The Answer for Overnights…

Screen Shot 2015-10-27 at 5.46.10 PM…I don’t have it.

I’ve been working hard towards learning it though experience for nearly nine years, or 3,200 trials and lots more errors. I’ve searched and asked many questions regarding it, but no clear direction has been discovered.

Overnight care is the final ugly beast of diabetes that wedges itself between Caleb and his full autonomy. There are other things that he doesn’t do – he hasn’t changed a Dexcom sensor by himself, he doesn’t call customer service when there are issues, he doesn’t manage basal program or sensitivity adjustments independently – but these are things I know he can learn and don’t present imminent danger. This overnight thing is different.

Sleepovers and extended field trips – these include periods of sleeping. Caleb is on the ball when he is awake. When he is asleep, well, he’s asleep and does it for numerous hours at a time. Diabetes works in 2 or 3 hour cycles. Sleeping in increments of 2 or 3 hours or even 4 hours is not healthy. I haven’t been able to balance these opposing needs after more than 3,000 attempts.

This is not to say that every night for the past nine years I’ve been up actively managing his blood sugar every 2 or 3 hours. Particularly with the use of Dexcom G4 Platinum, there have been a number of nights when I wake to just check the CGM number and go back to sleep until morning. But there has not been a single night that I have slept through uninterrupted. Over the past year I was lured into a feeling of safety because it was more the norm than exception that I could just do that eyeball thing at 1 or 2 am and all would be well. These past couple of months have rattled me back into the fear of how ugly overnights can be – highs that don’t correct and lows that won’t rise.

This isn’t new. It’s not pleasant, but I can handle it – or handle it well enough.

I don’t know the best way to prepare Caleb for these nights. The ones after long days of varying levels of activity that show up in overnight lows to an extent you cannot reasonably predict. The ones after uncommon and fatty foods are consumed in quantities that vary from the usual routine that release seemingly never-ending gushers of glucose into his bloodstream.

We’ve been able to normalize so many things. Special trips are the hardest to deal with and present the biggest danger because there are so many variables, yet are the times when he should be able to stretch his wings and leap and fly and learn from his mistakes.

It’s the fear of the magnitude of the mistake that has me on edge.

How do you manage overnights?

iPhone Medical ID

Apple Medical IDThis is not new, although it’s new to me. As soon as I saw Meri post about it, I got this set up on my phone and Caleb’s phone.

Caleb has just about every form of medical ID there is. Caleb is not consistently compliant with wearing any of them. I know – it’s important. I can’t think of many times when he is not with people who are acutely aware of the fact that he is T1D, but there are times where the awareness is more general, and there’s the fact that he has the peanut allergy thing as well, not to mention if we crash and are all unconscious. He’s aging as a middle schooler; high school is just around the corner. He’ll continue to become more and more independent, so he’s got to become more compliant…

Caleb’s phone is with him always. The iOS health app allows for you to set up an emergency medical ID page that is accessible even if your phone is locked (there is the option to disallow) and first responders are becoming more and more aware of this. In addition to checking for bracelets and necklaces, they are checking phones.

Setting this up allows for you to be detailed about medical conditions and treatment – things that don’t always fit very well on a jewelry charm – and the ability to directly call emergency contacts listed.

For more information and instruction check here and here, and also note the mention of weighing the risk of privacy.

#Dexcom CLARITY | #Diabetes Management App

Dexcom CLARITYWith the announcement of G5, Dexcom CLARITY reporting was introduced and I completely overlooked it. I assumed the enhanced reporting wouldn’t be available until I had the handy dandy new G5 transmitter in my hands.

I was looking for the new G5 app in the App Store, saw Dexcom CLARITY, downloaded it, logged in, got nothing, thought it didn’t apply to me, moved on.

Then I asked about the G5 mobile app in a TuD conversation and my eyes were opened!! I see now that Diabetes Mine caught it and reported on in in their original newsflash.
Upload Dexcom CLARITYYou can download this application on your computer now, and it’s Mac compatible – HUGE!!!!. Download data from your receiver and, just like that, a new world of reporting is open to you!

Go to your phone (iOS only right now), download the app, sign in to your account and a PDF report is generated. You can also  generate a code to share info with others – specifically medical professionals. They can enter the code as a healthcare professional and view all your reporting, including summaries, trends, etc. Here is a USER GUIDE with tons of more detail.

I find this reporting so much more intuitive than the reports from Dexcom Studio. I loved having all the data and reporting that Dexcom Studio provided, but found myself using only the one hourly stats graph, and only going to the trouble (finding a PC) of getting it just prior to an endo appointment.

Dexcom CLARITY Summary Low Trend Dexcom CLARITYDexcom CLARITY has a more streamlined feel and isolates data interactively for you right before your eyes. There’s less to manually sift through, but still all the data there and presented in summary or detailed format at your choosing. For example, it notes a trend of lows for Caleb after dinner – something I was aware of, but seeing it in front of me like that really makes me focus. This seems like friendly reporting that can be used with little effort, which means it has a greater likelihood of actually being used.

Sleepovers | Type 1 diabetes in tow

Brothers SleepingIt’s something we did early on with family, when Caleb was four years old and newly diagnosed. It proved to be an overly stressful situation. Invites were few and then non-existent.

Eight years later, Caleb is a tween in middle school and is invited for the first time ever to a friend’s house for a birthday party sleepover.

As with other milestones in his diabetes care, I took the cue from Caleb. He wanted to go. He developed a close group of friends in his new school and was excited about the party. Most notably, he did not even mention diabetes.

It’s often the first thing he thinks of, and a factor in choosing whether or not to do something. I see it in his face as the questions form: “who will be there, what kind of food will there be, how will I know if it has peanuts, how will I count carbs, what if I’m high, what if I’m low, what is this event about anyway? oh, who cares, it’s too much trouble, no thank you.”

This time the only question he had was, “Can I go, PLEEEEEEEZE?!?!?!?”

So he went.

There were a mountain of variables complicating blood sugar management, and by “complicating” I mean “bringing hell to earth”. He went to the party straight from a baseball game. Games vary in intensity and there is often some kind of blood sugar clean up needed on the other side. He arrived to ginormo pieces of ice cream cake – he was a late arrival because of the game and they were kind enough to hold off so he could be included. I’m not kidding when I say these pieces of cake were huge. Caleb often sends pictures of food with his hand in it as a point of reference for carb counting. His hand was dwarfed by the size of the piece of cake. And did I mention it was ice cream?  “Happy birthday to yous” transitioned to an intense and seemingly never-ending match of manhunt. Movies, snacks, chatting and at some point in the wee hours boys were starting to fall asleep.

Blood sugars were all over the map. Gus, juice boxes, sugar tabs, correction boluses, extended boluses – they were all in play. There was a period of about 45 minutes where Caleb and I were texting each other while everyone else was asleep because we needed to be sure he recovered from a low and was safe to sleep.

It was a nuisance and it was disruptive, but Caleb did not complain once. He rolled with it. He was responsible and attentive to his diabetes, but he did not worry about it. He was in communication with me, but also made decisions on his own. Not all of them worked out, but he took corrective action as he needed.

All I could think of the next morning was what a mess his bgs were and how tired he must be. When I picked him up, all he had to say was what a great time he had, and filled me in on a litany of details of tween-boy, fun activities.

CousinsTwo months later, he’s invited to his cousin’s new home for a sleepover with his brother and sister. Variables are fewer and blood sugars are much more cooperative. Caleb, who never ever wakes up to Dexcom alerts, blood sugar checks, or screaming sirens in his ear, set an alarm on his phone to wake and check at 2am. And he did! Bg was a magical 150 and it’s right back to sleep for him, nothing else to talk about until morning.

Sleepovers with type 1 diabetes – it seemed like the one “thing” we hadn’t yet dealt with and it was a gloomy cloud hanging over me, pulling at me, giving me angst. Although I’m not worry-free about the prospect of future sleepovers, Caleb has shown me he can be responsible and do what is needed to fit diabetes, the thing he can’t leave behind, into the fun he doesn’t want to miss.

#DexCom G5 Mobile CGM Approved

DexCom G5

The next generation of DexCom has been approved and is expected to begin shipping in late September. With this system, the need for a dedicated receiver will be eliminated if you use a compatible mobile device. One less thing to carry. Receivers are still a part of the system, but now they are optional.

What’s equally exciting is the enhanced app that will be used with G5. Alerts and the ability to log events right in the app sounds like we may finally have meaningful reports to help us best use all this information for better diabetes management.

More photos and information at

Forgetting Diabetes | Impact of Dexcom G4 and CGM in the Cloud

IMG_9106Minimizing Caleb’s disruption at school is paramount. Prioritizing this is less about restricting his classroom instruction, although that is an important right of his, but more about preserving his emotional health.

Every time Caleb has to perform a diabetes care task, it’s a reminder that he is different and that he has a burden from which those around him are free. It divides his attention from whatever is happening in his day, that those around him can give full attention. My goal is to minimize those disruptions, aka: reminders at the hope of avoiding burnout.

  • In first grade we minimized visits to the nurse’s office. He checked in class and the nurse came to him.
  • In third grade we removed the need for nurse supervision – he used a classroom phone to contact me when a care decision needed to be made.
  • In fourth grade we utilized the school wifi system to allow him to text with me for added discretion.
  • In sixth grade we introduced CGM in the Cloud.

In general, Caleb is more independent in his care. Where we used to have defined times to check in, now he checks in at his discretion.

There are even days when I don’t hear from him at all and the only diabetes task he has done at school is to bolus for lunch, and at that time, give Dexcom a look. On those days he’s had exactly one interruption to his day because of diabetes. Just one. It’s a taste of normalcy that struck me the first time it happened. It felt luxurious – like being pampered by not having to give this beast attention whenever it demanded it, which is something we’ve grown used to.

Because there are still beastly days, and you never really know when when they will be,  we’re always on guard for it. So when the luxury days occur, they are relishable.

We’ve been able to eliminate the schedule because of Dexcom and CGM in the Cloud. We trust Dexcom. Caleb’s been using it for six years and the G4 has fantastic accuracy. We allow it to watch his blood sugar and let Caleb know when it needs attention. The addition of CGM in the Cloud means I also get alerts when Caleb’s blood sugar needs attention, no matter where he is.

We therefore think less about it. Neither of us wonder what might be happening. I’m not worried that he might be distracted and forgetting to address his blood sugar, Dexcom and Share2 are keeping watch for us.

We are allowed to forget about diabetes, even if it’s just for a little while, and it’s fantastic.

Caleb has used both the Nightscout and Dexcom Share2 CGM in the Cloud systems. 

I am neither a doctor nor certified medical practitioner. How Caleb and I choose to manage his diabetes should not be taken as medical advice. Please consult with your doctor any treatment decisions.

Lilly Diabetes/Disney Books and Backpack Giveaway!

IMG_0317You may have seen these sets around the community in recent weeks. If you’ve missed out on other giveaways, you still have a chance. Lots of great resources targeted toward children with diabetes are included. The Coco books are targeted toward the younger child, but have meaningful messages for all ages. The ESPN books are targeted to a teen audience.

If you’re interested, use the below linkto enter! Good luck and act fast! This giveaway ends this Sunday!


a Rafflecopter giveaway

Updated Feb 6 to state: shipments made within the contiguous US only.


(click on the photo to enlarge)

Lilly Diabetes/Disney Books and Backpack Giveaway

FDA Approves #Dexcom G4 Platinum #CGM System with #Share

Fantastic news announced by Dexcom today. Cloud information has been approved for the G4 system. New receivers will be available soon – see below for details.

As posted at MarketWatch

SAN DIEGO, Jan 26, 2015 (BUSINESS WIRE) — DexCom, Inc., DXCM, -0.29% a leader in continuous glucose monitoring (CGM) for patients with diabetes, announced today that it has received U.S. Food and Drug Administration (FDA) approval for its Dexcom G4® PLATINUM Continuous Glucose Monitoring System with Share. The Dexcom Share receiver uses a secure wireless connection via Bluetooth Low Energy (BLE) between a patient’s receiver and an app on the patient’s smartphone to transmit glucose information to apps on the mobile devices of up to five designated recipients, or “followers,” without the need for a dedicated docking cradle. These followers can remotely monitor a patient’s glucose information and receive alert notifications from almost anywhere, initially via their Apple® iPhone® or iPod® touch and in the future on Android devices, giving them peace of mind and reassurance when they are apart. The “Share” and “Follower” apps will be available on the Apple App Store at no charge.

“The Dexcom Share receiver represents a significant step forward for our company and our mobile strategy, but more importantly, it will provide a huge improvement for people managing their diabetes and for those parents and caregivers who help them each and every day,” said Kevin Sayer, President and Chief Executive Officer of Dexcom. “The FDA understands the importance of this type of innovation and the need to regulate it appropriately, and we could not be more pleased with the speed at which they reviewed and approved this important innovation.”

About Dexcom G4 Platinum with Share:

The Share receiver is anticipated to ship to new patients in early March 2015.

All patients who purchased a Share cradle will receive a free upgrade to the Share receiver.

All purchasers of a G4 Platinum receiver from January 1, 2015, until the Share receiver is shipped, will receive a free upgrade to the Share receiver.

There will be a low cost cash upgrade to the Share receiver for those patients who are still under warranty with their existing receiver.

The Share receiver will be compatible with future generation Dexcom sensor systems.

About the De Novo Classification Process:

The FDA reviewed the mobile app software used with the Dexcom Share receiver (both the “Share” app on the patient’s phone and the “Follow” app on the caregiver’s phone) through its de novo classification process, a regulatory pathway for low- to moderate-risk medical devices that are novel and not substantially equivalent to any legally marketed device. The FDA has specifically classified the apps which communicate with the Share receiver as a secondary display device and has noted that similar devices which provide only secondary display for passive monitoring, but which do not replace the primary real-time display device, will be subject to the same classification, subject to compliance with certain special controls established by the Agency with respect to this secondary display. This means that devices which comply with appropriate FDA regulations, including the special controls, will not be required to submit a premarket notification to the FDA before marketing a secondary display device for continuous glucose monitoring. The Share receiver was still evaluated as a Class III medical device.

Management will hold a conference call to review this approval starting at 9:00 a.m. (Eastern Time) on Monday, January 26, 2015. The conference call will be concurrently webcast. The link to the webcast will be available on the Dexcom website at by navigating to “Our Company,” then “Investor Relations,” and then “Events and Webcasts,” and will be archived there for future reference.

#Nightscout | Harboring Autonomy #WeAreNotWaiting #CGMintheCloud

IMG_8890My number one reservation about starting Nightscout was the size and weight of the rig. It’s a definite price to pay. It’s not ideal, but Caleb’s been able to manage, and the benefits are currently worth the price.

My next concern was taking a step backward in the progress we had made in Caleb’s self-care.

Since he was in preschool, Caleb has always had some level of responsibility in his care, and it has advanced both organically and with careful planning each year. In third grade, we (his school nurse at the time, Caleb and I) started to take steps to prepare him for middle school. We targeted specific milestones for each of the next three years. Caleb was caring for himself as I expected a middle schooler would by the beginning of his last year in elementary school.

Given this success in autonomy, and on the verge of starting middle school, I didn’t want to compromise his progress. If I started watching his bgs, would the torch come back to me? That was absolutely not the goal. Why would we need remote access to his CGM data if he was now running the show? I didn’t have the answers to these questions, but I started seeing successes with the Nightscout Project, got over the hurdle of the rig size,  and figured with a limited financial investment, why not give it a try.

The role Nighscout played in Caleb’s autonomy was not one I anticipated. Knowing that he was no longer “alone” when I dropped him off somewhere, gave him security. This increased the opportunities to be places by himself because he was comfortable. The more he did this and saw that he could care for himself by himself, the more confidence he gained. Increased confidence added more security, which led to more confidence, and before we knew it, things had changed dramatically.

We had gone from discussing a careful plan of “what ifs” each time he was dropped somewhere, to no longer even thinking about it. This was a change in Caleb. Where he was once anxious, he was now assured. School days became easier as well. A middle school schedule is pretty hectic; he never seems to have a spare moment. He has greater flexibility to go throughout his day as he pleases, without being a slave to a diabetes care schedule. We probably would have gotten to that point because of Dexcom alone, but Nightscout got us there immediately upon starting school.

Does Caleb care for himself entirely independently? I’d say he does 90% of the work when he and I are apart. When he’s home, we’re definitely a team. He makes decisions, I make decisions, we make decisions together. When he’s at school or elsewhere, he’s in the driver’s seat. We consult throughout the day if needed. There are times when I see something on Nightscout that he hasn’t noticed yet and I will prompt him. I don’t feel like I’ve taken back control though. I feel like I’m helping him at a level that is appropriate for someone his age. He’s continued to move forward in his level of self-care. He hasn’t taken any steps back, which was my concern.

The biggest issue we were having when we starting using Nightscout, was Caleb’s self-confidence in his diabetes care. I knew he was capable, he wasn’t as sure. Nightscout propelled his confidence forward, the exact opposite outcome I had anticipated.

Related Posts:

Nightscout | Getting Started

Nightscout | The First Two Weeks

Nightscout | The New Rig