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.
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