This is not much of an answer, but my endo reminds me every time I enter her office that I will need less insulin as I lose weight. If I’m not mistaken, she usually talks about it in relation to my basal rates.
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If it’s related to delayed digestion, wouldn’t there be some predictability? E.g., I expect to see a rise Y hours after I eat. But in my case, the rise happens when I go to bed and fall asleep (they’re one and the same), regardless what time I go to sleep and regardless what time I ate dinner. The only predictable part is that I will rise when I fall asleep.
Mysterious.
(And probably a separate thread. Sorry.)
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I’m seeing the same thing, @Beacher. There are certainly times that I have post-fall-asleep spikes due to food…but I also have completely separate fall-asleep-spikes. It usually happens within 30 minutes of me falling asleep. Sometimes it corrects itself. Most of the time it requires intervention.
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@Beacher & @T1Allison I also get spikes like an hour after falling asleep! My endo was very puzzled by this and thought it was some type of extremely early dawn phenomenon (at like 1 am??), but I don’t know if that explanation makes sense. I did bump up my overnight basals to try to deal with the rise and it seemed to work out well last night, but I’m a little nervous about it because I essentially now have my dawn phenomenon rate running all night.
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@glitzabetes, very interesting!
I thought about working it into my basal profile but it seems too sporadic for me to count on it. Especially since mine is tied to when I fall asleep and that varies by two hours depending on how my household is running.
Also, back when I was doing my hard core pumping basal testing four years ago, I’d wake up every two hours for a finger stick. And that ruined all of my overnight basal rates. Once I started (mostly) sleeping through the night, I needed more basal insulin overall. It seems like lighter sleeping requires less basal for me. I’ll have to start paying attention to when I go into deepest sleep the first time each night (per my Fitbit) and if that corresponds to my spike.
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Yeah, this is what I’m concerned about also. My increased basal starts at midnight, so I guess I’m counting on the fact that I usually start heading to sleep by 1
My bedtime spike is pretty dramatic sometimes (like 100 mg/dL) and less so other nights (maybe only 20-40 points) so something really needed to be done about it. I’m just not sure how well basals will be able to handle that variation. I suppose if it can at least blunt the spike a little, that’s an improvement 
Too soon to tell if I’ll end up treating lows all night but I guess we’ll see.
Hopefully you can get some interesting data from your Fitbit, that sounds like it could be helpful!
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well for us it’s pretty clear it’s somewhat related to food because if he doesn’t eat he doesn’t spike – and the magnitude of insulin he needs is proportional to the meal he’s eaten. We rarely bolus upfront for his whole dinner; we usually bolus about 1 unit. If the food he ate was very high in fat and calories, like pizza (60 g total carbs, which should require about 2.5 units just for the carbs), he’ll need an additional 1.5 units as soon as he falls asleep, whereas if he eats whole wheat pasta (37g of carbs, so 1.8 units total), he’ll need another 0.8 units, for instance. But like you, we find this rise happens almost the moment he actually falls asleep (we can see this because we still have to lie down with him.)
So whether it’s purely digestion or some process that is only kicked off by eating it’s certainly tied to food consumption as it’s very proportional to the amount of insulin he’d typically need for food.
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This is why I really wish that there was some system that allowed integration of Fitbit, CGM, and pump data. Imagine how powerful that would be for uncovering mysterious patterns! “Oh look, on the nights I don’t sleep for at least seven hours my blood sugar the next day is unstable,” “Oh, look, the days X and Y of my period are high but Z is low,” “Oh, look, when I exercise in the morning I don’t go low but in the evening I do.”, “Oh, look, my heart rate and blood sugar are both trending higher, maybe I’m getting sick.”
I am constantly tweaking my overnight basal rates, moreso than my daytime ones, because I want to be able to sleep through the night without having to intervene, while intervention during the day is easy. Some nights, like last night, I have a complete flatline all night, but most nights have me drifting out of range one way or another.
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Diasend does this. I don’t use the fitbit part of diasend, just Dex and OmniPod, but I had thought I had seen fitbit, so I just now logged in and sure enough, fitbit is there. Diasend may or may not serve your purposes, but check it out. 
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Diasend only imports the total step count of the day, and that inforamtion only shows up in the one or two of the report types. It’s useful to see if you were overall active that day, but I wish it imported the moment-by-moment activity, sleep, heart rate and other data the fitbit records to plot it alongside pump and CGM data.
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Looking through my Fitbit sleep data, I usually go straight into deep sleep and then the rest of the night I cycle mostly between light and REM sleep. I’ll try to start watching my fall-asleep spikes and the duration of deep sleep (some nights it’s longer than others) to see if there is a correlation/pattern.
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I noted that last month I had to make no adjustments for my period. Nadda. Nothing. I also had stellar blood sugar control the entire month. No spikes from carbs. Perfect. Control was better than I have had in a long time.
I wondered what would happen my next period.
Well, about a week ago I noticed that the good period was over. Spikes from carbs, stubborn highs that wouldn’t come down. Basal seemed okay for a while. But yesterday, right on schedule, I bumped my basal rates up by 0.2 u/hr.
The only thing I can think of that was different last month is that my thyroid was low. Not super duper low, but my TSH was high and my free T4 was in the lower range of normal (about 12 in a range of 10-20). We adjusted medication and as of the beginning of September, things are back in range. I’ve said before that I feel like my blood sugar got a lot harder to control after my thyroid went crazy, and I think this just confirms the massive impact thyroid hormones have on blood sugar.
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Yesterday and last night I was running low, so I ended up putting my basal rate back down by 0.2 u/hr (however, I may raise it again by 0.1 u/hr). I would not even consider these basal fluctuations so much as small tweaks.
I’m pretty sure my thyroid is stable. But I’m getting it re-checked on Friday (along with a ton of other blood tests), so that’ll double-check that it is.
I’m really wondering if eating a low-carb diet was having a horrendous impact on my hormones. I started metformin a year or two ago because I had heard it might help blood sugar fluctuations caused by hormones. I found it had no impact at all. But I was also eating a low-carb diet at the time.
This summer I completely abandoned low-carb eating and have been eating over (often well over) 100 grams a day. And my last cycle, and so far this one, have had virtually no fluctuations in insulin needs. Maybe THIS is the way metformin was supposed to help but it was somehow being prevented by eating low-carb?
I’m getting my A1c checked on Friday, too, and I’m fairly sure that it will be the same as it was while I was following a low-carb diet. Maybe even lower, based on my average BGs.
Are any other women taking metformin?
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Glad you are experiencing stability!! That has to be a bit of a relief.
Thank you for your continued updates. They are helpful and interesting!
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So I went off the Nuvaring awhile back. My first period ended on 9/22. Basal Insulin needs dropped to 1-2 units lower than my prior lowest dose at that time of the month (26 units/day). It varies a bit depending on factors like exercise.
My insulin needs are ramping up again as my basal is now 26 units/day again. I determine when an increase/decrease is needed by by both my early morning trends and overall trends during the day. Trends right after I go to sleep are unreliable.
I’ve noticed no weight loss benefits as of yet, but it’s still relatively early. I increased my swimming frequency, but my shoulder started to hurt. Too much too soon I guess. I could tell on the day that I hurt it that the muscles were still healing from the last swim, but I wanted to swim anyway so I pushed through it and ended up hurting myself. Stupid.
I plan to heal up this week and go running instead. Then I plan to alternate between the two at least until my shoulder muscles are stronger.
So anyway, I definitely needed more insulin with the Nuvaring. I’m curious to see if I’ll need to continue increasing my dose until the end of the month.
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Don’t forget the breast stroke on your off days. Very easy on the shoulders. Still lets you swim. There is always the dreaded, legs only swimming workout using one of the boards…
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I’m curious if any of y’all have used basal body temperature tracking through the month to pinpoint when progesterone, FSH, LH, etc. are rising and falling and then seeing if you could use a temperature as a leading indicator of when you’d need to raise your basal? Maybe I missed this and you’ve already tried this? I just know there are a ton of apps now, a few which are FDA approved, which chart temperature and pinpoint transitions between fertile and non-fertile days of the month, so that might be an additional data point if you’re interested.
I’m not using temperature, but I am tracking my cycle in my Fitbit app, which predicts fertile period, ovulation, and period based on previous reporst and other things (such as heart rate and weight, though I don’t enter my weight). I’ve found it really helpful.
it seems my magical good period is over. I’ve raised my basal rates by 0.3 units an hour or so over the past week and am still spiking quite high after meals (except when I crash).
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I increased my dose by 1 unit for one day because I’d been trending high, but that sent me trending down the next night so I changed it back to 26. I guess my needs increased very temporarily about 3-4 days before my period started. I’m back at 26 now, and I expect I’ll stay here until the end of my cycle.
It appears that I need about 2 units less/day when I’m not using the NuvaRing, but the basal patterns are actually quite similar throughout my cycle. I start the cycle 2 units lower than I end the cycle.
I noticed some insulin resistance at meal times around the start of my period, but that resistance seems to be tapering off now (this pattern was similar with the NuvaRing with maybe a little more resistance). The last 24 hours look beautiful
I realize I’ve been stating the timeline all wrong. I guess the official “beginning” of a cycle is during menstruation, but I’ve considered that the end. I thought I’d clarify that in case anyone reading this gets confused.
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My amount of physical activity (moved) this cycle has either negated any insulin resistance from hormones -or- it’s made tracking my resistance impossible due to so many variables.
I’m just now adding 5% extra basal two days before the end of the road. That’s rare for me.