@T1Allison - this has been such an interesting thread in many areas. You’re asking great questions. I don’t have answers to them - I can add to the pile.
I’m a woman () in a very different phase of my life (post menopausal) than you young whipper snappers. And, as I mentioned before, the idea of hormonal fluctuations and their impact on BG control, well I used to brush that idea aside and assumed that the BG variability I’m seeing is due to something I’m doing wrong (incorrect I/C ratios, wrong carb counts for meals, etc.) or factors I haven’t fully considered.
Enter the discussion of “the drop” and bells started going off in my head. So here is an example from the last 24 hours that made no sense. The first chart is the last 12 hours, which doesn’t look bad.
The 24 hour view below tells a different story. I didn’t eat anything between 12 Noon and 6:30 pm. At 4:00 we left the house to go to a Cubs game (yay Cubs won)! At about 4:30 pm I started deploying the following techniques to blunt the spike I was seeing: 1) Bolus corrections; 2) 4u Afreeza correction; 3) temp basal increase; 4) rage Bolusing; [a break in the action - around 6:30pm had to have a foot long hot dog at Wrigley Field but didn’t eat much of the bun -] 5) IM shot; 6) 8u Afreeza correction; and all of this with a lot of walking during this time. Normally, an 8u Afrezza would be too much for me, let alone all the other adjustments!! Then about 8 pm “the drop”. After last night, I decided to start tracking swings, variability and stubborn trends to see if there is a pattern that might be hormone related.
@Millz, Thank you so much for your very kind, encouraging words and for adding your story to the thread. It’s SO valuable. We need as much of this as we can get, IMO.
Isn’t it amazing how boluses cannot hold a candle to what is likely an underlying situational basal need change? This is what I’ve been trying to unravel for the last four years and feel like I’m finally getting to the point that I can at least rule out pod site issues fairly quickly if I go high and level (bc a true site issue would probably keep climbing).
The thing for me is that too much basal can get me in deep trouble that could sneak up on me with relatively small amounts of insulin. Yet relying on correction boluses adds up to significantly more units of insulin that may or may not do anything, and once it Breaks Loose (as me and I husband constantly refer to it…“I’m breaking loose, you got the boys? I’m going inside, honey!”) who knows where it will dampen, if it will rebound, if you should keep treating…the questioning never ends for me.
Thank you for adding your experience and I hope you are able to find some pattern within what you are experiencing. I’m thrilled that @Nickyghaleb’s question to me helped me realize that I’m seeing my 4PM-7PM work day problem in multiple scenarios, so that is Priority #1 to re-basal test in three weeks on a level playing field.
I can manage problems just fine. I just need to be able to have the problem Accurately Identified. Isn’t that what 99% of T1D for women is? I feel like it is in my world, but cannot speak for others.
I completely agree! If I understand the patterns, if not the absolute root cause, I can adapt SO much better - with confidence, awareness and some semblance of a strategy, for the moment at hand!!
I’ve updated the original post on this thread, but for anyone who has read down to this point: Please Feel Free to Share your Questions and Struggles! If we can collect everyone’s individual struggles on this topic (at any phase of reproductive life), I believe it will help us see collective patterns in the big pictures. You don’t have to have answers to post here. We want every aspect of things.
That question goes to the crux of the matter, and underlies your original question about the actual mechanism by which basal insulin controls our BG. I haven’t chimed in til now because I don’t know the answer, but this statement of the underlying question is something that I could try to search out if I can gather some time.
Today is Day 23…typically my hardest day to pin down in range each cycle. Thank you, progesterone. I appreciate that.
I’ve done better than I typically do, but all the guess work and wait-and-see makes for out of range numbers while deciding what to do next. I have done a much better job of consuming calories today when so often before I just ended up waiting and waiting through meals. That’s bad.
Looking back, it was easier to manage my blood sugar while on birth control and ALSO while pregnant. At least with pregnancy once you get past the initial dip in insulin need, it’s all up from there. You aren’t swinging through resistance and sensitivity…you just keep needing more and more until labor. Not to minimize how difficult T1D pregnancies are…but it was much more straight forward in my experience than what I’m currently going through every month. And I think that’s saying something if I believe pregnancy to be easier than this.
Well, at least today was progress overall. Not final end goal…but progress.
This is what a “good” Day 23 looks like. I wasn’t pegged at 220 or higher all day. I didn’t have any scary drops or “breaking loose”.
Based on what happened overnight I thought it would be a milder Day 23 as far as how much temp basal I would need. After what happened with breakfast, though, I realized I was going to have to up my temp basal and be more aggressive with lunch dosing. That obviously wasn’t perfect. I was able to have an afternoon snack without disaster. I didn’t crash in the evening chasing my kiddos (like all of last week) which was nice. Notice what I call “drift” in the most recent hour. I was stuck 180ish. After adding another 5% basal, within a bit it drifted down towards 165 and I’ve held steady there for an hour. It doesn’t look like much movement, but that is the sort of thing I’m looking for when figuring out temp basals. If it responds to the temp basal change relatively quickly (within the hour) and finds a new resting spot, I’m pulling the right lever in my book.
These are what stuck hormone numbers look like for me. A lot has happened in this timeframe: low carb dinner, correction dose, shower (which usually drops me…especially if I have a correction and dinner IOB), playing outside, correction, snack. Nothing. Only thing that seems to matter with high hormones is the temp basal I’m running. That’s what caused the one drift downward.
Do you use temp basals to manage all your hormones? If so, how long do you set your temp basals for, and how do you remember to keep re-setting a new temp basal when the old one runs out? (It’s that last reason that I change my actual basal rates rather than using temp rates.)
I do use temp basals for everything. I’m in the habit of checking my Dexcom/doing a fingerstick/checking how much longer my temp basal has left on it each morning when I wake up. Then I just reset the temp basal (if I’m using one) for a fresh 12 hours. Then I also check on my temp basal every evening.
I also end up tinkering with the temp basal so much bc it takes so much trial and error for me to dial in the magical temp basal for the moment…and then either my hormones or my activity level changes or something. I’ve also gotten in the habit of turning it down about 2 hours before I leave work bc I don’t always need as much in the evening when I’m active at home (rather than at my desk all day). Still figuring that out. I have a ton of basal testing to do next “Week 2” that I get. I have some trouble areas while using temp basals and I want to see if my basal rates really are accurate during the low hormone resistance week.
So I said that last month I saw a gradual rise in my basal rates from abotu week three onwards, but especially in the final (fifth) week. This time around I’m seeing a huge increase in the third week. Last time I raised my basal rates by (I believe) about 45% in total, but it was gradual. This time I’ve raised my basal rates by 30% over the past 24 hours and am still running >11 mmol/L (>200 mg/dl), so I’ll probably raise them another 15% this morning.
This is the sort of variation that really gets to me. I can’t just come up with a plan, a single alternate basal rate, a single timing schedule, because it all varies so much. Likely there’s an interaction with other factors (diet, stress, activity, etc.). But how to sort all this out in a meaningful way…
@Jen, your basal changes seem to be pretty stark and dramatic to me. Do you find that they are at least lined up on a fairly regular frequency (every 30 days, this pattern pops up)? Or are they more cyclical in the sens that, say, the low period follows the high period, but the duration of each of those is highly variable?
I actually think this is a pretty typical magnitude of change based on other women I’ve spoken with. It’ll be interesting to see what emerges as other people post more about their experiences.
There’s definitely a pattern to the timing and general direction (increased insulin resistance or increased insulin sensitivity), but they aren’t always consistent in terms of exact day, speed, magnitude, or duration.
IDS had told me that 1/4 of women see a spike of 25-50% extra basal needed strictly during ovulation. And then the mythical 3-5 days before menstruation that “many women” need 25-50% more basal. I’m glad they discussed increased needs during ovulation, but I have asked them to beef up their women’s services because I think they could be great leaders on that front since some of their individual experiences as diabetics so closely match my own…meaning that it’s not just ovulation and PMS that you have to worry about. It’s the days before ovulation through (for me) most of menstruation where it is just a dang guessing game rollercoaster that whole stretch. And given the discussions we’ve had, I’m not entirely sure what the percentage of women they discuss is based on. Because they still have you basal test through ovulation which strategically makes little sense. So it’s something that is acknowledged, but really not scientific or understood at this point, IMO. I suspect that number of women who experience an ovulation spike would in reality be significantly higher if there was a way to educate women and then gather data on it. Which is admittedly incredibly difficult.
I currently will only go up to 20% extra personally because I’ve gotten so spooked by my long ditch lows that happened on 40%. I think I really did need 40% for a while…and then my body’s needs shifted and I really didn’t need 40% for so long. Or a “week 2” basal rate might be off and that 40% exacerbates the issue. But I rarely let one temp basal ride a full 12 hours without tinkering because I really do sense that my resistance and sensitivity are constantly fluctuating for the last 2.5 weeks of each cycle for me, and each 5% difference can make a huge bg difference…or none at all. It’s maddening.
I totally hear you on your experience, @Jen, and appreciate you sharing it for everyone’s benefit. I really like your engagement, @TiaG, on this topic. The discussion is great.
Also, @Jen, what are your steps-per-day like if you don’t mind my asking? I’m wondering how our steps compare with how our temp basals compare.
Even though I’m starting to add some exercise to my routine, it’s not like I’m not moving everyday anyway. I take four walks a day at work and do the stairs several times for extra movement. I’m usually at least 7000 steps a day on a work day and pass 10000 steps every weekend day. I suspect you get quite a few steps a day but was just curious. With all this movement in my life, I would hope my hormonal insulin resistance wouldn’t be such a huge factor for me, but it is. It tends to make me think that the insulin resistance portion of womanhood is going to be a huge factor for me in most lifestyle scenarios.
) in a very different phase of my life (post menopausal) than you young whipper snappers. And, as I mentioned before, the idea of hormonal fluctuations and their impact on BG control, well I used to brush that idea aside and assumed that the BG variability I’m seeing is due to something I’m doing wrong (incorrect I/C ratios, wrong carb counts for meals, etc.) or factors I haven’t fully considered.
