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!
The 4-Part Formula
Here are the four things that made a difference for me:
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 & Treatments
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 at home, I can also jump on my treadmill or Peloton if I feel I need to speed up the insulin action and slow my blood sugar from reaching 180 mg/dL.
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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Congratulations on this significant achievement.
Thank you…appreciate it!
I started using Afrezza a few months ago but am frustrated by the unavailability of a lower dose. I’ve had type1 for 60 years but am very insulin sensitive. The lowest dose of Afrezza- 4 units- will drop a bs of > 300 to 90 in 20 minutes. That’s great in a pump failure crisis but I can only use it for extreme highs or before the occasional very very high carb meal (Chinese take out, pizza, pasta & bread etc). When will they make a lower dose Afrezza?! There must be kids and adults out there like me who could use a 2-3 unit dose?
Wow, that’s an amazing drop….I’ve never seen that before. However, the company is currently working to approve a 2-unit cartridge, which is the approximate equivalent of 1-unit of injected insulin.
I pop open the Afrezza cartridges using tweezers and make my own lower-dose cartridges to allow for smaller BG adjustments. I saw a video on YouTube on how to pop open the cartridges and bought tiny scoops for capsule-making on Amazon. Not precise since it’s based on visual estimates vs weight and I lose a little powder sometimes, but better than going low too fast! Time-consuming at first but I got faster with practice.
The 2Us can be made by splitting a 4U dose in half. I also make a set of four 3U doses from three 4U cartridges by taking a small scoop of Afrezza from each and putting those scoops into an empty fourth cartridge. Save your used cartridges and label the new doses with sticky dots or a fine point Sharpie.
TIP: Get a (free) sample Afrezza pack of 4+8+12U doses (i.e., blue+green+yellow cartridges) from your doctor, then use those cartridges to make color-coded splits. My 2Us are in yellow cartridges and my 3Us are in green cartridges.
People have been doing this for a long time, but the company is working on a 2-unit cartridge. A lot of folks have been doing this for a while, and you obviously realize the benefits of rapid-on, rapid-off. Hopefully the company comes out soon with the 2-unit cartridge.
BRAVO and CONGRATULATIONS, Steve!!!!!!
I use MDI and I took a picture of my 95% TIR (2% low at the first level). I’m still proud of that. And yes, the higher the TIR, the slower it is for the next higher TIR to pop up. I felt like there was a snail invasion in my CGM.