Night time alarms

[Spathiphyllum]

... Going low seems, from all that I've heard and read in the last 18 months, to be more damaging than going high. If that is an incorrect understanding, why are the International consensus recommendations from the 2019 ADA Conference promulgating Clinical Targets for Continuous Glucose Monitoring for Time in Range as depicted in Figure 1? Notably under 4% below 3.9 and under 25% for above 10.0?

https://diabetesjournals.org/view-large/figure/3249168/dci190028f1.jpeg

Proud, condolences regarding your house sale! But, returning to Pandy8's husband's problem with multiple night-time alarms:

The link you posted is only to one chart from the 2019 international consensus statement on clinical targets, not the full statement/article. Here is the full text: https://diabetesjournals.org/care/a...cal-Targets-for-Continuous-Glucose-Monitoring . Amongst other things, it says this:

"When applying the CGM metrics in clinical practice, it may be more meaningful and motivating to communicate to people with diabetes the importance of working to reduce the time spent <70 mg/dL (.9 mmol/L) to less than 1 h per day and time spent <54 mg/dL (.0 mmol/L) to less than 15 min per day, rather than using <4% and <1%, respectively, as the goal." (If you download the PDF of the paper, this is at page 1600.)

So the international consensus, at least as of 2019, from dozens of experts around the world including the UK, and supported by the American and European diabetes associations, is that it's ok to dip below 3.9, provided it's for less than an hour a day. (And even below 3, provided it's for less than 15 minutes a day.) If you generally keep your glucose levels at or above 3.9 during the day, waking yourself up at night every time your levels dip even briefly below 3.9 may well mean a lot of unnecessary sleep disruption, which is itself harmful to your health.

Bottom line, though-- the problem Pandy8 describes is something her husband really must discuss with his consultant!! Obviously the best solution would be to find a way of adjusting his insulin and/or his carbohydrate consumption so that his alarms didn't keep going off overnight.

Personally-- to stop being woken up repeatedly, I didn't only (as mentioned in a previous post) lower the level at which my low-glucose alarm went off; I also started always checking my glucose level, and the way the arrows were pointing, before bed, and having a little snack if it seemed advisable.

And, looking just now at my graphs, I now see this has actually been the key thing! Since making this change, I haven't even gone below 3.9 at night; almost every night coasting in the range of 5-7.

(Although Pandy8's husband's alarm levels may need changing too, if Pandy8 is right in saying that his high alarm is set at 9.8 and his low at 4.5 ... Surely that would be bound to cause glucose ping-pong?? The only point of having the alarms is to make corrections. High alarm, inject some insulin-- with such a tight range, high risk of overcorrection-- leading to low alarm, consume some carbs-- with such a tight range, high risk of overcorrection-- rinse and repeat and end up completely wrung out the next day ...)

Anyway, Pandy8, I hope for you and your husband's sake you get this sorted out! All the best.

 

[Vamppir8]

Hi folks, could you please give me a steer on what is normal for you? T1 husband with Libre often has multiple alarms, high and low overnight. His overall figures are good with +90% in range. He says it must be because he isn’t managing BG well enough. I am concerned about the impact on sleep. How do others manage things overnight, please?

I leave mine in the bathroom at night, had me up every few hours first 2 nights with hypos that did not exist. Get up test with blood monitor 6.7.... libra 3.2... then wait 10 minutes and test with libra 6.4. I believe pressure and heat has some impact on it reading your blood and as its on back of arm. Strange thing is that when I download graph the hypos are not on it... It can be wildly inaccurate at the best of times. Yesterday on libra testing test strips 5.9, scanned 10.5, another test meter 8.3.

 

[rebrascora]

It can take a little while to learn not to lie on the sensor or find a place on your arm where it doesn't cause a problem with compression lows. Personally I think it is important to keep my testing gear within arm's reach at all times, so I would not be happy if the Libre was in a different room during the night particularly, because if you wake up with a proper hypo, you don't want to be getting out of bed and stumbling around looking for it when you are groggy with sleep and incapacitated by a hypo. I am pretty sure you can disable the alarm if you are getting lots of false alarms during the night.

The reason for some of the inaccuracy and that the graph doesn't show those lows is that Libre uses previous sensor readings to extrapolate in order to predict what your BG will be from the interstitial reading the sensor obtains. If you lie on the sensor for a while the compression will suggest that your levels are dropping and it will alarm and warn you but then that causes you to move position and your reading goes back up to where it was before and the algorithm realizes you couldn't have dipped and risen in such a short space of time so it essentially edits that bit out because it knows it got the prediction wrong. To me I think it is cheating..... it is like kids sitting an exam, then being shown the answers and going back and correcting their mistakes before handing their paper in. Maybe I see things a bit too black and white... 🙄 I guess the important thing is that you don't erroneously get red on your graph and your TIR stats negatively affected by it.

It is the same with the inaccurate results. The only tie I compare finger prick BG with Libre reading is when my levels are nice and stable usually for at least half an hour with no food or active insulin in my system to significantly affect my levels. If my levels are changing quite rapidly then it is a waste of time and a test strip comparing them unless I need to know the actual reading, like when hypo or recovering from one or Libre showing my levels heading for a hypo when I have just eaten something and I need to know if I need a Jelly baby to fend off a hypo or if the food is already releasing glucose but it hasn't yet reached the interstitial fluid.

 

[Vamppir8]

It can take a little while to learn not to lie on the sensor or find a place on your arm where it doesn't cause a problem with compression lows. Personally I think it is important to keep my testing gear within arm's reach at all times, so I would not be happy if the Libre was in a different room during the night particularly, because if you wake up with a proper hypo, you don't want to be getting out of bed and stumbling around looking for it when you are groggy with sleep and incapacitated by a hypo. I am pretty sure you can disable the alarm if you are getting lots of false alarms during the night.

The reason for some of the inaccuracy and that the graph doesn't show those lows is that Libre uses previous sensor readings to extrapolate in order to predict what your BG will be from the interstitial reading the sensor obtains. If you lie on the sensor for a while the compression will suggest that your levels are dropping and it will alarm and warn you but then that causes you to move position and your reading goes back up to where it was before and the algorithm realizes you couldn't have dipped and risen in such a short space of time so it essentially edits that bit out because it knows it got the prediction wrong. To me I think it is cheating..... it is like kids sitting an exam, then being shown the answers and going back and correcting their mistakes before handing their paper in. Maybe I see things a bit too black and white... 🙄 I guess the important thing is that you don't erroneously get red on your graph and your TIR stats negatively affected by it.

It is the same with the inaccurate results. The only tie I compare finger prick BG with Libre reading is when my levels are nice and stable usually for at least half an hour with no food or active insulin in my system to significantly affect my levels. If my levels are changing quite rapidly then it is a waste of time and a test strip comparing them unless I need to know the actual reading, like when hypo or recovering from one or Libre showing my levels heading for a hypo when I have just eaten something and I need to know if I need a Jelly baby to fend off a hypo or if the food is already releasing glucose but it hasn't yet reached the interstitial fluid.

Thanks for that, very informative. I also find it inaccurate the higher it goes, 10 and above. 5 and it's spot on.

 

[rebrascora]

Yes that is common although with Libre 1 I find that most of my in range readings are about 1mmol lower than a finger prick and if I am low (hypo), it exaggerates the difference a bit more and higher will be about the same or slightly higher once I get to mid teens..... but I rarely go anywhere near those high levels now.
Quite a few people say that Libre 2 is more accurate "in range", but I may struggle with that when I have to swap over to it because I have learned to factor in that 1mmol discrepancy to my mental approach... ie if Libre says I am 4.5 and dropping fast, I know I still have enough time to eat a slower acting carb rather than a JB because I am actually about 5.5. After 3 years you just develop an intuition of responding to the information it gives rather than stopping and thinking about it so I will no doubt be caught out a bit when I eventually upgrade.... I am hanging on till the bitter end with my Libre 1 though because it works really well for me and I value my sleep too much to have it disrupted by alarms.

 

[Pandy8]

I am really grateful to you all for your input. I will suggest that my husband reads the whole of this thread as it has interesting points on accuracy of meters/sensors and safe ranges. Yes, I really hope this will reassure him to make some changes. The trouble is that he thinks that this is all par for the course and just another annoying thing to put up with.

 

[rebrascora]

The trouble is that he thinks that this is all par for the course and just another annoying thing to put up with.

Sometimes it is par for the course.... until you fix it.... but it certainly should not be a regular persistent occurrence. Ie it will likely happen occasionally from time to time until you find the cause and rectify it. It absolutely should not be going on multiple times a night.... night after night. Most nights should be alarm free. Hopefully he will get help to find the cause and get it sorted soon. Good sleep is more important to diabetes management than good Libre stats and even if he won't sort it for himself, he needs to give you more consideration in my opinion.