around 5 days 19hrs of good use out of the sensor, but I left it in for a few extra hours before I pulled it because I thought it might come back from this. Nope!


Aw well; new sensor is in. I inserted this one at work! Other than not having a mirror so I could see better, and also the constant worry that someone would walk into my office and freak out (no one did), it went very smoothly!




Rafting and pump supplies

I went whitewater rafting this weekend.  I spoke to my d-team in advance so I could have a solid plan for switching to injections for a day, since my last pump vacation was a bit of a disaster. This time around wasn't perfect,  but it was pretty damn good!

I disconnected from my pump and left it in a cooler in the car (along with my transmitter) after giving a bolus for half of my morning basal insulin.  We decided  to go with half because
     a) rafting is a ton of exercise (possible lows),
     b) I would be in the sun all day (again,  another trigger for lows), and
     c) On my last "pump vacation, " I went super low for a loooong time (so my full dose of basal insulin would probably cause -- you guessed it -- lows!)

I went low somewhere during the safety training. 2 bottles of juice and a banana for me, & then we were off to the boats! The rafting team had my emergency bag in their dry bag; Boyfriend and another close friend both had glucose gel packs in the pockets of their shorts, and I felt as prepared for the day as I could possibly be.

By lunch I was 15.7. Hardly surprising,  since I gobbled down around 90g of carbs to treat the low before we left... At lunch I added together the insulin I'd need for the correction,  the meal bolus, and the "missed basal" bolus, then gave 2/3 of the whole thing, and by the time we finished for the day I was back at 5.6. I think I'd call this a successful(ish) pump-free day. I've obviously got a bit of work to do to fix what happened in the morning, but I stayed safe all day and ended up with a good #, so I'm happy with it!

Of course,  whitewater rafting beat the crap out of both my sensor and infusion set site. The infusion set (big bloody mess) still worked but was extremely sore afterwards,  so it has been changed to a new location. The sensor was also pretty badly squished and abused throughout the day (and gave me a sensor error when I first reconnected it) but seems to be working fairly well again. The excess tape that I had to use to hold it down is making the whole thing feel like a big sticky glob of constantly damp and itchy grossn.ess on my side, but at least it's only 36 hours until I'm due for a new sensor.


Arm site

I replaced yesterday's wonky sensor...


Arm sensor

New sensor site


I've never used an arm site for either my cgm or for an infusion set, but the Medtronic rep told me in my cgm training that as far as "off-label" sites go, users have reported very good results with using their upper arms. This sensor has been on for about 12 hours,  and so far it's been pretty accurate.


Here's hoping it works for at least 5.5 more days!


Failed sensor



Biiiig fail. Big, big fail.

wtf sensor? Not even close.


Ok, that's weird. Maybe I should wait a bit? That's only 90 minutes of weird numbers. Yeah, let's give it some more time.





Now 3 hours of this? Jumping from 12 with double arrows up to 5 or 6 with arrows down? I did some fingerstick testing through this, and I was gradually rising. I went from about 7 to 10 over those three hours, but verrry slowly. My real BG values were definitely nothing like what the sensor was showing me!


I called Medtronic  to ask if this sensor could be saved, whether by restarting it or recalibrating. The rep explained that results like this were most likely from the sensor being pulled partway out of the skin. When the sensor is pushed back, deeper into the skin, it becomes fully saturated with interstitial fluid and will give a higher BG reading. When the sensor gets pulled partway out of the skin it isn't reading as much interstitial fluid, so the sensor BG values will be low.

I waited it out and the problem continued, so I removed the sensor. The whole thing was bent, almost by 90 degrees!


This whole thing has been way too frustrating. I'm getting very, very sick of getting only 4-5 days of usage out of each sensor instead of the full 6 days.



CGM: My experience so far

When I started on CGM, things were going fairly well.  I was getting mostly accurate readings, and in general I had few complaints. My sensors felt ok, weren't overly irritating, and all of the alarms it gave me were for good reasons. It woke me up a few times for overnight lows, and overall I was starting to feel pretty cautiously optimistic about integrating cgm into life.


Lately though, I've been having some issues with my cgms. On Tuesday night I started getting "LOST SENSOR" alarms. After trying to reconnect to a sensor (one that was only 5 days old), and failing, I called Medtronic to ask what could cause an error like that. The rep told me it was most likely a transmitter battery issue, which to be honest was frustrating to hear. I charged the transmitter before starting my last sensor, so having it die after only 5 days was more than a little bit annoying. I removed the sensor and fully charged the transmitter after being told that Medtronic would replace the sensor that I had to pull out early.


My sensor stock was at 2, so luckily I still had enough to start a new one early. After the transmitter was charged, I tried out a new sensor...and then:






I've only been on cgm for about 3 weeks, and in that time I had not experienced any bleeding when I inserted a sensor. None. At all.


This time, though? SO much blood.  I followed the cgm instructions and put pressure on the sensor, and it stopped bleeding pretty quickly. I still had the issue of dealing with the blood-soaked tape that goes under the transmitter. The blood pretty much wrecked the stickiness of the tape, so I had to clip off some of it as I couldn't get it to stick to the skin. I called Medtronic again at this point - I know it might have been an overreaction, but as I'd never had any bleeding at all, I was wondering whether all of that blood would affect the sensor performance. The rep told me she couldn't say, and that it couldn't hurt to try it out, but not to expect much from it (I'm paraphrasing. She was much more professional than that). She also told me she'd replace the sensor. That's...um? Thanks? Not really why I called, but still nice I suppose.


She was right about the sensor, sort of. It had about 4 days of solid use (reliable numbers, etc) before it started to fail, but when it failed it failed hard. I went to bed with good sugars, and it spent an entire night waking me up with Low Suspend alarms every 90 minutes or so. I eventually turned off the low alarms and tried to get it to shut up, but the Low Suspend alarms just kept coming. By the time I woke up I was 18.6  -- buuut my cgm was showing a nice straight line.


It was only off by 12...

It was only off by 12 mmol/l... ( ~216mg/dl)


*sigh*... not exactly the number I wanted to wake up to on my birthday!


I switched everything yesterday, and this time made sure to separate my cgm and infusion set. I think part of my dissatisfaction with the sites and sensor might have been that the two were very close last time around, and both felt constantly irritated. When I'm always annoyed by a site, I'm just a teensy bit more prone to overreact to things.


Since changing both on Saturday I've been happier...ish. My cgm still trends lower while I'm sleeping, and last night (on a freesh cgm) I still got a few false low alarms. I finally googled it today, and found that apparently Medtronic cgms are sensitive to pressure. A few sites I read (mostly diabetes forums and comments from users) said that if you're sleeping on it, the increased pressure on a sensor can cause false readings.




I prefer to put my cgms in my back. They don't bug me there, and I find the sites to be much more comfortable (aka easier to ignore). I just started a new sensor yesterday, so I've got quite a bit of life left in it - but after this one I'm thinking of trying some new areas. I read a few good things about sensors in the top of the thigh, and I've never had issues with infusions sets there. Some users also recommended the arms, so that's another for the "maybe" list.




CGM Start

CGM start day was... interesting. I got up early to do a set change before breakfast, and since it was an important day, naturally my pump kept giving me "NO DELIVERY" alarms. Every time. I don't know what caused it, but something about the set was blocking the tubing. Infusion sets are expensive, so I really wanted to try to make this one work. I tried reattaching the plunger to the reservoir and manually pushing insulin through the set -- no luck there. I swapped out the new reservoir for the old one, as it still had a few units in it -- & this time, manually pushing insulin through the set worked. I reattach the new reservoir, prime the tubing, and this time it all works just fine.

But wait! It gets better!

I got to the hospital and met with my nurse, the Medtronic nurse, and John (someone else who sees the same endo as I do), and we sat down in a conference room to start the training. My nurse showed us, using a "training" sensor and a pillow shaped like an abdomen, how to do the full sensor start.

We got the chance to use our own "training" sensors to do a practice run first, and I'm glad we did. My sensor jammed up in my serter and failed to insert. It turns out the tape got caught and was preventing it from inserting the sensor :(!

They gave me a new practice sensor, and the second time went off without a hitch, so John and I prepared to insert our first *real* sensors. I chose to put mine on my back, still above the belt line but very far from my abdomen. I know it would have been easier to do it where I could easily see what I was doing, but I also know that having something in my stomach for 6 days would drive me crazy.

I picked a spot, inserted my sensor, waited 5 seconds, and removed the serter. Voila! It was in!

Before even removing the needle, I twisted to pull the top of my skirt down a bit so I could see the sensor clearly.. aaaaand in the process, I rip out my infusion set.

& to make things even better?


So that was fun - being the person who's bleeding from her butt (the top of my butt....but still) while everyone waits for her to catch up. Awesome.

I took a second to remove the sensor needle and apply the overtape at this point. I also used some Skin Prep around the sensor at that time, as I need it to keep things stuck (showers tend to dislodge infusion sets when I don't use Skin Prep 🙁 ), and the Medtronic nurse told me that if I used the Skin Prep prior to inserting the sensor, the sensor would get gummed up by the Skin Prep and might not work properly. I had no idea!

She said it's not a problem to use it as long as the Skin Prep (or any other product that makes skin sticker) is applied around the sensor after it's already in the skin. It felt extremely awkward to try to wipe under the sensor-tape with a Skin Prep swab, but despite that it still seemed to work ok.

My nurse brought me a spare infusion set, so I just swapped it out for a new one. My reservoir was still working and thankfully didn't give me any more "no delivery" alarms...

Medtronic sensors need about 5 minutes for the sensor to "wet" after they're inserted into the skin, so I spent that time setting up my new infusion set. After that, It was time to attach the transmitter and tape the whole thing down.

Overall, I guess the whole thing went pretty well. A few relatively minor setbacks (a test sensor that jammed, a yanked-out infusion set...) did occur, but honestly if I'm ever going to have a sensor-insertion-experience that's filled with drama and unexpected events, it's prbably best that it happened at a hospital :P.

I've since inserted one new sensor, which went fairly smoothly. I can't say I'm comfortable with the process yet, but hopefully that part will come with time.


CGM Day!

Today is CGM day! I'm on my way in to the hospital for my CGM training with my CDE, the nurse from Medtronic who does pump and CGM trainings, and another patient who sees his endo at the same clinic as I do (they sometimes do pump- and CGM-trainings in pairs).

My list of worries includes (but is SO not limited to), in no particular order:
- It will bleed for ever and I'll have to remove the sensor
- They will want me to insert the sensor on my stomach (seems likely), which will hurt (because stomach sites always hurt)
- It will continue to hurt for the life of the sensor
- I will dislike cgm because my first one started with 6 days of discomfort
- I will screw something up with the insertion
- I'll forget something and look like a tool (but I watched all of the Enlite training videos! I swear I did!)
- When it hurts, I will get all teary. I do not want to cry.

...and that's just the beginning. I know that most of these things are either unlikely (3+ minutes of bleeding) or not as bad as I imagine them to be (6 days of discomfort), but knowing that doesn't change my worry level.

Either way, in a few hours I will be hooked up to my cgm. Wish me luck!

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