Patient training checklist

MiniMed™ 780G system

with GuardianTM Sensor (3)

Technical Training Insulin Pump (Manual Mode)

Patient Name: Date:

Trainer: Infusion Set:

Pump Serial Number: New pump start Upgrade pump start

Patient reviewed and completed the recommended pre-training materials Yes No

Basic features
Button Functions Home Screen Menu Review Status Screens
& Shortcuts
Sleep mode Audio Options Paired devices
Battery Type/Insertion
Status bar icons Display Options
Startup Wizard

Basal
Enter Basal Pattern Change basal rates within a pattern Suspend Delivery / Resume
Set Temp Basal Max Basal Appropriate times to manually suspend

Bolus
Enter Bolus Wizard™ calculator settings Active Max Bolus
Insulin Time Using Manual Bolus
Using Bolus Wizard™ calculator
BG and Carbs BG only Carbs only

Infusion set
Fill reservoir and change infusion set with minimal assistance Importance of site rotation
Infusion set change frequency

Alerts & Alarms

Steps to take to address an alert or alarm

Carelink™ Personal software

Discussed the value of using CareLink™ Personal software Patient referred to instructions for sign-up and
Introduction to the MiniMed™ Mobile app upload
Patient referred to instructions for setting up the app
and how to use the app
Patient Name: Date:

Additional topics have been discussed:

Removal for X-ray, CT scan, MRI Sick Day guidelines
Back-up plan Pump clip

Additional Features (check only those features covered in training):

Summary / Daily History / Alarm History Preset Bolus Setup Block
Preset Temp Setup Dual/Square Wave: Off / On Auto Suspend
Bolus Increment: Easy Bolus
Bolus Speed Self Test

Reminders:
Bolus BG Check: Off / On Low Reservoir
Missed Meal Bolus Set Change

Safety
Active insulin from practice boluses has been cleared
Settings on the Pump Initiation Settings form have been entered and verified to be correct.
Patient has been made aware and taken note of the toll free Technical number: 1(800)284-4416

Was insulin started at this visit: Yes No

If No, plan for insulin initiation:

CGM training scheduled for:

Comments:

Patient signature: Date:

Trainer signature: Date:

Fax completed form within 30 days of training to 1-800-326-8322 or send scan/photo (in pdf format) to your specific Region’s email address:
cptinvoiceon@medtronic.com for ON, cptinvoicewest@medtronic.com for BC/AB/MB/SK,
cptinvoiceeast@medtronic.com for NS/NB/NL/PEI, cptinvoiceqc@medtronic.com for QC
Technical Training CGM (Manual Mode)

Patient Name: Date:

Trainer:

Transmitter Serial Number: New CGM Upgrade CGM

Patient reviewed and completed the recommended pre-training materials Yes No

Patient has Guardian™ Link (3) Transmitter (‘GL3’ imprint on shell) and Guardian™ Sensor (3) Yes No

Sensor glucose vs. blood glucose Trends

Sensor glucose vs. blood glucose Focusing on trends vs. SG value
Single, double, and triple trend arrows

Personalize alerts
Settings reviewed and entered as directed on CGM Initiation Settings form

Low Settings High Settings

Time periods & limits Suspend before low /on low Time Periods & Limits Alert on high
Alert before low Fixed low alert Alert /Time before high Rise Alert/Rise Limit
Alert on low Snooze Fixed high alert Snooze

Connecting pump and transmitter & Sensor insertion

Pairing pump and transmitter Ensuring thumb is on thumbprint when loading serter
Site selection, rotation, and preparation Importance of holding serter against body after insertion
Proper steps to sensor insertion Applying pressure to sensor adhesive

Taping
Importance of applying oval tape Connecting transmitter to sensor
Steps for applying oval tape correctly Applying adhesive tab carefully onto transmitter

Starting the sensor

Starting New Sensor Reading the 3, 6, 12, and 24-hour sensor graphs
Sensor Warm-up Sensor status screen
Home screen and icons

BG Measurements/Calibration
Calibration options Calibration best practices
Every BG reading confirmed on the pump is used
to calibrate the sensor
Patient Name: Date:

Sensor alerts
Responding to Alerts/Alarms Auto resume based on SG Steps to manually resume delivery
Home screen during low suspend 2 hours max suspend Suspend unavailable

Additional topics reviewed:

Charging/Cleaning the transmitter Alert Silence
Removal for X-ray, CT Scan, MRI

Expectations for success with SmartGuard™ technology

SmartGuard™ feature: Do not turn on the option before training
When in SmartGuard™ feature, basal insulin (Auto basal) will automatically be adjusted based on SG values
When in SmartGuard™ feature and Auto Correction is turned on, the system will automatically deliver auto correction
boluses to maximize time in range (3.9 - 10.0 mmol/L)
Give boluses 10-20 minutes before all meals and snacks
You will still be interacting with the pump; the pump screens will guide the actions that need to be taken
Use of CareLink™ Personal software is important
(automatic uploads via MiniMed™ Mobile app or - if app is not being used, regular upload into Carelink™ Personal software)

SmartGuard™ feature training scheduled: Yes No Date:

Comments:

Patient signature: Date:

Trainer signature: Date:

Fax completed form within 30 days of training to 1-800-326-8322 or send scan/photo (in pdf format) to your specific Region’s email address:
cptinvoiceon@medtronic.com for ON, cptinvoicewest@medtronic.com for BC/AB/MB/SK,
cptinvoiceeast@medtronic.com for NS/NB/NL/PEI, cptinvoiceqc@medtronic.com for QC
Technical Training SmartGuard™ feature

Patient Name: Date:

Trainer:

Pump Serial Number:

Patient reviewed and completed the recommended pre-training materials Yes No

General information
Introduction to SmartGuard™ technology

Ensure SmartGuard™ feature readiness

A sensor is on and working Carb Ratio and Active Insulin time entered
Warm-up is complete There is no active Temp Basal, Manual Suspend or Square/Dual Wave bolus

Start SmartGuard™ feature

SmartGuard™ feature turned On Auto Correction On
Auto Basal Target Set point: 5.5 mmol/L 6.1 mmol/L 6.7 mmol/L BG has been entered
(default)
Bolus Increment: SmartGuard™ Checklist

Using SmartGuard™ feature

SmartGuard™ Home screen/graphs Situations that require a BG meter value
Bolus Management when using Temp Target SmartGuard™ exit reasons reviewed
SmartGuard™ feature (safe bolus feature)
Auto Correction Follow instructions on pump screen
Reviewed common alerts and check SmartGuard™ checklist to
Baseline Insulin Delivery stay in SmartGuard™ feature
Reminders for success have been reviewed:
Follow a calibration schedule to ensure calibrations are not missed
Enter a BG anytime requested: BGs are sometimes needed for SmartGuard™ feature
Give boluses before all meals and snacks; give correction boluses when the pump recommends
The system can automatically deliver correction boluses based on SG when needed for correction.
This feature is not available when using Temp Target.
You will still be interacting with the pump; the pump screens will guide you and provide the actions that need to be taken
If SmartGuard™ exit occurs, the goal is to re-enter as soon as possible
If not using MiniMed™ Mobile app, regular CareLink™ Personal software uploads are needed
Review the System User Guide in case of technical questions and/or call Medtronic technical Support 1(800)284-4416.
For therapy related questions call your Healthcare Provider.

SmartGuard™ has been activated: Yes No If no, SmartGuard™ feature start scheduled for:

CPT has provided discharge summary to the clinic/physician: Yes No

Patient signature: Date:

Trainer signature: Date:

Fax completed form within 30 days of training to 1-800-326-8322 or send scan/photo (in pdf format) to your specific Region’s email address:
cptinvoiceon@medtronic.com for ON, cptinvoicewest@medtronic.com for BC/AB/MB/SK,
cptinvoiceeast@medtronic.com for NS/NB/NL/PEI, cptinvoiceqc@medtronic.com for QC
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ACCU-CHEK, ACCU-CHEK GUIDE, and ACCU-CHEK SOFTCLIX are trademarks of Roche Diabetes Care.
DreaMed Diabetes is a trademark of DreaMed Diabetes, Ltd. The MiniMed™ 780G system algorithm includes technology developed by DreaMed
Diabetes CA-DIB-0129-E Rev. 11/2022