Training Tips

Help your patients enjoy the holidays!

It’s that time of the year again and whether it’s the carb-rich foods, the unknown recipes, or the scarce food labels (among other things) the holidays can be a tricky time for people living with diabetes. With that in mind, we’re sharing some tips on bolusing and ways to stay active that may help to make the season’s challenges easier to navigate.

Bolusing Tips:

  • No menu? No problem. If a patient is unsure of what they will be eating, a reasonable suggestion may be to deliver some insulin ahead of time. If using a MiniMed™ insulin pump or the InPen™ Smart Insulin pen, a bolus can be delivered before the meal begins to help cover the grams of carbohydrate the patient is certain to eat. Doing so can allow the insulin to begin working and ultimately match up better with the glucose rise from food. Additionally, the patient can then enter and bolus for any additional grams of carbs as they are eaten.
  • Tune into trends. Holiday meals tend to be richer in fat and carbohydrates and therefore break down more slowly in the body; this may lead to unexpected glucose fluctuations. However, continuous glucose monitoring (CGM) can help. If using the Guardian™ Sensor 3 or the Guardian™ Connect system, patients can see this trend happening in real-time. For this reason, it’s important to encourage them to focus on CGM trends and deliver corrections as needed. Additionally, if a patient is noticing post-meal highs in SmartGuard™ Auto Mode, you may suggest splitting the recommended bolus in half, then delivering half at the start of the meal and the other half at the end of the meal. This may help to match the insulin action with the delayed digestion of the meal.
  • When in doubt, correct! After a holiday meal, chances are that glucose values may be elevated. In that case, it’s important to encourage patients to monitor their glucose 1 hour after meals and deliver corrections as needed. Both MiniMed™ insulin pumps and the InPen™ Smart Insulin Pen provide easy to use dose calculators that help to simplify this process. Patients can feel confident knowing their insulin doses are being accurately calculated based on their HCP prescribed settings while their device is also tracking their active insulin to help avoid hypoglycemia.
  • Leverage all resources. While it may be quite difficult to discern the amount of carbohydrates in a slice of apple pie patients don’t have to go at this alone. There are excellent online resources that can help provide guidance in this area. 
    • Beyond Type 1 has a number of lists that include carbohydrate counts for a variety of holiday meals.
    • Calorie King has a comprehensive list of nutrition information for most chain restaurants.
    • Figwee is a wonderful application for visual learners. This tool uses pictures to showcase portion sizes (available only on iOS).

Activity tips:

  • Leverage the Temp Target. For some patients, the fall and winter seasons may mean yard work, family outings or even some seasonal sports. Whatever the case, if doing any type of physical activity and using SmartGuard™ Auto Mode, encourage patients to turn on the Temp Target feature 1-2 hours before activity and leave it on for 1-2 hours after the activity is done. This will prompt the system to deliver less insulin as it aims for a target glucose of 150 mg/dL instead of 120 mg/dL and may help reduce the chance of hypoglycemia while being active. 
  • Use predictive alerts. If using the Guardian™ Connect system, predictive low alerts may allow the user to get ahead of a low glucose event. Alerts can be set for up to an hour before a low is predicted to occur, giving time to plan ahead and even help avoid a low.
  • Keep it cool. Whether your patients are spending time in hot or cold climate this holiday season, remind them about the importance of keeping insulin out of extreme temperatures. Did you know? InPen™ users can benefit from an in-app notification that lets them know when their insulin has been exposed to extreme temperatures.
  • Be prepared. As always, regardless of how a patient delivers their insulin, it is crucial they carry fast-acting carbohydrates (i.e. glucose tablets, or a fun-size pack of candy) in the event of a hypoglycemic event.

As always, training and support related to Medtronic therapies is available from your local Medtronic Clinical Territory Manager and from our 24-Hour Technical Support by calling 1-800-646-4633, option 1. All of us at Medtronic Diabetes wish you and your patients a joyous and safe holiday season.

Important safety information
Medtronic Diabetes insulin infusion pumps, continuous glucose monitoring systems and associated components are limited to sale by or on the order of a physician and should only be used under the direction of a healthcare professional familiar with the risks associated with the use of these systems. Successful operation of the insulin infusion pumps and/or continuous glucose monitoring systems requires adequate vision and hearing to recognize alerts and alarms. 

Medtronic Diabetes Insulin Infusion Pumps
Insulin pump therapy is not recommended for individuals who are unable or unwilling to perform a minimum of four blood glucose tests per day. Insulin pumps use rapid-acting insulin. If your insulin delivery is interrupted for any reason, you must be prepared to replace the missed insulin immediately.

Medtronic Diabetes Continuous Glucose Monitoring (CGM) Systems
The information provided by CGM systems is intended to supplement, not replace, blood glucose information obtained using a home glucose meter. A confirmatory finger stick is required prior to treatment.

Insertion of a glucose sensor may cause bleeding or irritation at the insertion site. Consult a physician immediately if you experience significant pain or if you suspect that the site is infected.

Please visit www.medtronicdiabetes.com/about/safety.html for additional details.

Important Safety Information: MiniMed™ 770G System with SmartGuard™ Technology
The MiniMed™ 770G system is intended for continuous delivery of basal insulin (at user selectable rates) and administration of insulin boluses (in user selectable amounts) for the management of type 1 diabetes mellitus in persons two years of age and older requiring insulin as well as for the continuous monitoring and trending of glucose levels in the fluid under the skin. The MiniMed™ 770G system includes SmartGuard™ technology, which can be programmed to automatically adjust delivery of basal insulin based on continuous glucose monitoring (CGM) sensor glucose (SG) values and can suspend delivery of insulin when the SG value falls below or is predicted to fall below predefined threshold values.

The Medtronic MiniMed™ 770G system consists of the following devices: MiniMed™ 770G insulin pump, the Guardian™ Link (3) transmitter, the Guardian™ Sensor (3), one-press serter, the Accu-Chek® Guide Link blood glucose meter, and the Accu-Chek® Guide test strips. The system requires a prescription.

The Guardian™ Sensor (3) has not been evaluated and is not intended to be used directly for making therapy adjustments, but rather to provide an indication of when a fingerstick may be required. All therapy adjustments should be based on measurements obtained using a blood glucose meter and not on values provided by the Guardian™ Sensor (3).

All therapy adjustments should be based on measurements obtained using the Accu-Chek® Guide Link blood glucose meter and not on values provided by the Guardian™ Sensor (3). Always check the pump display to ensure the glucose result shown agrees with the glucose results shown on the Accu-Chek® Guide Link blood glucose meter. Do not calibrate your CGM device or calculate a bolus using a blood glucose meter result taken from an alternative site. It is not recommended to calibrate your CGM device when sensor or blood glucose values are changing rapidly, e.g., following a meal or physical exercise.

WARNING: Do not use the SmartGuard™ Auto Mode for people who require less than 8 units or more than 250 units of total daily insulin per day. A total daily dose of at least 8 units, but no more than 250 units, is required to operate in SmartGuard™ Auto Mode.

WARNING: Do not use the MiniMed™ 770G system until appropriate training has been received from a healthcare professional. Training is essential to ensure the safe use of the MiniMed™ 770G system.

Pump therapy is not recommended for people whose vision or hearing does not allow recognition of pump signals and alarms. Pump therapy is not recommended for people who are unwilling or unable to maintain contact with their healthcare professional. The safety of the MiniMed™ 770G system has not been studied in pregnant women. For complete details of the system, including product and important safety information such as indications, contraindications, warnings and precautions associated with system and its components, please consult https://www.medtronicdiabetes.com/important-safety-information#minimed-770g and the appropriate user guide at https://www.medtronicdiabetes.com/download-library

Important safety information: CGM/Guardian™ Connect system
The Guardian™ Connect system requires a prescription and is indicated for continuous or periodic monitoring of glucose levels in the interstitial fluid under the skin, in patients (14 to 75 years of age) with diabetes mellitus. The system is intended to complement, not replace, information obtained from standard blood glucose monitoring devices, and is not recommended for people who are unwilling or unable to perform a minimum of two meter blood glucose tests per day, or for people who are unable or unwilling to maintain contact with their healthcare professional. The system requires a functioning mobile electronic device with correct settings in place for accurate operation. A non-functioning mobile device or incorrect settings may prevent the app from issuing alerts. Missing alerts may result in undetected low and high glucose levels. For complete details of the system and its components, including warnings, contraindications, and precautions, please consult the user guide at http://www.medtronicdiabetes.com/support/download-library/user-guides and www.medtronicdiabetes.com/importantsafetyinformation.

Important safety information: InPen™
The InPen requires a prescription. It is a home-use reusable pen injector for single-patient use by people with diabetes under the supervision of an adult caregiver, or by a patient age 7 and older for the self-injection of a desired dose of insulin. The pen injector is compatible with Lilly Humalog® U-100 3.0 mL cartridges, Novo Nordisk Novolog® U-100 3.0 mL cartridges, and Novo Nordisk Fiasp® U-100 3.0 mL cartridges and single-use detachable and disposable pen needles (not included). The pen injector allows the user to dial the desired dose from 0.5 to 30 units in one-half (1/2) unit increments.

The InPen dose calculator, a component of the InPen app, is indicated for the management of diabetes by people with diabetes under the supervision of an adult caregiver, or by a patient age 7 and older for calculating an insulin dose or carbohydrate intake based on user entered data.

For an insulin dose based on amount of carbohydrates, a healthcare professional must provide patient-specific target blood glucose, insulin-to-carbohydrate ratio, and insulin sensitivity parameters to be programmed into the software prior to use.

For an insulin dose based on fixed/variable meal sizes, a healthcare professional must provide patient-specific fixed doses/meal sizes to be programmed into the software prior to use.

For additional product and important safety considerations, see User Guide and http://bit.ly/InPenSafety