Founder & Director, TCOYD; Endocrinologist, Clinical Professor of Medicine, University of California, San Diego (UCSD) School of Medicine; Director, Diabetes Care Clinic, VA Medical Center San Diego
Dr. Edelman lives with Type 1 diabetes and is a renowned diabetes specialist who founded TCOYD in 1995. As a Professor of Medicine at UC San Diego and practicing endocrinologist, he’s dedicated his career to making diabetes education accessible and empowering. He’s authored over 200 publications and has been named among the top 1% of U.S. endocrinologists. His personal experience with diabetes gives him unique insight into what really matters for daily management.
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Last month I hit the diabetes equivalent of a triple no-hitter…three days in a row with 100% time in range!
I’ve never done that before in my life. In fact, achieving 100% time in range (TIR) for even one day is totally rare for most people, including me!
Before I explain how I did it, I want you to know that this is not something anyone needs to try to do for their diabetes management plan. Research shows that a TIR of 70% is associated with a lower risk of complications, so 70% is a solid goal for the majority of people.
That being said, I like to compete with myself!
When I noticed I had reached 94% TIR on my three-day Dexcom and Eversense reports (yes, I wear both), I thought, I wonder if I could hit 100%? I just wanted to see if I could do it!
So I started paying more attention to my day-to-day diabetes management, making small but consistent changes. I hovered at 99% TIR for what seemed like an eternity – it was so frustrating! I still can’t get over how hard it is to gain one percentage point, but how easy it is to lose them.
It took me about six weeks to reach my goal…I was so excited I took a screenshot!
DIY Loop App
I’ve been using the Loop app for several years, and I love it. Loop is an automated insulin delivery app that connects insulin pumps with CGMs. It’s not FDA-approved, but thousands of people use it and have great success with it.
One thing I like is that you can get a new operating system update once or twice a year, which would be impossible if you had to go through the FDA for each update. The latest version of the Loop app is excellent, and it definitely seemed to have an impact on my diabetes management. The algorithm is so good!
CGM Settings
I’m probably a little more aggressive with my high and low alert settings than most people. My upper alert is set at 160 mg/dL instead of 180 mg/dL or higher, and my low alert is set at 80 mg/dL instead of 70 mg/dL or lower (setting too high would lead to alarm fatigue). Essentially, I want to be notified before I hit the upper and lower limits so I can make adjustments earlier.
Trend Arrows
I always check trend arrows when my alerts go off so I know how quickly my blood sugar is changing and in what direction, and how fast I need to act.
When I’m going high, it’s all about Afrezza. I take 4, 8, or 12 units, depending on my blood sugar and where the trend arrows are heading. If I’m going low, I consume super-fast-acting carbs like juice, soda, or GU. No Snickers bars if I can help it – no matter how badly I want one!
When I’m on a mission to reach 100% TIR, every second that I’m out of range counts!
Meals and Timing
I really didn’t change my eating habits too much to reach this goal, but I did try to avoid foods that I know wreck my blood sugar, like noodles. Noodles really do it to me! So during this time period, I paid more attention to what I was eating, and I also didn’t eat a lot in one sitting. For example, I have a smoothie every morning, but I rarely have to bolus because I sip it so slowly over the course of 1-2 hours.
How to Manage Blood Sugar Levels for 100% Time in Range: Key Takeaways
Overall, I didn’t deviate significantly from my usual routine. I just paid a little closer attention to what I was eating, when I was eating, what my trend arrows were telling me, and how I handled impending highs and lows before they became bigger problems.
Even though I’ve loosened things up a bit, my three-day average has stayed pretty close to 95%, which is still the best it’s been in a long time. Will I ever have another three-day no-hitter? Who knows. The competitor in me wants to try to hit 100% TIR for seven days, but the donut lover in me wants to leave some wiggle room for a glazed maple!!
One of the most important things to remember is that a 70% time in range is associated with a very low risk of developing long-term diabetes complications. Thanks to the advanced AID systems (which are all very good), you don’t have to chase perfection to have a solid diabetes management plan and excellent diabetes control.
After living with diabetes for 56 years, sometimes I need to mix things up, so this was fun for me to try for a short period of time. Plus I’ll take any opportunity to beat the pants off of Dr. Jeremy Pettus whenever I can!
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