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Time in Range

R

Roach70

Member
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15
I have been a Type 1 for over 50 years.
About a year ago I was provided with a FreeStyle libre blood sugar monitor. I test on average 6 times a day.
My Time in Target results for the last 90 days are as follows:
>13.3. 17%
10.1-13.3. 17%
3.9-10.0. 51%
<3.9. 15%
My Estimated AIC is 7.9% (63 mmol)
In early October I have an appointment with the diabetic nurse and would like some advice on what questions I should raise.
On a separate issue, is there a thread on fasting which I could read to explain what this means and how it may help my blood sugar control. In all my appointments with diabetic nurses and Hospital Consultants this has never been mentioned!
.
 
Hello @Roach70

NICE guidelines suggest that we should be achieving a TIR of 70% as a goal to aim for, my questions to my DSN would be, what can I do to achieve this ? Ideally going on a DAFNE course (dose adjustment for normal eating) is a good starter course, we may well think we know everything to know about T1d but the course can be an eye opener and a chance also to review doses/insulin and make changes to help improve things if you haven't already done one, also nice to meet other T1d's too.

In regards to fasting, from time to time we should be doing basal checks to see if our background ratios are in range, getting basal dosages right is the foundation of our control, here's a good link to explain more: https://www.mysugr.com/en/blog/basal-rate-testing/

I have found that i've increased my knowledge greatly by talking to other T1d's here in this forum, which has helped me to improve my control, sadly our DSN's don't always offer the help we need unless we ask for it, but by asking them what courses are available and what resources are available in your area helps to open the door, best wishes J
 
It appears you're still using flash monitoring. Libre users should now be able to use CGM (continuous glucose measurement), assuming you have a smartphone or watch that is.
The clinic should be able to help with this or if not seek advice here.
CGM will make it possible to improve your TIR.
 
Hi @Roach70,

Like you - this is my 50th year of Type 1 - I started off with Libre 1 a good while back (and then Libre 2) , and thought....wouldn't it be nice to see it on my phone / watch.

So I looked at xDrip (pulls data from the Libre and displays it on my android phone and sends to my smartwatch - I could set alarms when high or low and then do something about it) - that set me off on a longer path to setting up an artificial pancreas (which is amazing), but thats a long step forward.

As @Zinadane says - the new version of LibreLink will pick up a signal from your Libre every minute and alarm if you're high or low (great for nighttime), so ask about them setting that up for you (this wont send to a watch though).

If you're on injections - ask them about an insulin pump or a referral to talk about it - once set-up these vastly improve your diabetes management.

There are other things coming along called 'Hybrid Closed Loops', where there are commercial artificial pancreas systems (CGM, software and pumps) so you just tell it what you eat, and it works out if you need insulin, or less insulin and adjusts automatically. Also worth asking for information.

If you've not been on a DAFNE course - ask about that too, it re-teaches you about food and how it affects your body when you eat it, and how to count carbs for the best control - again ask about this, its a great help.
 
Thanks for your response. Unfortunately I do not have a smart phone or wireless internet. Never thought about a watch - how much do these cost and what 'extra' do they do?
My health authority would not give me a libre device until I said it was a NiCE recommendation.
I will ask for a DAFNE course but my suspicion is the nurse will carry out the usual tests and tell me to carry on doing the same old things for fear of involving more expense to the NHS!
 
If you cannot get acces sto a DAFNE course through your DSN, there is an online version - BERTIE.
You can register to bertieonline.org.uk for free.
 
Hi @Roach70
Type 1 for 50 years here......

This is what i do which works for me ... my last hba1c was 42 which is 6.0 and my time in range is 92%....

As i say this works for me...

Your Libre is a magnificent tool its a friend and should be cherished......
I set my alarm for 3.9 and above 8.9 so this gives me enough time to avoid highs and lows....
Why only check 6 times per day?
Your libre helps understand the effect insulin exercise and food has on your BG and whilst i myself have analysed the data to the nth degree i have achieved decent results.
Please don't think i'm being smug i just want to explain what works for me.

I'm only a school caretaker but wish i could share my 50 years with a group of diabetics whilst hiking over the pennines with a rucksack of food and of course my Libre....

I wish you well

Tony
 
Sounds like you need a bit of help from a Diabetes Endocrinologist department at your local hospital - there should be a specialist group at your hospital who can advise to improve your healthcare.

Ask your Nurse to refer you to them - it actually saves them money as it improves your health in the long term, and can really improve your health and well being.


Worth considering a smartphone - first steps would be to connect to your libre automatically and get tour BG off it, and alarm when high or low - that can save your life (but will cost you a phone and a contract to do it - but it can be a cheap Android phone and a cheap contract)
 
Hi, please watch some Dr Jason Fung videos on YouTube re the intermittent fasting/diabetes, after years of this diabetes stuff, I have learnt so much from his videos recently, he speaks so understandably, even a dumbo like me can understand. Best of luck.
 
If only flash monitoring 6 times daily, it barely justifies having a libre.
IMO a smartphone is essential to get the best out of a libre.
I’m not sure if a standalone watch is possible without the smartphone as the link between the two.

A basic smartphone can be had for around the £100 mark.
But of course, it may be a steep learning curve if you’re not smartphone savvy.

Have you friends or family to help?
 
When I started with a Libre 2 before they changed it to a cgm I phoned Abbott and said my smart phone was to old to accept the app so I couldn't use it so they very kindly sent me a reader which I had to flash of course but was so much better than the countless finger pricks , I have since bought a new smart phone so can now use as a cgm which is even better , might be worth giving Abbott a ring .
 
Zinadane said:
If only flash monitoring 6 times daily, it barely justifies having a libre.
Click to expand...
Until the summer Libre upgrade, this was the situation for many users of Libre but they still got a lot of value from it.
As the Libre stores 8 hours of data which are downloaded when it is flashed, you get a lot of data to improve your diabetes management from flashing 6 times a day.
You can see what happens between "flashes" and adjust management. For example, if your BG rises above target after eating and then returns to normal, it is a good indication that the peak of carb digestion occurs before the peak for the bolus and you should try pre-bolusing earlier.
If the data is uploaded from the reader to LibreView, it is a wonderful tool for spotting trends such as a daily rise before taking basal insulin which indicates the long acting insulin is not lasting 24 hours.

It is not the flashes which add value - you may as well be finger pricking 6 times a day - but the 8 hours of data that comes with that flash.
 
The data is great to look back on for analysis, understanding and adjusting.
But the biggest value for me is from seeing my immediate trend line and direction arrow.
 
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If you want to have constant monitoring with libre, am I right in thinking you can only do this with your smart phone and not your meter?
 
Libre 2 cgm is only available with a smartphone.
I'm not sure if the libre 3 reader offers cgm.
 
Zinadane said:
I'm not sure if the libre 3 reader offers cgm.
Click to expand...
Libre 3 is very much like Libre 2 - so yes its CGM, but you can't scan it to get BG (a much reduced NFC aerial that's only used to start the sensor)

A phone or bluetooth device is needed to read BG levels
 
Not for me, but on behalf of the thread, I was trying to clarify if the libre 3 reader offers cgm?
 
I maybe wrong but I thought Libre 1 &2 readers only worked as a flash and you needed a suitable phone for them to operate as a cgm !
 
Yes I think you are right.
But it does look like the L3 reader will work as a CGM.
tbh, I know a small minority will never get a smartphone, but in order really get the best from CGM the smartphone is an essential part of the set up.
Its just the way life is now I'm afraid.
 
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