Time-In-Range

What Is Time-in-Range?

Time-in-Range, or TIR, is the amount of time those with diabetes spend with their blood glucose levels in a recommended target range and is represented as a percentage. Finding this “happy medium” can be difficult. So, more and more people with diabetes use continuous glucose monitors (CGM) to help achieve TIR. CGM generate a great deal of data showing where your current glucose levels are, where they’ve been, and what direction they are going. The hours per day spent “in range” and “out of range” can vary, but here are a few things to keep in mind:

  • Goals can vary for each person, but a typical target glucose range is from 70 to 180 mg/dL.
  • For most people with type 1 or type 2 diabetes, a TIR above 70% is recommended. That's about 17 hours of a 24-hour day. 
  • You should aim to spend less than 4% (58 minutes) below 70 mg/dL, less than 1% (14 minutes) below 54 mg/dL, less than 25% (6 hours) above 180 mg/dL, and less than 5% (1 hour, 12 minutes) above 250 mg/dL.
  • TIR targets can be lower for older or high-risk individuals and for those younger than age 25.

Talk to your health care provider about the TIR that's best for you.

Why is TIR Important?

Measuring A1C levels has been a common way to track success managing diabetes. But TIR can help you do it even better. A1C is an average over weeks or months. So, while your A1C may look good, you can experience fast and frequent blood glucose changes A1C doesn’t reflect. There can be parts of the day when you are spending time with blood glucose levels dangerously low (hypoglycemia) or high (hyperglycemia). 
TIR Chart
Today’s CGM systems allow you to track your blood glucose moment by moment and in real time. This helps you find times, such as before or after eating, or before or after physical activity, when your blood glucose is out of range. Identifying these times allows you to take steps, such as adjusting medication, to smooth out the highs and lows. Staying in range helps maintain your energy level, mood, and overall quality of life.

CGM can provide a daily glucose profile that displays a graph of the glucose readings from midnight to midnight. So, it’s easy to spot which hours of each day you are in range, above range, and below range. This information can help you adjust what you eat and drink, get the right amount of exercise, and modify your insulin dosing.

TIR During Pregnancy (with Type 1 Diabetes)

Special TIR guidelines are recommended for pregnant women with type 1 diabetes. They should:

  • Strive to maintain a target glucose range 63 to 149 mg/dL
  • Keep TIR above 70%, about 17 hours of a 24-hour day
  • Aim to spend less than 4% (58 minutes) below 63 mg/dL and less than 25% (6 hours) above 180 mg/dL

What Can Happen If I Am Unsuccessful at Achieving TIR?

TIR below the recommended level can mean poor blood glucose control and lead to diabetes complications. They can include:

Diabetes affects nearly every part of the body. It can lead to other serious diseases and can be life-threatening. You need to work with a healthcare provider to work toward achieving your best TIR.

Setting Goals for Success

Your healthcare provider may set target ranges for your blood glucose at various times of day. Check your glucose as recommended. The results can help you make appropriate adjustments to your diet, exercise, or medicine. And that can lead to better control of your diabetes.

Changes in glucose level can happen quickly. Instead of doing self-checks, some people with diabetes use CGM. The devices works with a tiny sensor placed under your skin and checks your glucose every few minutes around the clock. This real-time information helps you keep your diabetes on track with less risk for severe hypoglycemia. CGM can track your TIR and alert you when your glucose is high or low and predict the direction your glucose levels are heading. (Learn more about commonly used CGM systems)

How to Prepare for Hypoglycemia

Your heart is racing, your head aches, you feel shaky, and you’re in a cold sweat. Your blood glucose is dropping to a dangerously low level, and you’re feeling the effects. With diabetes, it’s essential to always be ready for hypoglycemia, or low blood glucose. It could save your life.

TIR PercentageHypoglycemia occurs when the amount of glucose in your blood falls lower than it should be. When blood glucose is too low, your body doesn’t have the fuel to function the right way. It becomes severe when levels are below 40 mg/dL. People with severe hypoglycemia are not able to function because physical and mental changes occur.

Certain diabetes medicines raise the risk of developing hypoglycemia. These medicines include insulin and sulfonylureas. In fact, for people with diabetes, nearly one in five hospitals stays is due to severe hypoglycemia.

If you don’t have noticeable symptoms, this is called hypoglycemia unawareness. It’s most common in people taking insulin who have chronically low blood glucose. If your glucose numbers are often in the 60s, but you don’t feel any changes, talk with your healthcare provider. The more you know, the better prepared you can be when hypoglycemia happens.

  1. Wear an emergency medical identification tag.
  2. Identify hypoglycemia. Be alert for signs of hypoglycemia. They may vary depending on how low your glucose levels go.
  3. Be ready to act quickly. Check your blood glucose. If it's below 70 mg/dL, you need to act right away. There is an easy way to remember what to do. Just think about the number 15: Consume 15 grams of a fast-acting sugar source. This could be glucose tablets or gel. Or it could be fruit juice, regular (not diet) soda, or hard candies.
  4. Recheck your blood glucose after 15 minutes. If it is 70 mg/dL or above, eat a meal or snack. If it is low, repeat the steps above.
  5. Keep extra glucose testing supplies on hand for these kinds of situations. You may need to test multiple times if your glucose level drops or changes frequently.

For severe symptoms: If your blood glucose falls very low, you may be unable to swallow a fast-acting sugar source. You might have a seizure or become unconscious. Emergency glucagon is the rescue medicine for this situation. Glucagon is a hormone that works with other hormones to control glucose levels.

Manage frequent changes in blood glucose. Your healthcare provider may set target ranges for your blood glucose at various times of the day. Check your blood glucose as recommended. The results can help you make appropriate adjustments to your diet, exercise, or medicine, which can lead to better control of your diabetes.

Stay calm. Panicking can only make things worse. Remind yourself that you've already prepared to handle this situation.

Get an emergency glucagon kit. Glucagon is the only emergency rescue treatment for severe hypoglycemia. It should always be kept nearby and may need to be administered by a family member, friend, or caregiver, especially if you are disoriented or unconscious. 
Plan the quickest route to an emergency facility. 
Keep important phone numbers visible.

View or Download the Happy Medium Action Plan to help achieve your TIR goals.↓

Questions to Ask Your Healthcare Provider:

  • Can you help me learn more about my TIR targets?
  • Can my diabetes medicines cause hypoglycemia?
  • Does CGM fit into my diabetes management plan? What adjustments would I need to make in my diabetes management plan to use CGM?
  • When hypoglycemia happens, what should I do to bring my blood glucose level back to normal?
  • How can I get an emergency glucagon kit? What is important to tell my friends and relatives about hypoglycemia?
  • Should I see a diabetes educator?
  • Should I see an endocrinologist?
The development of this resource was made from the generous support of our sponsor Lilly Diabetes, Inc.
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