How I Achieved 100% Time In Range: DOs and DONTs
After a bumpy holiday season, where despite eating very clean my blood glucose stayed in range only 78% of the time, my year started with some strong and encouraging results: 95% in range over a 9 days period, with an astonishing 100% time in range for three consecutive days.
That is not the result of some “new year’s resolution” plan, or of any radical life-style change that people commit to during this period of the year and that typically lasts one week or two. Rather, it followed a scrupulous analysis of what I didn’t do quite well during the past month, and just adjusting that.
Broadly speaking, I needed a period to decompress at the end of 2023, and part of simplifying my routines and “doing less” also involved being intentionally less detailed about my diabetes logging and tracking (one of the strategies I use to cope with stress, described in this article). But after a full recharge facilitated by many walks in the woods, I came back in stile, and I am very happy about it.
Here’s what I did and did not do to stay in range 95% (and 100%) of the time.
What I Did Do
Nothing special, it really comes down to mastering and nailing the basics: eat well, move plenty, sleep plenty.
Whole Plant Based Foods
The recipe is simple here: whole plant based foods that are naturally rich in carbohydrates and low in fats. That is also the Mastering Diabetes guideline for maximum insulin sensitivity, great mood, great energy, and long term sustainability. Excess fats and protein are among the biggest contributors to insulin resistance, and most process foods are a combination of the two. Other seemingly healthy foods such as olive oil, nuts and the like are also packed with them, so an excess in our daily consumption will only work against us. After more than three years letting this simple framework guide my daily menu, I love seeing that my daily 600 grams of carbs require barely 30 units of bolus - and my needs are always decreasing -, and I am 200% sure this is the way.
So what and how did I eat to maximize my insulin sensitivity and fuel all my daily activities and chores?
By the way, do you also want to achieve and maintain
a 90% (or more!) time in range?
I have listed The 5 Pillars of my strategy,
grounded in science and experience, in a Free PDF.
The framework is always the same: 80-90% of my calories come from whole plant based carbohydrates rich foods, which is plenty of seasonal fruits, potatoes and the like. Minimal amounts of processed carbs and baked products. No sugars, except for emergencies.
Then tons of leafy, starchy and non starchy vegetables and legumes to accompany every meal and provide proteins and micronutrients for my gut health.
The remaining 10-20% of my calories come from chia seeds, some nuts, and some soy products to add some healthy omega-3 fats and proteins. That’s it.
No keto, no extreme diets, no radical deprivations of anything. Just eat what nature evolved you to eat and you’ll be good to go.
(The fact that I am no chef and that any of my meals require 5-10 mins to prepare breaks any laziness barrier.)
The last trick about food: eat SLOWLY. Chew a lot, take your time. That will not only help with digestion but also to avoid violent spikes in blood glucose. I wrote more about this here.
Sleep
Another simple one I have covered many times already, but I repeat it because it is that impactful and that important. I average 8.5 hours of sleep, and that is dramatically good for the entire ecosystem that goes under the name of “Giovanni The Curious Diabetic”. Everything is enhanced by good sleep, type-1 diabetes and insulin sensitivity included.
I go to bed when I feel sleepy, and I wake up around the same time every day. I don’t force my schedule in any way, yet I am able to accomplish pretty much everything at work, in my training and in my side-projects. Sleep is a superpower.
Tips to sleep better from Andrew Huberman and Dr. Matt Walker.
Exercise
Despite the off-season and a relative break after the training season that led to the Pisa Marathon, I never stopped moving.
My runs became run-walk-runs to let my body absorb the immense training season that had just ended and recover while staying in motion and spending time outside.
I was not training if by “training” one only includes the usual 21st century activities such as lifting weights and doing yoga (which I did). But my lifestyle was very active: I carried weights and moved heavy objects, went for long walks in the woods (even walking backwards at times) and did physical chores at any given occasion. All of that easily lead to increase in strenght, endurance and to an overall calorie burn that equalled and even surpassed the one I had during my most intense days.
My body was in motion and optimized its insulin sensitivity just by the fact that I was awake and doing things. Most of that simply involved staying away from chairs and sitting in a natural squat position whenever possible.
Trusting The Process
As you can see, that was nothing difficult or dramatic. No radical life changes. Just eating well, moving, sleeping and doing the things a diabetic should be doing: logging food and insulin, commit to good blood sugars, learning from mistakes, and trusting the process.
And of course, remembering why I do all of this to begin with.
100% Time In Range over 2 days (95% over the week). It is also important to aim at a low Standard Deviation, which means that your blood sugar is stable and steady. In other words: no rollercoasters.
What I Did Not Do
The other side of the coin is, of course, everything I did not do. These things are just as simple as the things I did do, and didn’t entail forced restrictions, drastic cuts or living ini miserable conditions by any mean. Committing to only eating salad, or running 10k a day, or going to yoga classes each day no matter what are things most people do, but that usually cease to work after one month max. They make things complex.
By “what I did not do”, I simply refer to the opposite of what I did do. (Almost) zero effort involved: just do more of the good stuff, and the bad stuff will mostly take care of itself.
Here is what I did not do.
Falling to Cravings
That used to be a big problem of mine. Resisting to sweets, cakes, and all of the “tasty” things that a Christmas holiday usually involves can be hard. I deal with cravings in two ways: the first one is pre-commitment, or stating what you’re going to do and how you’re going to behave up-front. Things like “I will only eat one slice” before joining the family dinner, or “I don’t need more than one square of dark chocolate” before opening the chocolate package. Stating it out loud or in a written format before starting the action helps tremendously.
The second one is redesigning the environment. I perfected this one after re-reading my notes of Atomic Habits: according to the Third Law of Behavioral Change, I needed a way to “make it simple”, to make the good behavior the default behavior. I knew that buying a peanut butter jar would easily lead to a binge-eating feast, so I don’t buy it in the first place. Instead, I surround myself of tasty and nutritious foods that propel my health: fruits, greens, and all of that. In this season I lean towards some staples such as apples, bananas, lentils, potatoes, radish, cauliflower and swiss chard. These are pretty much always in my refrigerator or in my shelves, they are my default choice.
Then I simply add on top, changing the vegs to ensure a good variety of nutrients and throwing some less-ideal treats here and there, such as a good vegan cookie at my favorite café. The trick is: if I want the cookie, I have to move my butt and walk to the cafeteria. My house is filled with green light foods: falling to my junk food cravings is almost impossible because they are non-existent in my environment. The only things I can eat are the healthy ones, which I love to eat in any case.
Not Logging
I simply kept track of everything: the type of food, the quantity, the units of bolus, the activity level, and all of it. As soon as I saw that one food was compromising my blood glucose stability, I simply adjusted its amount at any given meal, or removed it from the meal. Logging is the less comfortable way of dealing with the issue because it requires effort, but the most effective one in the long term. So I simplified my meals to reduce the amount of mental effort required to calculate the grams of carbs, fats and to adjust my carb-to-insulin ratio, and basically went on autopilot.
That made everything so much simpler and staying in range was a mere consequence.
95% Time In Range for the week. Lows and highs will always happen. The trick is to have a process in place to make them a rare occurrence and a plan to deal with them when they pop up.
Of course, life happens and things cannot be always so smooth. Hyperglycaemias and hypoglycaemias will still happen, and we’ll get frustrated from time to time. But those will be rarer and rarer, and we’ll be more and more masters and commanders of our condition by doing the simple things well (eating, sleeping, moving), and making sure their slice of our everyday life is as big as possible, so that the space for the bad things is as little as possible. I am becoming more convinced that the true key to excellent type-1 diabetes management is to keep it simple.
