It’s been a while.
Anyway, I wanted to scribble something down about something that’s been massively contributing both to my overall health but also been an ongoing source of mental and emotional stress over the last 8 months or so.
That fucking alarm.
Shortly after I started work in August, after a run of hypos while on-call, I decided I needed to finally bite the bullet and invest in dexcom. It’s too easy to become engrossed in a busy shift and start to mistake the tell-tale rise in heart rate as just a side-effect of dashing between wards, and so I needed a helping hand.
Dexcom provided exactly that. It nudges me when my BG is falling too fast, or when it’s dipped below the magic line. I turned off the rate rise and high alarms because I wanted to treat it as a safety valve most of the time. And all was well.
Then I started to have some night hypos.
The incessant blaring alarm. Every 5 minutes. Dragging me from my sleep, or even worse dragging my girlfriend from her sleep to wake me. And then I blearily try to treat the hypo, but the alarm doesn’t care. Until the BG starts to shift it won’t shut up.
I understand why. There’s a lag between blood glucose and interstitial glucose. The sugar I put in my mouth has to reach my gut and be absorbed into my bloodstream, make its way around my heart and lungs and heart and then head back out on its way toward the slightly too generous layer of subcutaneous fat on my abdomen where the tiny Dexcom filament sits. Until that starts to sense an increase, the danger is still present.
None of this makes it any easier to live with. My sleep is precious. I live in a perpetual state of exhaustion. The hours I manage to get each night are important to me. I already live with diabetes-related disruptions to my sleep. The 4am pee because I misjudged my dinner when I got in at 2230. The near wakening every time I turn because I’m acutely aware of my sensor and my pump and position myself carefully so I don’t rip either of them out in the night. The hangover-with-none-of-the-fun-memories from the hypo overnight. The adrenaline release when hypo at night that stops me getting back to sleep. So another thing really. really. grates.
Alarm fatigue is something that everyone in healthcare is familiar with. Every piece of equipment has some sort of safety feature built into it that makes it bong or screech when a trigger is met. The problem is that systems are so risk-sensitive that the bonging threshold is incredibly low and so some devices seem to spend more time bonging than not. Over time, people pay less attention to the alarms because they’re always going off, and it’s always nothing. This is bad, because when this happens the alarm can be going off because of something serious, and it’ll be ignored. This is not a new problem in hospitals, but it’s one that’s getting worse and it’s something that almost no one has any good ideas how to fix. It’s also something that’s been observed in studies looking at CGM use in people with diabetes.
What I have isn’t alarm fatigue (although I’m certainly fatigued). What I have is:
Every time my Dexcom starts alerting me to to a hypo at night, I wake up (or am woken up by my long-suffering girlfriend) FURIOUS.
I. JUST. CANNOT. FUCKING BELIEVE THAT THIS NOISE IS INTRUDING INTO MY SLEEP. WHY AM I NOT ALLOWED TO JUST SLEEP.
In the best cases, I treat, it resolves quickly and I angrily shut my eyes and go back to sleep.
In the worst cases I treat. My BG rises. I go back to sleep. Then it dips again. AND THAT FUCKING NOISE STARTS UP AGAIN. I treat. Sleep. Repeat. Steam starts to blow out of my ears.
At 5 in the morning, these episodes can really stir up my most petulant and toddler-like tendencies. Sometimes I switch off my phone so there can be no more bonging. I’ve stopped and immediately re-started the sensor session to buy myself two hours of silence. Once I ripped the sensor out and slammed it onto the bedside table. I know that none of these is a good thing to do, and they’re all variously a bit unsafe.
I know, I know
I could probably do more to prevent these night hypos. If I ate better, carb counted better, exercised more/less, made better use of temporary basals, whatever. I’m sure there’s probably some sort of magic diet someone’s flogging out there that could solve all my woes. But I live an imperfect, messy life. My days are rarely directly comparable. Everything is an ever-shifting mess of interconnected variables that would be better if a bunch of things further upstream had just gone differently.
And sometimes I’ll finish work at 2200 and I’ll want pizza for dinner, because it’s easy and it’s hot, and it makes me feel better. And no matter how many times you try and flog it to me, tomato sauce and cheese on a base made of grated cauliflower is not, and never will be, pizza. And either way, night hypos are inevitable at some point (no matter how infrequent they might be).
I’m still trying to figure out how to make it easier to live at night with the thing that makes living my days so much safer. If I figure it out, I’ll let you know.