I’m doing perimenopause at the moment, for the last 3 years anyway, which is making patterns very tricky to detect!
I use Mirena, and have since 2003, but have always had a strong 28 day cycle, with ovulation bang on D14, and a massive drop in insulin requirements D1-4. I have a slow build of insulin resistance from about D21.
Currently I have anything from a 24-60 day cycle🙄. With only sporadic ovulation (I’ve always had ovulation pain, since age 12, often worse than menstrual cramps).
I’ve been looping for 8 months now, and have finally organised what I need to do at various stages of my cycle.
Days “7-21” or as close as I can figure out given my cycle weirdness, I just sit my profile on 100%, days “21-28”, or PMT time, I start increasing my percentage up to 120-125%, then when I get to day 1, I drop it to 70% for a couple of days. Alternatively, I eat a lot of chocolate and leave my profile on 100%
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Finally got around to analyzing last month’s week 4 (week of resistance for me) and have been using the trends I saw with this month’s week 4:
- Timeframe A: Week 4: in need of +10% basal each day because of a slight trend up overall. I was more aggressive with meal boluses and the sugar surfing (I would say using a flexible rough +30% on boluses) following meals than I normally am and than I have been in past months
- Timeframe B: 1 day prior to starting my period (Last day in Week 4): +40% basal, +50% boluses and when I’m rising, not being scared to give a lot of insulin up front and eat my way out if needed (though mainly I really have been suited to these aggressive upfront boluses when I start moving upwards on this day)
- I think that this increased resistance (timeframe B) may stretch into 12-36 hours AFTER starting my period, but it’s hard to tell the exact timing of it because of my generally lighter flow… which leads to -->
- Timeframe C: 12-36 hours after starting my period (Day 1) to Day 4/5ish : insulin sensitivity, as I have mentioned above
I will post my trends on week 1 after making it through it this month and after analyzing what I noticed 
I’m thinking of drawing up some diagrams overlapping hormones in the cycle and general trends of insulin sensitivity/resistance to help any newcomers/anyone who’s more visual
That is AMAZING information, @LarissaW. I know I will be referring back to these stats of yours often in my own analysis of my needs.
Total baller, you are.
Week 1, day 3: -15% basal, -30% boluses extended an hour longer
I think I could even do -20% in the morning
For last month and this month, I experienced insulin resistance persisting from week 4 into week 1 day 1 (after starting my period) that seems to last 12-36 hours
I started going down the rabbit hole of the research on effects of hormones on pre/peri/postmenopausal nondiabetic women’s insulin resistance … I’m really going to be gunning to find a professor in med school who’s on board with putting together a study on this
#myhero
Also - I think I’ll go with -35% basal tomorrow morning because I think that the -25% basal was not enough for this morning
I’ve really come to the conclusion that hormones are limiting the control I can achieve by a lot.
I’ve been posting that I need to make a 40-60% increase in basal rates. Turns out I was calculating wrong. I’m making an 80-110% increase in basal rates. So about four or six times a month, I’m having to raise or drop my basal rates by about 20-40% each time. That is huge to the average person.
Even with tracking my hormones, this is impossible to keep on top of. It results in days of running extremely high or extremely low. I have general patterns worked out, actually quite detailed ones (I know, for example, that there’s a period of time around ovulation where my body flips between insulin resistance and insulin sensitivity, which makes things hard to handle for a few days). But it’s responding to those patterns, which are just general and have no set timeline and no set amplitude that I can mark on a calendar, that is impossible.
And I find the lack of resources so frustrating. I’ve come across women on Facebook who have this figured out, but they all say that their cycle is so set in stone it’s marked on a calendar and they can use iPhone alerts. There are many others who say that isn’t the case for them…but none of them have this issue figured out.
I’ve heard stories of women who go into DKA with their cycles because they have such extreme changes in insulin needs. And in fact there are case studies on this. But, of course, no studies looking into the issue more deeply. Honestly, if I didn’t keep on top of things as much as I do, I think that could be me. If I had a 100% increase in insulin needs that I didn’t respond to, I could see how DKA could happen.
No answers, just needed to vent.
My hormones have swung around on me and I caught an impending tank (I was way lower 1 hour post meal than I should have been and was gaining steam downward) by chugging a full can of Pepsi accompanied by six glucose tabs. I eventually bounced a touch high an hour later and it corrected easily…but it’s disconcerting that doing so many things so routinely to create safety nets for myself with all of these variables (hormones are high on the variable list) still lead to a 65g of carb countermeasure. I haven’t thrown that much at a drop in a long time. I should have skyrocketed but didn’t. Glad I caught it early. I do hate panic consumption, though.
Ugh, yes. I usually treat with glucose tabs because it’s easier for me to restrict the amount (I’m usually very carb sensitive when low and only need 1-2 tabs). Tonight was the 4th night in the past 5 I’ve had a late evening low - very unusual; think my BG is beginning to be more affected by hormones - and they’re requiring more glucose than normal to bring up. 
managed not to overtreat tonight, but the first night it happened…when the glucose tabs didn’t slow it down, I went into full on panic eating mode, because that’s never happened to me before.
Since switching to Lantus, I’ve been watching to see how my monthly basal need patterns would change or stay the same.
So this is what I have found!
My basal needs remain highest during the week before my period and the week my period starts. My basal needs start to drop at the very end of my period.
My highest dose each month is a total dose of 23 units given in a 12 unit dose at 9 AM and an 11 unit dose at 4 PM. My lowest dose is a total of 21 units given in an 11 unit dose at 9 AM and 10 unit dose at 4 PM.
Below is a general guide for when my dose increases and decreases. There are no set days, just general time frames of when my dose will need to increase and when it will need to decrease. I tend to keep my lowest dose for a solid 1.5 weeks, and that’s my favorite time of the month diabetes-wise.
As my basal needs taper down, I begin to noticed lows in the early morning hours. Lows in the early morning hours indicate I need to drop my evening dose. I’ve found that maintaining at least a 1 unit differential between my morning and evening doses tends to work best for me. Lows around bedtime indicate that I need to drop my morning dose. The opposite trends indicate when I need to increase my dose.
Of course, exercise plays a role in all of this. If I’m anticipating needing to drop my basal dose in the near future and I plan on a really intense swim one night, then I’ll drop my 4 PM dose before I see the downward trend. A lot of this stuff is just a guessing game, and my timing estimates are only estimates. My cycle is not consistent from month to month, so i can’t just use the days of my cycle to guide my adjustments.
Still, I definitely have solid patterns based on my monthly cycle, and these adjustments
(as imperfect as they may be) really help me stay in range. I tend to experience more insulin sensitivity in general during the times of the month when my basal dose is lowest, and I experience more insulin resistance right before and during my period when my basal needs are the highest. Makes sense!
@T1Allison, I really appreciate you creating this thread and the other “hormone threads.” Since going back to Lantus, I feel like my control is the best it has ever been. I can’t really imagine it ever being much better. Afrezza makes things so easy, and now with Lantus, I can easily adjust my basal from one day to the next. The insulin pattern of Lantus, given at 9 AM and 4 PM, seems to just match my basal needs perfectly. When I was using Lantus before, I wasn’t identifying or adjusting for monthly basal patterns, and I didn’t have this awesome, amazing fast-acting insulin I use now. Everything is so much easier now than it was then.
That doesn’t mean I don’t have my bad days. They happen. They just happen so much less than they used to, and I don’t seem to end up on some never-ending roller coaster when they do because my insulin works so much faster and the risk of lows is so much lower. Knowing my monthly basal patterns and being able to adjust to those quickly with Lantus has also made a huge difference.
it sucks!!! I wonder if there even are any leading numbers that change before your hormones do? My guess is none that are accessible to us without a blood draw. 
That’s amazing!! I’m so happy for you!
Your chart is great! I love that!
Good stuff here! It’s so interesting how hormones affect us all a little differently. I’m glad you were able to figure out your pattern though and feel like control is better now (especially with the super quick Afrezza!) Thanks for relaying your findings!!!
I’m tracking my cycle on my fitbit, which works well because I can see when I’m in my “fertile window” and what day of my cycle I’m on and how many days it predicts it to be based on past cycles. So the timing has gotten much better, but that doesn’t help with keeping on top of my blood sugars because the exact timing and amount of changes I need to make differ…
For example, today is Day 16 for me (I have a cycle that’s closer to five week) and in the past 24 hours I’ve changed my I:C ratio from 1:15 to 1:10 and raised my basal rates by 30%. This is the beginning and I will raise more if I’m still seeing spikes, and even if these changes are sufficient, I’ll almost definitely have to do one or two (or three) more like this before my cycle is done, and then ramp everything back down over the first week or two of my next cycle. It’s just this constant background level of instability that makes me feel that my control is seriously limited. I find it almost impossible to get more than 75% of my readings within a 4-10 mmol/L range and have to work very, very, very hard to get my A1c below 6.5%, and I feel the constantly-shifting hormones have a lot to do with this.
It will be interesting to see if any of the loop systems are actually able to handle this. If they rely on past doses and responses to predict what will happen, I suspect those systems will have as much difficulty as I do. But at least with them the manual effort will be greatly lessened.
Last week, I needed 13 units to deal w dinner. Ate the same thing tonight and 7 units was way more than enough. Yowsers. Thank goodness for being as tuned in as I am just to keep it safe…not pretty, but safe. That’s all I can hope for some days.
Same experience here. I’ve gone from being about 95% in range to struggling to not go high. Even with my basal rates raised by 30% and I:C ratios lowered by 50%, I’ve had to add in additional “rage boluses” constantly to stop from rising, even when I’m not eating. So I’ll probably have to adjust settings more tomorrow.
I do manage better control overall (“better control” meaning I just spend maybe 50% of my time out of range instead of 100% of my time out of range) if I can be quick and very aggressive with changing settings. But then that brings the real risk that I guess wrong on timing and it ends up being some temporary issue that then disappears and I’m left with crashing lows. I wish there was some sort of rhyme or reason to it. Maybe a “hormone meter” that could at least tell us what level our hormones were throughout the month so we could raise or lower our insulin doses X percent from baseline…
For me, even though I haven’t solved this mystery yet, online threads like this over the years have at least helped me know that I’m not crazy. I used to feel like I was doing something seriously wrong to be managing fine one day and hanging on for dear life the next. I could not figure out what other people were doing that I wasn’t, and felt really stupid for not being able to figure it out. Turns out it’s just that at least half the population aren’t dealing with this madness, and even many of those who are aren’t dealing it to the same extent as I seem to, for whatever reason.