CGM alarms

Many missed alarms start with phone settings, not the sensor. Tonight, check:

• Make sure CGM notifications are allowed, including time-sensitive or critical alerts when available.

• Review Do Not Disturb, Focus, Sleep and battery-saving settings. Either turn them off overnight or specifically allow the CGM app.

• Keep the phone charged overnight. Low-power or battery-saving modes can interfere with background app activity.

• Check both ringer volume and media volume. Some alerts may use the media/audio channel.

• Recheck settings after phone updates, app updates, new headphones, new speakers or other Bluetooth accessories.

If your child sleeps deeply, keeps the phone across the room or has missed alarms before, add a backup:

• Dexcom G7 Direct to Apple Watch can provide an extra layer of protection for some users because the watch can receive glucose information directly from the sensor when set up correctly.

• FreeStyle Libre users may be able to view glucose information and notifications on a compatible Apple Watch through the Libre app, but the phone still needs to be nearby and configured correctly.

• A bedside display, such as Sugar Pixel or a similar device, can make glucose numbers and alarms harder to miss.

• Smart lights or vibrating devices may help heavy sleepers or households with hearing loss.

• The "bowl trick" can help. Place the phone in a hard bowl or cup on the nightstand so vibration is louder. Make sure the speaker is not covered and the phone remains charged.

Follower apps can help make sure someone else hears the alarm if your child does not. Dexcom Follow, LibreLinkUp, and Medtronic CareLink Connect allow trusted caregivers to receive glucose data and alerts. The setup and number of followers vary by system, so check your app's sharing settings.

A practical tip: Set caregiver alerts to happen a little earlier than the child's alert. For example, if the child's low alert is set at 70 mg/dL, a caregiver might consider an alert at 80 mg/dL overnight. Your diabetes team can help adjust this so it improves safety without creating too many alarms.

If your child uses an automated insulin delivery system, the pump is already making insulin adjustments overnight. That can reduce some routine high and low alarms, but it does not replace safety alarms. Urgent low, sensor failure, pump disconnection and occlusion alarms still need to wake someone. Do not silence these without reviewing the settings with your diabetes team.

Call the diabetes team if:

• Your child has had glucose below 54 mg/dL during sleep that was not caught in real time.

• You are getting so many alarms that your family is starting to ignore them. That usually means the settings need review.

• You have adjusted alerts and added a caregiver backup, but nighttime alarms are still being missed.

If the problem is that the app is not sounding or notifications are not coming through, also contact the device manufacturer's technical support.

Tonight, ask your child: "If your CGM alarm goes off at 3 AM and you do not wake up, what happens next?"

The answer should name the backup: a parent, caregiver follower app, Apple Watch, bedside display or another plan your family has chosen.