A Conversation with Diabetes Advocates About Time in Range
By Arvind SommiJulia Kenney
diaTribe’s Community Manager Cherise Shockley led an online discussion about Time in Range with Shay Webb, a diabetes advocate, and Julia Blanchette, a diabetes care and education specialist and nurse scientist. They covered a host of topics, including first introductions to Time in Range and preventing emotional burnout. To watch the full conversation, click here.
As the use of continuous glucose monitors (CGM) expands rapidly, Time in Range (TIR) is becoming an increasingly viable tool in diabetes management. A recent diaTribe Facebook Live event tackled some of the most persistent questions about the growing adoption of this new metric, which tracks the percentage of time a person spends with their blood glucose levels in a target range.
For instance, what are some best practices for using TIR for the day-to-day management of diabetes and with your healthcare team? How does TIR compare to A1C and how can both of these metrics be used in diabetes management? How can you use CGM data without getting overwhelmed with information? How can you talk to your healthcare team about it? If you have any of these questions, you are not alone!
diaTribe’s Cherise Shockley hosted a conversation with Shay Webb, a diabetes advocate and clinical trial coordinator who is completing her master’s degree at University of North Carolina, and Julia Blanchette, a diabetes care and education specialist and nurse scientist at University of Utah, in August on these topics. Both of them have type 1 diabetes and have been using a CGM for several years, and they both said that using TIR has improved their ability to take care of their health.
Talking with Your HCP about Time in Range
Webb said that using her TIR data empowered her to seek out more actionable advice and goals from her endocrinologist. She emphasized how important it was to find a team of healthcare professionals that you felt comfortable discussing the details of your health data with.
Blanchette, who often teaches people with diabetes how to use a CGM, agreed that TIR works best when working with a healthcare team that you trust. She added that since CGM data can be overwhelming, “When training someone how to use CGM and reviewing their data with them, I always print out the report.” If your provider does not print out your report, she recommended that you print it out yourself to bring to your appointment.
“This empowers you to bring up more specific details to clinicians who are busy,” she said.
Is Time in Range as a “Grade”?
No, the panelists reiterated. TIR is not a grade. It’s a tool to become healthier.
Webb drove this point home, saying, “You’re not passing a grade, you’re not going to class, you’re not graduating from diabetes.”
This can be hard to keep in perspective, both Webb and Blanchette agreed. One of the advantages of CGM is that you have access to so much data that can help you make decisions to improve your health each day. Tracking TIR provides immediate feedback on your diet and behaviors throughout the day. It’s easy to fall into the trap of thinking about your diabetes metrics, such as A1C and TIR, as if they are a “grade” on how well you might be managing your diabetes. However, it’s more realistic and practical to use TIR to inform positive, actionable steps in managing your diabetes.
Webb said she saw TIR as a “progress report” to better understand her health data in between A1C tests. She explained that TIR is “not the end-all-be-all” but rather is “showing you the improvements you need to make” to reach your goals. Using CGM and TIR can also help prevent hypoglycemia as well, since using your A1C alone can make it difficult to know when, and how often, you go low.
To read more about placing your data into perspective without treating it like a grade, read Adam Brown’s article “Blood Sugars Are Not ‘Tests’” and “Remember, Your Time in Range Isn’t A Grade Either”.
Preventing Emotional Burnout
Wearing a CGM can sometimes feel like someone is looking over your shoulder, providing a nonstop barrage of praise and criticism – overwhelming to say the least. So how can you manage your CGM data while making sure you don’t experience this kind of emotional burnout?
Webb and Blanchette both agreed that self-care is a vital component of effective diabetes management. It’s important to remember that you will have both good days and bad days, they said, but the more you can be optimistic and celebrate all of your hard work, the better. While burnout can happen to anyone, Shockley cautioned that it’s important that we don’t “sit and stay in that phase.”
Emphasizing that even small gestures of self-love can go a long way, Blanchette said, “Being kind to yourself is the bottom line.” Webb agreed: “I leave my endo appointment and go to Starbucks to remind myself this isn’t easy, and I’m celebrating all of the little things. Treat yourself.”
Webb explained that she avoids burnout though emotional release and staying optimistic. “I accept burnout is real and cry about it and talk about it,” she said. “Once you start talking about it, you start to look at the good things.”
Blanchette recommended finding a support system, recommending diabetes online communities as a good place to start. These support systems can help you get through challenges that many people with diabetes face.
Burnout is a serious problem; to learn more, check out Scott Johnson’s articles: “Is Diabetes Resilience a Muscle You Can Build?” and “Fighting Diabetes Fatigue with Gems from the Journey”.
You can watch the full discussion with Shockley, Webb, and Blanchette here.
