@JessicaD, Thank you for the intel! I’ll take a look at that one as I continue to circle this drain of indignity.
Yeah, I think you’re right. My complex migraines have only ever occurred (so far) when taking hormones. I’ve had three and they were hospital trip doozies with dysphasia.
But, my OB/GYN said I could start to experience complex migraines via my own hormone fluctuations as this progresses. Awesome!
New news: At this point, it appears that for my body I can use my resting heart rate as my indicator or carb sensitivity and prebolus needs.
As my hormones climb through my perimenopausal cycle, so does my resting heart rate, my carb sensitivity and my prebolus timeframe.
Just wanted to share. If that changes, I’ll update the thread. It is pretty mind blowing to watch how I need to go from 50% normal bolus and taking it almost after eating at low hormone times to needing to take 200% normal bolus with a 45 minute prebolus and a long walk afterward on high hormone days.
Fun!
ETA: Photo of my resting heart rate cyclical fluctuations below. The peaks match ovulation and also the increases in progesterone (and everything) toward the end of the cycle. The dips are from the cycle restarting and everything settling down for the first week and a half or so of the cycle. Shared in the interest of “SCIENCE!” like on Bill Nye’s show. But he didn’t talk about cycles.
This is fascinating to me. Can I ask what the average meal for you looks like?
Frustrating that I really see no resources for insulin use during perimenopause. I learned insulin from books I bought on Amazon and Dexcom experiments. It seems I will soon have to switch to only Dexcom experiments only for the next stage in life.
I’m 100% with you on the lack on info!
I just try to keep myself bolusing and eating something about every 3 hours. I keep to 40g of carbs or less per meal…usually 15-20g for snacks. On high hormone days I eat lower carb. And I walk 10000-14000 steps a day to try to keep my body using my insulin. As soon as I sit still for long periods of time, insulin does nothing for me.
Keeping what I eat as consistent as I can gives me the first clues about if I’m swinging more sensitive or more resistant so I know how hard to punch highs with rage bolusing or how patient to be to see if it corrects itself while it’s still got some life in the dose.
I wish it were less time consuming than that for me, but it’s not. Bc if I don’t put the work into planning and spacing, I’ll have all my energy sucked into fixing the high or the lows anyway.
I hope that’s helpful. I definitely don’t know what’s the “best” approach but this is the best thing I have come up with for my body and my circumstances so far.
Wow wow wow! A 45 minute pre bolus even with low carb!! That almost sounds worse than dosing during a virus. Something I’ve only experienced once.
Thank you for your reply and all this info. Seems like you do a lot of experiments yourself. I will be reading over these threads in my spare time for some real life experience.
I added my resting heart rate graph to show what I’m talking about between it and my hormonal fluctuations a few comments above just for reference.
My last A1C was 5.3% 
Lower than I want, but it shows that <6.0% is definitely possible. My endo and I are aiming for more like 5.8% to minimize my lows.
With all that in mind, a diabetic pregnancy is feeling more realistic… My endo recommends a care team of 3: 1) endo, 2) ob/gyn, 3) maternal/fetal medicine. I don’t have an ob/gyn, so I’ve started the insurance provider search. I hate the search. 
As a default “high risk” pregnancy, do you recommend looking for a high-risk ob/gyn from the get-go? Or just find an ob/gyn who comes highly rated and who I vibe with, since I’ll have maternal/fetal medicine appointments anyway if/when the time comes?
Those are great questions and I don’t feel 100% qualified to answer them…
…I had a high risk OB whom I also did preconception counseling with prior to my pregnancy. She left the mega OB practice I was going to prior to my second pregnancy. Then the mega OB practice claimed “well, ALL or our OB’s are ‘high risk’ OB’s!” which was code for “we don’t have a high risk OB”.
So I’ve done it both ways. Either way, if you have a maternal/fetal medicine practice you’re going to (which I’m not exactly clear on what that is)…it would sound to me like you’re covered.
Honestly, from what I saw, medical practices are so liability adverse that they check everything in diabetic pregnancies 10 million times. So I think you’re on the right path no matter what!
And GREAT job on your A1C! And I kind of chuckle at the endo aiming for .5% higher than what you currently have. I’m going to interpret that as supportive and not as micromanaging…but I love that the control is that good that we’re talking about decimal points under 6.0%. It’s cool! It didn’t use to operate that way with the tools we had! And I haven’t even been living on this block nearly as long as the OG’s like @Eric and @MM2!
@RachelMaraii you are in such a good place! Your a1c is incredible and you’re thinking of all the right things! My kids were born a long time ago (before even CGM was a thing), so I’m not super up to date on how pregnancies work now, and I had the good fortune of working with the Joslin pregnancy program in Boston for both of mine, but I’ll tell you how it worked for me. I worked through their program with an endo and MFM doctor (who is also an ob – I think MFM is a subspecialty?). So if you are close to wanting to conceive, it may make sense to just go the MFM route immediately? I learned a lot from my first pregnancy that I transferred to my second, most critically how intensely / closely I wanted to be followed. The Joslin program is intense and I had to push to decrease the optics for my second pregnancy b/c the constant monitoring and number of tests / diagnostics caused a lot of anxiety for me. That will be something for you to think about and decide what feels right for you. There are lots of us here who can be resources for you when it comes to it!
But, you are in a FANTASTIC place right now – I am so excited and happy for you! Keep us posted (and keep asking any questions)! Jessica
Thank you both, @T1Allison and @JessicaD! Still at the point of "who knows 
". But I am the type of person who likes as much info as possible before making decisions!
Yeah, I think you’re right. Probably will narrow down some providers and call their offices to see what they recommend. Or check in with my endo to specify her recommendations!
Yes! She’s very supportive. I had to laugh at my last appointment when she sat down to look over my numbers. “Okay, I see five different basal profiles here: Test, Test 2, Test 3… Which one are you actually using right now?” She’s a good balance of being available if I have questions/concerns and respecting that I drive this body every day.
