To sleep, perchance to dream of sleep

I didn’t know what I was going to write about today until exactly 4:19 this morning. That’s when my Dex G-4 woke me up with the news that my blood sugar had dipped below 75 mg/dL five minutes previously.

Why didn’t it wake me up at the time of the low? Because I slept right though the vibration that serves as the first-phase alarm. The Dex was sleeping on the nightstand because she needed recharging and the Dex recharging cable isn’t long enough to reach from the plug to the bed. In fact, it’s not long enough to reach from the plug to much of anywhere at all.

But I digress.

So it’s dark. And I’m tired. I cancel the alarm with my thumb and pry one eye open. I look at the trace line on the face of the Dex. Dinner left me a bit high, cresting at 250 for a short period. Then a bedtime correction on the t:Slim pump brought me nicely back down to target by 1 am. At that point, the trace is dead flat and level at 80 or so all night long, until it coasted a hair low and triggered the alarm.

So now I have three choices. One: I can assume that my super-accurate CGM knows what it’s talking about, take some sugar, suspend the pump, and roll over and try to get back to sleep. Two: I can take a fingerstick so I can be sure what’s really happening. Three: I can ignore it and try to go back to sleep.

Option one is harmless. Even if I’m not quite as low as the CGM thinks, 15 carbs isn’t going to kill me, and I often exercise this option, as it’s most likely to let me get back to sleep. Option two is the “proper” FDA-approved approach, but the extra work and brain-time is more likely to wake me up and prevent me from sleeping the rest of the night. Finally, option three is a loose-loose, because in a low-coasting pattern like this one, the Dex will just re-alarm in thirty minutes and wake me up again. (Note, this third option will work when the CGM does one of its funky chicken dance drops where the sensor signal suddenly “crashes,” then quickly recovers—the all too common nocturnal “V” pattern that drives me fucking crazy.)

For no clear reason, and with my brain only firing on two of its six cylinders, I chose to do the fingerstick. I fumbled in the dark for my meter case (attention developers: what about a glow-in-the-dark meter case?). Unzipped it. Popped open the teststrip vial with my thumb and removed a strip. Then, using diabetes brail, determined which side up it needed to go, inserted it into the mouth of my recalled-but-not-yet-replaced OneTouch Verio IQ, and quickly covered the full-color screen with one hand before it could blind me. Yes in a virtual symphony of design flaws, the Verio has probably the best-ever teststrip port light—a soft-glowing white nightlight across the top of the meter—that’s completely overwhelmed by a FBI interrogation-bright light that blasts out of the face of the meter itself like a nuclear explosion once it gets to the all-white “apply blood” screen. This always makes me appreciate the t:Slim’s mostly black-background screens. I lance the tip of my ring finger with a Accu-Check FastClick that’s Velcroed into the seam of my Verio case, and gently squeeze the finger, bringing up a nice dome of crimson blood. I touch the edge of the blood drop to the stripe on the golden teststrip and Zipppp! The strip wicks in the blood. Then the countdown starts. If you’ve never used the Verio, it has a moving countdown graphic like a doomsday device in a James Bond movie. 5… 4… 3…

By now I’m half awake, wondering if I need to adjust my basal rate.

I close my right eye completely, and squint with my left to read the result without melting my retina.

132 mg/dL.

Crap. Now I’m fully awake. I re-calibrate. The Dexcom magically changes its opinion of my blood sugar from the high sixties to 101. I have to say, I don’t understand how this whole calibration algorithm works. For instance, yesterday the Dex was at 103. The fingerstick was at 104. When I calibrated, the Dex jumped to 112. What’s up with that?

Anyway, when the sun crested the mesa this morning I found myself thinking that over this last eight-tenths of a decade it seems I dream of sleep more than I actually get it. First, I’m not the best sleeper to start with. I often have a hard time shutting off my brain at the end of the day, then once I finally get to sleep I’m easily wakened, and once awake, I have a hard time getting back to sleep again.

So from a sleep hygiene perspective, CGM-enabled diabetes was a pretty bad choice of diseases and gear for me. Although looking at other chronic illnesses, I’m not seeing anything on the list that really jumps out at me as being a whole lot of fun.

But I wonder… how many times have the various CGMs I’ve worn really saved my life at night? And how many nights of sleep have they robbed me of with no real cause? Will the systems I count on to keep me alive put me in an early grave from disturbed sleep, exhaustion, and all the short and long-term health issue that come with it?

I guess it’s a choice between the risk of a fast death vs. the promise of a slow death. Yeah, the damn CGMs are probably killing me a little at a time. But one bad hypo at night and it’s GAME OVER.