One of the hardest parts of managing a life with diabetes is keeping a close eye on your blood sugar and making sure it stays within a tight range most of the time.
Historically, this was measured with a simple blood test called the hemoglobin a1c or A1c test.
But now, more than ever before, a new concept is taking shape. This is called “Time in Range” or TiR for short.
What exactly is TiR and how can you use this new agent to improve your diabetes management?
This article will tell you everything you need to know about Time in Range and how you can use it.
What is Time Within Range (TiR)?
The time in range is the change from the A1c level measurement alone (a 3-month average blood sugar level that gives doctors a sense of a person’s overall diabetes management).
This is a way of measuring the percentage of time on a given day that a person stays within the recommended blood sugar range (usually between 70-180 mg/dL, but varies from patient to patient and is always individual to the person and their doctor) ).
Ideally, your TiR should be as high as possible, with 100% meaning that for all 24 hours of the day the person had their blood sugar in their target range and 0% meaning that for a while on any given day someone blood sugar levels were within range. Most people fall somewhere in the middle.
Depending on the type of diabetes you have, experts recommend aiming for a TiR of at least 50%, with low blood sugar occurring less than 5% throughout the day.
It is now seen as one of the most powerful indicators of modern diabetes management, as A1c levels can give a false sense of success.
For example, an A1c level of 6% (usually seen as “good”) may just mean a lot of high blood sugar and a lot of low blood sugar on average. Time in the Range can’t hide the truth.
Early research suggests that TiR may predict long-term diabetes complications. The researchers also found a strong link between different time levels in the range and complications of diabetes, such as eye and kidney disease.
The higher the time in the range, the lower the incidence of complications.
What are the disadvantages of TiR?
Unfortunately, TiR can only be measured with a continuous glucose monitoring (CGM) system such as Dexcom, FreeStyle Libre, or Medtronic’s Guardian.
This is because only CGM constantly measures blood sugar. CGM systems can be expensive and are not commonly covered by health insurance, especially if you are covered by the state Medicaid program.
While access to CGM continues to improve across the United States, for many people with high-deductible health plans, Medicaid, or the uninsured, TiR is a difficult, if not impossible, measure to measure without easy access to CGM.
Additionally, for people who don’t want to wear a CGM, the index cannot be measured by manually checking their blood sugar. In that case, using A1c is still best for time management tracking.
How can I use TiR to improve diabetes management?
TiR is a powerful tool to use to your advantage to minimize both long-term high and low blood sugar levels. Here are some tips to help you make sure it’s helpful for you.
Check patterns
Your T&R not only shows what percentage of your daily time you spend within (and outside!) your goal range, it can also show you trends.
Perhaps you have low blood sugar most nights, or maybe your blood sugar spikes after dinner every day and has been so for the last 14 days.
If you start noticing patterns, you can share this information with your doctor and plan accordingly to make changes to your eating habits or medications.
You may need to reduce your basal insulin dose at night (if using an insulin pump), split your long-acting insulin dose (if you take multiple injections per day), or you may need to eat more or less carbs at your midday meal if your blood sugar levels drop a few hours later is high or low!
Work with your doctor to make these changes and see how your TiR and resulting diabetes control improve as a result!
Focus on short-term goals
Using TiR as an incentive to prevent long-term complications may not always be a helpful mindset, especially for children and teens.
However, aiming for a higher TiR in the short term may be a more achievable and digestible goal.
Try starting with smaller goals, such as increasing your TiR by 5% next week, rather than aiming for 90% TiR all the time. Then build on your successes and see your diabetes management improve.
Let TiR be part of the bigger picture
Time in range is an amazing tool that can really improve your diabetes management, but it shouldn’t be the only metric you use.
Make sure you continue to eat well, exercise often, manage stress, and seek support when you need it.
Rage Time, coupled with HbA1c, regular doctor visits are tools you should use whenever possible to ensure your diabetes management is the best possible.
The improvement also includes mental health
All things considered, TiR can be overwhelming for people who focus too much on percentages.
It can cause stress, anxiety and be very difficult for people who struggle with obsessive compulsive disorder or perfectionism.
If TiR is stressing you out, talk to your doctor about more achievable goals you can set. For example, if your doctor wants to see you achieve 95% TiR, this may be unrealistic and may do nothing but harm you!
Additionally, if you are only able to achieve your T&R goals by limiting your food intake, exercising for many hours a day and not letting go and actually living, then the indicator is not helping you to be the healthiest, most balanced you can be.
Talk to your doctor or mental health professional if your mental health is having problems as a result of TiR and about ways to find a better balance in managing your diabetes.
Conclusions
Time in range is a powerful and relatively new metric used to monitor how well someone is keeping their blood sugar within the proper range. It is measured as a percentage of the total number of hours in a day, someone’s blood sugar is (usually) between 70-180 mg/dl, but the target range can vary from person to person.
The TiR is thought to be an improvement over the A1c tests, which only measure average blood glucose levels over the last three months, but may give the false impression of ‘good’ diabetes treatment. The average of many highs and many lows is unfortunately a great A1c.
TiR is measured with a continuous glucose monitor (CGM). This is great because people can track their TiR in real time without waiting for the A1c test. However, CGMs can be prohibitively expensive, especially for those who are uninsured or uninsured in the United States. Although access to CGM is increasing, it is still not universal.
You can use TiR to improve your diabetes management by checking your CGM data more often, making small changes throughout the day that will have a big impact, checking your blood sugar patterns and trends, focusing on smaller, short-term goals in the bigger picture, and incorporating TiR into your overall diabetes management plan, without taking over your life and negatively impacting your mental health.
Talk to your doctor if you are using CGM but not currently using TiR, or if you are not using CGM but are curious about continuous glucose monitoring and how TiR can help you!
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