This blog suggests a new approach when it comes to diabetes management wearing a Libre sensor: Own Your Zone
Around 144,000 persons with type one diabetes in England have access to FreeStyle Libre and are largely able to avoid finger-pricking. But, although we’ve adapted our method for measuring glucose levels, at the same time we still seem stuck on the old measurement of HbA1c and ‘passing’ that 3 or 6 monthly test is the key measure of whether or not we are winning in terms of our diabetes management.
The use of HbA1c is compounded by the fact that many healthcare professionals treat this as sacrosanct and many of us feel that it is ‘the stick we’re beaten with’.
HbA1c as a measure for diabetes has been around for over 40 years but there is now an active debate as to whether, using FreeStyle Libre, Time in Target - renamed as Time in Range (to avoid the TIT acronym! - is a better indicator of glucose management.
TIME IN RANGE
The goal for most people with diabetes is a HbA1c of less than 7% and 70% of time in the range of 3.9 to 10 mmol/L puts you in this ballpark. So, to benefit best from the use of a Libre sensor my personal approach is that we need to simplify the way we look at the metrics and own this zone!
ACCURACY AND TRENDS
To Own Your Zone we need to move away from constantly comparing finger pricks and blood glucose readings (with exceptions, of course) and away from focussing on individual numbers. This may seem to go against all our training and experience as every time we see a glucose reading we make a judgement.
Apart from not measuring like-for-like (i.e. blood glucose versus interstitial fluid), there are actually many variances in the data that we rely on and by attempting to match different systems we are actually increasing the likelihood of getting an ‘inaccurate’ result. A common frustration felt by Libre sensor wearers.
Instead, we need to get our heads around the fact that nothing we are currently measuring is actually ‘accurate’. And that includes HbA1c tests (even carried out in a lab), finger-pricks, any reader used to get blood glucose levels, your calculations for carb-counting and the Libre reader or algorithm on your phone. All of these operate with acceptable tolerances that are not always evident to users.
The emphasis for management using Own Your Zone is that every day is a new one and the aim is to keep in the zone for as much time as possible that day. To achieve 70% of time in your zone you’ll need to be between 3.9 and 10.0 mmol/L for at least 16 hours 48 minutes. But if you don’t achieve this, even if you’re way off you shouldn’t be disheartened and for sometimes it’s better to aim to make small improvements and accept that some days it’s just not possible to avoid being on a rollercoaster ride.
GET IN THE ZONE
Most of us with diabetes know that it’s almost impossible to predict and be accuratewhen balancing blood glucose. But this is the job we are tasked to do on a daily basis. The most useful feature of using a Libre is that it allows users to see trends, so make informed predictions and be proactive.
Over time and by adopting this approach to Own Your Zone, you should see a reduction in hypos, hypers and by default our HbA1c test carried out by a lab will be a closer correlation to the estimated A1c we see on our Libre app. We are also more likely to flatten the line and improve our overall health, avoiding the swings of being on a pirate ship, and hence reduce our chances of developing diabetes-related complications. And perhaps a magical unicorn will become possible.
Rather than waiting to periodically take the HbA1c exam, congratulate yourself every day on the amount of time you do spend in your zone and if you’re having a good week perhaps look at this 7-day period on LibreLink. It may even help to keep your own daily chart of your time in the green zone.
Most importantly, by focussing on your zone your overall health should improve with better quality sleep and less stress and anxiety than when looking at discrepancies and illogic in figures. Why not join me and own your zone today?
Read also: What's wrong with HbA1c tests.
Love My Libre is not associated or affiliated with Abbott or FreeStyle Libre. Content here and on our website www.lovemylibre.com does not constitute medical advice or replace the relationship between you and healthcare professionals nor the advice you receive from them.
The author of this blog has type 1 diabetes and uses the FreeStyle Libre 2 which is provided on NHS prescription.
FreeStyle Libre is a registered trademark of Abbott Diabetes Care Inc.