One of the most difficult parts of managing your life with diabetes is to carefully monitor your blood sugar levels and make sure they stay in close range in most cases.
This has been historically measured using a simple blood test called the hemoglobin A1C or A1C test.
But now, more than ever, new concepts are in shape. It is called “time within range” or TIR for short.
What exactly is TIR? How can I improve diabetes management using this new scale?
In this article, we will explore everything you need to know about time within range and how to use it to help you.
What is the time (TIR) in the range?
Time within range is apart from measuring A1c levels only (average blood glucose over the course of three months gives the doctor a sense of general diabetes management for a person).
This is a way to measure the percentage of time on a particular day. People are recommended blood glucose levels (usually between 70 and 180 mg/dl, varying from patient to patient, always personalised between the person and their doctor).
It’s best to have the Tir as high as possible. Means 100%. This means that for all 24 hours a day, the person will have blood sugar levels within the target range, meaning 0% on certain days. Most people fall somewhere in the middle.
Depending on the type of diabetes, experts recommend that hypoglycemia occurs in less than 5% of the day, aiming for a TIR of at least 50%.
Currently, A1C levels are considered one of the most powerful indicators of modern diabetes management, as they can give you a false sense of success.
For example, A1C levels of 6% (usually considered “good”) are just giving you average hyperglycemia and a lot of hypoglycemia. Range times cannot hide the truth.
Early studies suggest that TIR can predict long-term diabetes complications. The researchers also found a strong relationship between levels of different ranges and diabetic complications such as eye and kidney disease.
The higher the range, the lower the prevalence of complications.
What are the drawbacks of TIR?
Unfortunately, TIR can only be measured using continuous glucose monitoring (CGM) systems such as Dexcom, Freestyle Libre, and Medtronic Guardians.
This is because only CGM is constantly measuring blood glucose levels. CGM systems can potentially contain costs, and are not universally covered by health insurance, especially when covered by the state’s Medicaid program.
Access to CGM continues to improve across the US, but for deductible health plans, Medicaid, or uninsured people, TIR is difficult, if not impossible, to measure without easy access to CGM.
Furthermore, for those who don’t want to wear CGM, you cannot measure metrics by manually testing your blood sugar levels. In that case, using A1C is best for tracking management over time.
How can I improve diabetes management using TIR?
TIR is a powerful tool that you need to use for your benefit to minimize both long-term hyperglycemia and hypoglycemia. Here are some tips to make sure this is useful for you.
Check the pattern
TIRs can also show trends as well as percentage of time spent within (and outside of) the target range.
Perhaps you’re running low for most of the night, or your blood sugar levels are surged every day after lunch, and you’ve been doing so for the past 14 days.
Once you start to notice a pattern, you can bring that information to your doctor and change your dietary pattern or medication accordingly.
You may need to split the long-acting insulin dose (when using an insulin pump) or if blood glucose levels run after a few hours, you may need to lower your carbohydrates at lunchtime (if using an insulin pump).
Work with your doctor to make these changes, check your TIR and check the resulting diabetes management. As a result, please improve!
Focus on short-term goals
Using TIR as an incentive to prevent long-term complications may not always be a beneficial idea, especially for children and teenagers.
However, aiming for a higher TIR in the short term may be a more achievable and digestible goal.
Instead of always aiming for a 90% TIR, try starting with smaller goals, such as increasing by 5% next week. Then build on success and improve diabetes management.
Create a part of the big picture
Time in Range is an incredible tool that can really improve diabetes management, but it should not be the only metric to use.
Keep eating well, exercise frequently, manage stress, and seek support when needed.
Along with A1c, Rage Time is all the tools you need to use if possible to ensure diabetes management is best.
Improvements include mental health
That being said, Till is overwhelming for people who focus too much on percentages.
It can cause stress, anxiety and be extremely difficult for people struggling with obsessive-compulsive disorder or perfectionism.
If TIR is stressing you, talk to your doctor about more achievable goals you can set. For example, if you want to see your doctor achieve a TIR of 95%, this may be unrealistic and you may not do anything but harm you!
Furthermore, if you can only achieve your TIR goals by limiting your food intake, exercising for a few hours a day, letting go and actually living your life, the metric won’t help you become the healthiest and balanced.
If your mental health is struggling as a result of TIR, and talk to your doctor or mental health professional about how to find a more balance in your diabetes management.
Conclusion
Time is a powerful and relatively new metric used to monitor someone maintaining their blood sugar levels in a range. Someone’s blood sugar level (usually) is measured as a percentage of the total time of day that stays between 70 and 180 mg/dL, but the target range varies from person to person.
The TIR is considered an improvement in the A1C test. This only measures the average blood glucose level over the past three months, but can give the false impression of “good” diabetes management. Unfortunately, the average of many highs and many lows is a great A1C.
TIR is measured using a continuous glucose monitor (CGM). This is great. Because people can track it in real time without waiting for an A1C test. However, CGMs can potentially reduce costs, especially for under-insured or uninsured individuals in the US. Access to CGM is increasing, but it is not yet universal.
You can use TIR to check your CGM data more frequently, make small changes that have a big impact throughout the day, check your glucose patterns and trends, focus on short-term goals beyond the big picture, focus on your entire diabetes management plan, pass your life and focus on your TIR without negating mental health.
If you are using CGM but are not currently using TIR or are not using CGM but are interested in the power of continuous glucose monitoring and how TIR can help, talk to your doctor!
