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.  
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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. 

Diabetes, Labs, And Taking A Beat Before Clicking On The Link.

Back in early August, when I was dealing with a nasty viral infection that made me break out all over and feel like crap; required a slew of lab work and forced me to finally signed up for LabCorp’s patient portal. 

Bottom line it made communicating with my GP's office easier, especially since the staff was in rotating vacation mode, which resulted in unreturned phone calls re: my labs. 

I’ll admit that it was cool to see years worth of my lab work online, at my fingertips, and organized in one place by date and doctor.

In August I thought it was great. But last Wednesday? Not so much.

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Cut to last Wednesday afternoon. 

3pm, me deep in thought and working on a project that was due on Friday.

I took a break, opened my email tab and immediately focused on the Subject Line of an email from labcorp, letting me know that my labs were available online.

All I needed to do was click on the portal link and sign in. 

INSTEAD, I IGNORED IT. 

I knew if I clicked on the link,I would be either happy... or I wouldn’t - because of my A1C.

Clicking on that link would take me down the rabbit hole of numbers that I didn’t have the time or mindset to go down.  

And at that moment, I knew I was reaching the brink re: my diabetes numbers breaking point. I took a beat, told myself my Endo appointment was the next morning and I would go over my results with Dr. J.
Until then, I was going to give myself a break so I could assess and be proactive at my appointment - no matter what. 

It wasn’t easy to ignore the email.... at first. 

Seriously, (like for the first 20 minutes,) I kept toggling back and forth between screens. 

But slowly, I forgot about it, except for when I didn't - but I never clicked on the link.  

Cut to Thursday morning at my Endo’s office. 

I sat in the exam room with a slightly elevated blood sugar and a normal blood pressure of 120 over a number I can’t recall. 

Dr. J walked in, said hello, shook my hand and stated: The good news - your A1C didn’t go up.......It’s exactly what it was last time you were here.

And at that moment I was so glad I'd stayed above ground and hadn’t clicked on the link and ventured down the diabetes rabbit hole of numbers and what-ifs. 

I would have lost focus and been upset for the rest of the day. 

I wasn't thrilled, but I ready to talk it out and make some changes. 

Sidebar: I know a 7.4 A1C isn't terrible - it's not.
But honest to God I really thought that I'd made strides since the beginning of August. 

I'd started on the Omnipod, (and really like it,) I'm taking less insulin per day, (by at least 10+ units,) and I thought my A1C would have reflected that. 

I was expecting it to be 7.0 or lower and not stuck in an the same a1c moment - and I told him that.

I was frustrated with myself and with diabetes - and I knew Dr. J was too - even though he remained calm and kept his game face on. 

We talked it out. Dr. J asked me what changes I’d made that led me to believe my a1c would be lower.

I told him about cutting back on my daily insulin intake and how I’d been trying to eat healthier. 

He asked if I’d been sick or dealing with anything that might have contributed to my A1C.

I explained about the viral infection that had me down for the count for parts of July and August... but it was November 18th. 

I was grasping at straws and we both knew it. 

He asked me if I thought I was getting enough exercise.  

I was honest. I told him that needed to do better in that department. 

And then he asked if I’d downloaded the Glooko app on my phone so I could download  my Omnipod PDM’s info, and share it with my Sorceress of a CDE, Cheryl - so she could work her magic on my basal rates, carb ratios, etc and assist me in getting unstuck. 
Sidebar: Insulet (the company that makes Omnipod,) and Glooko have been data management partners since last year - the Glooko cable and instructions are included with your first PDM and first pod order  - and my cable and instructions were still in the box. 

“Cheryl’s really knows what she’s doing,” he said. 

And he's totally right, Cheryl does know what she's doing. 
She and I had discussed me getting my data to her via Glooko when she was training me on the Omnipod. 

I told her I would - and I talked about doing it. 

But I didn't.

I needed to revisit and reconsider.

Calmness prevailed and Dr. J pointed out the positives in my labs - and I love that he always points out the good. ALWAYS. 

And then I blurted out to Dr. J how I’d ignored yesterday’s email - and he looked a little surprised and asked me how come. 

Me: I knew that if I clicked on the link and it didn't take me to the number I wanted to see - I wouldn’t be able to concentrate or get things done. I’m always dealing with numbers - I knew I was seeing you this morning. I needed a break, so I took one. 

Dr.J: OK, fair enough. Set up the Glooko, share your PDM data with Cheryl; make an an appointment with her for December. I'll be right back, I’m going to see if we have any insulin samples for you.

When he came back with insulin in hand, I'd downloaded the app to my phone and was willing to try it out. 

Because I am going to tackle those damn basal rates with my CDE. 
I am forging ahead.
I am keeping the promise I made to my healthcare healthcare team.
I am going to keep the promise I made to myself. 
And we'll see how it how it goes. 

Diabetes: Of Labs; Life Circumstances, Being More Than Our Numbers & Acknowledging How Hard We Work~

Tomorrow is my D Day and I could let the fact that circumstances beyond my control may indeed have messed with my lab results - And I could beat myself up - Or...I could go the other route.
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Tomorrow is my endo appointment  - A person living with diabetes own personal D Day, for sure. A day when we tend freak ourselves out and beat ourselves up based on our lab results - at least that’s my usual M.O.

But this time around, I just don’t have it in me to freakout, drive myself crazy or beat myself up - And I don't want to. 

I’ve tried my best since my last Endo appointment, I really have. 
Since my last appointment, I’ve worked hard; I trialed the Snap for 7 weeks with positive results, shared #Iwishpeopleknewthatdiabetes with the diabetes global community and learned from them, started yoga and walking and battled a gnarly case of Bronchitis (and a whole bunch of other itises,) that almost almost put me in the hospital, required a week of steroids and copious amounts of insulin - and still requires more than my usual amount. I’ve been on two rounds (3 weeks in total ,) of antibiotics - the last of which will be finished on Wednesday. I still don’t feel 100% better, but I’m getting there. 
Sidebar: Yes, I swore I wouldn't write about my bronchitis again, but trust me - there's a point. 

And the point is, I can’t focus on how the bronchitis, the steroids and the antibiotics might have negatively affected my A1C results or I’ll go effing crazy.
Honestly, whatever my labs reveal tomorrow -I know I tried my best with diabetes, regardless of what BS obstacles crossed my path. 
I dodged all sorts of crap and rolled with the punches - diabetes and other wise. 
I know I tried and I know that I am more than the sum of my numbers - we all are.

Still, I know from experience that I will take my A1C results personally - And that I'm great at beating myself up - I could teach a master class on that subject. 
Here’s the thing: I don’t feel like taking my a1c personally tomorrow, or beating myself up. So come tomorrow, when I’m sitting in the exam room before the fabulous Dr. J walks in, I’m going to do my best and remind myself of what I did right, I’m going to remind myself to learn from my mistakes and I’m going to be grateful for what is... and what isn’t. 

And if your the one sitting in your Endo’s exam room tomorrow or anytime after, I hope you do the same. 
People living with diabetes are resilient and tough - and people living with diabetes are their own worst critics - While we preach to our friends about “giving yourself a break & acknowledge how hard you work," we rarely allow ourselves to do either.
Each and every one of us need to remind ourselves how hard we work when it comes to diabetes, how we never get a break from diabetes, and how we continually pull ourselves by our diabetes bootstraps  - even when it’s the last thing we feel like doing, so can live our best lives.

We rarely acknowledge all our efforts and hard work and I think we should - And no matter what my A1C is, I’m going to try my damnedest tomorrow to do just that - and I hope you do too.