To sleep, perchance to dream… ah that sleepy beautiful bliss. For T1Ds sleep is often our elusive majestic white stag… we know if it out there somewhere but rarely see it. If sleep is our white stag, deep REM sleep is our Pegasus. Why? Because of BGs being low, BGs being really low, BGs being high, BGs being low and then high and then low, BGs being low and then low and then low and then really high, pump sites being torn off in the middle of the night, cats eating through pump tubing (yes that has happened, my rabbit bit through it too once), getting your arm caught in pump tubing, sleeping on a hard square pump, ALARMS; i.e. pump alarms such as low battery, or low reservoirs, CGM alarms for low BG, CGM alarms for high BG, CGM alarms for high BG that is not really high, CGM alarms a low BG that is actually not low, CGM alarms for really really low BGs that is not low at all, and everything else in normal life. I will explain: So again when your BG goes low your body starts shutting down and to protect itself it will focus on your internal organs and the brain, so sleep isn’t necessary, you usually aren’t sleeping well at all somewhere between sleep and awake and you can wake up freezing, sweaty, shaking, or having a hard time breathing, or I have to go the bathroom really really bad, OR all of the above. I actually will have a hell of a time even falling asleep if my BG is dropping fast. It is so much stress on your body you can’t relax at all. Did I mention the symptoms are ever changing for a low BG? For a while I would wake up and my legs would be cold from the inside, like my body slowed down blood flow to my extremities to take care of my organs (which is what is actually can do) and when my BG would start to go back up after treating it I could feel the warmth start to fill my legs. Yes it was very, very creepy. Luckily that symptom only lasted for a couple of months. Sometime I will wake up from shaking so hard. Sometimes I wake up because I am freezing and sweating buckets. Luckily my body wakes me up, this is not the case for all T1Ds. Remember symptoms are different for everyone. High BGs can wake me up too. Sometimes because I can’t breathe, sometimes because my heart is beating so hard I can feel it and hear in my head, or sometimes because I am so thirsty, or sometimes because I have a headache, OR sometimes from all of the above. Also, like I said earlier lows and highs can occur multiple times a night, over and over like a rollercoaster. When I have nights like these I feel like I have a hangover, got hit by a bus, and was rolled back over all at the same time. My CGM can be fantastic at alerting me, I have it on vibrate now because I sleep through the beeping now and I have to wear it on my so the vibrating wakes me up. The only drawback is with the 20% variance the lows and highs can be inaccurate. So say my CGM goes off because it says my BG is low (70), but when I check my BG with my meter it is actually 100, (not low). I will calibrate my CGM to tell my BG is 100, and then my CGM will alert my BG is low again, (this time is reads 77). If my BG is with target range 80-110 this can happen ALL NIGHT. Also a fun little fact: if my CGM reads that my BG is below 55 (very low), it will beep and vibrate incessantly. This is a very necessary life saving feature, but again comes with the 20% variance. So my BG can actually read 70 by meter, which is low, but not as low as 55 when my CGM reads 55. I treat my lows differently. If my BG is below 60 I have to eat twice as many carbs as if it is 60-80. I have found for me that if it is below 60 it will just keep going down unless I have at least 40 carbs. Again every T1D is different. All this applies to the CGM and high BG readings too. That 20% can make a huge difference. Say it reads my BG as 298, but my meter reads 238. Yes 238 is a bit high, but the insulin dosing to correct it is very different. Also depending on what I am doing, like if I am going to be moving for a while, I would not treat 238 when I would definitely treat 298 with insulin. So some nights I have alarms going off because my BG is low or high and some nights it is going off because it thinks it is low or high. The latter happens more often with low BG readings. So why wear the CGM? Because the pros way outweigh all this and it has saved my live more times I can count. So my pump will alarm every 5 minutes when my reservoir, (the part that holds the insulin), is low until I hit a button to turn it off. It is a very sing-songy alarm but annoying non-the less. Also sometimes, not very often, I forget to change it before I go to bed and it runs out of insulin and then alarms every minute, and rightfully so, so then I get to get up and change my pump site and reservoir. Or say my pump site gets torn off while I am sleeping, and yes that wakes me up because it hurts, and then I have to get up and change the site. That is something I REALLY don’t like to do is wake up in the middle of the night and stab myself with the long-ass infusion set needle and sometime it really hurts. I don’t mind it during the day, but there is something about waking up in the night and inflicting pain on yourself. When my pump needs a new battery I have to rewind the cartridge part where the reservoir goes and act like I am changing my site without actually changing my site. I get to do this in the middle of the night sometimes too. Insulin pumps aren’t very big but they are not comfortable to sleep on at all, they are very hard and have rounded corners, but they are still corners. Also anytime you have something connected to you it is easy to get tangled up in it. Fun times right? There is a running joke with T1Ds that goes with the movie Elf -I got a full forty minutes of sleep last night. Because this is how we feel most of the time. Now, off to bed all this talk of sleep and lack of sleep is making me tired.