Time in Range: Seeing the Bigger Picture

January 29, 2024
Samantha Wells
Samantha is a class of 2023 nurse graduate at Wisconsin Lutheran College in Milwaukee, and aspiring diabetes nurse educator! Completing her senior preceptorship at the Children’s Hospital of Wisconsin Diabetes Clinic, Samantha recognizes the importance of individualized and compassionate care for those who live with diabetes and their families. A type one diabetic since 2007, Samantha has used her voice over the last 16 years to educate and advocate in her personal, local, and national communities.

Hi friends! My name is Samantha and I have been living with T1D for 16 years. I was also a 2023 NextGen Fellow with The Diabetes Link!

In my 16 years with diabetes, I have witnessed a lot of change in the diabetes game. I’ve tried a few brands of pumps and started on one of the early CGMs available for kids when I was about 12. I won’t name names, but it was not good. CGMs have come a long way since then and there are not really any bad choices. Today, my CGM works with my insulin pump and adjusts my insulin accordingly. 

For me, having a CGM has been life changing. I’ve been able to lessen some of the mental burden living with diabetes comes with, and stay out of danger. Just the other night, my CGM was screaming at me that I was “LOW” with an arrow down and I kind of brushed it off thinking “there’s no way I’m that low, I don’t even feel low”. I decided to do a finger stick anyways and it said I was 54. I was certified low, and I didn’t realize it… Needless to say, my CGM has saved me countless times over the last several years

The sensors today have something in common, Time in Range or TIR! If you are not familiar with all the ranges and targets, refer to the resource hub for “Time in Range: Why is it Important”. The short version is that it’s the breakdown of where your blood sugars spend time: in range, above range, very high, below range, and very low.

CGMs do more than just tell you what’s going on or what is about to happen, they can help you make impactful decisions on your management by showing you the big picture.

When you get your A1C done, it tells you your average blood sugar over the last 3 months, that’s it. It’s hard to make decisions off of A1C alone, that’s why when looking at making dose adjustments your providers want either a log or your CGM data from the past few weeks.

TIR, unlike A1C, gives you more specific data and paints a better picture of what your diabetes management looks like and how effective it is. For example, your A1C may be where it’s recommended to be, but TIR might show that you’re spending way too much time above and below range and it’s averaging out to your A1C goal. TIR is valuable to you and your provider and allows you to create goals and track progress. For me there was a time my A1C was at my goal, but my TIR showed I was spending too much time below my goal aka- I was having too many lows. I took that information and looked at what my days looked like, and saw I was having lows after dinner before bed. I was able to make targeted adjustments to my carb ratio at dinner and when I saw my TIR 2 weeks later, my in range time increased and my below range decreased. 

Not enough providers are utilizing TIR, so if you have access to the data- bring it up to your provider! Check out the resource hub’s “Time in Range: a Conversation Guide”. It has empowered me to make safe changes like adjusting my correction factor and highlighting my trend of post lunch spikes. Believe me, It can be hard to not get obsessed with another number to look at and goal to achieve. I try to remember that numbers are there to help me decide what my next action is, not make me feel bad or anxious. Numbers like BG, A1C, and TIR are just data, not a reflection of you or how well you take care of yourself. I combat the button pushing, by only occasionally checking my TIR reports or making changes unless something is seriously off. By doing so, I’ve successfully been able to increase my TIR by 30% and maintain it, which has ultimately lowered my A1C.

It’s important to remember that there are only so many adjustments to insulin that you can do to increase your TIR. There are a number of simple habit changes that can help you achieve your goals too. Dehydration is a big deal when you have diabetes, it happens much quicker and causes your numbers to rise. No need to carry a gallon jug around, but being mindful of how much water you drink can really make a difference. Additionally, sleep is crucial not just for your mind and body, but your blood sugars too! Blood sugars will increase with the stress hormones your body produces when you aren’t well rested. The third big habit is exercise! Regular exercise, even as simple as taking a walk, can increase insulin sensitivity, making your insulin more effective. Mindful habits and thoughtful adjustments can help you meet your goals.

I hope that you learned something about what CGMs and TIR have to offer. For me, the benefit of giving peace of mind plus the ability to provide reliable data to make safe and informed dose adjustments has played a big role in living a happy healthy life with diabetes.

Thank you to Freestyle Libre for sponsoring this article!

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