First: Can we start a category for Women’s Health and Diabetes? I saw tags for pregnancy but we have more to our story than just that. There is a dearth of information out there for life processes affecting nearly 50% of diabetics and I think FUD can be at the leading edge of changing that.
Because I’ve searched for this information online many times and only ever come up with short threads on other web forums with no meat to the discussion…or super generalized blog posts with no actionable recommendations…and because I’ve never met an endocrinologist who understands that reproductive hormones can significantly impact basal rates or HOW they might do so…I want to try to get this discussion going or at least put what I know out there in case anyone ever finds it to be useful.
Female Cyclical Hormones and Rules of Thumb per my diabetic CDE:
-During Ovulation, about 25% of women see a spike in basal needs for two days.
-For 3-5 days prior to menstruation, many women need 25-50% more basal.
-After menstruation starts, most women see a 10% basal need decrease for the first day or two.
In the next post I’ll put my own specific basal percentages after the last four years of observation just for reference.
FOR ANY WOMAN (or anyone) reading this thread, please feel free to post your questions, your struggles, your examples. Figuring out all of the problem areas is Just AS Important as trying to nail down the answers.
I only basal test during week 2 of my cycle (about Days 8-12) because they are the least affected by hormones. This sets the “shape” of my basal profile and I change amplitude (temp basals) the rest of the cycle based on need. Conventional wisdom says you can basal test anytime other than menstruation, but I have found it can make your basal profile really lopsided which can become slightly disastrous when you add temporary basals (i.e. something was set at a high hormone time, then when you add 20% next month due to swings it goes that much higher and hello lows!)
My typical cycle plan for basal rates:
Day 1: -10%
Days 2-13: +0
Days 14-17: +15 - +40%
Days 18-21: +20% - +25%
Days 22-23: +25% - +35% (for some reason Day 23 is a sluggish disaster every month so may need more)
Days 24-30: +20% - +30%
**Also note that exercise can really help keep the extra basal needs in check. If I am sedentary during ovulation, all bets are off. I try to get 10,000 steps a day to keep basals functioning properly in my body.
Where would you envision this category existing or are you proposing making women’s health a main category with the pregnancy category as a sub category under women’s health?
I don’t really know the structure of the categories…but from the drop down I was just looking for something like “Type 1 - Women” or “Type 1 - Women’s Health” since there are categories for kids and teens and adults…seems like having one for “women” would be helpful.
THANK YOU! This topic is BADLY needed. None of the diabetes books give it more than a fleeting mention, where I feel that these books need a chapter dedicated to this just like they have chapters dedicates to each other subject, because this is at least as difficult to handle (if not more difficult to handle) than food and exercise. And when I post about it in forums or even Facebook groups dedicated to tight control, I get mostly just, “Yeah, I have the same struggle. it sucks.”
I seem to require a 35-50% increase in all settings (basal and bolus) for the second half of my cycle, then a drop to about -10% of where things were for a day or two at the start of my cycle, and then things increase by about 10% (which I consider my “baseline” level) until around ovulation. The struggle for me is that the timing and the amount of these changes is not exact from month to month, and combined with all the other confounding factors such as food, activity, illness, stress, weather, medication, and so on, I find myself feeling like I have no truly steady basal rates but rather end up changing them every week or so.
I’ve just started using Fitbit to track my cycles, so I’m hoping this data combined with my pump and CGM data will help me figure out patterns that I can use to better my control.
So glad to know I’m not the only woman experiencing these questions with no guidance!!!
It’s really interesting about the basal and bolus question. I asked my CDE last month if my bolus “should” be decreasing or increasing commensurate with my basal changes. Her answer was, “Most often for hormone resistance/sensitivity women see a need to reduce only basal. I noticed that around ovulation I needed to adjust basal and my IC ratio to get control. So, it wouldn’t be odd to possibly need to adjust the IC ratio up a bit to give less to boluses when your basal needs have dropped at the same time. A good eval would be to test and see if the basal reduction keeps things stable, if so, then in the same time frame if you give a bolus you’ll know if the IC ratio is too strong if your BG goes low after the meal when it would normally stay stable.”
I’m still tinkering with my tracking to see about my boluses during hormone resistance…I’m pretty sure I need more of both basal and bolus at the same time as you’ve experienced.
When I joined FUD, I was planning on starting on Nuvaring to regulate my hormones for better blood sugar control and predictability. I changed my mind after researching Nuvaring and recent lawsuits over blood clots. I had been on Nuvaring from 2006-2009, but unfortunately I had tossed my BG binders for those years when I started pumping. Darn.
I keep being offered by my CDE that “we can set a basal profile for that” for each time I see a change. I just don’t think that’s a good idea for me. I’m really theorizing that my basal profile “shape” from Week 2 of my cycle is my best bet and I use temporary basals from there each week. That seems to be the best way to stay in tune with my body and see when changes are needed. Add that variation to pump changes, stress, food variation, activity variation…and it gets hard to know which “lever” to pull. I hope careful tracking will keep improving things for me…but every ovulation seems awfully different each month.
Thank you, this is such a welcome topic for me! I see a consistent increased need for a solid 3/4 of my cycle now that they’ve returned post-baby. Since I’m not on basal insulin, and currently my doctor is unwilling to prescribe it, I’m stuck giving corrections and tiny boluses of Novolog every day to keep things in check.
@T1Allison, the lounge is a top secret part of our site reserved for TL3 trust level 3s and higher. I tagged you in the post so I’m hoping you are able to see it anyway. If not plz let me know.
Hurry and get that TL3!!
Many good things await in the Lounge… Hint: UFOs are real!!!
Copied from my Other thread:
So I’m writing this for my own reference as much as anyone else’s. Continuining w my observations of insulin resistance due to hormones and finding the magic basal rate for the day…this morning I was level at 115 w +20% basal for hormones. I was super nauseous and unsettled at 4AM and didn’t want to risk a low depending on what might happen next, so I cancelled the temp basal and it floated up and leveled at 150 which is what I wanted for the conditions. So it seems to me that on the right days of my cycle, +20% equates to an average level drop of 35 points. I’ll keep watching and reporting back…but it also seems to be true that once I’m more than 25% off w my basals (which is EASY to do as a woman in my experience), I get pegged at 200 or 220 and no correction bolus is going to bring that down in a meaningful way unless it is rage-bolusing that leads to tanking and rebounding. The stuck lines at 200 and 220 due to hormones are crazy flat for me no matter the correction dose or if I eat food. It’s just stuck. I’ll copy and post this on my Hormones/Basal Rates thread for consistency.
The thing that keeps interesting me on this topic is how it flies in the face of what we’re taught…even by “Sugar Surfing”…that if you’re level, then all you need is a correction dose if you’re too high. That’s not true in my female body during weeks 1/3/4 of each cycle. It does work in week 2 when hormones are benign.
This is exactly my experience as well. When my basal rates are off due to hormones, I do not experience a rise in BG over time, but rather a flatline at a high, out-of-range level. And corrections do not work as normal to bring it down, nor do other strategies such as sugar surfing, fasting, eating low-carb, and so on. Until I get my basal levels re-set, I will run high for literally weeks until it ends.
I really feel like a solid pool of knowledge, strategies, and resources (such as tracking apps or other ideas) from women who use insulin and have direct experience in this could be extremely valuable to the diabetes community and it’s something that, to my knowledge, has never been done before.
I’ve been documenting my current experience with hormones and Lantus over in my untethered thread (my experiences are also scattered across many threads, including my Tresiba experiment thread). I am looking forward to an area of this forum dedicated to this subject.
There is a dearth of information out there for life processes affecting nearly 50% of diabetics and I think FUD can be at the leading edge of changing that.
