Nov 13, 2023
Time in Range in diabetes management: What is it and why is it important?
Time in Range (TIR) is an important metric for people living with diabetes to monitor and manage their blood glucose levels effectively. This measure represents the percentage of time during which blood glucose levels are within a defined target range. For most individuals, the standard target glucose range is set between 70-180 mg/dL (3.9-10.0 mmol/l). By regularly assessing TIR, individuals can gain a more comprehensive understanding of their blood glucose management over a given time frame, empowering them to make well-informed decisions when adjusting diabetes management strategies.
Why does Time in Range matter when it comes to diabetes management?
Managing diabetes is an ongoing challenge, but it's essential for maintaining good health and preventing long-term complications. Traditionally, many individuals with diabetes focused solely on their HbA1c as a measure of their glucose management. However, HbA1c provides only a snapshot of overall glucose management and may not capture the full picture of daily fluctuations. Today, TIR has become a potentially more valuable way to assess glucose management thanks to the development and wider availability of continuous glucose monitors (CGM).
Healthcare experts suggest aiming to spend at least 70% of your time with blood glucose between 70 mg/dL and 180 mg/dL. In addition, it’s suggested that you should aim to spend less than 5% of your time in the hypoglycemic range (low blood glucose). By doing so, individuals can reduce the risk of immediate and long-term health complications associated with blood glucose fluctuations. Moreover, focusing on TIR rather than the overall average blood glucose level can improve one's quality of life, reducing the stress and worry that often accompanies unpredictable glucose levels.
TIR offers a more informed understanding of blood glucose management than by showing the percentage of time your blood glucose stays within a specific range, typically 70-180 mg/dL (3.9-10.0 mmol/l).
Here's why TIR is so important:
Real-Life Insights: TIR reflects your daily experiences, highlighting how often your blood glucose levels are in the desired range during a given day. This provides a more realistic perspective of your diabetes management compared to a single HbA1c reading taken every few months.
Immediate Feedback: Unlike HbA1c, which reflects an average of your blood glucose over the past 2-3 months, TIR offers immediate feedback that you can check on your CGM. It helps you identify patterns and make adjustments more quickly, leading to more effective blood glucose management.
Helps to Reduce Time Above and Below the Target Range: TIR can help reduce the risk of both hypoglycemia (low blood glucose) and hyperglycemia (high blood glucose) events. Staying within the target range minimizes these extremes, which can be dangerous and cause discomfort.
Personalized Goals: TIR allows for personalized blood glucose goals. While the 70-180 mg/dL range is standard and a great starting point, it can be adjusted to fit individual circumstances, such as pregnancy or specific situations such as during exercise.
Improved Quality of Life: Achieving a higher TIR can lead to a number of benefits. It means fewer diabetes-related complications, boosted energy levels, and an overall better quality of life. You'll have more stable energy levels and less disruption to your daily activities.
How to Track and Improve TIR
Now that you understand the importance of TIR, you may be wondering how to track and improve it. While research hasn’t yet pinpoint the ideal frequency for checking your TIR status yet, many people living with diabetes find daily and weekly summaries to be helpful.
Here are some tips:
Continuous Glucose Monitoring (CGM): If you can access a CGM system that provides real-time data about your blood sugar levels. CGMs offer a more detailed view of your TIR, helping you spot trends and make timely adjustments.
Nutrition and Diet: Consult a registered dietitian to create a personalized meal plan that helps you maintain stable blood sugar levels.
Medication Management: If you're on diabetes medications or insulin, work closely with your healthcare provider to adjust your regimen as needed.
Physical Activity: Regular exercise can help improve TIR by making your body more sensitive to insulin. Discuss a suitable exercise plan with your healthcare team.
Stress Management: Stress can affect blood glucose levels. Practice stress-reduction techniques like mindfulness, yoga, or meditation.
Why is maintaining TIR important during exercise?
During exercise, the importance of maintaining TIR cannot be overstated for several reasons:
1. Hypoglycemia Prevention: Exercise can lead to rapid drops in blood glucose levels, especially in individuals using insulin or certain medications. Maintaining TIR helps prevent hypoglycemia, which can cause dizziness, weakness, confusion, and, in severe cases, unconsciousness. Hypoglycemia is a significant concern during and after exercise, and TIR monitoring can help individuals detect and address low blood sugar levels promptly.
2. Hyperglycemia Management: On the other hand, some forms of exercise can trigger hyperglycemia (high blood glucose levels). Monitoring TIR allows individuals to manage and correct hyperglycemia during exercise to avoid long-term health complications and poor feelings detrimental to performance.
3. Improved Performance and Safety: Staying within the target range optimizes performance during physical activity. Individuals are more likely to feel energetic and can exercise safely, avoiding sudden performance losses caused by extreme blood glucose fluctuations.
Guidelines for managing TIR during exercise for people with diabetes include:
1. Regular Monitoring: Frequent monitoring of blood glucose levels before, during, and after exercise is essential. CGM systems provide portable, reliable and real-time data and can be especially helpful around physical activities.
2. Adjusting Medications: Depending on the type, intensity, and duration of exercise, individuals may need to adjust their insulin or other medications in consultation with their healthcare provider. Reducing insulin doses before exercise can help prevent hypoglycemia, while increasing insulin doses may be necessary to manage hyperglycemia for certain activities. Consulting with a healthcare provider or diabetes educator is crucial to develop a suitable exercise and medication plan that incorporates TIR management.
3. Carbohydrate Consumption: Carbohydrate intake can be adjusted based on blood glucose levels and exercise duration and intensity. Consuming carbohydrates before and during exercise can help maintain stable blood sugar levels. While ensuring a proper meal schedule after exercise can help in preventing post-exercise hypoglycemia.
4. Hydration: Staying well-hydrated is crucial for individuals with diabetes during exercise. Dehydration can lead to higher blood sugar levels; besides all the detrimental physiological effects of poor hydration on feeling and performance.
5. Individualized Plans: Diabetes management is highly individualized, and the guidelines for TIR during exercise should be tailored to each person's specific needs, taking into account their diabetes type, medications, and other factors.
6. Experimentation and Learning: Achieving the right balance may require some trial and error. Individuals should keep records of their experiences to better understand how their body responds to different forms of exercise and adjust their strategies accordingly.
In summary, maintaining TIR during exercise is paramount for individuals with diabetes to ensure their safety, optimize performance, and prevent extreme blood glucose fluctuations. Following personalized guidelines and regular monitoring is essential to achieve and maintain TIR goals during physical activity.
How the Enhance-d app and dashboard can help with TIR
Enhance-d aims to streamline data management for people with type 1 and type 2 diabetes. The platform allows users to seamlessly integrate their CGM, exercise wearables, log food intake, and track sleeping patterns. It empowers users to set personalized goals, making it the one-stop solution for informed decision making around diabetes. Enhance-d also fosters collaboration and data sharing with your healthcare professional meaning you can make well-informed directions, take charge of your health and enjoy a balanced and healthy life.
Time in Range is a valuable metric for individuals with diabetes. It offers a more comprehensive and holistic view of blood glucose management that surpasses traditional markers like HbA1c. By keeping a close eye on your TIR, you gain a powerful tool to better manage your diabetes, reduce the risk of complications, and enjoy a higher quality of life. Enhance-d is able to help you understand how behaviors such as exercise, nutrition and sleep impact your glucose levels. Remember, diabetes management is a journey, and TIR with Enhance-d is your trusty companion to help you along the way.