The T1D Sleep-Blood Sugar Feedback Loop

Your Pre-Sleep Blood Sugar Check Is a Sleep Decision, Not Just a Safety Check

SHOW NOTES: You already do this. You check your blood sugar before bed, glance at your CGM, maybe set a temp basal. You've been doing it for as long as you've had T1D. Here's the reframe: you've been doing it as a safety check. "Am I okay to go to sleep?" This episode argues it's also a sleep decision -- and that shift changes what you're actually optimizing for. Active insulin at midnight is a sleep variable. A correction dose from 9pm is still tailing off at 1am. That tail can create glucose variability that pulls you out of deep sleep without triggering an alarm -- a partial arousal that costs you sleep quality without you knowing it happened. The more stable your blood sugar heading into sleep, the fewer overnight alarms, the better your sleep architecture, and the better your insulin sensitivity the next morning. Welcome to June. Welcome to Week 5 of the While You Were Sleeping Challenge. This is where we start doing something about it. In this episode: * How pre-sleep blood sugar affects sleep quality, not just overnight safety * What active insulin at bedtime does to your 1am and 2am sleep stages * The 30-minutes-before-bed check and why timing makes a difference * How pre-sleep glucose stability connects directly to tomorrow morning's insulin sensitivity * Starting the feedback loop running in the right direction tonight This Week's Challenge: Check your blood sugar 30 minutes before bed -- not right when you're about to sleep. Note the number and any active insulin on board. Do this three nights and see what the mornings look like. Helpful resources and newsletter: https://yourbestt1dyear.com [https://yourbestt1dyear.com] Connect with Neil: TikTok: https://tiktok.com/@the.betes [https://tiktok.com/@the.betes] Instagram: https://instagram.com/thebetes [https://instagram.com/thebetes] Facebook: https://facebook.com/neilgreathouse [https://facebook.com/neilgreathouse] LinkedIn: https://linkedin.com/in/neil-greathouse-a607b912 [https://linkedin.com/in/neil-greathouse-a607b912] Website: https://yourbestt1dyear.com [https://yourbestt1dyear.com] Books on Amazon: Type 1 Diabetes – One Day at a Time: https://a.co/d/6UHooWJ [https://a.co/d/6UHooWJ] Type 1 Diabetes – True Stories: https://a.co/d/dfIlyI1 [https://a.co/d/dfIlyI1]

T1D Sleep Challenge: Four Weeks In, What We've Learned

SHOW NOTES: Four weeks ago, Neil asked you to do one thing: write down how many hours you slept. That was it. Just a number. And now here we are. This is the halftime checkpoint of the While You Were Sleeping Challenge. Neil does what any good coach does at halftime -- pulls everyone in, takes a breath, and goes over what we actually know. Because the first four weeks covered a lot: recognition, the 21% number, the dawn phenomenon, the sleep-blood sugar feedback loop, bedtime consistency, sleep architecture differences in T1D, and CGM alarm fatigue. And the goal today is to actually sit with what changed before we move into solutions. May was all problem and mechanism. June is different. June is where we build. We're in Week 5 of the While You Were Sleeping Challenge. If you're just finding this, jump in right here. You're not behind. In this episode: * A full recap of Weeks 1 through 4 and everything established so far * Why problem-naming has to come before solution-building * What the second half of the challenge covers (cortisol, Fear of Hypoglycemia, CGM as a proactive tool, pre-sleep routines) * How to look at your own four weeks of data before June begins * What "paying attention" for four weeks actually produced, even if the tracking wasn't perfect This Week's Challenge: What's one thing you noticed in the last four weeks? Not a conclusion. Not a solved problem. One thing you noticed. Write it in one sentence. Helpful resources and newsletter: https://yourbestt1dyear.com [https://yourbestt1dyear.com] Connect with Neil: TikTok: https://tiktok.com/@the.betes [https://tiktok.com/@the.betes] Instagram: https://instagram.com/thebetes [https://instagram.com/thebetes] Facebook: https://facebook.com/neilgreathouse [https://facebook.com/neilgreathouse] LinkedIn: https://linkedin.com/in/neil-greathouse-a607b912 [https://linkedin.com/in/neil-greathouse-a607b912] Website: https://yourbestt1dyear.com [https://yourbestt1dyear.com] Books on Amazon: Type 1 Diabetes – One Day at a Time: https://a.co/d/6UHooWJ [https://a.co/d/6UHooWJ] Type 1 Diabetes – True Stories: https://a.co/d/dfIlyI1 [https://a.co/d/dfIlyI1]

How to Adjust CGM Alarm Thresholds for Better Sleep with Type 1 Diabetes

SHOW NOTES: When did you last actually look at your CGM alarm threshold settings? Not to silence an alarm. Not to check a number. To actually look at the thresholds -- the settings, the specific values, when they were last changed. If your answer is "when I first set up the device," this episode is for you. Neil walks through what CGM alarm thresholds are, why they're not permanent features of having T1D, and why the settings you're running right now may be calibrated for a different version of your management than the one you have today. Your diabetes has changed. Your time in range has changed. Your thresholds probably haven't. This is a practical episode -- no heavy science, just a straightforward conversation about settings you can actually look at and, when appropriate, adjust. We're in Week 4 of the While You Were Sleeping Challenge. This is the actionable follow-up to Monday's alarm fatigue episode. In this episode: * What CGM alarm thresholds are and how most people originally set them * Why outdated thresholds create unnecessary overnight wake-ups even when management has improved * The difference between thresholds optimized for daytime control vs. overnight sleep * Quiet hours and do-not-disturb settings most CGM users don't know exist * Why this conversation is worth having with your care team This Week's Challenge: Open your CGM app. Find the alarm threshold settings. Look at the numbers. Do they still match where your management actually is? Helpful resources and newsletter: https://yourbestt1dyear.com [https://yourbestt1dyear.com] Connect with Neil: TikTok: https://tiktok.com/@the.betes [https://tiktok.com/@the.betes] Instagram: https://instagram.com/thebetes [https://instagram.com/thebetes] Facebook: https://facebook.com/neilgreathouse [https://facebook.com/neilgreathouse] LinkedIn: https://linkedin.com/in/neil-greathouse-a607b912 [https://linkedin.com/in/neil-greathouse-a607b912] Website: https://yourbestt1dyear.com [https://yourbestt1dyear.com] Books on Amazon: Type 1 Diabetes – One Day at a Time: https://a.co/d/6UHooWJ [https://a.co/d/6UHooWJ] Type 1 Diabetes – True Stories: https://a.co/d/dfIlyI1 [https://a.co/d/dfIlyI1]

CGM Alarm Fatigue in Type 1 Diabetes: How Your Alerts Are Wrecking Your Sleep

SHOW NOTES: How many times did your CGM alarm last night? If you have to guess -- or if you're honestly not sure because your arm is doing the silence-and-go-back-to-sleep thing on autopilot -- that's alarm fatigue. And it's a documented, peer-reviewed phenomenon that's costing you sleep in ways that quietly compound every single night. This episode is about the complicated relationship T1D people have with CGM alarms. They're lifesaving. They're also, at times, genuinely maddening. There's a real, measurable difference between alarms that protect you and alarms that interrupt your sleep architecture without adding any safety benefit. Neil talks about how alarm fatigue develops, what it costs your sleep stages, and why the answer isn't to turn everything off -- it's calibration. We're in Week 4 of the While You Were Sleeping Challenge. In this episode: * What alarm fatigue is and how it develops in T1D people over time * How sub-threshold wake-ups disrupt sleep architecture without a full wake-up * The boy-who-cried-wolf problem in CGM management -- and why the wolf is still real * Why calibration (not silence) is the right response * The peer-reviewed paper with a title that's definitely just a research paper title This Week's Challenge: Count how many times your CGM alarmed last night. Don't do anything about it yet. Just get the number. Helpful resources and newsletter: https://yourbestt1dyear.com [https://yourbestt1dyear.com] Connect with Neil: TikTok: https://tiktok.com/@the.betes [https://tiktok.com/@the.betes] Instagram: https://instagram.com/thebetes [https://instagram.com/thebetes] Facebook: https://facebook.com/neilgreathouse [https://facebook.com/neilgreathouse] LinkedIn: https://linkedin.com/in/neil-greathouse-a607b912 [https://linkedin.com/in/neil-greathouse-a607b912] Website: https://yourbestt1dyear.com [https://yourbestt1dyear.com] Books on Amazon: Type 1 Diabetes – One Day at a Time: https://a.co/d/6UHooWJ [https://a.co/d/6UHooWJ] Type 1 Diabetes – True Stories: https://a.co/d/dfIlyI1 [https://a.co/d/dfIlyI1]

What Type 1 Diabetes Actually Does to Your Sleep Architecture | Episode 200

SHOW NOTES: 200 episodes. Neil didn't plan on this. He definitely didn't plan on spending episode 200 explaining what your liver does at 3am without your permission. And yet here we are. This is the episode that contains the most important thing Neil has said in this entire challenge. Most T1D content talks about sleep in two ways: the safety angle (set your alarms right) or the wellness angle (get enough rest). Neither goes far enough. What the research actually shows is that T1D adults have fundamentally different sleep architecture than adults without T1D -- measurably less slow-wave sleep, higher overnight hormone levels, and a higher arousal index that keeps them closer to the surface all night. You're not bad at sleeping. You've been sleeping with a condition that literally changes how sleep works in your body. And nobody told you. This is Week 4 of the While You Were Sleeping Challenge. 200 episodes in. This one matters. In this episode: * The documented differences in T1D sleep architecture vs. non-T1D adults * What slow-wave sleep is and why T1D people get measurably less of it * What "arousal index" means and why it explains waking up tired after 7 hours * Why endocrinologists and sleep doctors don't talk to each other (but should) * Why episode 200 was the right moment to say this out loud This Week's Challenge: Tell one person about this challenge. Someone with T1D, or who loves someone with T1D. One ripple. Helpful resources and newsletter: https://yourbestt1dyear.com [https://yourbestt1dyear.com] Connect with Neil: TikTok: https://tiktok.com/@the.betes [https://tiktok.com/@the.betes] Instagram: https://instagram.com/thebetes [https://instagram.com/thebetes] Facebook: https://facebook.com/neilgreathouse [https://facebook.com/neilgreathouse] LinkedIn: https://linkedin.com/in/neil-greathouse-a607b912 [https://linkedin.com/in/neil-greathouse-a607b912] Website: https://yourbestt1dyear.com [https://yourbestt1dyear.com] Books on Amazon: Type 1 Diabetes – One Day at a Time: https://a.co/d/6UHooWJ [https://a.co/d/6UHooWJ] Type 1 Diabetes – True Stories: https://a.co/d/dfIlyI1 [https://a.co/d/dfIlyI1]