Your Best T1D Year

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Why outdated thresholds create unnecessary overnight wake-ups even when management has improved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
Connect with Neil: TikTok: https://tiktok.com/@the.betes Instagram: https://instagram.com/thebetes Facebook: https://facebook.com/neilgreathouse LinkedIn: https://linkedin.com/in/neil-greathouse-a607b912 Website: https://yourbestt1dyear.com
Books on Amazon: Type 1 Diabetes – One Day at a Time: https://a.co/d/6UHooWJ Type 1 Diabetes – True Stories: https://a.co/d/dfIlyI1

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
Connect with Neil: TikTok: https://tiktok.com/@the.betes Instagram: https://instagram.com/thebetes Facebook: https://facebook.com/neilgreathouse LinkedIn: https://linkedin.com/in/neil-greathouse-a607b912 Website: https://yourbestt1dyear.com
Books on Amazon: Type 1 Diabetes – One Day at a Time: https://a.co/d/6UHooWJ Type 1 Diabetes – True Stories: https://a.co/d/dfIlyI1

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
Connect with Neil: TikTok: https://tiktok.com/@the.betes Instagram: https://instagram.com/thebetes Facebook: https://facebook.com/neilgreathouse LinkedIn: https://linkedin.com/in/neil-greathouse-a607b912 Website: https://yourbestt1dyear.com
Books on Amazon: Type 1 Diabetes – One Day at a Time: https://a.co/d/6UHooWJ Type 1 Diabetes – True Stories: https://a.co/d/dfIlyI1

SHOW NOTES:
You've been told to get eight hours. Here's what the research actually found.
A 2023 study of 76 adults with type 1 diabetes tracked both CGM and sleep data for one week. The finding: sleep duration alone was not independently associated with time in range. What was? Bedtime consistency. Every extra hour of variability in bedtime was associated with roughly 10% less time in range. Your CGM noticed. It was taking notes.
This episode reframes the sleep conversation for T1D: it's not just about how much you sleep. It's about when. Your body doesn't know it's Saturday. Your cortisol doesn't know it's Saturday. Only your social calendar knows it's Saturday -- and your social calendar is not in charge of your A1C.
We're in Week 3 of the While You Were Sleeping Challenge.
In this episode:
The 2023 T1D sleep study and what it actually measured
Why six people who each got 7 hours got six different results
What bedtime consistency means practically -- and why it matters more than total hours
Why weekend sleep timing is where this breaks down for most people
The 60-minute window and why it works
This Week's Challenge: Try to go to bed within a 60-minute window of the same time, three nights this week. Not all seven. Just three.
Helpful resources and newsletter: https://yourbestt1dyear.com
Connect with Neil: TikTok: https://tiktok.com/@the.betes Instagram: https://instagram.com/thebetes Facebook: https://facebook.com/neilgreathouse LinkedIn: https://linkedin.com/in/neil-greathouse-a607b912 Website: https://yourbestt1dyear.com
Books on Amazon: Type 1 Diabetes – One Day at a Time: https://a.co/d/6UHooWJ Type 1 Diabetes – True Stories: https://a.co/d/dfIlyI1

SHOW NOTES:
Bad sleep makes your blood sugar harder to manage. Worse blood sugar disrupts your sleep. Worse sleep makes your blood sugar worse. You've been running a feedback loop -- without knowing it.
This is the episode where things click. Neil connects all the pieces from Weeks 1 and 2 into the full picture: the bidirectional relationship between sleep and glucose management in type 1 diabetes. High blood sugar increases overnight bathroom trips. Low blood sugar fires the alarm. Glucose variability through the night disrupts sleep architecture even without a full wake-up. And the worse you sleep, the more your insulin sensitivity drops the next day. The loop is real. And here's what nobody usually says: you can interrupt it from either side.
We're in Week 3 of the While You Were Sleeping Challenge.
In this episode:
The full sleep-blood sugar feedback loop in T1D, explained end to end
Why both high and low blood sugar disrupt sleep in different ways
How glucose variability affects sleep stages even without a full wake-up
Why you don't have to fix both sides of the loop at once
How to pick one end of the rope and start pulling
This Week's Challenge: Pick one small thing to try before bed. Just one. An early blood sugar check, consistent bedtime two nights in a row, screens down an hour before sleep. Write down what happened in the morning.
Helpful resources and newsletter: https://yourbestt1dyear.com
Connect with Neil: TikTok: https://tiktok.com/@the.betes Instagram: https://instagram.com/thebetes Facebook: https://facebook.com/neilgreathouse LinkedIn: https://linkedin.com/in/neil-greathouse-a607b912 Website: https://yourbestt1dyear.com
Books on Amazon: Type 1 Diabetes – One Day at a Time: https://a.co/d/6UHooWJ Type 1 Diabetes – True Stories: https://a.co/d/dfIlyI1