Glukozni senzori

KONTINUIRANI MONITORING GLIKEMIJAVera Zdravkovi

Diabetes mellitus tip 1Hronina bolestBolja metabolika kontrola produava ivot i spreava i odlae komplikacijeProcena kontrole - HbA1c i glikemijeto vie glikemija odreujemo, moemo doneti bolje odluke o doziranju insulinaPreporuke 4x dnevno i poneka nonaSenzor sadri enzim oksidovane glukoze koji omoguava konvertovanje u elektrini signal proporcionalan koncentraciji glukoze u intersticijalnom tkivuGluconic AcidGlucoseOxidase 0.6 voltsGlucose + O2 H2O22H+ + O2 + 2e-Sensor signal (ISIG)

PRINCIP RADA SENZORA3In summary, what you need to know is : Sensor contains the enzyme glucose oxidase, which converts glucose into an electronic signal proportional to the quantity of glucose in the interstitial fluid. You have the previous slides and the chemical formula below as reference

GLUKOZNI SENZORSenzor meri koncentraciju glukoze u intersticijalnom tkivu

Da bi se oitavanja iz intersticijalne tenosti konvertovala u oitavanja glukoze potrebna je kalibracija

Kontrola

17 god: Insulinska pumpa 12 mes: A1c 7.0%

15 god - pumpa 3 god: A1c 6.8%

14 god : 2 dnevne doze insulina: A1c 8.7%KOMPONENTE SISTEMA

Monitor kontinuirano pokazuje oitavanja sa senzora, upozorenja ako je glukoza van dozvoljenih granica, i prikazuje sauvane podatkeMiniLink REAL-Time transmiter je prikaen za senzor i beino alje podatke monitoru na svakih 5 minutaSenzor je smeten pod koom i oitava vrednosti glukoze u intersticijalnom tkivu

Sen-serter je sprava za insertovanje senzora

MiniLink charger slui za punjenje baterije transmitera

Medtronic CareLink Personal Software slui da bi se bolje sagledale eme, statistike i problemi

9(Note to speaker: Read each item and the description)Monitor- The monitor looks much the same as the Paradigm REAL-Time Insulin Pump. Well go through button pushing and programming the monitor a little later.Glucose sensor- This is the same sensor youve used with our other CGM products.Sen-serter This is also the same device that youve used to insert your glucose sensorYour personal BG meter- not included with the system. You may use any BG meter to calibrate your Guardian system.Transmitter- The MiniLink transmitter is smaller, lighter-weight, and can be used without tape. It attaches to the sensor, and the sensor tape is often strong enough to hold it. If you prefer, you can use tape over iteither a transparent tape, like IV3000 or tegaderm, a strip of paper tape, or any other type of tape that you prefer. The MiniLink is small enough that often one piece of transparent tape can cover both the glucose sensor and the MiniLink. The MiniLink Transmitter is rechargeable, using the MiniLink charger. One charge can last as long as 14 days, but its recommended that you charge it after each use, before you put your next glucose sensor on. If you charge it each time, it should take less than 20 minutes to charge completely.Both the Guardian monitor and the MiniLink charger run on one AAA battery.

Guardian REAL-Time

Kontinuirana oitavanja nivoa glukoze u krvi3, 6, 12 & 24 grafikoni Strelice tendencija3 nivoa upozorenjaHigh / Low upozorenjeUpozorenje predvianjaUpozorenje na brzinu promeneRadi uz pomo MiniLink Transmitera10Smaller, more customer friendly menusTrend graphs, arrowsMore alerts than the Paradigm REAL-Time. Ekran: Strelice tendencija Jedna ili dve strelice pored vrednosti koju oitava senzor ukazuju na brz porast ili pad vrednosti glukoze koju oitava senzor (SG)

ta znae streliceVaa SG raste 0.06-0.11 mmol/L u minutu Vaa SG raste 0.11 mmol/L ili vie u minutuVaa SG pada 0.06-0.11 mmol/L u minutuVaa SG pada 0.11 mmol/L ili vie u minutu 11When SG measurements have changed rapidly, Rapid Change Arrows automatically appear in the graphs next to the SG value. You will see one or two arrows associated with rapid change.

Sometimes we also refer to the Rapid Change Arrows as Up and Down arrows. Up arrows indicate that the glucose level has been rising, and down arrows indicate that the glucose level has been falling. The number of arrows indicate how fast the glucose levels have been changing.

Note to speaker- Read chart

Please note that when Rapid Change Arrows appear, it is to provide a visual cue, there is no alarm associated with it. A little later well discuss a Rate of Change alert, which can be set to notify you of rapid rates of change.

Alarmi predvianja neeljenih glikemijaOmoguava upozorenje kada se vrednost koju oitava senzor ( SG ) priblii granicama podeenih opsega

LOW granica je podeena na 4.4mml/l Vreme predvianja je postavljeno na 20minMonitor vas upozorava 20min pre nego to predvia da e SG dostii 4.4 mml/l

HIGH granica je podeena na 13.3mml/lVreme predvianja je postavljeno na 30 minMonitor vas upozorava 30 min pre nego to predviada e SG dostii 13.3 mmol/l12Lets use the example of how John Smith, a fictional patient, might use the Predictive Low Glucose Alert.The low limit of Johns target glucose range is 80 mg/dL, and John has set his Predictive Low Glucose Alert for 20 minutes. So, John will be alerted 20 minutes before his sensor glucose level is expected to reach 80 mg/dL.Note: Your glucose level may not actually reach the level of the Predictive alert if something, such as food, insulin, or activity, impacts your glucose level and changes your glucose trend. For instance, if you receive a predictive low alert, then ate some carbohydrate, you may not actually reach the predicted low. Note to speaker: May compare to driving at a certain MPH, for x number of miles. You can predict what time youll reach your destination, but something could happen, like road construction, that could cause you to arrive sooner or later than predicted.

Dogaaji: bolusi, obroci, rekreacija Enter BG: vrednosti sa meraa koje ne koristite za kalibracijuInsulin: vrsta i dozaMeal: Doruak, ruak,veera,uineExercise: Visok, srednji ili nizak nivo teine treningaOther: Po izboruOmoguava vam da upiete i sauvate relevantne dogaaje

13Enter BG: This is to enter BGs that you dont necessarily want to use for calibration, but when you enter it through this menu, you have the option to use it as a cal.

Insulin: Fast acting, Short acting, Intermediate acting, Long acting, Mixed 70/30, Mixed 50/50

Meal: Breakfast, Lunch, Dinner, Snack (select gm or exch first time)

Exercise: High, Medium, Low Intensity

Other: User determines what he wants it to signify Can be anything that may impact glucose control Stress, illness, medication

Ciljne vrednosti glukoza-programiranje opsegaMogue je programirati 8 opsegaPoetno vreme prvog podeavanja je ponoPodeavanje opsega ini jedna donja i jedna gornja granica za vrednosti glukoze14In the Guardian REAL-Time Continuous Glucose Monitoring System, a pair of high and low glucose values in a specific time period is referred to as 1 Glucose Limit.

Different glucose limits can be set for 8 different time periods a day to accommodate your needs for different time periods. As you can pre-set these, you do not need to re-set them as you go through the day.

The diagram in this slide shows an example of the system being programmed with 2 Glucose Limits. When you enter your glucose limits, the first screen will have a 12:00 am time period pre-selected. This time period is factory set and cannot be changed, so your first glucose limit will always start at 12:00 am. If you set only one glucose limit (one high and low pair), then it will go from 12:00 am until the next 12:00 am. So think about what limits you want at 12:00 am, and set the low and high for that time first. After youve activated those limits, if you want more than one limit setting, set the beginning of the next time period.As you can see on this slide, from 12 AM to 9 AM, the low glucose limit is 90 mg/dL and the high glucose limit is 240 mg/dL. Then at 9 AM, the low and high glucose limits change to 80 mg/dL and 220 mg/dL.Carelink Softver

Adherence ReportMonitoring InformationBolus InformationPrime / Set InformationSuspendInformation

16

Sensor Report17Jedan dan naeg pacijenta

UMESTO ZAKLJUKAGlukozni senzor:Trendovi glikemija tokom 24 h

Alarmi upozorenja

Neprocenjiva je pomo lekaru

Omoguava pacijentu da lake uvidi uticaj hrane, stresa, fizike aktivnosti HVALA

HVALA NA PANJI !

SenzorIglaSensor Elektrodazatiena iglomZadnji deo senzoraTelo senzoraDra za igluO-prstenovi22Here are the sections of the sensor. Never hold the sensor by the introducer needle handle.