These days, many people with type 1 diabetes are swimming in a sea of tracking data.
Insulin pumps and some insulin pens collect glucose data, as do our continuous glucose monitors (CGMs) and traditional fingerstick meters. Many of these devices share the data with other pieces of gear we carry with us: our smartphones, smart watches, exercise trackers, and more. We also have a plethora of assorted diabetes tracking apps available to us that generate and assemble yet more data.
Of course it’s useful that this data can be beamed to our loved ones and to our doctors to keep tabs on our highs and lows, but how can we PWDs (people with diabetes) ourselves actually make use of all of this information to control our diabetes better? Especially those of us who aren’t… you know, data enthusiasts at heart.
We asked a panel of experts for their top tips on simple, hands-on methods for using this data effectively without being a full-time tech geek. Here is what they told us:
Dr. Calvin Wu, an endocrinologist at the novel Steady Health data-driven virtual diabetes treatment center, says PWDs should use their data to “focus on the extremes,” meaning your highest and lowest blood glucose readings. He views taming the extremes on both ends of the spectrum as the first step in improved control.
How would you do that? For Dexcom CGM users, a good place to start is the weekly summary graph, which is part of the company’s CLARITY suite of software. This simplified graph overlays a full week’s worth of data on a single table. Highs or lows that commonly repeat at about the same time of the day are easy to spot, and at the same time, the appearance of outliers is reduced so that we’re not distracted by them.
OK, so you have the extremes in your sights. Now what? For insulin pumpers, it’s time to look at settings:
- Running low more times than not in the late afternoon? Maybe your basal rate is set too high for your current needs. You can try reducing the rate the rate two hours upstream of the time you’re seeing lows, to cut back the flow of insulin well in advance, reducing or eliminating the pattern of lows.
- Tend to run high after breakfast every day? Maybe your insulin-to-carb ratio is too anemic. Boost that puppy!
Important tip: If you make any changes to your settings, be sure to record what you did, and then compare the next week’s report to the current week’s, to evaluate the effectiveness.
Wu says that while both highs and lows are important, “figure out the lows first. Hypoglycemia isn’t just uncomfortable and potentially dangerous; it also turns on your body’s hunger signals, which naturally make you want to eat everything in reach — and that can set off a frustrating roller coaster ride of highs and then more lows from trying to treat the resulting highs.”
In agreement about stamping out lows as the first and most important thing PWDs can do with their D-data is nurse practitioner Geralyn Spollett of the Yale Diabetes Center. But she cautions PWDs to not be all about the insulin. “Use the data to look more carefully at hypoglycemic events,” she told DiabetesMine, “and think about precipitating causes.”
Such as? Spollett urges PWDs to remember the “basics” when reviewing D-data, and to think about cause and effect. For instance:
- A meal with less protein or fat can result in a more rapid blood sugar drop.
- Increased activity before a meal “supersizes” the effect of a given bolus dose of insulin.
“Often times people will get hung up on only the insulin doses given as the cause of the low blood sugar and forget about the rest,” Spollett warns.
On the other hand, Dr. Irl B. Hirsch, at the University of Washington Medicine Diabetes Institute, is more interested in focusing on the middle. He says, “Keep time in range above 70 percent. If you can get above 80 percent, even better.”
What’s time in range? You can think of time in range (TIR) as the modern descendant of the long-standing A1C test for measuring average glucose. TIR is a total of the number of hours and minutes in a day that your blood glucose stays within accepted levels for staying healthy with diabetes, expressed in a percentage of the day. It’s calculated from data from CGMs, which, as Hirsch points out, is finally widely available “for most in the U.S. with type 1 diabetes.”
What do you need to do to find your TIR? Not much. In fact, you can have it delivered right to your phone or smart watch. As noted, the Dexcom CLARITY software gives PWDs the option of having a weekly notification automatically sent to their smart devices that provides a quick view of their glucose results for the week, including TIR, and how it compared to the week before.
Important tip: TIR reports also include the percent of time your blood sugar is either above or below target. This provides PWDs with a road map to where they need to make changes — either on the high end or the low end — to increase their time in range.
Steady Health founder and CEO Henrik Berggren, who lives with type 1 diabetes himself, suggests using diabetes data “to experiment.”
Experiment? On what? Food, he tells us. Or more precisely, on determining the perfect insulin dose for food. Berggren illustrates by using breakfast as an example:
- Eat a breakfast you like for 5 days in a row, making the meals as consistent as you can.
- Take a photo of the meal every day, and jot down your bolus dose.
- After 5 days, look in your CGM app and see where your BG (blood glucose) ended up 2 hours after each meal.
- If you ended up high, increase your dose. If you ended up low, decrease your dose. Let the data inform your decision about this specific meal.
When done, says Berggren, “move on to your second favorite breakfast, then your lunch options, then dinner and snacks. After a few weeks, you will have built a library of meals that you know exactly how much insulin to take for. This will allow you to spend less time carb counting, less time worrying, and less time thinking about diabetes.”
Echoing that is diabetes tech expert and longtime type 1 Adam Brown of Close Concerns. He tells DiabetesMine: “In terms of diabetes data, I think one of the most valuable things is using blood glucose data after eating to figure out what foods are or aren’t keeping your blood glucose in range.”
Brown goes on to say, “Of course, this can be done with fingersticks — I find 2 to 3 hours after meals is most helpful — or CGM. To me, this is the single best use of diabetes data, since food has such a big impact on blood glucose.”
He says of his famous 42 Factors That Affect Blood Sugars: “If I only could pick one category to focus on to improve blood glucose, it would be food.” During your detective work, Brown says to ask yourself:
- What foods or meals keep me consistently in-range? How can I eat them more often?
- What are my “landmine” foods or meals — those that consistently drive me out-of-range, either high or low? How can I eat them less often? How can I make them harder to access at home?
Brown tells us, “When I was diagnosed, checking after meals was just never explained to me — I think it would have helped a lot.”
Meanwhile, Bruce Taylor, director of government affairs and market access at CGM maker Dexcom, thinks the first step to making good use of your data is fully embracing your diabetes. He says, “I think the biggest step is in owning your diabetes. It’s not the diabetes, it’s my diabetes. Once that hurdle is overcome, then the data empowers you to take control.”
- Accept that diabetes is a stormy sea. High and low tides will happen. And the occasional rip tide.
- Don’t take out-of-range numbers personally, or as a sign of failure. Rather, they are problems to be fixed or challenges to overcome.
He suggests that PWDs acknowledge, “I am not perfect… I have glucose excursions… but I have diabetes.” But thanks to data, “I am empowered to own it and to control it.”
Wil Dubois lives with type 1 diabetes and is the author of five books on the illness, including “Taming The Tiger” and “Beyond Fingersticks.” He spent many years helping treat patients at a rural medical center in New Mexico. An aviation enthusiast, Wil lives in Las Vegas, NM, with his wife and son, and one too many cats.