Well, being so high isn’t entirely unexpected because I’ve got raging hormones right now. So in a week or a week and a half, that will all disappear and my basal dose will be much lower. But with a pump, typically how I’d deal with this is correcting more aggressively (which I’ve been doing) and running a +100% temporary basal rate that I then may make permanent if I thought it would stick around… So, if my dose does end up needing to be higher, it shall be very interesting what happens in a week or a week and a half or whenever when that dose suddenly then needs to be lowered by 50% overnight… One of the huge advantages of the pump is being able to make rapid basal adjustments rather than having to wait three days to make a change… I used to spend half of every month running high like this during the years I was using Lantus, so I’d like to avoid that somehow, if I can.
Well if it’s predictable like you just described you can ramp up your tresiba dose during those times of the month too… granted it wouldn’t be as instantaneous of an adjustment as is possible with the pump but it’s still possible… eg I take a few extra units of tresiba for 2-3 days when I go to work assignments just because my patterns change so much and my basal needs seem to increase…
It’s somewhat predictable, in that it comes in the middle of my cycle but +/- a week, and it’s variable whether I’ll need a 35% change or a 60% change. Typically, my basal will increase by 12-18 units. On the pump, I’d increase the dose with many smaller adjustments that end up taking a couple of days, since I don’t want to just increase all my basal rates by 16 units in one go, and also there’s often a week in there where I run high intermittently but not all the time before it turns to running steadily high, so I’m never quite sure when or by how much I’ll ultimately have to increase. But on Tresiba the ramp-up of doing it over many smaller adjustments waiting three days in between would be spread out over a couple of weeks, by which time change would be reverting back and my basal doses would be dropping back down even more rapidly.
It will be very interesting to see. It’s also distinctly possible that those hormonal changes are affecting the absorbtion instead of actually the demand so it may end up that it’s less of an issue with some formulations than others… time will tell
I often would use IM injections and would experience the same resistance, so I’m pretty sure the hormones (which essentially act like steroids) are affecting insulin resistance. At least, I also experienced the same problem with taking NPH and Lantus for years (and Regular, Humalog, Apidra, and Fiasp), so I’d be shocked if it magically resolved at this point.
I’m hovering at 16.7 mmol/L and just took a 5u IM injection (attempted, at least), plus have other insulin on board, in hopes I can maybe drive things down into range before I go to bed tonight. I do not look forward to spending another night high non-stop!
What’s your normal ISF for corrections? Roughly…
There’s good evidence linking female reproductive hormones to real changes in insulin sensitivity, and research on the mechanisms out there if you want to read it. This is also why you see dramatic effects on insulin needs in pregnancy, when those hormones are shifting even more and in a more steady way. Also why PCOS and T2 diabetes/insulin resistance are linked.
Well…it ranges from 1:3 to 1:1.5 mmol/L (and sometimes even 1:1.2), depending on where in my cycle I am. Currently I’m using 1:2, but I’ll probably switch to 1:1.5 for my next correction.
There’s good general documentation of this (every diabetes source in existance acknowledges that women’s cycles affect insulin needs), but I wish there was an in-depth study that showed just how crazy it can get. I’m not the only one who experiences a doubling of insulin needs overnight from talking to many other women with T1. I’ve talked to some who say they need 10x more insulin, and there are even many case studies of women going into DKA due to the extreme changes in insulin needs caused by their cycles.
So I just forwarded the text of your comment to my close friend and collaborator who is a menstrual cycle researcher, and she said:
“Oh man… I am SO interested in this kind of thing. I would love to collab with an endocrinologist on an R01… I’ll have to see who at [HER INSTITUTION] has diabetes funding…”
And now we are talking about what that kind of study would look like.
Heh, I just love when I do a correction and then go from staying level to rising instead of falling…almost like the insulin had the opposite effect.
It’s interesting, because last night I also had a rise up to 21 mmol/L. I’m sitting at 18.2 mmol/L right now and rising. In the evening is one of the times I have an increased bump in the basal rate my pump delivers. It’s hard to tell right now, since I’m just running so high in general, but I wonder if I’ll have to take some extra rapid insulin in the evening to compensate for this rise. I used to have the same issue with Lantus (as well as in the early morning hours with the DP). Definitely these two evenings have seen significantly higher readings than the rest of the day (even though that’s all still high, too). Maybe tomorrow, if I’m running lower, I’ll try skipping dinner to see what happens.
That is awesome!
Oh, if your friend does do this research, I think it should focus on women who have achieved tight control (A1c <6.5%). There are studies out there documenting that women’s control worsens during their cycle, but I think if someone has an A1c of 7.5-8% (which is around average, I think) it’s likely they’re not making full adjustments for their cycle and aren’t aware of the full extent of the craziness. I didn’t fully become aware of it until I got a CGM and started trying to stay in range as much as possible and lowered my A1c into the low 6s, because that’s what forced me to actually make the insulin adjustments and see how extreme they sometimes were.
That’s a really good point, and definitely true for me as well—I think I suspected it might have effects before, but really wouldn’t have been able to tell you. I also think that I’m not currently adjusting for them optimally, which is part of what’s keeping me in the mid-6s, vs getting much lower. I think getting both CGM and complete insulin data would be key, since then you can track both adjustments that are being made and also whether control is slipping when they aren’t being made. Definitely would be complex data to analyze.
You were diagnosed as a kid, right? It really seems to me that those of us diagnosed as kids have a much harder time hitting that 5% level than others… I know there are several of us here who have been aiming for that for years, and some still haven’t hit it (me included). I think that topic came up on this site in the past, actually… Another study that would (in my opinion) be really interesting, looking at differences in control between those diagnosed as kids/teenagers and those diagnosed as adults in achieving tight control.
And food data. Heck, one of the things that makes PMS and diabetes so freakin’ hard is that it’s the one time I really, really, really crave carbohydrates and it’s really, really hard to resist! LOL.
Yeah, diagnosed when I was 10, and I agree. I think part of it may be that LADA/adult onset is really pretty different, in part because there may be a little insulin production left for the adult-onset folks, which may make a huge difference. Also I wonder about the effects of all the years before we had the tools we do now, and how that impacts current control, if it does.
Also omg yes, while I don’t have a lot of PMS symptoms, there are a couple of days where I could eat ALL THE FOOD and still be hungry. That symptom is like clockwork for me.
And I know you and I are both examples of people who have other chronic illnesses going on… I think managing multiple chronic illnesses also really changes things up from managing just diabetes alone…
And I am still sitting at 16.6 mmol/L. One of those instances where I wonder where the heck those five units of insulin have gone, because my BG certainly hasn’t budged at all since taking them.
Yeah, the multiple chronic illness thing is part of why I’m honestly really thrilled with my 6.4, which for years I never thought I’d see. I’d love to get it to 6 or lower, but it’s all a balancing act, since I’d also love to be able to get far enough in my PT to be more physically active and comfortable than I am now, not to mention the fact that my job is about to kick into high gear in the next couple of months (which is exciting and stressful), so I’d honestly be pretty happy with just maintaining the improvements I’ve made already for now.
Ugh that sucks! I hate that feeling, especially since then I want to take more insulin, which sometimes works fine and sometimes it’s like oh wait here it all is just kidding CRASH.