Medtronic Guardian Real-time Manuale Utente

1LeeErbe,NP‐BC,CDEMedicalUniversityofSouthCarolinaCharleston,SC9/12/2014ObjectivesIdentify problem-solving options and management patterns r

10Insulin Pump: Continuous Subcutaneous Insulin Infusion (CSII)Insulin pumps areprogrammed to slowly deliver insulin from the pump to the body throug

11Patient Selection CriteriaAn ideal candidate: Is self-motivated and monitors regularly Wants to improve glucose control Desires to live a more no

12Multiple Daily Dose vs. Insulin Pump (CSII)Variable Bolus OptionsSquare-wave bolus Slower delivery of insulin over longer period of time Good for

13BolusCalculatoror“Wizard” Takesintoconsideration: TargetBG Carbohydratecount BGbeforethemeal Amountofinsulin“onboard” Encouraget

14On Board Insulin (Active Insulin)Bolus Amount1 hr 2 hr 3 hr 4 hr 5 hr6 units 4.8 3.6 2.4 1.2 010 units86420Patient Knowledge and SkillsQuestion the

15PumpsandFlyingRecs Cartridgeshouldonlycontain1.5mlofinsulin Disconnectpumpbeforetakeoff At cruisingaltitude, takethecartridgeo

16AfterDCCTandEDIC Intensivetherapyaimedatnormalizingglucoselevelsreducesthedevelopmentandprogressionofalldiabetic‐specificcomplica

17AppropriateusesofCGMS• Tracking/trendinginformationorpatternmanagement• Immediatefeedbackonhowlifestylechangesaffectglucoselevels• Re

18ReducedA1c UsingtheGuardian®Real‐TimeSystem AllonintensiveinsulinwithA1cofatleast8.1% 156completed Providerintervention 3arms

192010ADAStandardsofMedicalCareinGlucoseMonitoring• Continuousglucosemonitoring(CGM)inconjunctionwithintensiveinsulinregimenscanbe

2ADA AACEFPG (mg/dL)70-130 <1102 hr. PPG (mg/dL)<180 < 140A1c(%) <7.0 <6.5Glycemic Goals: ADA and AACE GuidelinesNote: Values are for

20CommonFeatures• Systemincludesareceiver/display,transmitterandsubcutaneoussensor• Mechanicaldeviceusedtoinsertsensors• Wirelesssystem•

21DexcomG4PlatinumMedtronicGuardian®REAL‐TimeSystemReceiverSize 4.5”x2.3”x0.85” 2.0”x3.2”x0.77”ReceiverWeight 2.9oz 2.8ozReceiverPower Rech

22ComputerSoftwareDexcom– GlucoseTrendhttp://www.thecgmresourcecenter.com/image_library.aspxRevieweventmarkersandsubsequentglucosecontrol

23Dexcom– HourlyTrendsAllencompassingreporttoeasilyreviewbothglucosetrendsandglycemicvariabilityhttp://www.thecgmresourcecenter.com/image_

24DeviceSettingsProvidedbyMedtronicrepresentativeOverviewProvidedbyMedtronicrepresentative

25Summary CGMShavebeenproventoassistwithloweringA1cwithoutincreasinghypoglycemia NotareplacementforSMBG Helpfulforspecificpatien

3CGS iPro RecorderMedtroniciProProfessionalCGM 3daysensorinsertedforpatientatofficevisit Patientkeepsadiaryofevents Canreturnfor

4ParadigmRevel InsulinpumpwithbuiltinCGM IndicateduseinchildrenTSlimInsulinPump

5T‐SlimInsulinPump ColorTouchScreen MicroDeliveryTechnology 300unitsCartridge RechargeableBattery(7daysofpower) USBconnectivity Sl

6Guardian REAL TimeMedtronicGuardian®REAL‐TimeSystem Age>7years Specificallydesignedversionindicatedforage7‐17years Notintendedt

7Minimed 530GEnliteDexcom Platinum G4Continuous Glucose MonitorAccess real time BG readingsTrends– 1, 3, 6, 12, 24 hour graphAlarms—personal high/low

8ClinicalIndicationsofCGMSTolowerA1CNocturnalHypoglycemiaHypoglycemiaUnawarenessPersistentdisablinghypoglycemiaIdentificationofglycemicex

9ApprovedinEuropenowFDAsubmittedinUScurrentlyUsesDexcomtechnologytocommunicatetopumpLithiumbatterylifeupto3weeksBolusincrements(0