Dexcom Alerts During The Night

[crumpy]

Just wondering how others get on with managing their BG during the night and Dexcom alerts.

I've just checked clarity and my wife has had at least one alert overnight (high or low) for 11 of the past 14 nights. Low level set at 3.9 and high at 8.5. She's always struggled with overnight levels and currently has tresiba as her basal. We've got a clinic checkup coming up shortly and were thinking about going down the ominpod route as a pump is the only thing she is yet to try. Any thoughts as I'm concerned about her lack of sleep.

 

[Deleted Account]

If you are convinced the overnight DexCom alerts are due to BG levels, a pump may be very useful as it will allow your wife to have a different basal profile at different times of the day.

However:
- are you sure the alerts are definitely BG issues? Some provide low readings when pressure is applied. This often happens when asleep. For example, when I used a DexCom, it would wake me with alerts telling me my BG was under 3.9 whereas it was really 6.4. The only way of telling is to take a finger prick reading when woken by the alarm.
- is the issue always a too low BG? If the alerts are sometimes high BG and sometimes low BG, it is difficult to set up a basal profile to know in advance which way the BG is going to go. In this case it may be useful to start a diary and see if there are any patterns. For example, I often experienced a night time high after eating pasta and have been trialling double bolus to reduce that night time high.

If your wife choses to go down the pump route, it would be good to talk to her diabetes team to find out
- what are the criteria for a pump in your area? This varies a lot. Some CCGs have a lot of hoops to jump through.
- what pumps are available? An Omnipod seems like a great idea because it is tubeless. However, many CCGs (mine included) do not offer the Omnipod because it is an expensive option. But do not be put off by a tubey pump. I have had one for two and a half years, the tube rarely gets in the way, I can disconnect at any time (which you cannot do with the Omnipod) and when I was forced to go back to injections, recently, my diabetes management went haywire.

One more thought, if the alarms are due to very slight and consistent dips, has your wife considered switching off the alarms overnight for a good night's sleep occasionally? There is obviously some risk with this approach but she needs to weigh up the benefits of a good night's sleep with the risk of high or low BG. One night of slightly out of range BG should not cause major long term complications.

Finally, how does your wife feel? It is lovely that you are concerned for her but if the peace of mind the DexCom provides helps her go back to sleep, there may be nothing to worry about.

 

[crumpy]

Thanks for you reply.

Its definitely BG issues. She always checks alerts with a finger prick and the Dexcom is spot on. She likes the reassurance of the Dexcom as it does wake her up when she is low which she doesn't think will happen without it although her awareness is fine during the day.

It's not always a low alert. She has done endless basal testing it's just her BG seems to have big swings which we think are linked to her menstrual cycle. At some points of the month she has to take 1 unit of Humalog for 10g carbs evening meal and then it'll be 1 to 25g carbs for another week. Its hard to get a handle on it but there is a slight pattern. Think the problem with Tresiba is that it takes 3-4days to feed through a change.

Will discuss the pump options at the app. We bumped into somebody at a local coffee shop who had one and it sounded good. Worth a trial I think.

 

[Juicyj]

Hello @crumpy As she's already exhausted the basal testing route, then keep a diary and record when levels are changing, this way you will be able to see for sure if it's connected to her menstrual cycle, I also have to increase basal rates around 3-5 day prior to starting my period however my total daily needs increase rather than just an overnight high, keeping a diary will check this for sure.

Yes tresiba does take around 3-4 days to see any effects from a dose change, a pump would give you greater flexibility in managing basal changes and a quicker turnaround on seeing the effect too, as your novorapid is acting as both basal and bolus, so should be ideal for her. There are criteria to meet with getting access to a pump, so have a read through the NICE guidelines beforehand, but as she is someone who has a good handle on things and is still struggling there should be some consideration for this, she should of also completed DAFNE too. https://www.nice.org.uk/guidance/ta151

 

[crumpy]

Thanks JucyJ. Will have a look at the guidelines and post back to say how we get on.