Staying in Range While I Sleep.

When I first started using CGM in September this year, one of the features I was most looking forward to having was glucose alerts while I slept.

I’ll be honest. Of all the times of day, night time is by far one of the most difficult times of day to navigate. There’s the after effects of more variable evening meals in play, not to mention dawn phenomenon kicking in and causing a surge in BGLs in the wee hours. To this day, I still look at my blood glucose graphs and struggle to identify overnight patterns because they can vary so much from day to day.

There would be mornings where I’d wake up to the realisation that I hadn’t stirred in the night and checked my blood sugar. Some mornings, I’d be saying thank goodness! to a number between 4 and 8. But there were, equally, other mornings where I would be ridden with guilt seeing a number of 9 or 10 on my meter that I’d most likely been sporting for the majority of the night. Not to mention how difficult diabetes can be when you start your day out of range.

CGM has definitely been enlightening for me in those wee hours of the night while I sleep. One of the first things I quickly picked up on was that my elevated basal rate to combat dawn phenomenon, which usually kicks in at 1am, is now needed pretty much as soon as I fall asleep. How did I not pick up on that sooner!

It’s also nice being able to rest my head on the pillow without hoping I’ll wake up in the middle of the night to check my blood sugar, knowing that my CGM will alert me if my diabetes needs my attention. So far, the alerts are pretty hard to sleep over. They continue to sound, getting progressively louder, until I open the app on my phone to silence it. I also have my phone alert set to ‘vibrate while silent,’ which is another added noise to wake me up.

I originally had my low alert set to 3.9mmol. The problem with that is, I have a tendency not to treat my hypos as promptly as I should. Part of that is that I absolutely hate my orange glucose tabs. But hey, hypo treatments aren’t supposed to be nice, right? Sometimes I attempt to suspend my way out of a low, or am too busy that I just forget. I’ve recently reverted to the system’s default 4.4mmol low alert, and I’m really liking it. Instead of thinking oh crap I’m low!, I’m pleasantly surprised when I realise that I’m not actually low yet and have a bit of a buffer to ward it off.

My high threshold has been at around 9mmol for quite a long time. This actually pre-dates my CGM life. That’s been a realistic target range for me to aim for, and I felt that anything tighter than that was going to lead to me doing more harm than good. But, over time as I’ve gotten better at diabetes, I’ve comfortably lowered that to my current threshold of 8mmol. My blood sugar still does go above 8 from time to time, particularly after I eat, but that alert is still a nice reminder for me during busy days where blood sugars might not get my attention.

As I’ve become more comfortable with my overnight numbers, I have become more aggressive with my blood glucose targets while I sleep. Before I go to bed, I shift my high alert from 8 to 7mmol. I also turn on the setting to ‘repeat’ the alert every hour while high. This way, in the event that a high blood sugar doesn’t go down after I’ve silenced the alert and taken action, I will be alerted again.

For me, hands down the best thing about using CGM is that I no longer wake up with dread wondering what my blood sugar is.

I can honestly say that since I have started CGM, I have seen some of my best ever numbers while I sleep. While a well tuned basal rate is definitely a big factor in this department, I see CGM as an added layer of security that ensures I get my diabetes started on the best foot for the day.

With so many variables in play overnight, CGM ensures that I wake up between 4 and 7mmol almost every morning. I can wake up almost every morning knowing that my blood glucose is fine, or else my CGM would have alerted me otherwise. That still feels somewhat surreal.

That’s exactly why this technology needs to be accessible and affordable to every person with diabetes who wishes to pursue it.

(Even though I’m sporting a rebatteried transmitter, and stretching my sensor life far beyond its limits, I still acknowledge my privilege in being able to do so).

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