Next to lowering A1c, the biggest goal my clients are looking to achieve is the magical 70% in range. In this blog post, I’m going to show you 3 super easy ways to increase your time in range that you can do today. What is time in range, and why is it important? Time in range is the percentage of time your blood sugars spend in a selected range. The ADA recommends that people with diabetes (PWD) aim for 70% time in range. The range being 70–180 mg/dL (3.9–10.0 mmol/L) for individuals with type 1 diabetes and type 2 diabetes and 63–140 mg/dL (3.5–7.8 mmol/L) during pregnancy 2. An analysis of 4 randomized control trials studying people with type 1 diabetes found that an increase in TIR of 10% (2.4 hours per day) corresponded to a decrease in A1c of 0.6%, on average 1. So aiming to lower your time in range can also benefit your A1c as well. While A1c is currently considered the hallmark for measuring adequate control of blood sugars, time in range could be a better indicator. It gives us a bigger picture to look at and takes into account blood sugar excursions above and below target. A bigger picture of your blood sugar control is important because your A1c and time in range don’t always coordinate. Three people with a 7% A1c could all have pretty different TIRs. Fine Tune Your Settings The most important step to take towards improving time in range is to make sure your settings are correct. You can test basal rates, insulin to carb ratios, and sensitivity factors. Adjust them until you achieve a desired predictability. Try This Start by testing your basal rate overnight. Take note of the last time you bolused/ate food. Your fast starts 3 hours after this. If you don’t have a CGM, you can do this during the day. Make sure it is 3-4 hours after you’ve eaten and you don’t have any active bolus insulin on board. Pull up your results. Your blood sugar should stay steady throughout the night. If you wake up and your fasting blood sugar is above target, you’re not getting enough insulin. If your fasting blood sugar is below target, you are getting too much insulin. You can adjust your basal rate by 10% two hours before you notice a rise or drop in your blood sugar. Continue titrating up or down until you stay steady throughout the night. If you want to see my step by step strategy for basal testing, download my guide here. Prevent High BGs - don’t react to them This is by far the most helpful action I’ve ever taken towards tight control. I used to only start injecting insulin or taking action whenever my high alert went off at 180 or 200 mg/dL. One week, I decided to experiment with switching my Dexcom high alert to 120 mg/dL. My time in range increased 20% that week. Why? Because I started preventing high blood sugars instead of treating them once they happened. When PWD are first diagnosed, they're doctor often tells them that 80-180 or even 200 mg/dL is the target range. This puts your brain in the mindset of “Ok, I gotta keep my blood sugar in this range.” And you probably get really good at it! So try using the skills you have to tighten up your range even more. But Rachel. I don’t want to be tied down to all these high alerts! I get it. This takes a lot of courage. But I promise, after a few days of working towards preventing blood sugars from going higher than 120 mg/dL, you will be receiving the same amount of alerts or spending the same amount of time as you were before, but with better pay off. Try This Switch your high alert or threshold to 30-40 mg/dL lower than what it is now. After 3 days, look at your time in range. Has it increased? I think you’ll surprise yourself. See if you can go even lower if you’re feeling up for the challenge. This is a great time to start utilizing those 0.1 boluses on your pump that you’ve never used. Review and Reset Throughout my childhood, I faithfully went to my endocrinology appointments every 3 months. This was the time my endocrinologist would make insulin dose changes and other recommendations. But at some point it occurred to me. Three months is a REALLY long time to wait to make a change to something. Especially considering that blood sugars need ongoing titration until corrected. Don’t wait until you see your doctor! Be an active participant in your diabetes management (after all, you have to live with the darn thing). Try This Hold a 30 minute weekly review of your blood sugars each week. Dexcom Clarity app has an option to email you a weekly report if that’s your style - CEO of Diabetes here you come. During this 30 minutes, take the time to look at your logs or your CGM data. Use an app like OneTouch Reveal or Sugarmate for some extra beautiful graphs and PDF’s. Look for similar patterns in blood sugar fluctuations over 3 days. If something repeats 3 days or more in a row, this is a pattern. Make a note and adjust your insulin if you’re comfortable doing that or send your endo a message! Give them a PDF of your report for extra brownie points. Now Watch that Time in Range These three actions have helped so many of my clients increase their time in range and lower their A1c’s. Want more? Download my guide!References
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AuthorRachel Halverson is a registered nurse and certified diabetes care and education specialist. She specializes in helping women with type 1 diabetes balance their blood sugars and take back control of their lives by healing their monthly cycles, learning about nutrition, and empowering them with strategies for tackling type 1 diabetes. Archives
June 2021
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