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CGM Alarm Fatigue

June 1, 2022
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When you have a device that monitors your glucose levels as a person with type 1 diabetes, you are likely quite familiar with alerts and alarms. At diabetes events, like Friends for Life conferences, or diabetes camps, you will hear an assortment of alarms from pumps, CGMs, smart phones, etc. It can even be fun to try and pick out what beep came from what device.

Less enjoyable are the alarms that we get about our own glucose levels. The feeling that we get when we get a high alert after eating something we know we probably underestimated the carb count for is a feeling that is very unpleasant. Even though we know that diabetes is difficult, it’s still frustrating when you feel like you made a mistake and now are paying for it with hyperglycemia.

What Happens if you Can’t Hear Your Alerts?

But what happens when you stop hearing your alerts? If you have friends with diabetes, you probably have at least one friend (I have a few…) who seem to never hear the alerts on their devices. And what happens when that person is you, and you can’t ever seem to wake up at night to your continuous glucose monitor (CGM) alerts?

There are some ways to help amplify the sound of devices, or using different alarms, especially if you’re adjusting the sounds on a cell phone. I will periodically change my alert noise to help ensure I will wake up from the sound, and this seems to help me. You can also put your phone or CGM Receiver in a glass to amplify the noise from vibration. But sometimes, it’s a case of alarm fatigue, and some other changes may be more helpful.

What is Alarm Fatigue?

There is a term used for when people adapt to alarms after continued use, called “alarm fatigue,” which happens often to healthcare workers, and now that we have so many diabetes technologies, to people with diabetes.1 The other challenge for CGMs is the use of unnecessary or inaccurate alerts, which was particularly common among the earlier generations of CGMs.

As for unnecessary alerts, there are typically ways to minimize the number of alerts that you get from your CGM, insulin pump, or hybrid-closed loop (HCL) system. This also applies for cases where you get your CGM data on multiple devices, such as phone and pump. It can be helpful to relax the alerts on one of the devices so that you’re at least not getting double the alerts. Because doubling the high alert would definitely make me doubly irritated.

Ways to Minimize Alerts:

  • Raise the high alert to something realistic based on your glucose levels, but still safe
    • Example: for adolescents, it’s expected that they will have higher blood glucose levels, so raising the high alert can be helpful, or temporarily turning it off
  • Turn the alerts off on the child’s or partner’s phone, and leaving them on the caregiver or loved one of the person with diabetes (PWD)
  • Consider use of a flash CGM instead of having alerts on devices, even if it’s just temporary2
  • Turn off the rate of change alarms, especially for rising
  • Turn alerts on for only one device, as opposed to both if you use multiple devices

Other Tips and Tricks:

A few years ago, I decided to make my high alert happier sounding, so that when I heard it, I would be less irritated. Honestly, it works, even if it seems silly. It’s a little thing that you can do to help reduce the burden of diabetes. If you’re a parent of a child with diabetes, let them help choose the sounds. (As long as it keeps them safe, of course!)

There are also many challenges with sharing glucose data, and figuring out the best way to navigate relationships with diabetes. Sharing data is something that takes time, patience, and importantly – conversations. And conversations with your healthcare team about your glucose targets and your desires for alert goals could be helpful for preventing or helping reduce alarm fatigue.

Looking forward to all the alerts and alarms at Friends for Life Orlando in a few weeks!

  1. “Turn It Off!”: Diabetes Device Alarm Fatigue Considerations for the Present and the Future
  2. Just Because You Can, Doesn’t Mean You Should … Now. A Practical Approach to Counseling Persons with Diabetes on Use of Optional CGM Alarms

Written and clinically reviewed by Marissa Town, RN, BSN, CDCES