Time in Range

[Lorna Tinker]

Just noticed on my Libra monitor time in range 95% Estimated bloods 6.7. Hope that's good.

 

[Melgar]

I have read that Time in Range is a far better measure of diabetes management than the HbAc1 blood test. The estimated Ac1 reading on the Libre is just that, an estimation based on your Libre readings, not your blood over 3 months, which is what the HbAc1 blood test measures. I personally prefer time in range as an indicator as to how well I’m doing. 6.7% would suggest you are very mildly diabetic . At those levels, if your Libre estimation is accurate, then a reduction in your carb intake would drop you back into the pre diabetic range. I very recently tightened my parameters on my Libre Time in Range from 4.5 - 10.3 to 4.5 - 7.5 mmol/L in order to get better control. As a result my Time in Range fell from 90% in range to 70% in range.

 

[oldgreymare]

After a few years of using a CGM, I've decided a first priority is achieving the international standard of maintaining TIR between 10 - 3.9 mmol of at least 70&% is my target. Almost always achieving this.

So new target is increasing TOR % higher and also aiming for average BG of less than 5.5 mmol. This is massively harder but appears super important to damping down internal inflammation. But my endocrinologist is adamant I must not "cheat" using hypo levels to lower average BGs...

 

[In Response]

Doesn't it depend what your range is.
For Type 1, it tends to be between 4 and 10 mmol/l but I have seen others mention that they have seen the default range as being higher. You can set it to whatever you want.

 

[Art Of Flowers]

On my Dexcom One+ the in range setting is 3.9 to 10. I don't think you can change this. There is a high and low alert setting which you can change. My high is set to 14 and low is switched off. Low also defaults to 3.9.

I seem to be in range 98% of the time. I should not have eaten a mochi the other day or had quiche for lunch. Otherwise it would be 100% in the last week. My average glucose for the last week is 7.6.

 

[Melgar]

After a few years of using a CGM, I've decided a first priority is achieving the international standard of maintaining TIR between 10 - 3.9 mmol of at least 70&% is my target. Almost always achieving this.

So new target is increasing TOR % higher and also aiming for average BG of less than 5.5 mmol. This is massively harder but appears super important to damping down internal inflammation. But my endocrinologist is adamant I must not "cheat" using hypo levels to lower average BGs...

And that is the issue with relying on Ac1’s as an accurate measure as to how well you are doing with managing your sugars. My blood sugars are unstable and can drop, recorded as low glucose events featured on my Libre. I have no doubt these lows Impact my Ac1 numbers.

 

[oldgreymare]

And that is the issue with relying on Ac1’s as an accurate measure as to how well you are doing with managing your sugars. My blood sugars are unstable and can drop, recorded as low glucose events featured on my Libre. I have no doubt these lows Impact my Ac1 numbers.

I was late onset diagnosis, but now 15+ years in with almost benign complications, my endo is adamant that my biggest risk is hypos - he is happy for me to aim for as low HbA1C as I wish, but only if I can prove very low to zero hypo events.

 

[Melgar]

I was late onset diagnosis, but now 15+ years in with almost benign complications, my endo is adamant that my biggest risk is hypos - he is happy for me to aim for as low HbA1C as I wish, but only if I can prove very low to zero hypo events.

The Drs think I maybe late onset type 1 , but who knows, it’s a wait and see situation. My brother is LADA his diabetic team control his insulin. I’m always shocked at how high is blood sugars run. I worry for him. If I end up on insulin I’ll insist on controlling my own insulin. Easy for me to say now as I just take blood lowering tablets.

 

[EllieM]

My brother is LADA his diabetic team control his insulin.

This may be a difference in control between countries. I've lived in UK, Australia and Aoteroa/ New Zealand and (post glucomters) I've always been in control of my own insulin, albeit with advice from my team. Your brother is in Canada like you?


Edited to add.

Sorry, that was off topic.

As regards the time in range, hba1cs were brought in because they are cheap and easy to administer, but I would always believe bgs from a cgm over hba1cs given that some blood conditions and ethnicities can give falsely high or low hba1cs. Mind you, I also check my cgm against a glucomter occasionally, and calibrate when necessary.

 

[Melgar]

This may be a difference in control between countries. I've lived in UK, Australia and Aoteroa/ New Zealand and (post glucomters) I've always been in control of my own insulin, albeit with advice from my team. Your brother is in Canada like you?

@EllieM he lives in the UK (North Wales), I‘ve asked him why he doesn’t control his own blood sugars. He simply says because the diabetic nurse at the hospital controls the amount of insulin for him. He seems okay with it. I don’t press him on it. He sees me as overly concerned about health matters. I have also suggested he gets tested for Coeliac too, he simply says because I don’t have it. He doesn’t have it because he loves all the gluteny stuff he wouldn’t be able to eat. Type 1 diabetes is a risk factor for Coeliac and vice versa.

 

[EllieM]

At those levels, if your Libre estimation is accurate, then a reduction in your carb intake would drop you back into the pre diabetic range.

I may be being pedantic here, but I think "could" or "might" is better than "would" here, given that we don't know what meds @Lorna Tinker is on, or what levels of carbs they are currently taking....

 

[Lorna Tinker]

Medication and food.
Type 2 with insulin.

For breakfast I have porridge with a spoonful of coconut flakes and flaked almonds.
Lunch 2 pieces of nimble bread with egg or cheese and salad. I apple.
Dinner chicken salad with 6 new portatoes. Plain yogurt with strawberries afters. I graze during the day on nuts or a banana.

I take metformin, antistan and omeprazole I also take insulin Tresiba and Novorapid.

I have started cutting back on Tresiba from 34 units to 28 and hope through diet to keep on reducing.

Novorapid I take very little units as I keep my carbohydrates very low.

I have to keep a sharp eye on my sugar levels as I can easily go into low sugar levels. When I get to below 4 I eat a few jelly babies or drink a glass of full fat lemonade.

I only see my diabetic nurse once a year so I am trying my best to get off insulin.

 

[EllieM]

I suppose it's too much too hope that anyone has given you a cpetide test @Lorna Tinker ?? (measures insulin production).

The thing is that there would seem (to this T1) to be a some scope for you to reduce carbs, but if you are already having issues with hypos then you'd need to reduce your insulin at the same time to avoid hypos.

And to be honest, as a T1 I'd be overjoyed by your bg levels and happy to maintain a regime that generated those levels. (54 years T1, still no significant complications and I had truly awful bgs in my youth).

To be honest, I think your results are fantastic.

 

[HSSS]

Medication and food.
Type 2 with insulin.

For breakfast I have porridge with a spoonful of coconut flakes and flaked almonds.
Lunch 2 pieces of nimble bread with egg or cheese and salad. I apple.
Dinner chicken salad with 6 new portatoes. Plain yogurt with strawberries afters. I graze during the day on nuts or a banana.

I take metformin, antistan and omeprazole I also take insulin Tresiba and Novorapid.

I have started cutting back on Tresiba from 34 units to 28 and hope through diet to keep on reducing.

Novorapid I take very little units as I keep my carbohydrates very low.

I have to keep a sharp eye on my sugar levels as I can easily go into low sugar levels. When I get to below 4 I eat a few jelly babies or drink a glass of full fat lemonade.

I only see my diabetic nurse once a year so I am trying my best to get off insulin.

If your goal is to get off insulin then there is still a fair bit of room to adjust your diet. But if you are sensitive to lows adjusting insulin completely in tandem is essential. I’m assuming from your comments you are on fixed doses of insulin, is that right? It’s going to need to be baby steps, with much monitoring and a HCP willing to work with you or you being very confident you can safely adjust your own doses.

The places I see for lowering carbs further, a gentle step at a time, if that’s your wish is

1. the porridge (2/3 carbs!) swapped out for a non grain version (plenty of online recipe) eggs, meats, fish etc.
2. The bread. Nimble or otherwise all mainstream grain based bread is high in carbs for the weight of the item. Just have more eggs, cheese and salad and transport it from plate to mouth with a fork not a bread wrapper.
3. The apple. Maybe swap for strawberries, raspberries or blackberries
4. The potatoes. Again a higher carb item. Have fewer or none and more of the rest of the items on the plate
5. Nuts are ok but not too many and avoid pistachios and cashews as they are the highest carb nuts.
6. Banana is probably one of the highest sugar fruits there is.

Lowering carbs probably also means increasing proteins and natural fats to avoid hunger.

 

[Melgar]

I may be being pedantic here, but I think "could" or "might" is better than "would" here, given that we don't know what meds @Lorna Tinker is on, or what levels of carbs they are currently taking....

You are absolutely right @EllieM thanks for the correction

 

[Eric8080]

Medication and food.
Type 2 with insulin.

For breakfast I have porridge with a spoonful of coconut flakes and flaked almonds.
Lunch 2 pieces of nimble bread with egg or cheese and salad. I apple.
Dinner chicken salad with 6 new portatoes. Plain yogurt with strawberries afters. I graze during the day on nuts or a banana.

I take metformin, antistan and omeprazole I also take insulin Tresiba and Novorapid.

I have started cutting back on Tresiba from 34 units to 28 and hope through diet to keep on reducing.

Novorapid I take very little units as I keep my carbohydrates very low.

I have to keep a sharp eye on my sugar levels as I can easily go into low sugar levels. When I get to below 4 I eat a few jelly babies or drink a glass of full fat lemonade.

I only see my diabetic nurse once a year so I am trying my best to get off insulin.

I taken metformin 1mg slow release and 10mg Dapagliflozin.

My TiR was around 60% but I recently started mounjaro (currently 2 weeks on 5mg having progressed from the 2.5mg start dose.

The impact has been transformational. I’m 91% TiR for 7days, 83% for 14days & 81% for 30 days. Minimal side effects and 7lbs lost.

I have had to pay for my prescription (£150 per month) but I’ve probably saved that on food!

I halved my metformin (which has stopped long standing GI issues) and if things continue I’ll look to halve my Dapagliflozin.

I would recommend Mounjaro if you can get it.

 

[SarahHammond]

I have read that Time in Range is a far better measure of diabetes management than the HbAc1 blood test. The estimated Ac1 reading on the Libre is just that, an estimation based on your Libre readings, not your blood over 3 months, which is what the HbAc1 blood test measures. I personally prefer time in range as an indicator as to how well I’m doing. 6.7% would suggest you are very mildly diabetic . At those levels, if your Libre estimation is accurate, then a reduction in your carb intake would drop you back into the pre diabetic range. I very recently tightened my parameters on my Libre Time in Range from 4.5 - 10.3 to 4.5 - 7.5 mmol/L in order to get better control. As a result my Time in Range fell from 90% in range to 70% in range.

That's really helpful, thank you. My time in range is around the 8s but my Hba1c is 41/42. On waking I'm around 9 to 11,premeals 7 to 8,but Dr says nothing to worry about . I am going to tighten up with carbs and walk more. Thank you

 

[Eric8080]

I taken metformin 1mg slow release and 10mg Dapagliflozin.

My TiR was around 60% but I recently started mounjaro (currently 2 weeks on 5mg having progressed from the 2.5mg start dose.

The impact has been transformational. I’m 91% TiR for 7days, 83% for 14days & 81% for 30 days. Minimal side effects and 7lbs lost.

I have had to pay for my prescription (£150 per month) but I’ve probably saved that on food!

I halved my metformin (which has stopped long standing GI issues) and if things continue I’ll look to halve my Dapagliflozin.

I would recommend Mounjaro if you can get it.

Update - I’ve carried on self funding Mounjaro. I’m currently on 7.5mg with minimal side effect. Reflux is the main one so I’m taking Omeprazole which works well.

I’ve lost 7kg. My time in range is 96% - 85% at 90 days which includes 3 weeks before I started the mounjaro.

I’m off Metformin (and have seen a real benefit in my gut health) and have halved my Dapagliflozin (5mg). I’ve a check A1C in a couple of weeks but my CGM is currently estimating 6.8% / 51mmols - this includes an early period without monitoring so I suspect a 40-something mmols result.

For me this remains transformational and I remain a strong advocate.

 

[Binky21]

Not really relevant, I manage without a meter but I have to say that as to HBA1C, in 20 years of diabetes and medication, I have very rarely been able to figure out what leads to 54 as opposed to 48 for example. If its Christmas etc, I might find this happening as I relax my diet for a month but otherwise I dont vary food much and cant account for the HBA1C readings I get. I kind of cross my fingers when it comes to HBA1C

 

[jaywak]

Just noticed on my Libra monitor time in range 95% Estimated bloods 6.7. Hope that's good.

Over what period of time are you getting the time in range of 95% ? the Libre gives it for 7 days 14 days 30 days and 90 , the Hba1c is over a 90 day period .