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Glucose Monitoring: Understanding Time in Range (TIR)

November 10, 2021
Written by
Team NutriSense
Reviewed by

Here at NutriSense, we believe in glucose optimization and prioritizing a healthy metabolism. With our continuous glucose monitors (CGMs), you can track your glucose levels in real-time. You can then use this data to make healthy changes to your diet and lifestyle! However, before you can really start to make changes while wearing a CGM, you should first understand the metrics. If you’re new to the world of CGMs, here’s everything you need to know before you get yours. 

One thing you can measure with a CGM is something called time in range or TIR. In a nutshell: when you look at TIR, you’re measuring the percentage of time spent between a certain minimum and maximum threshold. This gives you a good idea of the total time your glucose is either above or below that set range, so you know exactly what you need to work on optimizing.

By now, you likely know we think wearing a CGM is not just for those with diabetes. In fact, even healthy people who check their glucose levels in a lab with tests like the A1C may not be getting the whole story. When you pay attention to your TIR metric, you can get crucial information about what your glucose looks like in real-time versus at just one point in time. 

This helps to keep glucose levels within normal limits. It’s like watching a movie versus looking at a photograph! In fact, if you’re looking at A1C alone, you may miss both hypoglycemic (time below range, or TBR) and hyperglycemic (time above range, or TAR) excursions that you can see through the time in range metric.

What is Time in Range?

Want to know a little more about the specifics of time in range? For starters, the common recommendation for TIR for those with type 2 diabetes is 70–180 mg/dL [3.9–10.0 mmol/L]. The goal is to limit both hypo and hyperglycemic excursions. Using your CGM may be an invaluable tool here! In fact, one recent study reported that those with type 2 diabetes could increase their TIR by 10 percent while wearing a CGM for 24 weeks.

A 10 percent increase in TIR also corresponded to a decrease in A1C of approximately 0.5 percentage points. Similar associations were seen in an analysis of 18 randomized controlled trials (RCTs). The American Diabetes Association (ADA) recommends those with type 2 diabetes stay in range for 70 percent of the day (or 17 out of 24 hours), either above or below the target range of 70-180.

For those without diabetes, few studies have looked at this directly. When studies are specific to those without diabetes (with average weight and health measures), they find that they remain below 140 mg/dL around 95-99 percent of the time. Those with diabetes tend to stay below 140 only 65 percent of the time. In a recent study, people without diabetes wore a CGM for 10 days. The study found they spent about 96 percent of the TIR (set at 70-140 mg/dl), with blood glucose levels averaging between 98-99 mg/dl and showing little variation. Among participants who were over 60, the average glucose was 104 mg/dL.

There also may be differences in how different genders process the same type of meals. There’s an interesting study you can check out to find out more about this, which examined the differences in CGM values between men and women who ate the same meals for six days. It found that the percentage of values over the range of normal glycemia (> 140 mg/dL) in the postprandial period that they analyzed (six hours) was 9.7 percentage points in women and 7.1 percentage points in men. This suggests that different genders process the same meals differently, which could have interesting applications for assessing individual carbohydrate tolerance.

A1C vs. Time in Range

Remember that A1C measures average glucose levels over three months. It’s been seen as the gold standard when looking at glycemic control. However, because it is so dependent on the lifespan of the red blood cell (which is around 115 days but can vary), there can be some downsides. The lifespan of a red blood cell is affected by many things, including smoking, pregnancy, ethnicity, uremia, or anemia, all of which can skew the A1C value. It also does not reflect any high or low blood sugar excursions or any variability in glucose levels throughout the day. This means that two people may have similar A1C values but different shifts or swings in their glucose levels throughout the day.

It also does not identify how high your glucose is climbing after a meal. It’s crucial to have this information because, as some studies show, the risk for type 2 diabetes increases the more time non-diabetic people spend above a level of 140.

Interestingly, your A1C and TIR can inform each other. Take this study as an example. Looking through 18 studies, the authors of the study found a strong relationship between the two. For every 10 percent change in TIR, there was a correlating 0.8 percent change in the A1C value. Every hour above the range translates to an extra five percent shift in the TIR value, which is a significant change! This highlights the importance of looking at both an A1C and the data from the CGM.

Reasons Measuring Time in Range is Important For Monitoring Glucose

Can Be Measured At Home, Daily

An A1C value needs to be drawn by a medical professional at a lab or doctor’s office. The CGM, on the other hand, is a convenient (and painless) way to see what your glucose is doing in real-time. You can see your levels fluctuate during the day and in response to specific activities, meals, sleep, stress, and so on.

Allows You To See Direct Correlations Between Behaviors and Glucose Fluctuations

Glucose shifts through the day can impact everything from your mood to the amount of energy and cravings you have. Instead of looking at an A1C, which offers an average across a period, using the TIR metric with a CGM can give you information on-the-spot about how certain foods and behaviors impact glucose values.

For example, perhaps you ate an apple at 8 p.m. and saw a glucose spike above 160. This may also impact your A1C value, but with just an A1C test, you won’t know what you ate to cause this spike. However, you can see it reflected in the TIR value while wearing a CGM because that will reflect the actual number of hours you spent in and out of a set range during the day.

If you’re still not convinced, think of it this way: with a CGM, you can check an application on your phone to find out what your TIR is whenever you want. With an A1C test, you will have to wait for three months to pass to check it. Once you have this information, you can make specific tweaks to optimize any responses that cause glucose to spike above or below range.

More Time in Range Means Fewer Health Complications Related to Blood Sugar

Studies have shown that looking at TIR can help avoid complications in those with diabetes, especially microvascular complications like retinopathy or kidney disease. Those who spent less time in range and higher glycemic variability were less likely to have advanced diabetic retinopathy. In fact, TIR may be a better predictor of these complications than A1C. This is because it captures the direct impact of higher glucose values on the blood vessels and the swings in glucose. Recent evidence is also coming to light that glucose variability is directly tied to adverse health outcomes.

Different Time in Range Goals For Everyone

As we’ve gone over already, the TIR for glucose will look different based on various things. These include diverse populations, their health needs, medications, diets, lifestyles, and specific risk of hypoglycemia. It sounds confusing, but don’t worry, you don’t have to figure this out yourself. The ADA recently set some TIR goal recommendations for specific populations that you can refer to.

Time in Range For Healthy People Without Diabetes

Based on the current scientific evidence, we recommend trying to stay in range (between 70-140 mg/dL) at least 95 percent of the time when you’re tracking data with a CGM. Remember that one percent of the time translates to <15 minutes, so we’re looking for less than 75 minutes a day spent out of range.

Time in Range During Pregnancy (With and Without Diabetes)

Current recommendations for pregnancy for those with type 1 diabetes are to stay between 63-140 mg/dL 70 percent of the time (more than 16 hours a day). Pregnant women with gestational or type 2 diabetes should aim to stay between 63-140 mg/dL for more than 90 percent of the time (or more than 21 hours).

Time in Range For People With Diabetes

For those with type 1 or type 2 diabetes, the goal is to stay between 70 180 mg/dL for more than 70 percent of the time (or more than 16 hours and 48 minutes) and more than 60 percent of the time for people less than 25 years old (or 14 hours, 24 minutes). For older populations or those with a high risk of developing diabetes, the recommendation is to stay in the range between 70-180 mg/dL more than 50 percent of the time (or more than 12 hours).

How Time in Range is Measured

To determine the TIR metric when wearing a CGM, you will want to go through at least 10-14 days of data. The CGM’ counts’ the time that your glucose was above, below, and in between a set range. With the NutriSense app, you can change this range based on your health status and goals because we know how unique each member is. Want to see how the NutriSense app measures and shows you this metric? ​​Below you’ll see exactly how our app calculates the time in range and the different ways to track the metric.

From left to right: 
  • The bar graph shows the percentage of time in target ranges 0-70, 70-140, 140-280, 281-999.
  • The analytics tab shows the percentage of total time spent in range.     
  • Finally, on the last screen, you can see the correlating time spent above the threshold with spikes above 140.

How to Improve Time in Range

While all this can sound like a bunch of confusing numbers and medical jargon, we’re here to help you make sense of your own TIR, so you can learn what changes you need to make to improve it. Start with a few of these easy tips to improve your TIR while wearing a CGM:

  • Focus on your daily TIR rather than simply getting a good A1C value every couple of months. This will create a daily focus instead of an arbitrary goal to decrease your A1C value.
  • Identify events that cause your glucose to shift out of range and then tweak them as necessary. For example, if a whole sweet potato made your glucose spike out of range, try a smaller portion, or try to time that type of carbohydrate around movement or exercise.
  • Remember that every one percent out of range translates to 15 minutes. It can be helpful to set an attainable goal for yourself. Instead of simply saying, “I will improve my TIR,” you should know how that’s going to happen so you can make it happen! If you spend five percent of the time above range, focus on decreasing it to four percent by doing things like modifying your carbohydrate intake and pairing carbohydrates with fat/protein. You can also try getting more sleep, not eating too close to bedtime, and reducing stress levels.
  • Scan as often as possible! Your CGM will capture all the data when you scan it at least three times a day or every eight hours. When you’re wearing a NutriSense CGM, make sure to scan at least once every eight hours to capture everything. It’s a good idea to scan it after meals/snacks to see how your glucose reacts. If you see your glucose going too high or low, act in the moment to address it.
  • Check out this podcast that discusses helpful ways to bio-hack your glucose levels, which can ultimately help improve your TIR.        

NutriSense Automatically Calculates Your TIR And Gives Members Advice From Their Very Own Dietitian

Ready to start tracking your own TIR? CGMs are a great way to start a preventive health plan, and now anyone can get one thanks to NutriSense, which offers the same technology for the public for the first time.

When you activate your first sensor, you get paired with a registered dietitian to help you interpret the data and make it less daunting. They will also help you take actionable steps to improve your TIR, to help you on your journey to becoming your healthiest self.

Click here to listen to the podcast.
Listen to the full podcast:
Glucose Monitoring: Understanding Time in Range (TIR)
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min
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Pairing Your Food: Are there Good and Bad Combinations?
Pairing Your Food: Are there Good and Bad Combinations?

Are eggs and beans bad for you? Should you forgo the fruit juice with your cereal at breakfast? The NutriSense Nutrition Team tells you more about how healthy some common food pairings are for you.

Story
8
min
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Eating for Endurance
Eating for Endurance

Learn everything you need to know about eating if you are an endurance athlete.

Story
12
min
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A Closer Look at Heart Rate Variability
A Closer Look at Heart Rate Variability

Heart rate variability is the variation in time between your heartbeats. Learn more about it, why tracking your trends matters and how it can give you insights into your fitness, stress, diet, and overall health.

Story
8
min
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Living with Autoimmune Conditions: Multiple Sclerosis
Living with Autoimmune Conditions: Multiple Sclerosis

Living with an autoimmune condition can be challenging. Continuing our series on these conditions, learn more about detecting, treating, and managing Multiple Sclerosis.

Story
6
min
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Reading Nutrition Facts Labels Like a Pro: Dietitian Tips and Tricks
Reading Nutrition Facts Labels Like a Pro: Dietitian Tips and Tricks

When you're looking to buy a specific food product, the nutrition facts label can help you make informed choices about the foods you eat. Our dietitians put some tips together on what to look for on nutrition labels to make the best choices for your health.

Podcast
46
min
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FUELED | Wellness + Nutrition with Molly Kimball
FUELED | Wellness + Nutrition with Molly Kimball

Molly Downey, RDN, LDN, nutrition manager at NutriSense, delves into all things glucose and wellness, and how devices like these can inform us about our health, on this episode of FUELED with Molly Kimball.

Story
8
min
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Are Sardines Good for Your Health?
Are Sardines Good for Your Health?

Sardines are small, but they pack a big nutritional punch! Learn more about the health benefits associated with eating them and check out some fun facts about this flavorful, nutrient-dense food.

Story
9
min
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9 Essential Ways to Track Your Fitness (That Don’t Involve a Scale)
9 Essential Ways to Track Your Fitness (That Don’t Involve a Scale)

Most fitness tracking metrics involve stepping on the scale, but they don't always have to! Here are nine other ways to track your fitness.

Story
14
min
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Foods You Should Avoid Eating If You Have Prediabetes
Foods You Should Avoid Eating If You Have Prediabetes

There are many food items that can worsen the effects of prediabetes. Here are some foods you should avoid or limit your intake of throughout your day.

Story
11
min
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How Many Meals Should You Eat in a Day?
How Many Meals Should You Eat in a Day?

What's the perfect time to eat, and how many meals should you eat in a day? Explore how eating at different times and frequencies each day impacts your body and blood glucose.

Story
6
min
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NutriSense Dietitians Recommend: Glucose-Friendly Apple Cider Vinegar Drinks
NutriSense Dietitians Recommend: Glucose-Friendly Apple Cider Vinegar Drinks

Looking for a way to add apple cider vinegar into your diet? Start with some of these delicious glucose-friendly ACV drinks, recommended by our Nutrition Team.

Story
8
min
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Benefits of Walking After Eating: From Regulating Blood Sugar To Lowering Blood Pressure 
Benefits of Walking After Eating: From Regulating Blood Sugar To Lowering Blood Pressure 

Find out how taking a walk after your next meal can benefit various aspects of your health, including your blood glucose levels.

Podcast
55
min
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I Think, I Can—Using Technology as a Window Into Your Physiology
I Think, I Can—Using Technology as a Window Into Your Physiology

Molly explains how using a continuous glucose monitor is what personalized health care means. If you want to fine-tune your health, tune in to this special episode of I Think, I Can.

Podcast
10
min
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My Day | My Life: Nutritionist Carlee Hayes' Canine Cuddles
My Day | My Life: Nutritionist Carlee Hayes' Canine Cuddles

My Day | My Life explores the lives of people who have, in one way or another, mastered the art of aging. In this episode, meet Carlee Hayes, dietitian and Nutrition Manager at NutriSense.

Story
9
min
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Common Workout Injuries and How to Prevent Them
Common Workout Injuries and How to Prevent Them

Worried about getting injured during your next workout? Learn about the most common workout injuries, how they can affect blood glucose levels, and some tips to help you prevent them.

Story
6
min
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Eat with NutriSense This St. Patrick's Day
Eat with NutriSense This St. Patrick's Day

Would eating the same meal, at the same time, have the same blood glucose response for three different people? See what our team found out after sampling a delicious corned beef and cabbage dish in preparation for St. Patrick's Day!

Story
7
min
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Build Healthy Habits During Lent
Build Healthy Habits During Lent

Do you know what you're giving up for Lent this year? For those who observe it, this can be a good time to give up bad habits, and add healthy ones into your routine! Read on to find out more about how to build healthy habits this season.

Story
11
min
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Do You Know How Healthy Your Breakfast Cereal Is?
Do You Know How Healthy Your Breakfast Cereal Is?

Cereal is one of the most popular breakfast foods out there—but how healthy is it, really? Review the nutritional content of some popular breakfast cereals, and learn how to choose a healthy option for your individual needs.

Story
9
min
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Obesity: What You Should Know and Some New Research on the Condition
Obesity: What You Should Know and Some New Research on the Condition

Did you know that more than two in five adults have obesity? Find out more about the pressing public health issue, review some new research that is shedding light on the condition, and learn how to diagnose and treat it.

Story
7
min
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Tips for a Healthy, Happy Purim
Tips for a Healthy, Happy Purim

Purim, a joyous occasion celebrated around March or April every year, is just around the corner! Read on to learn more about the holiday and the delicious foods that accompany it.

Story
9
min
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Vinegar and Blood Sugar: Does It Lower It?
Vinegar and Blood Sugar: Does It Lower It?

Read on to find out what impact, if any, vinegar really has on our body’s ability to balance blood sugar.

Story
8
min
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Meal Frequency and Insulin Sensitivity: How Many Times Should You be Eating in a Day?
Meal Frequency and Insulin Sensitivity: How Many Times Should You be Eating in a Day?

If you have insulin sensitivity, is eating two large meals a day or three to five smaller meals better? Find out more about the relationship between meal frequency and insulin sensitivity, and how many times you should be eating in a day.

Story
9
min
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Understanding the Causes and Symptoms of Endometriosis
Understanding the Causes and Symptoms of Endometriosis

Endometriosis is a common yet often ignored condition. Learn more about the symptoms to watch out for, how you can seek treatment, and read first-hand accounts from two women who have dealt with endometriosis.

Story
8
min
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The Benefits and Risks of Popular Ayurvedic Herbs and Spices
The Benefits and Risks of Popular Ayurvedic Herbs and Spices

Ayurveda is an ancient Indian holistic healing system that dates back over 5,000 years. In the second installment of our series on the practice, review the benefits and risks associated with popular Ayurvedic herbs and spices.

Story
7
min
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Can Eating Pizza Raise Your Blood Glucose Levels?
Can Eating Pizza Raise Your Blood Glucose Levels?

Pizza can be challenging to enjoy eating without worrying about how it affects your health. But while it may be indulgent, it is possible to prepare or order it in a way that won’t wreak havoc on your health or blood sugar levels. Read on to find out more!

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8
min
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Do Artificial Sweeteners Raise Insulin Levels?
Do Artificial Sweeteners Raise Insulin Levels?

Review our post on the impacts artificial sweeteners have on blood glucose, insulin, and other areas of your personal health.

Story
8
min
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What Research Says About Sleep and Blood Sugar Levels
What Research Says About Sleep and Blood Sugar Levels

Recent research has shown that sleep and blood glucose are intricately connected. Read on to learn more about what this means for your blood sugar levels and overall health.

Story
8
min
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Understanding the Relationship Between Menopause and Metabolic Health
Understanding the Relationship Between Menopause and Metabolic Health

Did you know that menopause can affect your metabolic health, and vice versa? Read on to understand the relationship between metabolic health and menopause, and how to manage metabolic health during your menopausal journey. 

Podcast
57
min
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How a Continuous Blood Sugar Monitor Can Help You Find Your Perfect Diet
How a Continuous Blood Sugar Monitor Can Help You Find Your Perfect Diet

In this episode learn the truth about how we react to certain foods in regards to our blood sugar response and how you can tailor your diet according to your CGM results.

Podcast
66
min
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All About Blood Sugar With Molly Downey, RDN
All About Blood Sugar With Molly Downey, RDN

This week, dive into how to eat your carbs and manage your blood sugar, too with Molly Downey, RDN, LDN.

Story
8
min
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A NutriSense Dietitian's Favorite Kitchen Staples
A NutriSense Dietitian's Favorite Kitchen Staples

Food can be fun, pleasurable, and nutritious all at the same time. Read on to learn more about the two nutrient-dense kitchen staples one of our dietitians swears by to help optimize her health!

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10
min
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10 Tastiest Nutrient-Dense Foods From Around the World
10 Tastiest Nutrient-Dense Foods From Around the World

Instead of the type or amount of food you eat, you should focus on the amount of nutrients you're adding to every meal. Here are some of our favorite nutrient-dense foods from around the world to help you get started.

Story
7
min
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Do Pineapples Raise Blood Sugar Levels?
Do Pineapples Raise Blood Sugar Levels?

Learn everything you need to know about pineapples, your health, and your blood glucose levels, and see how our dietitians like to eat the sweet, tropical fruit. 

Story
14
min
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Setting Up The Right Diet Plan For Prediabetes [+Sample Diet Plan Included]
Setting Up The Right Diet Plan For Prediabetes [+Sample Diet Plan Included]

Learn more about the relationship between prediabetes and your diet, and see how to build a diet plan that works for you with some great tips, tricks and recipes from our nutrition team!

Story
9
min
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What You Should Know About Acupuncture
What You Should Know About Acupuncture

Learn more about the research on, as well as the benefits and risks of acupuncture, a form of alternative medicine that involves inserting needles into your body for pain and stress relief.

Story
6
min
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Triglycerides and Blood Glucose [+Tips to Lower Triglyceride Levels]
Triglycerides and Blood Glucose [+Tips to Lower Triglyceride Levels]

Learn everything you need to know about the relationship between triglycerides levels and blood glucose.


Story
5
min
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A Guide to Ayurveda
A Guide to Ayurveda

From acupuncture to chiropractic treatments and homeopathy to holistic healing, complementary and alternative medicine is increasing in popularity. Read on to learn more about Ayurveda, a healing system that originated in India thousands of years ago.  

Story
7
min
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Sugar and Cholesterol: Does Sugar Raise Your Cholesterol Levels?
Sugar and Cholesterol: Does Sugar Raise Your Cholesterol Levels?

Learn about the impact sugar has on your cholesterol levels and ways to manage your sugar intake.