Very varying insulin requirement

Hi Avi

I get what you describe, varying with my menstrual cycle. Is that is what you mean by 'hormonal'? A thyroid problem won't help either. Ifind it essential to test during the night several times a week to keep an eye on what's happening, too dangerous to assume its too little BI or a night hypo without testing.

Annoying, isn't it? I get fed up with having to adjust things all the time.

The hormonal cause was confirmed for me recently. A 72-hour monitor in my premenstrual week in April, showed bs stayed up too long after breakfast, but not after other meals. Then GP put me on some tablets to regulate my periods, which effectively made me pre-menstrual all the time. Needed 3 times my usual insulin with breakfast double insulin with other meals, but only a little extra BI. Sill my bs stayed up for 4 hours after bfast, but could suddenly fall by 10mmol before meals without feeling it. Getting a cold on top hardly made any difference! Stopped the tablets, dropped insulin to normal and still had loads of mid-morning hypos. Settling now, thank goodness, but back to the weekly variations in ratios and BI instead.

Avi, I have 3 different carb ratios according to the time of day. Easy for me to sort out as I'm on a pump, but a pain to determine initially. It's not at all uncommon.

The only reason given so far is 'hormone imbalance' although all the blood tests were normal. This was from the GP though, who I think expected to find a thyroid problem (but didn't). I'm going to diabetic clinic tomorrow so will ask more about it. I was expecting it to be the start of menopause but apparently the blood results rule this out.

I've known for years that I need much less insulin when menstruating. Prior to DAFNE things were pretty random though, so its hard to know if I've always had these fluctuations. Might help explain the randomness. I wondered if it was just DAFNE making things clearer. But they certainly seem to have got worse in the past year and my HbA1c deteriorated. I've already asked for a continuous sensor on long-term loan, to track the changes over a complete month or two without sleep deprivation, but could only get it for 72 hours. Had wondered whether a pump would be the answer, but would still need to test frequently at night, and constantly change the programming, so I'm not sure it would help much.

Saw the consultant in diabetic clinic today. He confirmed that they see quite a few diabetic ladies with this problem. Sometimes they resort to continuous hormone tablets, like I was on, to stop the periods completely. Fortunately he wasn't suggesting we even consider doing that. He agreed this hormonal variation has probably been a factor in my lack of control over the years and that DAFNE helped unmask it.

The plan is see him in 3 months and probably do another 72-hour monitor then if things haven't improved, because at present things may not have settled after stopping the tablets. He'll see me at short notice if I'm really struggling. Meanwhile I'm going to concentrate on upping the ratios more in appropriate weeks, to try to get bs back to baseline sooner after breakfast. He suggested the hormone variations make one more insulin resistant, so logically I'd need more basal rather than more bolus, but the monitor and the tablets showed that when I'm premenstrual I need higher meal ratios. Also in the past year my basal has gradually gone up anyway so I've probably done that bit already.

Amazingly, my HbA1c has come down from 7.2 to 6.6 despite covering the time taking those horrid tablets! Guess that shows that a good average can mask problems.

THANK YOU!!!!

I also thought this was just me this happened to.

It was only when I kept a diary for a month - testing, food etc that I determined a pattern. As soon as my period starts my sugars and insulin requirements plummet. The two weeks before however are a total nightmare. I feel like no matter how much I inject, nothing happens, then suddenly (like last night in the bath of all places!) is fall through the floor!

It's such a relief that others are having the same problem (although I wouldn't wish it on anyone!)

I have just handed back a CGM today after a 72 hour loan and being the worst time of the month to wear it am hoping they can analyse what the hell is happening!!! Will let you know when I get the results!

I've thought for a long time that a pump might be the answer for me, with the adjustable basals etc, and the CGM was a step toward getting me approved for one....here's hoping!!!

Only one thing has helped slightly, and that's hitting the gym. Hard. Although even after a couple of hours there and returning home with a BM of 5.5mmol, I can test 2 hours later and it can be low double figures, despite eating NOTHING! :shock: That's when I feel like jacking it all in and eating a tub of Haribo......mmmmmm *drools*

It's a permanent struggle...some days are easier than others, and I just try to cling on to the fact that soon they will have a cure for this and we'll be much stronger and more resourceful (plus healthier!) people for it!

Hang in there!!!

ma5on