Diabetes, BG, A1C: Here's What Happened When I Focused On Time-In-Range For 99 Days

Me getting all scientifical.
Not really, it's Google Doodle's salute to Hedy Lamarr's contributions to science. 

This is what happened when I committed to focusing on TiR (Time In Range,) for 99 days,  re-embraced my inner D scientist and used my body as lab and experiment.

Diabetes Weaponry: Omnipod OG, Omnipod PDM, Dexcom G6, Glooko, G6 App, Clarity App, Apple Laptop,6+iPhone, The Diabetes Online Community. 

Longer than usual post and it's straight from the heart.  
#######

There was a time in my adult life where I kicked diabetes ass with A1c’s in the upper 6 range. Times change, life got hectic, adulting is complicated and I’ve been struggling with my A1c on and off since 2011. 

I've tried all sorts of things to get back in my diabetes comfort zone. Some things helped, some things didn’t. 

My a1c has fluctuated between 7 and 7.8 since 2011 - with the exception of one lone 6.9 in January of 2017.

7/17 - 11/17: My a1c refused to budge from 7.4. 

07/18: Officially diagnosed with Hashimoto’s. My a1c dipped slightly after the Dx to 7.3, then stubbornly increased every 3 months until 10/19. 

10/21/19 Endo Visit

A1C: 7.8. The “Rocking Dr. J” and I were incredibly frustrated in all dimensions. 

Dr. J, his right hand and my AMAZING Diabetes Care & Education Specialist Cheryl, and I had managed my diabetes together since the late ’90s and we’d achieved much.  

But we'd encounter A1c roadblocks in recent years, and 2019s continual A1C creep in the wrong direction was a collective drain on my Diabetes team.

Dr. J looked at me and asked: Kelly, do you what Time In Range is? 

Indeed I did. TiR (Time in Range,) is the amount of time you spend in your preferred blood glucose target range on a daily basis. It doesn’t mean you don’t have high blood sugars. 

Of course you do you have diabetes. But you have more time when your blood sugars are within your set target range. 

Your TiR is determined between you and your healthcare team. 

TiR was one of the big buzz words at ADA, AADE, and DTM. 

My personal time in range is set between 70 and 180 during the day, with an evening TiR between 70-170. Clearly, that wasn't happening. 

I agreed to upload my Omnipod PDM and Cgm data to Cheryl so we could make tweaks, and promised that for the next 99 days I’d focus on TiR. 

I waited until I hit the parking garage before I started to cry.

FUCK THIS. I was done. Come hell or high water I was going to share my diabetes data, focus on my TiR one day at a time, record my observations, and hopefully learn from them.

I was going to re-embrace my inner D scientist and use my body as both lab and experiment.

And So It Begins

10/22/19

I uploaded my devices to Glooko and Clarity, emailed Cheryl and sent her a share code. 

Starting TiR

Glucose numbers weren’t terrible. 

My TiR for the previous 3 months was 57%, thirteen percent lower then the 70% goal we’d set when I started CGMing in March of 2019.

Cheryl noticed that my overnight basal seemed too high and the culprit might be my constantly fiddling with my temp basals - which seemed to be “reactive re: increased glucose levels, not proactive - as in preventing them.” 

She offered several options and told me the choice was mine. 

I gave up all control and told Cheryl it was her call. 

We changed my carb ratio to 7, between 12pm to 12am and lowered my 12am basal  to 0.90 

Observations

I noticed more positive numbers immediately. 

In the beginning, I looked at my TiR, but not every day. I celebrated when my TiR increased by a percentage point. I was OK with it when it didn’t. 

As the weeks passed, I checked TiR almost daily - except when I didn’t check at all. 

Dietary Tweaks

In October of 2018, I made a goal to maintain my weight during the holidays & I did. 
I made the same goal in October of 2019.

November
I switched from half-& Half to full-fat Oatly milk in my morning coffee, in the hopes of reducing my post morning coffee bg spikes. 
Also: I needed to break my 1/2&1/2 habit - I was going through 1 quart a week! 

Oatly Full Fat milk didn’t taste disgusting in my coffee, contained more carbs and fat per 8 oz serving than half-and-half, but since I was only using 2 or 3 ounces, I bolused for the same amount of carbs. 

My post-coffee morning spike numbers time reduced by half. 

I upped my plant-based protein consumption at home to roughly 75% and stuck with “anything goes” when eating out. 

And yes, I’m still addicted to and enjoying cheese as a food group, fish, the occasional cheeseburger with the works and the likes thereof.
I'm not eating birdseed and I'm most definitely eating carbs! 

Practicing Conscious Pre-Meal Bolusing

I committed to pre-bolusing 20 minutes before every meal - and I noticed decreased numbers and shorter time re:post-meal blood sugar spikes. 

I continued with my separate morning coffee bolus (which I've been doing for a couple of years now,) followed by my breakfast meal bolus. 

Depending on my blood sugar and the dinner I was making, I began giving a blood glucose correction bolus while prepping/making my dinner, followed by a carb/bg bolus 10 minutes before the meal was ready. 

I Looked At My CGM Arrow Before Post Meal Rage Bolusing
Patience is a virtue - one I have - except when I don't. 
After I gave myself a meal or correction bolus, I did my best not to automatically rage-bolusing if my BG went passed a certain number and under a certain amount of time,
post-meal. 
If my CGM arrow was flat - I forced myself to wait. Nine times out of ten, my glucose number would start decreasing - just like it was supposed to. 

A-HA Moment

11/14/2019 

I covered (DTM) the Diabetes Technological Society’s meeting for Ascensia Diabetes Care, where I sat in on a discussion re: glycemic variability metrics,TiR & heart damage.  

It was the first time the whys behind the diabetes/heart disease connection were explained to me clearly - from the inside - in terms of the damage long term time spent outside of range does to the heart’s arteries and blood vessels. 

It was a goddamn game changer. 

I’d always assumed “diabetes and heart issues automatically went hand-in-hand,” because, since my DX as a child, that’s what I’d always been told. 

"That” and of course, genetics.  

My family genetics is interesting. 

My diabetes team knows my genetic health history because I shared it with them from the get-go - and we’ve been proactive re: my both diabetes and good heart health since the mid 90s. 

With that being said: I thought about the heart/TiR connection for weeks, and every time I looked at my cgm, did a finger stick, or pre-bolused for a meal. 

It was and is an excellent motivator.

You can read about that life-changing session by clicking HERE, scroll down to Day 2:Diabetes Data From All Sides, and give a read.

Insulin Reduction 

At the beginning of December, I noticed that my 24-hr daily insulin totals were decreasing. By January my 24-hour daily insulin totals had dropped to the mid-30s and mid-40s, versus pre TiR experiment insulin totals in the mid-40s to 50s.

Exercise

Tendonitis was slowly easing up. I started walking three days a week (20-40 minutes,) in December, and up until I sprained my ankle falling down the steps (and totally sober,) the Friday before Christmas. 
The ankle is better. I need to get back on the exercise horse.

PARADOX

12/25/19 

Lots of Christmas cookies and pumpkin bread, and a freakishly good time TiR.

On the flip side and on odd rando days, the opposite occurred - and that was OK. 

Technical Difficulties 

1/03/2020 

Uploaded devices to Glooko And Clarity, and sent Cheryl a share code. 

After looking at my data, she realized I had a faulty transmitter.

HOW? While my TiR was 62%, only around 30% of my actual data had uploaded to Clarity since the transmitter’s November start date. 

Heads up: If your G6 app graph lines continually stop and start when you're less than 20 feet away, you probably have a faulty transmitter.

My Clarity data was unusable in determining the last 60+ days of my TiR. 

I. WAS. LIVID.  
I let Dexcom know it. They overnighted me a replacement transmitter, plus two replacement sensors.

I kept moving forward. 

Cheryl suggested that we stick with my current settings, told me to continue doing what I was doing and to send her my data uploads a few days before my January 30th Endo appointment. 

Days Outside of Range Didn’t Make Me Feel Like A Failure

Don’t get me wrong, it was (and is) annoying, and sometimes I’m downright pissed.  

BUT... I realized that the days my blood sugar graph was full-on wonky, were occurring less often.

Percentage-wise, my day/clusters of days spent outside of range weren’t nearly as horrible as they could have been.

1/21/2020

9 days before my Endo appointment, the first day of my period, and the first time I’d stepped on the scale since before Christmas. 

Even with bloating, I weighed 3 lbs less than my pre-Christmas/pre-period weight. Usually, I'm 3 or 4 pounds heavier than my normal weight. WEIRD. 

1/27/2020

Received email from Labcorp informing me my results were available via their portal. 

Ignored it. I know me - I’d start googling and obsessing. 

Nope, I had shit to do. I'd let Dr. J tell me.

1/28/2020

Uploaded my data to both Glooko and Clarity, sent Cheryl the Clarity share code and she promised to get back to me by my Thursday afternoon appointment.

1/29/2020

Weighed myself. 
Immediately stepped off the scale and then back on and weighed myself again. 

I’d dropped 8 pounds since Christmas. 

Did I need a new scale? 

Put on a pair of jeans that had been way too tight in July - and not in a good way. 

They fit. 

1/30/2020 - Endo Day
Checked email on my phone in the waiting room and no surprise because she always keeps her word, there was an email from Cheryl, who works from home on Thursdays.  

According to Cheryl,(who was super stoked,) my TiR for the past 99 days: 84% with 1% in the low range. 

COME AGAIN? 

Before I could process or reply, I was called back by the PA to get weighed (still 8 lbs lighter,) and blood pressure checked in one of the waiting rooms. 

I tried not to think about my labs.

30 and 60 day estimated A1C on my CGM clocked in at 6.8, but with transmitter issues, 

I wasn’t banking on anything.

10 minutes later Doctor J walks in: What’s going on Kelly? 

OK, let me rephrase: What have you been doing differently? 

And how are you feeling about the changes you made?  Your A1c is great! 

Me: What’s my A1C? 

Dr. J: You didn’t check the portal? 

Me: NOPE. 

Dr. J: Your A1C is 6.7%, down 1.1 points from last time! I’M SO HAPPY. 

I don’t know what your TiR is, because I haven’t talked with Cheryl yet and she’s not here today. I can let you know tomorrow - unless she’s already emailed you? 

The rest of your labs( which we went over,) are awesome - And you’ve dropped 8 pounds. I’m so proud of you!

Me: You’re sure my a1c is 6.7?

Dr. J: Yes.

Me; You’re positive? 

Dr. J: YES.

Me: Cheryl emailed 30 minutes ago. My TiR is 84% with 1% lows. 

Dr. J: AWESOME. We want TiR to be 70% - I am so proud of you!

What changed for you Kel?

Me: Honestly? Focusing on TiR one day at a time is a lot easier than focusing on a good A1C for three months. 

Then we had a heart-to-heart and I shared my 3-month TiR observations. 

I left feeling happy and a little weird - but in a good way.

CONCLUSION

Whatever happens between now and my next Endo appointment, I’m taking it one day, one daily TiR at a time because it’s working for me. 

People with diabetes are continually bombarded re: long term diabetes management, complications, etc. And I absolutely understand why - but sometimes the weight of all that knowledge gets incredibly heavy to carry.

For me, managing my diabetes one day at a time re: TiR is not only easier, it's also more gentle and less overwhelming for me to process emotionally, mentally, and physically - both on paper and in real life. 

This Week My Diabetes Has Been Batshit Crazy.

My diabetes this week.
Image courtesy of Design By Humans.

This Week My Diabetes Has Been Batshit Crazy - and I'm owning it. 

Cut to Monday morning (which was my scheduled site change day,) when I woke up at 5:17 AM, with a fuzzy mouth and blood sugar of 336. I believe the words “FUCK ME,” were uttered multiple times. 

Omnipod site had gone bad in the middle of the night and I slept through Dexcom’s high blood sugar alarm. 

I’d had 24 units left in my pod before I went to bed on Sunday night, with15 hours left before it was empty. Shit happens and I know that. Yet I'm mad at myself for the site crapping out and not changing it out the night before. But all signs pointed to me not having to. Shit happens. Accept and move on. 

Speaking of.. I felt like shit. Downed a huge glass of water, calculated and administered a correction injection, and changed out my site.

5:20 AM 

New pod’s occlusion alarm goes off and I have to change it out. 

Once again I utter “FUCK ME,” followed by “WHAT THE ACTUAL FUCK?!” 

Now I’m BOTH pissed and annoyed.

5:26 AM 

Second new pod site of the day goes in. I set my alarm an go back to sleep

7:30 AM

I wake up and my bg is 289. I think to myself that it should be lower, give myself a correction bolus and sent a 3 hour increased temp basal rate of 45%.

9:20 AM  

Bg is 240. I AM NOT AMUSED. A correction bolus of 1.05 units is given. 

10:45 AM

Bg is 266 and going in the wrong direction. I make the decision to deactivate the pod. 

3rd new pod put in.

Temp basal rate of 60% for 3 hours set. Bg slowly starts going down. 

Small ketones, massive amounts of water consumed. 

I'd scheduled take Monday afternoon off last week, so I answered emails plowed through, and hoped things would kilter out by 1:30 pm. 

1:30 PM 

Meet a friend for lunch. Bg is 210 and I’m like: Hey OK, things are getting back to normal. Except they weren’t. 

I have mahi-mahi fish tacos or lunch. They are delicious and I bolus generously.

3:13 PM  

Blood sugar is 260 and my head hurts. Correction bolus 0.80 given. 

Temp Basal increased by 45% and for three hours, and I down more water. 

My friend asks if I want to get a pedicure. I do, I really do.  

But I decline. I don’t feel good. 

5:09 PM  

Bg is 323. Temp basal rate is increased and set to 60%. 

Correction bolus of 2.25 given.

I drink 20 ounces of water, set the alarm on my phone and take a nap because I am exhausted

6:51 PM 

Bg is 281, with a correction bolus of 0.45 units. No way I’m eating dinner. 

Trace amount of ketones detected, more water consumed. 

8:22 PM  

Blood sugar of 215, with a 0.30 correction bolus. I still feel crappy and watch Brokenwood Mysteries on Acorn TV. Started watching over the weekend and it’s pretty good with a great musical soundtrack. If you haven't already, tune in.

I also check PeriodTracker and confirm that I am ovulating - which normally causes elevated numbers for a few days - but not even close to this current batshit craziness. 

9:13 PM 

Bg 198, 0.85 correction unit given. Drink club soda with a splash of juice and a few crackers because I have 3.3 units of insulin on board and the arrow on my Dex is pointing in a south east direction. 

Speaking of arrows, my graph looks like… well I don’t know what the hell it looks like, but doesn’t look good. 

12 AM Tuesday morning: Blood sugars have evened out and now in the 120s. 

The insulin tally for Tuesday - 71 units of insulin. I normally average somewhere between 39 and 47 units per 24 hour period. 

I turn off the temp basal rate, eat a few more crackers and officially have zero fucks left to give, and head to bed. 

7 AM Tuesday morning: Wake up with a glucose of 240. 

Whatever the hell is going on with my body -  be it hormones, fighting off a cold or allergies, or just because it’s freaking Tuesday - my body requires a higher temp basal rate and more insulin.

Numbers hover between 180 and 215 all day and my 24-hour old site (my leg,) starts to hurt after dinner. 

I don’t want to change it out - but in my heart I know it’s crossed over and become a zombie infusion site. 

10:42 PM Tuesday Night: Change out site and numbers immediately start to depart zombie land. I stay up late to make sure every thing is stable re: my numbers and watch the final episode of Brokenwood, season 5. Bummed it was the final episode and looking forward to season six. 

As of today (Thursday,) I’m still running a temp basal rate that’s increased by 15%. 

Not sweating it, though. My numbers are on the decent side of normal and I know for whatever reasons, my body needs the increased basal rates right now.

I know this to shall pass and I have too much adulting to do to pinpoint the why(s).  

Stuff: Blogging, Exercising, May Is National Mental Health Month, CGMing, GoT

Yep, it's been a while since I've posted. 
My excuses: Things have been slightly crazy, I needed to regroup, one week of not blogging quickly turned into multiple and  accompanied by a wicked case of "what the hell do I write about/didn't I already write about that a million times already?! 
Because after blogging for almost 12 years about life with diabetes - sometimes I'm afraid "I've said and or written about that already." But you know what? Everyone who blogs about diabetes feels that way from time to time - and that's OK. 

After taking a short sabbatical - I'm back writing on the blog about my life and my life with diabetes! 

What's New? 
Lots: I've started exercising and thank God because I'm out of practice and I absolutely think better when I'm moving. 

Work has been active - lots of stuff going on and on the horizon  - I am both glad and thankful. 

It's May, which means it's National Mental Health Month. With that being said, I started seeing a therapist in March - because while I was going through the motions of my life, 
I was missing Olivia terribly at the end of the day and I was sad. 
I'm sharing because talking to someone is helping me deal with the trauma of losing my niece Olivia in January - and it's making me stronger in all areas of my life. 
If you're dealing with any form of stress, anxiety, or trauma - including diabetes burnout or grief - go talk to and with a professional.
Seriously - talk with someone - you are worth it! 

Is That  A CGM On Your Arm... Or Are You Just Happy To See Me? 
The answer is BOTH. 
I LOVE seeing you - you look great! And and yeah... I started wearing a CGM (Dexcom G6) in March because my Dr. and I need to make tweaks - I've committed to wearing it for at least 3 months. 
I was supposed to start in January, but Livy passed and I didn't feel like dealing with the learning curve while heading out west for her funeral. February I was bogged with assignments and starting on the Dex was pushed back into March.  

Initial Observations
Graphs have the potential to make you effing crazy!
I believe that people must be trained  on the anxiety that watching your graph can cause. Knowledge is great  - but so is realizing that when you/your loved one eat... or have a cold... are stressed... or just because it's Tuesday, your graph can and will go up. 

Also and I kid you not, we need to step away from the graph after a correction bolus. 
I knew all of the above before wearing a CGM  - and I was still looking at it way to much in the beginning!

CGM alarms are wicked loud.

Compression Low bgs are a thing - As in your CGM Low alarm goes off and reads 59, and you just ate lunch 40 minutes ago and you feel absolutely fine, do a fingerstick check. 
Because Compression Lows (unknowingly pushing against the sensor or sleeping/leaning on it can cause it to read low (at least according to my multiple friends and my CDE,) are real and they happen. Of course I learned about Compression Lows  after treating for said 59 low that really wasn't. HELLO 200! 

On the flip side - I barely felt a 53 low a few days ago that caused my alarm to go off.... at least until I did. It was real and I knew it! 

I'm more mindful of grazing since slapping on a CGM. That's a good thing. 

It's interesting to see how quickly certain foods impact your blood sugar via a graph.
It's equally as interesting and annoying to see how some foods seem to flat arrow for an hour or two and then spike towards the sky for a good three or four hours.
Ahhhh.... Good times..... good times. 

My graph was elevated the week before my period - I always knew this to be true - seeing it on a graph was trippy. 

Watching Game of Thrones absolutely impacts my blood sugars! 
Or at least I'm blaming GoT... and the Show Runners and Writers of GoT.
During last night's finale my bgs were running low. 
The previous weeks, not so much - especially when that ass of a Night King and his army hit Winterfell - I was topping 306 by the time that episode ended! 

Graph during the battle of Winterfell and dinner was not crazy high in carbs.
Also: Changed out my Omnipod site the next day (as in 1 day early,) b/c it was getting skunky.
So yeah, site starting to crap out might have had something to do with my elevated graph.
Whatever, I blame the Night King!

Graph during GoT finale.
I might have over bolused for my big tuna salad.
But the sucky writing certainly didn't help!
Also: Why'd you all demonize Dani and where the hell is my dragon!! 

Speaking of blood sugars - you ABSOLUTELY need to check your blood sugars via finger-sticks while wearing a CGM. Certainly not as much .... most of the time. 
My previous sensor required 8 calibration checks in one day before it started syncing - and that required massive amounts of self restraint because I wanted to rip out my sensor and start a new one... but I didn't and being things worked out.
My current sensor was within range on the first (and second) calibration. 
Depending on the day, how my numbers are running, physical activity, and how old my Omnipod site is - my amount of finger-sticks per day varies. 

Bottom line: My pancreas is stone cold busted - I need to make sure whatever robot diabetes part I'm wearing is reading correctly and that requires finger-stick checks~  

So that's all for now. HOW THE HELL ARE YOU DOING?