Once upon a time the most annoying piece of technology we had to deal with was a rotary phone, then it was a photocopier, now it is the notification!
It used to be the only beeping that annoyed us was the alarm clock, but now they are constant. Text message! Email! Update! Post! Weather alert! Meet your step counts! We even have notifications going off to remind us to disconnect and breathe! When we add diabetes technology to that world the beep fatigue is very real and can be very detrimental to our mental and physical health.
Too many alerts increase the number of interactions we have with diabetes. This increases our thinking about diabetes and how much time and energy it takes from our daily lives. Alerts can help us sleep secure knowing we have a low blood sugar warning, but they can also wake us unnecessarily, further deteriorating our health and increasing stress.
Knowledge is power and helps us manage our diabetes world with empowerment and confidence, but it can also overwhelm and suffocate us in a sea of anxiety-inducing, attention-robbing data.
So how can we reduce the impact of alerts, while still making the most of our technology?
> Set USEFUL high and low alerts.
High and low alerts should signal us to ACTION! We don’t need to know every time our management is remotely suboptimal. If our blood sugar runs high then an alert set too low will only leave us frustrated and burdened. And low alerts set too high can increase fears and anxieties around low blood sugars or drive us to under bolus or avoid corrections leading to elevated blood sugars. I recommend setting targets so that you get one high or low blood sugar notification daily. (If you’re having more than one significant low blood sugar per day seek assistance from your prescriber to adjust your insulin therapy to reduce lows) Then work to reduce that one daily alert to none. When you go a couple of days with no alerts, tighten in the high/low alert value and work on reducing the frequency of that one. If life is getting rough and management is taking a less dominant role, widen those alerts to give you a little more mental space. Alerts should not be notifications of imperfection. Alerts should not be disciplinary slaps on our wrists for messing up, and they shouldn’t be tools to shame or embarrass us into better behaviors. They should be motivational and empowering calls to action.
> Use rise and fall alerts sparingly!
Do you need your CGM to let you know you just ate? Do you need it to let you know when your bolus is working and dropping blood sugar? For most of us the answer is NO! rapid rise alerts can be helpful to let us know we missed a bolus, but rapid fall alerts can also scare us half to death for no real reason (A fast drop from 240 to 200 is generally nothing to be alarmed about). So save those rise and fall alerts for times when you need the extra warning for safety, like workouts; or for times when things should otherwise be stable and a sudden move would be unexpected like sleeping or at work.
> ONE AT A TIME!
With pumps, apps, CGMs watches and more all alerting us about our diabetes management it is important to be selective about which of these will alert for what. Don’t have your Dexcom app and your Tandem pump both alert for a high at 220 when the control IQ system will alert for a high about 200! That is three alerts for the same event! Don’t have your child’s phone and your phone both alert at the same level! For younger children eliminate non-safety-related alerts entirely. For older children taking on their own management set their alerts to give them an opportunity to take action and the caregiver’s alert wider for safety backup in case they don’t act. To support a young adult or partner set your alerts only for safety and allow them the freedom to make mistakes without comment unless they ask you to do otherwise.
> Schedule alerts appropriately!
Some CGMs allow us to schedule what alerts we will get at different times or different days. This is hugely helpful at reducing unwanted or unneeded alerts that, while they might help our blood sugar management, could ruin our mental health! At 2 in the afternoon, I’m at my desk at work and would really like to know if my blood sugar is still above 160 from lunch, which signals me that I could benefit from taking action. However, if I am on stage performing at 2 pm that same alert could be from a case of nerves and completely ruin a performance! Likewise, I might want to know about a blood sugar of 80 on a busy day, but being woken up at 3 am for the remarkably lovely overnight blood sugar of 80 would be infuriating for me. Use scheduled alerts to reduce alert fatigue.
> Select your tech!
Not all tech is created equal. Some CGMs are notorious for having rigid alert options. (yes we’re looking at you Guardian) and some hybrid closed loop systems seem to demand more attention than a small child (yup still looking at you Medtronic) While others are so quiet and gentle that we can easily sleep right through major situations (thanks for not generally disrupting my sleep Tandem but I once went a good part of the night with a massive high blood sugar and ketones because the high alert was too quiet and the vibration too soft to wake me) Does your CGM pair to a watch so you can use haptic alerts and not wake your roommates? Did you know that there are also lights that you can get that turn on when your phone gets an alert? This could be life-saving for someone with hearing deficits or heavy sleepers. Does your system partner to a follow app so a loved one can get a notification of a life-threatening situation even hundred of miles away? Do you need a louder alert? Try investing in an amplifier.
> Share the burden!
This is a MUST for caregivers of people with type 1. Being the only watchdog over another human is exhausting! Have someone else who can respond to alerts. If you don’t have another person in your household recruit babysitters, grandparents, friends, anyone for even a night here or there! Hand that beep over to the school nurse for the day and turn your alerts off (I promise this does not make you a bad parent!). Maybe sharing the burden of alerts looks like alternating nights, days, or one day one person takes highs and the other lows so you don’t have to hear two phones going off all the time. For independent adults, this can even mean having someone you trust take the alarms for you for a time. Maybe your partner can take on helping you remember to change an infusion set instead of having a pump beep about it. Maybe they can take on your low alerts during vacation and be tasked with bringing you a sweet treat with a wink rather than you having to get a buzz and trudge to get it yourself. Diabetes never gives us a break, so having even a short time where someone else can take on even a part of the burden is hugely helpful at maintaining longevity and it also helps those around us feel more welcomed and needed in our diabetes world. And, studies have shown that sharing our diabetes data with a loved one actually improves our diabetes management! Win-win!
> Reminder, or another ignored beep?
Let’s face it, anyone living with diabetes tech for any period of time has gotten really REALLY good at ignoring it! Most of us can clear a CGM alert without looking while juggling chainsaws! (not recommended!) So, if you set a site change reminder for 3 days, but over the last 30 days you’ve never changed on day 3, you have not used the reminder to change your behavior, you have used it to reinforce your behavior! You started out ignoring the need to change the site, and now you ignore the need and the alert! So don’t set alerts you’re just going to ignore. Then you will not ACT on the others! You’ll ignore the reminder alert, then get a high alert groan eye roll, and ignore that one too! And low insulin alerts should be set with enough insulin that you’re not always scrambling for a vial, but not so high that you’ve got no sense of urgency to actually motivate you to fill the thing!
> Don’t repeat yourself!
We want alerts to drive us to action, but once we’ve taken action the alert needs to stop. Repeated alerts can drive us to over action. We recommend setting low repeats to at least 30 minutes to allow the CGM data to catch up to finger stick data. This way we don’t over-treat lows. We also recommend setting high repeats to at least 2 hours to allow one correction bolus delivered time to actually begin to drop blood sugar before following up with another correction which can easily lead to insulin stacking and a big low.
> Reduce your overall notification load
DO you need a missed meal alert? Do you need to know that the blood sugar you just manually entered is below your target range? DO you need to hear a beep when a bolus is finished delivering? Do you need to know that a new episode of your favorite show just became available or the score of the game at 3 am? DO you need to know when you got another spam email or when random people on social medial have something to say at every hour of the day? For most people, the answer to all of these is going to be NO! Don’t drive yourself crazy with the plague of our age FOMO (fear of missing out) cut the beeps, the notification banners, the little red dot with an ever-growing number. If it’s not going to make you unsafe do you really need it? Is it making you happy or just hyper? Reduce the overall notification burden on your life and then you’ll have a little more digital bandwidth for your diabetes management, and probably be happier and healthier overall.
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