Top 10 Tips to Optimise Time in Range

10 top tips to optimise time in range

Should you follow them? I do not know. I do not know your physiology, your lifestyle, or your constraints – and I do not have skin in your game. View this as education, not instruction, and discuss changes with your diabetes care team.

Prefer a podcast? Episode 6: Ten Tips to Optimise Time in Range

Here is the quick index with timestamps from the episode:

1. Food and insulin: 3 balanced meals with 10 minutes of activity after – (minutes 0 – 4)
2. High fat and protein meals: “Find out before you fiddle” then 25% extra insulin increments – (minutes 4 – 10)
3. After meal spikes: Insulin 15 minutes before in the abdomen or arm – (minutes 10 – 14)
4. 3 every 30: 3 minutes of movement every 30 minutes sitting – (minutes 14 – 16)
5. 10 by 2: 10 minutes of activity drops glucose by approximately 2 mmol/L (35 – 40 mg/dL) between meals – (minutes 16 – 22)
6. 50/50/20: Exercise insulin reductions for injections and standard pump therapy – (minutes 22 – 30)
7. T25/T25: Exercise insulin reductions for AID therapy – (minutes 30 – 38)
8. CGM: SLO ARSE: Slow and Low, Oil, Arm, Relax, Soft, Elevate – (minutes 38 – 40)
9. Site management: CAR – Change, Abdomen, Rotate – (minutes 40 – 41)
10. Does your CGM change what your time in range means? (minutes 41 to 50)

Tip 1: Food and insulin

• Strategy: Three balanced meals and 10 minutes of physical activity after each meal to enhance insulin effectiveness.
• Quote: “Putting in that 10 minutes of walking after eating really makes a huge difference on the glucose levels.”
• Details: The post-meal movement helps match the timing of peak rapid-acting insulin with glucose entering the bloodstream, smoothing out spikes.
• Extra tip: Consistency in meal timing and composition can stabilise glucose and make CGM patterns much easier to interpret.

Tip 2: High fat and protein meals – “find out before you fiddle”

Francesca Annan RD

• Strategy: Adjust insulin dosing for high-fat, high-protein meals.
• Quote: “Find out before you fiddle” – and consider approximately 25% extra insulin increments if needed.
• Details: Fat delays gastric emptying and can induce insulin resistance, often requiring more insulin over a longer period.
• Extra tip: Use your CGM to learn your response. Watch the 3 – 6 hour post-meal window and build up your own pattern knowledge over multiple similar meals.

Tip 3: After-meal spikes

• Strategy: Take rapid-acting insulin about 15 minutes before eating to reduce post-meal spikes.
• Quote: “Where is the fastest place for absorption for your insulin? The belly… not far behind is the arm.”
• Details: Pre-bolusing and using faster-absorbing sites improve alignment between insulin action and glucose rise.
• Extra tip: Rotating injection or pump sites between abdomen and arm helps maintain good absorption over time.

Tip 4: 3 every 30

• Strategy: Take 3 minutes of light movement every 30 minutes of sitting.
• Quote: “Every 30 minutes they got up to walk around at a normal pace for three minutes… time in range improved by 14%.”
• Details: Regular breaks reduce insulin resistance and help CGM time in range without changing insulin doses.
• Extra tip: Setting phone or watch reminders is a simple way to build this into any working day. The benefit extends well beyond diabetes.

Tip 5: 10 by 2 mmol/L (or approximately 10 by 40 mg/dL)

• Strategy: Use brief activity to quickly lower glucose between meals.
• Quote: “Ten minutes will drop the glucose level by two… or 10 will drop you by about 40 milligrams per decilitre if you are in those units.”
• Details: A short walk or similar light activity can reduce mild highs without extra insulin, particularly helpful if there is still insulin on board from a recent dose.
• Extra tip: The glucose-lowering effect of activity varies with intensity, timing, and individual response – your own CGM data is the best guide to what works for you.

Tip 6: 50/50/20 – exercise adjustments for injections and standard pump therapy

• Strategy: Use a structured framework for insulin reductions around exercise when on MDI or standard pump therapy.
• Quote: “50/50/20… 50% insulin reductions for meals before (within 2 hours) and after, and 20% reductions of insulin overnight – or 20 g of carbs or 20 g protein.”
• Details: Exercise with rapid-acting insulin on board is a high-risk time for hypos. Planned dose reductions and snacks greatly reduce that risk.
• Extra tip: For many people, a bolus taken in the last 3 hours means there is likely still active insulin that can amplify the glucose-lowering effect of moderate activity – worth exploring carefully with your own CGM data and care team.

Tip 7: T25/T25 – exercise adjustments for AID therapy

• Strategy: For AID users, adjust insulin dosing and targets by 25% around exercise.
• Quote: “The first T25 is the two hours before exercise – aim for a 25% reduction for meals within two hours and start the exercise target 1 – 2 hours before. The second T25 is stopping the exercise target once you finish, and considering a 25% reduction for the meal after.”
• Details: Algorithms are powerful but not magic. They still need help around large changes like exercise.
• Extra tip: Trend arrows during exercise are one of the clearest signals available – and building a picture of your own response patterns over multiple sessions is far more informative than any average framework.

Tip 8: CGM management – SLO ARSE

• Strategy: Use the SLO ARSE approach for better sensor sites and fewer failures.
• Quote: “Slow and low is the key… Relax your arm, make sure it is applied softly and elevate the skin off the muscle.”
• Details: Technique, skin prep, and site choice all affect accuracy and sensor life.
• Extra tip: Inserting the sensor a day before activating it is a technique some people find improves first-day accuracy – worth exploring if first-day readings seem inconsistent.

Tip 9: Site management

• Strategy: Rotate infusion, injection, and sensor sites to maintain good absorption and skin health.
• Quote: “Change every two to three days and look after your skin as you go along. Rotate where you do the sites.”
• Details: Lipohypertrophy and scar tissue can significantly blunt insulin absorption and distort CGM readings.
• Extra tip: A simple rotation map or chart can take the guesswork out of this over time.