FUDiabetes

Ideas for Interpreting Female Basal Testing Results on CGM when Considering Hormones (Insulin Resistance)

#1

I am making this its own post so it’s not buried and missed by women looking for this information.

This post is pulled from: Interpreting overnight basal test

"I am a woman in my reproductive years and have not yet reached perimenopause. I have observed my own patterns for years and kept lots of notes. I want to pass this along to hopefully give you some things to look for to see if they behave similarly for you (or any other reproductive aged woman reading this). Note that my personal bg ranges are what I use to keep me safe since I experience bigger sensitivity fluctuations now that I am no longer on birth control. FWIW, and a Big YDMV here, the following are the indicators I use for safely adjusting my basals [when using a basal profile that keeps me level in Week 2 of my cycle] in response to hormone-induced insulin sensitivity changes each cycle:

  1. In general, individual spikes and dips (greater than 30 points) indicate an incorrectly set basal rate at a specific point in time. This alone would not make me think that hormones were causing a big picture problem.
  2. In general, here are the five main scenarios I look for in reviewing fasting bg’s (typically looking at overnight numbers on my Dexcom) as they relate to insulin sensitivity changes due to hormones:
    a. level bg AND within my ideal range (somewhere around 100 is great in my book): Yay! My basals are working for my current insulin sensitivity! Leave it alone!
    b. level bg BUT higher than my ideal range (once it is stuck level at 150 or above for my safety parameters): Hmmm. My basal rates are strong enough to keep me level, but not strong enough to keep me level near 100. Add 5% and see what happens.
    c. level bg BUT lower than my ideal range (lower than 80 for my safety parameters): Hmmm. My basal is keeping me level but too low, I’ll try removing 5% and see what happens.
    d. steadily climbing bg: My basal is not strong enough to keep me level. I will need even more basal than a “level but high” basal setting. At this point, I’ll add another 5% for 12-24 hours to see what it does. [Also, I pay attention to if I might have a site issue or oncoming illness. Although I play the “wait and see” game on making basal adjustments for accommodating hormones, I obviously take stronger actions if my bg is in an unsafe range. I will change pods, etc.]
    e. steadily dropping bg: My basal is too strong to keep me level. I will need to drop my basal to try to find where it will stop dropping, and then evaluate what is best for my ideal leveling point (shooting for 100).
  3. I eat the same breakfast every morning. This gives me an early warning system that hormone resistance is cropping up. When 3 units typically works for me, but then I have to start correcting bc it didn’t do the full job…that’s when I know to start preparing for hormone resistance before I even see it in my fasting bg’s overnight.
  4. I keep notes on a cycle basis and check my hypothesis for a given day against what’s worked the last few months. If there is a big discrepancy between what I currently need and what I’ve been needing the past few months, odds are good there is another issue to diagnose, such as a site going bad.

All of this is shared in the spirit of helpfulness. I hope it’s not overwhelming. These are the indicators that work for me in making the “correct” adjustment as quickly and safely as possible."

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#2

Thanks for this information!

I would have thought the opposite, that a blood sugar rise from in range to high overnight needs less aggressive adjustment than a blood sugar that just stays high all night (especially with a correction). A blood sugar that says high AND rises I think would need the most aggressive adjustments.

As I’ve said before, I also always change my infusion set if I have a blood sugar that is stuck high. Very often, a new set resolves that problem within 30 minutes of changing it, and it saves me from adjusting basal settings and then going low and having to adjust them back.

I really need to start keeping some records. My settings have been all over the place (my basal has gone from 67 units to 46 units over the past month) and my bolus has been through a similar range, but I’m not really keeping notes, just winging it.

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#3

That exactly how I feel with all my experimenting and adjusting how I bolus, temp basals, etc.

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