Creating attainable A1C goals has long been the standard to keep your diabetes management on track. But, as we learn more about the complications of T1D and the specific causes behind them, we are also learning that A1C may not be the best metric for determining success.
Wide swings in blood sugar are now believed to increase your risk for heart disease and other common T1D complications.
Focusing on the amount of time you spend in your normal range rather than just looking at your average blood sugar seems to provide a clearer picture of your risk factors.
By improving your time in range, usually defined as the amount of time you spend between 70 and 180mmol/l, you can decrease your risk for complications like heart disease, kidney problems, neuropathy, and eye damage. Focusing on this number instead of your A1C also makes it easier to keep your diabetes management at the forefront of your mind because it is something you can calculate on your own at the end of every day or every week.
Of course, measuring your time in range is only the beginning. Once you know that number, you’ll likely want to make strides to improve it. And that’s where most of the work comes in.
Here are a few tricks that you can easily put into practice to help improve the amount of time your blood sugars stay in range.
1. Reduce Post-Meal Spikes
Because not eating is not an option, dealing with post-meal blood sugar spikes is just a fact of life when living with T1D. But there are a few things you can do to help avoid spikes that can so easily push your blood sugars above your target range.
- Pre-Bolus – Because insulin typically peaks after blood sugars do, taking your insulin before you eat can help quell those pesky spikes. Experiment with taking your insulin anywhere from fifteen to forty-five minutes before a meal to figure out what works best for your body and for different meal types.
- Eat Low Glycemic Meals – Foods that are high in processed starch and sugar tend to peak much more quickly than foods that are loaded with fiber and complex sugars. Replace high glycemic foods like white rice, white bread, and white sugar with their lower glycemic counterparts like brown rice, whole grain bread, and agave sweetener.
- Eat Fat With Carbs – Fat slows down digestion and can help slow the release of sugar into your bloodstream. That’s why adding more fat to your meals can help you avoid spikes right after you eat. But you do need to be aware that sugars may rise later, so utilizing a dual bolus or taking a second shot a while after you eat can help. Also, keep in mind that while fat may be helpful for blood sugars, it isn’t great for your heart health, so always use this trick in moderation.
2. Utilize Different Blood Sugar Lowering Techniques
If your sugars do wander above your upper limit, it can be a frustrating and painful process waiting for them to come back in range. Luckily, there are some tools you can use to help stubborn sugars come back down more quickly so they don’t have such a large impact on your time in range stat.
- Exercise – If your insulin correction just isn’t working well to decrease blood sugars, or you’d rather save a little of that precious liquid, opting for a quick bout of exercise can help bring sugars down with or without extra insulin on board. Just make sure you choose an aerobic activity like jogging, hiking, biking, or swimming since anaerobic exercises are more likely to raise sugars than lower them. And always use caution if you are shedding ketones.
- Hydrate – Drinking a lot of water when your blood sugars are elevated can help dilute the amount of glucose in your bloodstream and aid your kidneys in flushing it out of your system. While you still need insulin to help lower sugars back to a normal level, drinking extra water can help speed the process.
3. Don’t Overtreat Lows
One of the easiest ways to get on the blood sugar roller coaster is to let your stomach do the thinking while you’re suffering from a low. If you consume too many carbs when your sugars have dipped, they are likely to rise too high later on. Instead of treating your lows with any sugar in available, follow these tips to bring your sugars back into range quickly without overdoing it.
- Treat With Only Simple Sugars – Using foods that contain fat, protein, and fiber when treating lows will slow the time it takes for your blood sugar to react, making it more likely that your will overtreat with a second or even third dose. Instead opt for simple carbs that are largely sugar like hard candies, juice, fruit snacks, or honey.
- Treat Based On The Severity Of The Low – For most diabetics, 15g of simple carbs is enough to reverse the average low. But a mild low that is dropping very slowly will require fewer carbs to treat than a plummeting low that is already well below 70 mmol/l. You can avoid overtreating (and undertreating) by choosing the number of carbs you need to treat based on the severity of the low and your symptoms.
- Wait 10 To 15 Minutes Between Treatments – When you are low, your appetite hormones go into overdrive. By setting a strict time limit to wait between treatments, you can help avoid overtreating a low by putting your brain, instead of your stomach, in the driver’s seat. After ten or fifteen minutes, check your sugars and only treat again if they are still below your low limit.
4. Tighten High and Low Alarms
If you have a CGM, you have a huge advantage in improving your time in range by utilizing high and low alarm functions. These obnoxious alerts and vibrations will force you to think about when your blood sugars are going out of range and find the reason why.
Setting your alarms to 70 and 180, may not be the best approach.
If you struggle to keep your sugars in that tight of a range, it is better to start with a higher upper limit. Otherwise, you will hear your alarm so often you’ll learn to ignore it. Instead, start with an upper limit that makes more sense for your sugars and lower it slowly as you gain better and better control.
On the other hand, if you already have pretty good control, tightening up your limits can help you attain even better in-range stats by alerting you well before your numbers go too high or low. Lowering your high limit can be an especially good idea at night when your sugars are more likely to be stable and therefore, easier to keep within a tighter range.
5. Keep Good Records
Finally, whether you are looking at your A1C or your time in range, there is no better way to tighten your control than by keeping detailed records. Even if you have a CGM that logs your blood sugars for you, having a written record of what you ate, when you exercised, and other important events, will help you understand where you need to make changes.
Once you see an established pattern in your sugars, having this record will allow you to determine what might be responsible for them falling below or above your target range. As you implement the changes necessary to correct the issue, all the above tips can help you reduce the impact of those out of range sugars and get you back to where you want to be.