Paradigm is a state of art Insulin pump and this article is aimed at providing simple but complete information on operating a paradigm Insulin pump .
There are 5 buttons in Paradigm pump. These are -
Act, Esc, up scroll, down scroll and B. There is no on / off button.
For starting the pump, battery has to be installed first. For this, the battery cover needs to be opened with the help of a coin, and a new AAA battery should be inserted in the battery compartment and then replace the cover. After placing the battery, it should not be taken out till it is discharged. If by mistake it is taken out then it should not be reused. When pump is on, it will show various icons. First it will show a count down after which the screen goes dark and then the version of the particular pump will appear on the screen eg. Ver 1.4c.Then a dark circle, a battery sign and a syringe sign will appear on the screen and the word Minimed will appear in the middle of the screen
Generally the battery lasts for 10 to 12 days. If there is a Low battery alarm, then the battery should be immediately changed. If the pump displays “No power” and battery is not changed within 45 minutes, then all the previous settings of the pump are erased.
Once pump is tuned on, by pressing The Act button, the main menu can be reached then to select any function, Scroll buttons are used. When desired option is reached, Act must be again pressed to activate that particular option.
On pressing Esc, a summary of pumps functioning is displayed and in addition, Esc is exit button and is used for going back to main menu, from any level.
The Up scroll is for going up the menu, for increasing the numbers and it is also used for taking the easy bolus.
The down scroll is for going down the menu or for decreasing the numbers. It is also used for switching on the light for the screen.
The B is a short cut way to give a bolus.
Once the pump is on, the first thing to do is to set the Time and date. For this the user needs to open the main menu by pressing Act and then reach Utility, in Utility select time/date and again press act. Now, turn the screen On the Time- date setup will be seen, and below this 12 Hour setup and 24 Hour setup can be seen. One of these two choices has to be selected by pressing Act. The pump will now display Time /Date set. On pressing Act again, pump screen will display Set Hour and the Hours will blink. With up scroll button set the hours and press act. Similarly the user needs to set minute, Year, month, day etc. In the end the screen will display Time, Day, Month and year.
When pump is turned on the word “Minimed” is displayed in center, an icon of syringe in left and icon of battery on right is seen.
To see overall status of the pump, just press Esc button needs to be pressed. Then the pump screen will show different functions which are running in pump e.g. Status i.e. the current time for example 12:15, type of insulin 100U, fast, then the Last Bolus taken e.g. N 2.0U with date and time i.e. 11:00 30 OCT, current Basal rate, Reservoir Started with date and time e.g. 29 OCT 08:45 then Units left in the reservoir eg 181.6U Time left for the reservoir to get empty 24 Hours Battery status eg Normal date Tues 30 OCT 2007 serial number and model number of pump
Menu of Paradigm -
On pressing Act the main menu opens and has the following options-
1. Bolus
2. Suspend
3. Basal
4. Prime
5. Utility
1. Bolus - This option is used to set the bolus insulin dose, type of bolus, bolus history etc. Three types of bolus options are available -
• Normal
• Dual
• Square
If a user wants to take Normal bolus then after reaching to Bolus menu, Normal Bolus has to be selected and then Set the dose and finally again press Act to start bolus delivery.
While if user needs Square Wave Bolus, square wave bolus option has to be chosen and implemented by pressing act and Set the dose implement it by pressing act then set the Duration and again use Act to confirm delivery. The Bolus will be delivered in defined duration.
If Dual Wave Bolus is needed then after setting Insulin dose, by using act option the quantity of insulin to be delivered can be decided in units or percentage and quantity of Insulin to be delivered slowly then duration of the square part of Insulin to be defined .
To see bolus history, select Bolus history while Bolus Wizard setup also can be reached via Bolus option of main menu.
In insulin pump, generally there is maximum bolus is set by default to 20 units. This can be changed to desired limit via Max bolus option of Bolus menu.
Similarly there is option to ON the Dual / Square wave bolus, Easy Bolus, Blood Glucose Reminder etc.
2. Suspend - This option is used to suspend the pump .After selecting suspend, Act is pressed. The screen will blink suspend, when Act is pressed again and the pump goes in suspended mode. During Suspend mode pump will not deliver Insulin, and it beeps 6 times every 10 minutes. To restart the pump, simply Act has to be pressed two times.
3. Basal - This option is used to set the basal Insulin infusion rate or rate of background delivery. 48 basal profiles can be set in paradigm.
Basal menu has following features:
• Set / Edit Temp Basal
• Set / Edit Basal
• Basal Review
• Patterns
• Temp Basal Type
Apart from a basal rate setting, a temporary change in basal rate without disturbing the whole settings can be done by Temp Basal option. In addition, a separate basal for holiday or Sunday can be stored as pattern.
4. Prime - for priming the pump the prime button is pressed then rewind the pump by pressing act. The piston of pump will go back with vibration, after completion of rewind three beeps will be heard.
For Fixed Prime, after pressing act on fixed prime the unit for fixed prime is set and then act button is pressed.
Prime History can be seen in menu. Press act to see the Prime history.
Insulin type like U 100 Fast Acting and U 100 regular Acting can be selected and stored.
5. Utility - Press act to go to Utility menu. Now press act to go to alarm, Daily Totals, Time/Date, Alarm Clock, remote options, Meter options, Block, Self Test, Clear Pump, and Language etc. If Act is not pressed after selecting any menu, then the pump goes back to the main screen after 15 seconds.
USING A PUMP - 6 STEPS FOR BEGINNER
1. Filling the reservoir: Take a reservoir, and insert the needle into the rubber of the penfill. Pull the Plunger from reservoir by keeping it downwards. Now fill the insulin for three days use. For e.g. if you require 180 units of insulin for 3 days, you have to fill 1.8 ml insulin in the reservoir. Take out air from the reservoir by keeping it upward. Tap the reservoir slowly so that the air bubbles may release in upward direction. Release the air bubbles from the reservoir by pressing the plunger gradually. Now to detach the transfer guard from reservoir, move the reservoir in anticlockwise direction and plug it upwards. Now take the new infusion set and insert the needle in the reservoir straight and by pressing it move it in the clockwise direction. There will be a click sound after revolving the whole reservoir which indicates that the reservoir has been set properly. Now remove the plunger by unscrewing it.
2. Prime the tubing - prime the pump to remove the air, manual priming is used so that the tube of infusion set is filled with insulin
To prime the pump, press act and go to the menu screen. With the help of Scroll down Button go to Prime and Press the act Button. With the help of Scroll down Button go to the Rewind and Press act Button. By pressing act again the rewinding process starts. During this process the pump vibrates slightly and then beeps 3 times on completion of the rewind. Now the screen will display manual priming Put the reservoir in the pump and turn it clockwise, the pump will display manual prime. Meaning that it is ready for prime. Place the pump vertically and keep pressing act button. The pump will beep while priming and during this the pump screen will display “Disconnect” Keep pressing act till a drop of insulin is seen on the tip of the canula. On seeing the drop of canula, press the Esc button. On pressing Esc the pump will display Fixed Prime. Priming of tubing is completed and cannula is ready for insertion.
3. Insert Cannula - For inserting the cannula clean the skin, with spirit and wait for 1 minute. Insert the canula only after drying the skin. Put the cannula on quick serter and remove the paper from the tape slowly. Load the quick serter by plugging from downwards. Now remove the needle guard slowly by revolving it. Place the quick serter on the cleaned skin and press both the white buttons on it. While keeping the outer tip of cannula pressed raise (pull) the quick serter upwards. Now align the tape with fingers and pull the needle out in straight direction. Fixed priming to fill cannula is next step.
4. Prime the Cannula - The cannula can be primed by pressing the esc button, the pump comes at fixed prime. To remove the air fromcannula fixed priming is done with 0.5 units for 9 mm cannulla and with 0.3 units for 6 mm cannulla. Fixed prime is important for replacing air of cannula.
Now the pump is ready for insulin delivery.
5. Set the basal rate - First basal dose always starts at 12 midnight. By Pressing act menu is opened. Then basal is reached with down arrow key.
By pressing act the basal is set. And then basal is set by pressing act. With the help of arrow keys the insulin dose is set and don't forget to press act to fulfill the command.
To set the second basal rate, set the time with the help of arrow keys. And press act with the help of arrow keys, set time. And then press act button. To set the third basal, set the time with the help of arrow keys, it is set by pressing the act button. With the help of arrow keys units are set by pressing act. In this way a user can set many basal rate profiles and can have from 2 to 48 profiles. As an exercise try to set the following basal rates:
Midnight 12 - 02 am = 0.8 unit per hour
Morning 02 - 05 am = 0.6 unit per hour
Morning 05 - 08 = 0.9 unit per hour
Morning 08 - 11pm = 1.0 unit per hour
11pm to 12 midnight = 0.8 unit per hour
Press act 2 times after setting the last basal dose.
After setting all the basal rates, the screen will display the amount of total insulin in 24 hours as basal. To see the basal profile, go to basal review.
Third screen of basal menu is of basal review. To see the basal review press act to open the menu. With the help of arrow key go to basal and press act. With the help of down arrow key go to basal review. Press act. Here, different basal rates taken in 24 hours can be reviewed.
6. Taking Bolus - To take Bolus dose, go to bolus menu and choose the bolus type. Insulin is immediately delivered when normal bolus is given. To take normal bolus. Press on bolus, the units will blink. With scroll button set the units and press Act. Screen will display "Bolus Delivery" and bolus will be delivered.
By pressing B button pump goes directly on bolus screen.
Setting the Max Bolus Dose: The max dose can be set by going to menu and pressing act. Press the button and go to bolus screen. Press act with the help of arrow button, go to Max bolus. With the help of arrow keys set the max bolus. Max bolus can be set from 00 units to 25 units. Factory setting of max bolus is 10 units.
Bolus History: To see the Bolus histories go to bolus history and press Act. With the help of scroll buttons, last 24 readings can be viewed.
In modern pump the bolus insulin can be delivered according to the type of food. Other than normal; square and dual bolus can also be given. Dual bolus delivers the insulin in 2 different parts. Some insulin is delivered immediately and the rest is delivered in the time span decided by user, where as in square bolus total insulin is delivered slowly in a user defined time span.
To take other type of Bolus -
Dual / Square wave bolus: To activate this press act & open the menu. Press act on Bolus & with the help of go to Dual / Square and press act. Screen will display on/off. With the help of go to "On" and press act. Now whenever, to take a bolus & when set Bolus is pressed the pump screen will display Normal / Square / Dual.
Square Wave Bolus: To take square bolus Press act & go to square bolus. Again press act, the units will blink. With the help of button set the units & press act. The screen will display "Square Duration" & the time will blink. The time can be set from 30 minutes to 8 hours. Set time & press act. Screen will display bolus delivery & square for sometime and empty circles on left side of the word "Minimed" can be seen. Then again the pump will be back on normal screen these circles also go away when the insulin is delivered.
Dual Wave Bolus : To use dual wave bolus, , reach to dual bolus via menu. Now Set total amount of Insulin to be bolused. Then pump will ask amount of bolus now and amount to be bloused as square. First set percentage of bolus now then pump will ask duration of square bolus. This duration may be set from 30 minutes to 8 hours. Finally press act to start dual delivery.
There will be empty circles on left side of the word "Minimed" during square component of bolus dose . Once square component is delivered , pump will display normal screen features.
IMPORTANT PUMP FUNCTIONS -
Insulin left - To Know the Remaining Insulin in the reservoir just use the Esc button.
TDD - For knowing the Total Daily Dose (TDD) reach utility and then Daily total dose and use act option press act. Here the insulin history of last 14 days can be seen
Audio bolus -To take a bolus dose without seeing the pump [audio bolus], can be done with Up scroll button. For setting of easy bolus, go to bolus, then reach easy bolus, the pump will display units. Choose from .01 units to 1.0 unit and press act. . If one has selected 0.5 units, then on pressing up scroll button once, .5 Unit bolus can be delivered .Thus to pump 2 units, user needs to press it 4 times and press act. The pump will set a bolus of 2.0 units and will beep 4times. Press act again for the insulin delivery.
Suspend - To suspend pump: Press act button go to suspend and press act two times.
Temporary Basal - can be used by reaching basal menu and then using the act button set/edit temp basal is selected and by using act option the desired duration can be set.
Dual Bolus - To deliver dual wave bolus, use Act button. And then use set bolus option. With down scroll key reach dual wave Bolus and again use the Act option. Now units will blink. Set units with the help of up scroll key and press act. Screen will display the units blinking on the right side and on the left 50 and square 50, with up and down scroll keys the bolus to be taken immediately and the one to be taken later can be set. This bolus can be set both by units and percentage. For e.g. 25 now and 75 square. Now the time will blink which can be set from 30 minutes to 8 hours. Set time and then press Act button. On screen bolus delivery will appear. After sometime the pump will come back to normal screen and there will be empty circles on both sides of the word "Minimed". In this way the decided dose of Insulin at the time fed in the pump is delivered to the body.
B.G. Reminder - This a alarm like function to remind user to do a blood glucose test. To activate this function, open bolus menu, and activate B.G. reminder set up by selecting "On". Now whenever a bolus is taken pump will ask time of next glucose test. This time can be selected with scroll button and varies from 2 hours to 5 hours.
Remote Option - To On the remote option press act & open the menu. With button go to utility & press act. Again with button go to remote options & press act. On / off on the pump screen will be seen with button go to on and press act. The screen will open remove I.D. menu. See 1) Add ID 2) Delete ID and 3) Review ID. Press act on Add ID. Add remote ID will display. Feed the 6 digit number written on the remote and press act. Now the pump can be operated by remote also.
Meter Option - Press act to on the meter option and open the menu with button go to meter option & press act. The pump screen will display off/on. With key go to on and press act. On the screen will open I.D. menu. In this 1) Add ID 2) Delete ID and 3) Review ID will be shown. Go to Add ID & press act. Now the pump will display Add Meter ID. Feed; the 6 digit number written on the meter on this and press Act.
Block - To on the block option press act & open the menu and go to utility. Press act, with the help of button go to block & press act. Pump screen will display on/off. With button go to on & press act. After activating this pump delivers the basal dose in the pre-decided pattern. But any kind of bolus cannot be taken & the settings of the pump cannot be changed. This option is sometimes useful in kids.
Auto off - To close the pump on a pre-decided time press act & open menu, with arrow key go to utility & press act. Now go to alarm & press act. The screen will display auto off duration and 2 times will blink with button set the time with button set the no. of hours after which the pump has to be closed and also set the time for the no. of hours the pump has to be closed for with the time set, the pump will automatically close with the sound of 3 beeps and the pump screen will display "Auto Off". The pump will beep 6 times every minute. To remove auto off press sel & then act to restart the insulin delivery press ESC and press act.
Low reservoir warning - This is reached by opening the menu after pressing act. With down scroll button go to utility. And again use act option and then the Alarm option is activated. With down button go to low reservoir volume and again use the act option. Pump screen will show reservoir warning type and Insulin units and time written below it.
With button and one can be chosen. If the insulin units are chosen then pump screen will show units blinking. It is possible to set 5 units to 50 units. Set the desired units and again press act. Now whenever the insulin is less then pre-decided units, the pump will give low reservoir alarm and the pump screen will show black solid circles or both sides of the word "Minimed".
If the time option is used then pump screen will display warning time and time will blink. Time can be set from 2 to 24 hours.
For this Set time and again press act. When the pre decided time is over, then pump will give low reservoir alarm and the pump screen will display solid black circles on both sides of word "Minimed".
Common Pump Alarms -
Suspend Alarm - This alarm beeps when the pump is in suspended mode.
Weak Battery - Change the battery immediately when this alarm beeps. If the battery is not changed, within 45 minutes after "No alarm" comes then the pump has to be reset again like basal profile, time etc.
No Delivery - This alarm beeps when the insulin is not delivered for any reason. Immediately check the reservoir, infusion set and if needed change them. In this alarm black filled circles on both sides of the word "Minimed"can be seen.
Low Reservoir Volume - When there is only 20 units insulin left in reservoir then the pump will display "Low Reservoir Volume" and also at 10 units the pump will beep again.
In case of any alarm or error the pump will beep or vibrate six times every minute. To remove alarm or error press ESC & press Act.
Empty Reservoir - This alarm beeps when the insulin is furnished in the reservoir. To remove the alarm press Esc and change the reservoir immediately.
Max Delivery - If 2½ times more insulin is taken within 1 hour then this alarm beeps.
No Delivery - If the insulin is not delivered for any reason, then this alarm beeps. Immediately check reservoir infusion set and change it if needed. In this alarm black solid circles on both sides of the word "Minimed" can be seen.
No Reservoir - This alarm beeps when the reservoir is not installed properly. Take out the reservoir from the pump and reinstall it again.
Off No Power - This alarm beeps when the battery power is totally finished.
The setting of the pump is such that if attention is not paid to the alarms (when insulin delivery is obstructed) for 10 minutes then after that every minute the pump will give a siren. To remove the alarm, or closing of siren press Esc and Press Act.
It is important that after any alarm or error, always self test the pump.
Special Features Alarm - This alarm beeps when any special feature is on. Here empty circles appear on both sides of the word "Minimed".
BOLUS WIZARD -
The required quantity of Bolus dose can be known through the software called Bolus wizard of paradigm pump. In Bolus wizard software, if Blood glucose level & carbs present in the food are informed to pump, then the bolus insulin required is known through the pump.
To use bolus wizard, it has to be activated via Bolus menu. After activating bolus wizard setting, information about carb unit, carb factor, Insulin sensitivity factor needs to be entered then wizard starts working.
Go to bolus wizard setup, and On bolus wizard by set /edit bolus wizard option. Then pump will ask to select carb units as gram or exchange. User should prefer gram as carb counting in gram is a more accurate way. Then Glucose units to be selected i.e. mg/dl or mmol. Then Insulin sensitivity factor needs to be entered with help of scroll button. Lastly blood glucose targets during different time of day should be entered. For example, 12 midnight to 8 am can be 100 mg, 8am to 12 night may be 140 mg.
Now whenever a bolus is planned, pump will ask the user to select bolus wizard or manual bolus. Since pump knows carb factor, current glucose level, Insulin sensitivity factor, last bolus time and dose, amount of Insulin still working from last bolus etc., so pump soft ware can advise user about amount of Insulin to be pushed as bolus.
That’s how paradigm Insulin pump works..