FUDiabetes

Do Women Need to Change their Meal Boluses During High Hormone (Insulin Resistant) Weeks?

#1

Continuing the discussion from Basal Rates and Hormones:

Yup. Yup. Yup.

I’m still wrestling with the basal and bolus relationships throughout different hormone phases (i.e. different insulin resistance phases). But it seems to me from my experience, if I am resistant to basal insulin, I’m going to be resistant to bolus insulin, as well.

This whole prevailing idea that you use basal to get your bg level, and that your bolus addresses food…and that if your basal is holding you level that your food bolusing shouldn’t change…yeah, that works great in a Male Body IMHO. And there’s nothing wrong with that. I would love to have that. But I’m working with a Female body with female hormone changes and insulin resistance changes.

For example, during my quiet hormone phase, my super routinely composed and timed work lunch spikes me to 160. (In my world, that’s awesome.). BUT, during insulin resistant hormone weeks, that same lunch, same timing, even with extra basal to keep me level in the face of hormones, will spike me to 230 without breaking a sweat. So I have to adjust my meal boluses Carefully as well as my basal. It’s just not good enough to get my basal dialed in each week. I have to change my boluses, too, even with the extra basal.

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#2

YES. I’m glad you made a thread of this. I was totally confused that my routine lunches were sending me to the 200s in Week 4 whereas normally they rise me to ~140

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#3

Exactly!! It’s nice to have someone to bat this back and forth with. When discussing challenges with meal bolusing, I routinely get, “Take what you need and move on!” sorts of responses. But when that target keeps moving every week or few days, how on Earth would I not get crazy spikes and dips without diagnosing this problem? I know it comes across as obsessive to people who don’t deal with this phenomenon, but I’m trying to be tightly controlled and I can’t get there without peeling the layers of this onion. This is what I’m finding to be true. Hopefully we can keep collaborating on this!

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#4

I don’t think it’s obsessive at all. It’s one of the factors that’s effecting your diabetes management that needs unearthing as to WHY it’s changes your numbers this way and that. It’s like any other factor like exercise, fatty meals, or stress that require a huge amount of experimenting to figure out what’s really going on underneath

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#5

I relearned in a BIG way about the need for more MEAL insulin during hormone-induced insulin resistance over the last few days. Fortunately, @LarissaW’s observations rang around in my head when I was ready to chuck everything out the window.

It’s amazing to me that a salad that can be covered with a 5-unit 30-minute bolus with room to spare one week can require upwards of 8 units during a different hormone week for me…and it still might struggle to stay pretty.

And that’s even when I have my basal “correctly” adjusted to keep me beautifully flat at 80 during fasting. What the HECK, hormones???

I know I get nervous about piling on extra meal insulin when I know I’m already running extra basal insulin. To me it seems that theoretically the meal insulin needs should stay the same if basal is adequately covered. But I can Unequivocally state that in my hormone experience, just because my basal gets dialed in correctly to manage insulin resistance does not mean that my meals will behave the same. Bc they don’t.

Thanks, again, @LarissaW for your contributions on this front!

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#6

I definitely feel that both basal and bolus need to be adjusted. In fact, lately I have only been adjusting basal, and I think it’s in part why my basal needs rise by 50%.

I just find all this hormone stuff SO frustrating. I mean, T1D is hard enough when all you need to deal with is figuring out basal and bolus needs and how to compensate for food, exercise, stress, and illness. Doing all of that on top of constantly shifting hormones that are never quite the same is just so frustrating. I don’t know that I will ever get it figured out.

The past couple weeks I’ve been raising my basal significantly due to prolonged overnight highs and have made a few other tweaks. I was really happy that my overnight numbers were relatively flat (by no means perfect for those with a super low A1c, but good enough for me). Then the past couple of days my blood sugar has been behaving oddly, so I lowered my basal a touch. Last night I suddenly spiked to 17 mmol/L (300 mg/dl) as I was going to bed and just had no energy to deal with it. I figured I’d correct if I woke up in a few hours and was still high. Well, I woke up in the morning with a blood sugar of 5.5 mmol/L (100 mg/dl) and proceeded to drop low before eating breakfast. I mean…what? That kind of drop literally never happens to me unless I have done a correction or my basal rate is way too high. But the past four or five nights have been flat, indicating that basal is apparently not too high…so, huh?

So anyway, now I’m thinking I need to lower my basal significantly and up my bolus significantly. Or maybe my Fitbit period prediction is off by a few days (though it’s usually pretty spot on) and I’m getting an early drop. I just … ARGH! It is never ending. NEVER ENDING!!!

And yet you get people saying they manage super tight control with “little effort.” HOW?!?! I mean I have been doing this for over 27 years and still feel like the sand is shifting beneath my feet and I’m struggling just to keep my balance most of the time. The only time I can manage tight control with little effort is one week each month. I can do practically anything and as long as I check my CGM and dose insulin I stay in range. IT’S BLISSFUL! If diabetes were like that all time time it would be a non-issue. Instead I get to spend my entire life trying to figure out baseline doses. Never mind any tweaking or fancy stuff. Maybe when I’m 65 and not dealing with this craziness I’ll have time for that. But that’s still almost 30 years off.

Anyway, clearly I’m hormonal since I’m grouchy. I’ll stop ranting now…

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#7

I’ve thought the same thing. I’m happy for those who experience this. I just take issue with the sometimes added on editorializing that this can be the result for everyone who tries hard enough. Yeah. We aren’t all dealt the same hand of cards. That’s not to minimize anyone’s individual success or efforts…but let’s keep what we each experience in context and realize that what is possible for one might not even be possible for another. Maybe it is…but maybe it’s not.

I’m having that day right now. My CGM looks like I’ve been fasting all day. Whereas the last three days have been crazy correction dose after crazy correction dose after no opportunity to have a snack bc the correction dose never brought me down after basal increase after basal increase. So. Much. Fun.

I mean, maybe you’re grouchy. But I haven’t seen anything expressed here that is not backed up by expressed fact. So I wouldn’t blow it off as emotional. It’s true.

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#8

Case in point: in this 24 hour image from right now…you can see my struggle to get out of the 200 orbit yesterday afternoon and evening. And I was thrilled to not be stuck in the 230’s or 240’s all day like the prior day no matter what I did. And today? I’ve eaten meals. I’ve had coffee. I’ve had snacks. You know, like a normal human? With no problem.

If only everyday was this easy.

Shifting sands is a major enemy of joy and quality of life and eating.

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#9

@T1Allison glad my observations could help!!

I completely agree. I strongly believe that the medical community has neglected to identify this need with patients. Half of the patients have an unmet need that a large portion are unaware of, counting up the hormonal fluctuations as insufficient or improper management (with say improper carb counting or whatever). I don’t know about you gals, but before reading Allison’s thread and all the contributors’ posts, I didn’t know my cycle had such a large impact on my numbers. I was basal testing and testing ICR and ISF on different weeks, and didn’t understand how to interpret my data that seemed to contradict itself.

A WILD RADICAL notion, but maybe if the medical community looked into the female cycle past the very general study we’ve all seen to get some data we can work with, and maybe if MDs communicated that hormonal fluctuations are another component of management to look out for, then HALF of diabetic patients would feel less out of control. (and I would bet that would save a lot frustration and giving up in many patients.) just a crazy idea though

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#10

I don’t know Larissa, asking the medical community to treat women like women, you always seem to expect a lot of your practitioners. /s

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#11

Like I’d said, a truly revolutionary idea

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#12

I mean, I know I’m tempting the blood sugar gawds, but dang…I can do no wrong with my blood sugar today. If every day was this easy…take a bolus…eat…glance at a graph…take a bolus…eat…I’d think this was totally doable, too.

I must sound like I’m dramatic to people who don’t experience these hormone swings. Oh well. I’m just going to enjoy the ease of today for now.

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#13

You must have your pod in the right place.

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#14

[quote=“LarissaW, post:9, topic:6689”]
A WILD RADICAL notion, but maybe if the medical community looked into the female cycle past the very general study we’ve all seen to get some data we can work with, and maybe if MDs communicated that hormonal fluctuations are another component of management to look out for, then HALF of diabetic patients would feel less out of control. (and I would bet that would save a lot frustration and giving up in many patients.) just a crazy idea though
[/quote]n

Sad to hear this is still happening, with all the advances and use of CGMS.

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#15

By the way, I’m so glad this helped you!

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#16

This has been my last 24 hours… The past few days have just been crazy like this, after feeling pretty good that things were getting better as I adjusted basal rates. No rhyme nor reason, either. A massive drop overnight with no correction followed by highs today that soared for hours despite taking about 15 units near the start. And trying to prevent the latest low by suspending my pump when I was still half an hour away from hitting the low limit. I sort of feel like all my insulin is massively delayed and Fiasp and my food hit at unpredictable times that could be anywhere from an hour to four hours after I eat or take a bolus (and I am testing with a meter every couple of hours, so this is not just sensor lag). So this isn’t entirely new, but just on top of hormones, ugh.

I was really lucky and learned about hormones and their effects in 2006 or so when I first sought out the diabetes online community. But I continued thinking that I must be missing something obvious until 2009, when I went on a “blinded” CGM for five days. During that time I ate literally the same thing every day (except one day where I changed up breakfast because I wanted to see what happened) and kept a super detailed log. So when the results were downloaded, and I saw that I went from spending 95% time in range one day to only 23% the next (the other 77% being highs), despite doing everything the same and actively correcting those highs, and realizing that the timing correlated with day 14 (or day 15 or 16 or 17…it’s never exact!), that finally convinced me that hormones just unleash chaos. Even the CDE reviewing the results with me commented on the contrast with something like, “Wow, you didn’t spend 77% of that day high, did you?! Oh…I guess you did…”

Another time I was struck was when I asked over in the Flatliners group on TuD if anyone else in that thread got hit with hours-long highs that were not caused by splurging on food (such as eating out). I could not understand how some of them were posting flatlines that lasted for weeks or even months when the best I’d ever managed in 25 years was four days. I wanted to know what strategies they used when faced with such a problem. The only responses I got were one or two people (both men) who said they didn’t experience this problem. That also convinced me that I’m living in a different diabetes world from many.

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#17

My previous two days have been full of ghost doses…which are actually just insulin doses that never chipped away at the insulin resistance I believe. My sites were fresh and fine. I had stress mixed in there…but the calm to the bg storm matching my hormonal timing is such a stark change that I have to rule out the stress as the problem the other days. And this series of swings has been totally different in amplitude than the other previous cycles. And timing is always an unpredictable beast, as well.

I’ve not ever seen a woman tell others that when they get more studied at their diabetes care that it will all stay in range more often than not effortlessly. I think that is indicative of our different variables that (some? all?) women have to account for in dosing ourselves for our iteration of this disease.

Thank God for these last 12 hours. It’s a relief to get to eat without jumping through hoops to keep it super low carb or having to cut portions to stay under 300 or to cut portions and go to 270 for four hours anyway despite adding buffer and prebolusing and even more temp basal. And it’s such a relief to not be worried about a potential timebomb of 8 ghost units that were supposed to correct me and let me have a tiny snack but never did and is this going to catch up w me later??

It truly is a quality of life issue.

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#18

I am so drooling over those numbers. Gratz on that virtual flatline!

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#19

@ClaudnDaye, Thank you! I post it to show that even though I’m fighting like hell to get my A1C under 7.0, it’s not bc I’m not trying hard enough or am unwilling to learn or anything like that. I know FUDders probably don’t think any of those negative things…but look at how much my bg doesn’t suck today!! If only hormones didn’t screw everything up in the worst game of Battleship ever so much of the time for me…

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#20

Neither have I.

I’m 27.5 years in, and it certainly hasn’t gotten any easier for me. The lack of consistent amplitude or timing or duration is the main issue. It’s all just guesswork. And I feel it wouldn’t be such a big deal if it didn’t affect 50-75% of our diabetes control time…

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