Some noob questions

Hi

1) I haven't noticed any difference being on insulin, although I am on the pill and also most of the time have a migraine with it. For this reason I actually deliberately skip a few periods and probably average 4-5 per year now. My docs recommended I do this as it's my biggest migraine trigger and I just can't keep taking time off work for it.... plus it messes with other things for me. Also hard to tell if I'm having a hypo or it's the migraine as similar symptoms.

2) With me the night time hypos I can sleep right through and I wake up with the hypo hangover. Sometimes I half wake up and I recall spinning out but then I immediately fall back to sleep. Other times I actually do wake up and treat it. I seem to be sleeping through them a lot of the time though which worries me. I have been in the 3's when awake and not noticed before until I checked.... although usually I do have symptoms most of the time. Maybe you need to invest in a CGM to see what is happening at night to see if you can correct? I'm thinking about if I can get one too.

I wish you the best.

Mynameiskez said:

Thanks for the honesty.

I have a coil fitted as the pill makes me a bit of a crazy ******. I get quite nasty with them. Tried all sorts of brands and types.
I'm not comfortable with irregularity.

I'm a bit concerned you can wake up and fall asleep again. That is really dangerous. You could slip into a coma! What's a CGM?
My morning readings have been 6s and 5s since I was advised to increase my lantus to 22 units.
The last week my apidra (fast acting) hasn't quite been covering meals. I go up a point or two after but my nurse said she didn't want to mess with the carb to unit ratio just yet.
Today was the same. But then I just caught both hypos.

Also make that 2 hypos without symptoms today. Just checked and was 3.2

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Kez - I'm not insulin dependent, and have never knowingly had a hypo (although I do have low blood numbers), so I can't comment on that.

If you are concerned about hypo awareness, the site has a Hypo Awareness Programme, aimed at improving hypo awareness. You'll find a link to it in my signature.

Good luck with it all.

Mynameiskez said:

What's a CGM?

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It stands for Continuous Glucose Monitoring. It's a device that monitors your sugar levels day and night. They're expensive to get. I'm going to look into getting one though to see how I'm tracking. My T1 diabetic friend managed to hire one for 2 weeks I think it was... so I may be able to do that as well. She wears a pump and was having problems with hypos at night too and she was getting the time wrong thinking it was just before wake up but the CGM showed her she was getting them between 12-1 am. So she adjusted her basal on her pump as a result of the findings.

Mynameiskez said:

The last week my apidra (fast acting) hasn't quite been covering meals. I go up a point or two after but my nurse said she didn't want to mess with the carb to unit ratio just yet.

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I'm confused about what you say about your bolus covering meals. You do know that anyone, diabetic or not, will go up after eating? The aim isn't to get your blood sugar not to move, it's to keep the movement within a non-diabetic range so 4-7 pre meal, 7-9 at least 90 minutes after eating. Going up 1 or 2 mmol isn't an indication that your bolus isn't covering meals.

Insulin doesn't mess with menstraution. But stress can. If you've only recently started insulin and your stressed abou that that could be causing delayed/missed periods.

You should talk to your nurse about hypo awareness. If you think you have a problem with symptomless hypos to see if you need to consider raising your targets up to avoid hypos for a while and regain awareness. You should also ask for advice on whether you should be driving.

@Mynameiskez Your bolus can carry on working after two hours. As @catapillar says, a rise of 1 or 2mmol is ideal and not something to be worried about

If it was me, I'd do some basal testing first to make sure that's ok. I'd also set an alarm to test in the night if I was going low. Once I'd got my basal checked/sorted, I'd move on to checking my meal time ratios.

As for the periods, I think any change, good or bad, can occasionally cause a missed one. Unless you have other symptoms, I'd forget it for now and see if it settles down as your body gets used to your new regime.

Edited to add that there are other insulins available if you find the ones you're on don't suit you. I've found nurses/doctors tend to have their 'favourites' but we're all different and not all insulins suit all people.

Mynameiskez said:

My post meal readings are taken 2 hours after eating when the bolus is not longer affective.

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What do your pre and post meal readings actually look like? A rise of 1 or 2 is fine.

I don't think apidra is no longer effective after two hours. It peaks at 2 hours and can continue to be effective for up to 5 hours - http://www.diabetesnet.com/about-diabetes/insulin/insulin-action-time.

The end of a horrible era migh not seem stressful in the way that we traditionally think of stress, but it could still have caused you and your body enough stress to miss a period.

@Mynameiskez any hormonal disturbance can cause the periods to miss or disappear.
Not always diabetes related. If it continues seek medical advice.
Stress can be a catalyst.

Mynameiskez said:

1) for the ladies.
Can insulin mess with menstruation?
I missed a period (definitely not pregnant) this month. Which is very unusual for me. Has anyone else had this?

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It definitely messed with mine. I've had the Implanon (stick in the arm under the skin) for 1.5 years before becoming fully insulin dependent. I started menstruating end of March/beginning of April and I'm still menstruating today. I'm basically having 4 week periods now, and the only change for me has been going on insulin.

I'm no more stressed than usual, not eating differently either, and it's telling that my first period on insulin and the ones after that have been dramatic to say the least. I'm going to guess the birth control and insulin don't work well together in my body. I'm considering having it removed if I see no improvement by the end of June.

Mynameiskez said:

My post meal readings are taken 2 hours after eating when the bolus is not longer affective. As advised by nurse. Nurse agreed it wasn't quite covering.

I don't drive I cycle.

I will give my nurse a call today.
My morning reading today was 4.2 so maybe it's a bit too much basal.

I don't think stress was the cause I've been off work, interrupted my studies and getting insulin marked the end of a horrible era. I'll chat to my nurse.

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I agree with the others that bolus remains effective past 2 hours. It's just that it peaks and after 2 hours slows down. The website has more information on that but supports the statement: http://www.apidra.com/apidra/dosing.aspx
I recommend you check 4 hours after meals and see if you went back down to your target value (for example 6 mmol/L). If after 4 hours you're still too high then I agree it isn't covering your carbs and you need to adjust, but at 2 hours basically everyone is reading 1 or 2 points higher - this is not just normal, it's advised, precisely because fast acting insulin lasts more than 2 hours. Very important! You'd be slipping into hypos constantly if you don't rise within 2 hours.

The thing with night time hypos is that your background insulin (and whether or not you had alcohol) is a lot more responsible for them than Apidra will be. If your last injection was more than 4 hours ago before you go to bed and your reading is 5 or more, the only thing lowering your bloodsugar during the night into a hypo will be Lantus. (Either because your dose is too high or because alcohol stops the liver from feeding your body a steady amount of glucose.) Apidra can't cause hypos past those 4 hours because it's all used up by then, so that's not something to worry and focus on.

Hypo unawareness is very annoying and scary especially when you're just starting out, but you can compensate for this by testing more frequently for now. I also bike all the bike and because my symptoms start with shaking, sweating and racing heart, I can't exactly rely on those initial symptoms when biking causes/hides those. I always either test before I ride or shove a biscuit down my gullet to tide me over.

At this point my basal insulin is so well adjusted that I can ride for 20 minutes and only see a 0.5 mmol/L drop in my values, and that definitely helps. I still have to be careful when I have active insulin on board, but I've found all my sweet spots and they're all very reliable so far. This is definitely something you can figure out as well!

It's scary now and that's okay, but the more you read up and get help on these forums, the better you'll be at it. I've learned more than I thought possible in just 4 months since starting insulin and it gets easier and less scary, I promise!

And if you're ever in doubt, have a biscuit before bed. It's better to wake up at 7 or 8 and not deal with the anxiety of nypos all the time. You can take a unit extra in the morning to get back down to target and you'll likely feel better than if you slept through a hypo.

Hi. My diabetes came on at the same time as menopause ( I'd had gestational diabetes 12 years before )
Initially diagnosed type 2, then after a year diagnosed type 1 LADA. As soon as I went on insulin I got my 1st period in a year. While the experts said it wasn't linked, I suspect there is a hormonal connection somehow.

Hi,

I split my Basal into two injections per day, therefore I take half before bed and half first thing in the morning. This works really well for me. Also, make sure your basal injection is in a fatty tissue area. We are advised to use our thighs, but in most ppl there is a lot more muscle in this area. I use my bum cheeks, changing sides often. Perhaps you can discuss these options with your diabetes team, it might resolve your night time hypos'. Also, with smaller insulin doses comes small blood sugar movements, so it is safer. Look up Dr. Bernstein's law of small numbers, best bit of diabetes advice I have read so far.

viv k said:

Hi. My diabetes came on at the same time as menopause ( I'd had gestational diabetes 12 years before )
Initially diagnosed type 2, then after a year diagnosed type 1 LADA. As soon as I went on insulin I got my 1st period in a year. While the experts said it wasn't linked, I suspect there is a hormonal connection somehow.

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I visualise the whole hormone situation in humans as one of those old-style circus acts, with poles and spinning plates.
know the ones I mean?
Where the entertainer runs round as fast as they can flicking the plates as they slow down to stop them from falling and crashing.

If each plate is a hormone, and the body is is the entertainer, constantly tweaking and adjusting - insulin, glucagon, growth hormones, multiple sex hormones, reproductive hormones, stress hormones... it is a long list. And all it takes is for one plate to fall, and the whole of the rest of the 'act' gets a little off kilter.

And the more hormones that go out of wack, the more everything else needs to be adjusted to compensate (says the woman with several out of wack hormones, seriously out of wack menstrual shenanigins, and blood glucose that seems to go haywire with stress, time of month and suchlike).

Basically, they are ALL connected.

Recently I sat in an endocrinology appt where the consultant smiled, threw his hands in the air and said 'we just don't know what will happen in your case after menopause. There are too many variables, and everyone reacts differently. We will just have to wait and see.'

How refreshing! And such a relief to find someone who was admitting that they don't have all the answers!

I

Brunneria said:

I visualise the whole hormone situation in humans as one of those old-style circus acts, with poles and spinning plates.
know the ones I mean?
Where the entertainer runs round as fast as they can flicking the plates as they slow down to stop them from falling and crashing.

If each plate is a hormone, and the body is is the entertainer, constantly tweaking and adjusting - insulin, glucagon, growth hormones, multiple sex hormones, reproductive hormones, stress hormones... it is a long list. And all it takes is for one plate to fall, and the whole of the rest of the 'act' gets a little off kilter.

And the more hormones that go out of wack, the more everything else needs to be adjusted to compensate (says the woman with several out of wack hormones, seriously out of wack menstrual shenanigins, and blood glucose that seems to go haywire with stress, time of month and suchlike).

Basically, they are ALL connected.

Recently I sat in an endocrinology appt where the consultant smiled, threw his hands in the air and said 'we just don't know what will happen in your case after menopause. There are too many variables, and everyone reacts differently. We will just have to wait and see.'

How refreshing! And such a relief to find someone who was admitting that they don't have all the answers!

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I like the way you describe the circus act ☺
Also good to hear a professional admitting they don't know all the answers, because I'm pretty sure there hasn't been much research done on it all.

Diabetes involves so much juggling between food, insulin, activity, stress, infection, then throw in hormones and some general randomness. We're all doing **** well to (mostly) manage all that AND cope with life in general ☺

Contralto said:

What kind of birth control? If you have an IUD and you are having extra long periods from , say, a pituitary disorder or some other reason, your chances of an infection like toxic shock would be higher, maybe. I think it is high time we women talk about the basics with one another

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Implanon. No IUDs for me. It's been removed as of a few weeks ago and all my negative symptoms have gone though!

Did you have unstable periods before Implanon and was this your first time on Implanon.? And why did you come off it? I hope you don't mind me asking.
I was on it 8mths basically continued to bleed constantly....it also gave me psychological issues. This was waaaay before I got diabetes.

It can take a few months for your cycle to settle back down again, but if you are concerned about your missed period then please see your doctor and also especially if constant bleeding reoccurs, you'll be losing iron. They can prescribe medicine in case of any heavy bleeding.
Also you don't happen to have any other Gynae related issue such as endometriosis?

My experience is that it's Progesterone that impacts the insulin as in it makes the body resistant and if there are wild fluctuations of this and Oestrogen it causes havoc for diabetic women.
Any further addition of artificial Progesterone can add to this havoc.

I have had several years of going through synthetic hormones to help the endometriosis was put on pill non stop 4 years then chemically induced menopause and this impacted my diabetes incredibly dramatically.

I decided to stay free of hormonal interference for a year and a half, it took 6 months for cycles to become predictable. However having a a really hellish year so far of dramatic insulin changes every cycle. Going on the pump in a few months.

I use an app called Clue to monitor my cycle and symptoms, it's a lifesaver! It predicts next period, ovulation,
I even have alerts in it to warn me of pre period and ovulation hypos and post ovulation insulin resistance.

Please feel free to PM, I am so glad to see discussions around female hormones and insulin.

Star_Anise said:

Did you have unstable periods before Implanon and was this your first time on Implanon.? And why did you come off it? I hope you don't mind me asking.
I was on it 8mths basically continued to bleed constantly....it also gave me psychological issues. This was waaaay before I got diabetes.

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I'm assuming this is directed towards me?

I've always had hormonal issues since I was a teen, so yes. I tried several pills and other medication to manage this. The Implanon was one of my last choices to regulate hormones. I got it around the time I was diagnosed with LADA in 2014, I was on oral meds up until January this year, and I had to get the Implanon taken out because as soon as I started insulin full time I bled for 4 weeks straight, every other month, until the end of May.

It's been out for a month and a few weeks and my cycle is back to normal. Got my first period exactly 4 weeks after removal, only lasted 5-6 days, and everything has already settled down.