How to Prevent Alarm Fatigue in Diabetes
Technology like insulin pumps, continuous glucose monitors (CGM), and mobile apps can be helpful and even lifesaving for people with diabetes.
But they can also be incredibly frustrating at times.
Along with the many benefits, these important devices may also bring frustration and annoyance because of the various alerts and alarms.
This can be a small annoyance at times, but diabetes devices can also lead to diabetes alarm fatigue, distress, and burnout, which affect overall management. There are simple ways to manage your mental health as it relates to these diabetes tools and cope with the frustration and fatigue that might arise.
What is diabetes device alarm fatigue?
Alarm fatigue is what it sounds like: You get overwhelmed by all the beeps and alerts.
In this 2024 analysis article, researchers examined four past studies on the topic and found that diabetes alarm fatigue commonly led to higher blood sugars outside of a tight target range, defined as keeping blood sugars between 70 and 140 mg/dL (milligrams per deciliter) for at least 50% of the time.
That time in tight range (TITR), versus keeping blood sugars just a bit higher according to current diabetes guidelines, raises the potential for people to experience alarm fatigue from their diabetes devices. Researchers also point out that just trying to stay in that tighter range could lead to more diabetes distress and burnout.
This may present itself in many forms, depending on the types of diabetes devices, tech, and tools you may use.
Insulin pumps
Insulin pumps are wearable devices that people with diabetes use to deliver insulin. They are connected to a spot on your body and continuously give insulin for 2 to 4 days.
Modern pumps may have several different basic alerts:
low battery
you're low on insulin in the device
it's time to check your blood sugar
insulin isn't being delivered into your body due to a kink in the insulin pump tubing or the little plastic cannula under your skin
a variety of other alerts if the pump's connected to a continuous glucose monitor (CGM) that tracks your blood sugars
if the time change happens, and the clocks don't match
These different alerts can vary depending on the particular insulin pump you have and based on your personal settings in the device.
»MORE: Learn more about insulin pumps and how they work.
Continuous glucose monitors (CGMs)
This diabetes technology offers a continuous stream of data to show a more complete picture of your blood sugars over time. This is different from a fingerstick meter that only represents that moment.
Each may offer different alerts, ranging from low or high blood sugars to rising or dropping glucose levels, and if a CGM sensor is expiring, isn't working, or has lost connection from a connected insulin pump or smartphone app.
Traditional CGMs include Dexcom, Medtronic Minimed, and Abbott Libre. Each varies slightly in how it works, but generally, it includes a sensor that you wear on your arm or abdomen with a tiny needle going under your skin to monitor glucose levels. It beams data every 1 to 5 minutes to a compatible smartphone mobile app or a separate handheld receiver. Depending on the type of CGM tech you use, it generally lasts between 7 and 15 days.
There is also an implantable CGM known as the Eversense, which can last as long as 365 days and is implanted in your skin through a surgical procedure by a trained medical professional.
Many people using modern diabetes technology have integrated systems, which may include both CGM and insulin pump devices. This means that they work together to both monitor blood sugar and deliver insulin, and that can also mean they have even more types of alerts and alarms between the devices and any compatible smarphone mobile apps.
How can alert fatigue lead to diabetes distress and burnout?
Research is clear on the benefits most of the technology has for people with diabetes, and the alerts that come with those devices are often beneficial and even lifesaving.
But a frequent, sometimes incessant amount of alerts can be a deterrent for some people. This can lead to frustration and diabetes distress, or being stressed and anxious about many parts of diabetes management.
In turn, that pattern can lead to diabetes burnout, less interest in focusing on diabetes management, higher blood sugars and A1C, and effects on quality of life.
The topic has been a long-standing concern in the Diabetes Community, for both people living with the condition to those in the medical profession and making these diabetes devices.
As these devices and systems have become more advanced, the prevalence of diabetes device alarm fatigue has remained an issue alongside the evolving technology.
Alarm fatigue is just as present for caregivers and parents of children with diabetes who use these devices to manage the condition.
This 2024 study on advanced technology combining insulin pumps and CGM suggests that people who use and care for children and teens using these systems may have trouble sleeping, since frequent alarms.
In this 2022 research article, the authors reviewed an anonymous survey that studied the sleep deprivation effects of diabetes device alerts from insulin pumps and CGMs on those who cared for children with T1D.
It used self-reported data from people in support groups who responded to a survey, meaning those who participated and were part of that group might be more prone to experiencing challenges than others in the general diabetes population.
Still, the findings echo what others in the Diabetes Community when experiencing diabetes device alarm fatigue.
About a quarter of respondents stated that when the CGM alarms go off repeatedly, they become indifferent to the alarm
Approximately 75% of caregivers strongly disagreed or disagreed that they deactivate some CGM alarms so that they or the children could have uninterrupted sleep at night.
About 40% of the caregivers also agreed or strongly agreed that the CGM alarms make them nervous.
About a third of caregivers agreed or strongly agreed that they change alarm settings to decrease the number of alarms at specific times.
Diabetes distress is quite common. More than half of people with diabetes experience some type of diabetes distress at some point in their lives, which may impact their mental health and overall diabetes management.
This 2024 research found that diabetes distress and burnout can affect people with type 2 diabetes, leading to less management of blood sugars due to the distress they feel from many aspects of management, including coping with diabetes device alerts.
How do I live with diabetes alarm fatigue?
Living with T1D for most of my life, I've been connected to a diabetes device since my college days in 2001. That means I've used multiple devices through the years, all of them bringing their own brand of alerts and alarms that have seeped their way into my life:
in the middle of the night when I'm fast asleep
during business meetings, both virtual and in-person
important events and settings, from weddings and funerals to court sessions
intimate moments with my spouse
as I'm outdoors mowing the lawn or shoveling the snow
on planes, trains, automobiles, and golf carts
in the shower, when the device is on a nearby countertop
That's just a small handful of the many, many more.
We can take steps to minimize alerts and alarms, to stop them from interfering with our daily routines and important moments in life.
That can include adjusting their settings so that alerts don't shout at you in unwanted moments.
But like most parts of life, you can't plan for everything. Sometimes you forget, and other times, you just aren't as concerned in a moment, and it returns for you with an alert later on.
That is why I've had to take steps to manage my diabetes device use, and also keep tabs on my own mental health to ensure my diabetes-related stress levels aren't reaching a boiling point.
Diabetes distress and burnout have been a part of my life. I've experienced these throughout my life, and consulted a mental health professional in my late 20s to help better manage the psychosocial aspects of life with diabetes.
This is how I manage that diabetes distress now, to minimize it and prevent burnout.
Remember, you are not alone.
Tips to manage diabetes device fatigue
Diabetes care professionals and the community share several ways to help prevent diabetes alarm fatigue. This may include:
Try using vibrate mode instead of an audible tone. This can help make alerts more tolerable at different times a day, if you don't want to silence or eliminate them entirely.
Consider a specific 'night-time' profile to help minimize non-critical alerts during sleep. This may mean lowering the low and high blood sugar thresholds to help prevent alarms that aren't as urgent, but making sure that critical alerts are still received.
People who use smartphone apps along with their insulin pumps or CGM systems may consider deactivating automatic alerts to reduce the number of alerts overall and only rely on the alerts from the device itself.
Review that features like 'Do Not Disturb', 'Silent Mode', and app notification permissions do not interfere with alarms or alert delivery.
Keep track of key moments in your diabetes management and device use that might trigger an alert, from high or low blood sugar levels to the amount of insulin in your insulin pump. Addressing these situations before they trigger an alert can save peace of mind later.
Consider a 'device vacation.' This isn't always possible for everyone, but taking a break from an insulin pump, CGM, or smartphone app can alleviate any fatigue, distress, or burnout you might be experiencing due to constant diabetes management and device notifications.
Always consult your diabetes care team before many any changes to your management plan, including your use of insulin pumps or CGM technology. They may be able to help you switch up your care plan, or better cope with device and alarm fatigue.
Frequently Asked Questions
Why do some people with diabetes sleep through device alerts?
There are many reasons someone may not wake up for a diabetes device alert. Deep sleep, alarm fatigue, and the body's adaptation to frequent alerts can play a part in reducing responsiveness. This can lead to both high and low blood sugar emergencies if someone doesn't wake up to treat that instance.
There are many reasons someone may not wake up for a diabetes device alert. Deep sleep, alarm fatigue, and the body's adaptation to frequent alerts can play a part in reducing responsiveness. This can lead to both high and low blood sugar emergencies if someone doesn't wake up to treat that instance.
Can you make alerts louder for when you're asleep?
Yes, you can make diabetes device alerts louder of enhance them so you don't miss them while sleeping. This can include turning up the volume, but it also may include other lifestyle hacks:
change the alert tones and use multi-sensory alerts, with both audible sound and vibrate alerts to make noise
set the device on vibrate on a table or in a bowl of loose coins, so that it makes more noise
use a smartphone diabetes app to include other tones and alerts
smarthouse technology may also offer ways to attach flashing lights or connect with Bluetooth speakers for louder device alerts
Yes, you can make diabetes device alerts louder of enhance them so you don't miss them while sleeping. This can include turning up the volume, but it also may include other lifestyle hacks:
change the alert tones and use multi-sensory alerts, with both audible sound and vibrate alerts to make noise
set the device on vibrate on a table or in a bowl of loose coins, so that it makes more noise
use a smartphone diabetes app to include other tones and alerts
smarthouse technology may also offer ways to attach flashing lights or connect with Bluetooth speakers for louder device alerts
What do medical guidelines say about diabetes device alerts?
The American Diabetes Association recommends real-time alerts for those at risk for hypoglycemia, especially people who can't tell they are having a low blood sugar (hypoglycemia unawareness). The ADA suggests CGM and insulin pump alerts can be important for people with type 1 diabetes and insulin-treated type 2 diabetes.
The American Diabetes Association recommends real-time alerts for those at risk for hypoglycemia, especially people who can't tell they are having a low blood sugar (hypoglycemia unawareness). The ADA suggests CGM and insulin pump alerts can be important for people with type 1 diabetes and insulin-treated type 2 diabetes.
The takeaway
The alerts and alarms on diabetes devices and mobile apps can become frustrating and overwhelming. This can lead to diabetes burnout, which can affect your mental health and management overall.
You can reduce alert fatigue in several ways. One way is to watch your blood sugar levels and diabetes management closely so your device doesn't need to send as many alerts. If the alerts are overwhelming, you can also talk with your diabetes care team about taking a short break from the device.
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