Type 1 Insulin taking 10 hours to work - periods and resistance

[Jimmybetes]

With the libre sensor I'm finally able to prove to the specialist team that days before my periods I get insulin resistance.
I've been experimenting with upping basal and bolus during that time.

During recent discussion late Nov last year with the nurse, we concluded stacking all day by liberally increasing my doses during this time was causing overnight hypos. So over the last two monthly cycles I've conservatively reduced the increased doses increasing by one unit basal each day and seeing how that goes.
Today I experimented with not corrective dosing at mealtimes. My usual corrective dose is 1:4

Looking at my graphs it shows, despite upping doses, it's taking ten hours for insulin to take effect:

Today on waking, was BG 6, noticed yesterday terrible resistance so upped my basal by one unit (under recent clinical advice) to 12u walked 45 mins to work, BG 13.7 at 0830. Ate my usual breakfast oats, seeds and nuts (30g carbs), upped my usual dose (1:10) 3units novorapid to 4.5 units (note not adding in corrective dosing to avoid the 1am hypos). BG one hour later 14 and rising arrow. Another hour later BG 18 and straight up arrow. Feel terrible, eye pressure, 'furry' feeling around my heart, moody, yada, yada.
Asked to go on an early lunch to walk it off, if only the anxiety/bad mood. That helped. BG 13.8 at midday, decided to skip lunch to look at how the basal was affecting. BG 9.7 at 1700 when I left work, 45mins walk home later I'm BG 7.8 and 6.2 at 1900.
Is anyone experiencing these 10/12 hour lags of insulin effect?
Usually the rest of the month with good management I return to normal levels within the hour to within two hours of eating.

Should I go back to corrective dosing before meals and deal with the overnight hypos? Finding it difficult to focus and think about all the different factors in the wider view to come to any conclusions and where I go from here.

Really worried that this resistance happens every month (and has done for years) and what my long term complications may be.

Diagnosed 2006 age 27.
Not looking forward to how my bonkers hormones will affect me and how I will ride this **** through impending menopause jeez. Help me please.

 

[EllieM]

How confident are you that the libre readings are accurate? They are renowned for inaccuracies outside the 4-7 range so I'd want to back up some of those readings with a glucometer before relying on them.

As regards today's readings, could they be explained by dawn phenomena and increased insulin resistance? If you don't eat on waking your liver pumps out sugar so that would explain the initial rise to 13.7. You then did not have enough insulin to cope with your existing blood sugar and your breakfast, so your blood sugar soared up. Skipping lunch and walking reduced your insulin resistance and allowed your basal to bring your bg down.... I'd argue that you may be now having too much basal....

Remember : insulin resistance and carb ratios can vary with time of day as well as hormones and exercise.

Other thoughts:
insulin pump????
method of contraception that reduces or eliminates periods??

Good luck.

 

[Jimmybetes]

Ellie M,

Thank you for your detailed reply I'm most grateful for your wisdom.

You're right, I've not been doing enough cross referencing with fingerpricks. I have noticed the difference in both meters readings 50% of the time.

The readings I reported could dawn phenomena and increased insulin resistance. Im not hungry on waking and like to get some exercise in before I do. I realise this could be pushing up BGs. Doh! But I take what you say to heart and might try forcing down a small sensible snack on waking and a tiny relative amount of insulin and look at how that effects levels. After a couple of weeks it might change my gut biome and make me want to eat first thing (although I have to get up at five some days to go to work).
You argue that i may be now having too much basal....I think you're right!

I do remember : insulin resistance and carb ratios can vary with time of day - so true! - as well as hormones and exercise.

I'm taking what you say to my next appointment as these are excellent points to discuss.

I'm having a minera coil fitted at the end of the month. A couple of years ago the gynecologist prescribed the progesterone pill. I took it without checking the adverse effects and feel stupid and very angry the Dr didnt flag them to me. Within 4 months I noticed BG readings of 5s pretty much every time I tested great! Up until month 6 by which time I'd lost a stone in weight (I'm slim already), I lost muscle and my face looked drawn in the cheeks, my gums receeded to that of a 65 year olds and had an abscess and lost a tooth, had terrible headaches too - BGs went haywire again from all the illness.

So the GP assures me the hormones in the coil are a much lesser concentration and shouldn't 'travel' outside the womb. Hmmm...
I'm obviously wary to spot the signs again but willing to give it a go as a last resort to see if it's worth it if it eases this terrible resistance each month.
However, after what you say about eating straight after waking, maybe I have more to consider and should keep experimenting a couple more months?

Pumps - what benefit would that have? - being able to set difference ratios for this time of the month?
Eliminating the efforts of balance of levemir and novorapid, is that what you meant?

Again, thank you so much for your words.

 

[EllieM]

Pumps - what benefit would that have? - being able to set difference ratios for this time of the month?
Eliminating the efforts of balance of levemir and novorapid, is that what you meant?

Yes. My understanding is that using a pump allows you to vary your insulin levels throughout the day with much more flexibility - and if you could work out what your body is doing at that time of the month it would be possible to set your pump levels to match it. But I personally am not a pump user, I manage to make basal/bolus work sufficiently well so as to avoid that route, though several doctors have said they would prescribe one if I wanted. So I'm not the right person to comment on this. I don't think a pump is less work than basal/bolus, it just gives you more flexibility if you need it and are willing to put a lot of effort into calculating your daily insulin needs.

Interestingly, when I was in a slightly similar position to you, issues with high morning readings, I ended up reducing my basal after my clinic examined carefully my 7 day food and bg diary, combined with a cgm.

But I think that your problem is that you don't really understand what is happening with your insulin. And you've only got a relatively small window to investigate, so it's harder to work out what's happening. The combo of variable insulin sensitivity and hormones is a confusing cocktail. When calculating insulin ratios the first thing you need to do is get the basal right - there are just too many variables to adjust before you've sorted that important detail.

Good luck, I hope your clinic are able to help with some suggestions. I also strongly recommend that you keep a food diary during your monthly hiatus. (I guess the libre is supplying a bg diary).

 

[Jimmybetes]

Thanks again for your response. Yes, the libre app on my phone allows me to record detailed notes on my food and carb counts. I'd prefer to get this bolus right before considering the pump. I like the freedom of pens.
Best wishes.