What TIR is considered Good

[Bubbleblower]

Moderator note: This thread developed from an earlier thread, and was split away to avoid derailing the original conversation

 

[Lucyr]

Because you are recently diagnosed you should aim for well over 70% TIR, if your C-peptide (ask for a test) is above 0,17 nmol/l aim for at least 90%.

Honestly that’s so unrealistic for someone newly diagnosed who is only just getting their head round it all

 

[Robin]

Because you are recently diagnosed you should aim for well over 70% TIR, if your C-peptide (ask for a test) is above 0,17 nmol/l aim for at least 90%.

I doubt if any NHS surgery or clinic in the U.K. would be ready to do a c-peptide where the actual diagnosis is fairly clear already. They are expensive, and need an expert to interpret them correctly.

I was diagnosed at the age of 51,@Stane . I don’t think I'd ever get as flat a line as the one shown in Bubbleblowers post. We are all different, and my blood glucose happens to do a slide downwards as soon as my head hits the pillow, and then rises again towards dawn, so my Libre graph always looks like a slack washing line overnight. Then there are all the times when life gets in the way…you eat out and daren’t take your insulin til the food actually appears, (just in case there’s a delay in the kitchen), so you get an upwards spike until it sorts itself out, or you take more exercise than you’d planned, and find yourself heading for hypoland, or you’re coming down with a cold, etc, etc.

I normally get 80% time in range, if life is on a fairly even keel, but this dips to 70% if I’m ill or on holiday. It’s improved as I've gone on, I’m now 17 years in, and got more used to when my body is going to throw a curveball, but it still catches me out quite often, by doing something unexpected.

 

[Lucyr]

The whole “if cpeptide is higher should aim for a higher time in range” is nonsense too though. Mines 0.365 and no way could I get 90%, my pancreas insulin production is erratic not predictable which makes it harder to get insulin doses right, not easier.

 

[Inka]

You said/implied on another thread that you had Type 2, Bubbleblower.

Wow, looks like I don’t know much….
Not sure what my C peptide is…. Have been90% precent most of the time( very limited carb intake, only good staff, honestly am hungry lots and trying to put weight on, so hard! I could eat my dinner twice! But eating small amount of carbs can sort of get insulin right if i double it, doesnt work…
All you need is high GB while asleep and bad day and you are down to 80% very quickly..

There’s no need to limit carbs. Although it would be tricky to eat vast amounts of them, you can eat a normal healthy diet as a Type 1 and still get very good results. With Type 1, the issue is almost always the insulin not the food - wrong amount of insulin, wrong timing of insulin, etc.

You shouldn’t be hungry lots. Type 1 is nothing to do with poor diet or lifestyle and doesn’t need a spartan diet. You can eat bread, cereal, pasta, rice, potatoes, fruit, fruit crumble, cheesecake, etc etc, and still get good results.

 

[Lucyr]

Can you explain how Stane did achieve 90% TIR if that is so unrealistic?

By starving themselves from the sound of it

“am hungry lots and trying to put weight on, so hard! I could eat my dinner twice”

 

[everydayupsanddowns]

This is not true, why are you saying that?

I think that refers to your thinking that you have MODY (a monogenic form of diabetes) rather than T1. You mention thinking you have MODY here:

https://forum.diabetes.org.uk/board...nt-and-insulin-secretion.108142/#post-1286861

MODY isn’t a form of T1. It is a separate form of diabetes.

Coming off insulin IS possible in some cases of MODY. Though I’m not sure that is considered a form of remission?

Also according to you I am dead, remember?

Is this a reference to my what my friend at the Diabeter clinic said? Diabeter do not take people with T1off insulin, she said, because that would not be appropriate and would harm them. She said that some people who were misdiagnosed and labelled T1 when they really had MODY, had been taken off insulin at Diabeter.

The study you link to I think reflects the experience of many members here - especially those diagnosed later in life / after childhood who are statistically more likely to have some trace residual b-cell function remaining.



But it is important to note that the study is talking about improvements in diabetes management while continuing to take insulin. This is not about T1 remission.

The table in the PDF you linked shows that those with the highest residual beta cell function were able to have good results while taking less insulin (about half as much as the lowest group in some cases), but they still needed to take insulin as prescribed.

 

[Inka]

I didn’t say you were dead @Bubbleblower I said that in the past, prior to the discovery and purification of insulin, everyone with Type 1 died, some quickly, some slowly. You keep saying that Type 1 can be reversed but it can’t. You then re-named the diabetes types. I can’t remember exactly what you called them, but you said I had ‘MODA’, I think. I don’t. I have Type 1, auto-immune, proved by antibodies testing.

I asked you once if you actually had MODY and I think you said they wouldn’t do the tests. Some people with MODY are misdiagnosed as Type 1. I had an atypical presentation of Type 1 and my consultant wanted to rule out MODY. She did and I’m confirmed to be Type 1. Occasionally tests will discover that a Type 1 is actually MODY and occasionally they can come off insulin.

TBH, I can’t even remember if you’re taking insulin now or not.

 

[Wendal]

But it is important to note that the study is talking about improvements in diabetes management while continuing to take insulin. This is not about T1 remission.

Absolutely Mike and as you said

The study you link to I think reflects the experience of many members here - especially those diagnosed later in life / after childhood who are statistically more likely to have some trace residual b-cell function remaining.

whilst the experience of others differs and that is fine as we all have different experiences and our individual situation varies.
To me the logic of having some endogenous insulin production is likely to mean for many people but especially newly diagnosed individuals that you are generally statistically more likely to require less exogenous insulin and also manage an increased TIR.
This supposition is supported by this particular ( presume peer reviewed study) therefore has a degree of credence over and above individual experiences which again are equally valid but statistically not significant.

 

[Inka]

Except for my father and his brother who were 2 of the 14000 type 1 diabetics who didn't receive insulin for 8 months after Oss (where Organon the only insulin supplier was) was liberated in Operation Market Garden.

Read what I said again: “some died quickly, some died slowly”. 90% of people diagnosed with Type 1 don’t have close relatives with it. You do and you think you might have MODY. Can you not get the tests done privately?

 

[Jasmin2000]

Not sure whether you guys have moved on from the original question but my 2 week CGM window has given me 71% to 98% TIR - the former when I began on statins, which sent my BG up to 14 and the latter for no apparent reason. Non-diabetics are expected to be over 90% but not 100% as they get spikes too.

I think the TIR idea is fine as long as the GP isn't leaving it at that and actually looks at the variation within - half 10 and half 3.9 might make 100% TIR but there's something going on in there that needs addressing.

 

[everydayupsanddowns]

First thing they did was exclude me from it, because I did not use insulin and my TIR was 100%, so that would mess up that table you posted completely.

The study said it excluded one candidate (which appears to be you) because they did not have T1 diabetes.

I think it would be helpful to other members, especially new members, for your diabetes type to be changed to ‘other type’ as the study has concluded you don’t have T1 (of which LADA is a form).

 

[everydayupsanddowns]

Do you have a citation for that, because all I can find is the concensus TIR should at least be 70% because that corresponds with an A1c of 53 mmol/mol.

This is the consensus report.

Clinical Targets for Continuous Glucose Monitoring Data Interpretation: Recommendations From the International Consensus on Time in Range

Improvements in sensor accuracy, greater convenience and ease of use, and expanding reimbursement have led to growing adoption of continuous glucose monito

diabetesjournals.org

It does not set 70% as an upper limit, of course, but it certainly does not describe 70% as “poor”.

No one here is denying your experience of admirable TIR, and no need for insulin (which essentially confirms you aren’t T1 - type 1 diabetes being characterised by absolute insulin deficiency, which you evidently no longer have).

But we need to be clear for other newbie members reading that in T1 diabetes 70% is a challenging and aspirational target to aim for. And for those newly diagnosed who are struggling we need to be supportive of their efforts towards that goal.

Some newly diagnosed T1s arrive in a state of upset and confusion. They may not want to take insulin injections. It is not helpful for them to read your unusual experiences, unless they are clarified in the context of your not being T1, as the study team have concluded?

 

[Kol]

but there's something going on in there that needs addressing.

Unfortunately it’s called life and the variation of work, rest, play and food can tend to mess up a nice flat 6/7 of which is unrealistic unless possibly you sit still 24hrs a day.

That’s probably why 3.9-10 was considered acceptable while still allowing some sort of life.

If you drive then the window becomes even smaller between 5-10

 

[Bruce Stephens]

It does not set 70% as an upper limit, of course, but it certainly does not describe 70% as “poor”.

I've seen talk of Time in Tight Range (3.9-7.8). Sometimes for Type 2 but sometimes also for Type 1. I think there's general agreement that it's more for the future (when more people have HCL) than for now, though, because the regular range is hard enough.

As always, I suspect people who participate here are (on the whole) outliers. While an HbA1c of under 58 might seem normal to most of us (I'd be surprised if I got one over that), about 70% (might be slightly less) of people with Type 1 don't achieve that. I'm sure the same applies to TIR.

 

[Jasmin2000]

Unfortunately it’s called life and the variation of work, rest, play and food can tend to mess up a nice flat 6/7 of which is unrealistic unless possibly you sit still 24hrs a day.

That’s probably why 3.9-10 was considered acceptable while still allowing some sort of life.

If you drive then the window becomes even smaller between 5-10

The variation is fine with me, but when is someone going to tell the GPs and practice nurses that? I don't need to be tutted at like a schoolgirl who didn't do her homework, just because I was 90% last visit and am now 71%. I hate that.

 

[Inka]

The variation is fine with me, but when is someone going to tell the GPs and practice nurses that? I don't need to be tutted at like a schoolgirl who didn't do her homework, just because I was 90% last visit and am now 71%. I hate that.

Don’t tell them @Jasmin2000 I don’t. They don’t understand.

 

[Kol]

I've seen talk of Time in Tight Range (3.9-7.8). Sometimes for Type 2 but sometimes also for Type 1.

😱🙂
For the TTR figures does that not leave T1 at risk of developing Hypo Unawareness?

 

[Kol]

The variation is fine with me, but when is someone going to tell the GPs and practice nurses that? I don't need to be tutted at like a schoolgirl who didn't do her homework, just because I was 90% last visit and am now 71%. I hate that.

Seem's like Some GP's and PN's are maybe not doing their homework or even skipped a lesson or two
🙂

 

[Inka]

😱🙂
For the TTR figures does that not leave T1 at risk of developing Hypo Unawareness?

Yes, it does. That range is close to the pregnancy targets which are super-strict.