Very varying insulin requirement

[avi]

Hi
Been having a few problems recently, was waking up with high readings, and after reading a few posts started testing through the night and realised I was having hypos and the dawn effect at times as well. I started to excersise and have a bedtime snack which sometimes cures the problem but not always. The other problems I have been having is I seem to need 14 units of BI some of the month and 16 units some of the month, my ratios also seem to fluctuate as well, as when I need the 14 units these drop but when I need the 16 units the go up considerably for example from a one and a half to one teatime ratio to a three to one teatime ratio, was wondering if anyone can shed some light on this, I thought it could be hormonal or the fact that I still haven't got my thyroid sorted out? I did ask my practice nurse but she didn't have a clue why this was happening, I used to have very good control but now not so much.

Hope someone can help a very vexing problem!

Avi

 

[LittleSue]

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]

Hi
Yes I did mean menstrual cycle, its a right royal pain in the backside, it took me a long time to work it out with lots of testing through the night and day and looking back over my diary to try and work out some sort of pattern. I get told that if my Hbac1 is ok then not too worry too much about the highs and lows, alright for the nurse to say as she doesn't have to deal with the effects. My periods are pretty regular though so did they give you a reason as to why this would suddenly start to happen as before my insulin never had to change too much. I was begining to think I was going loopy with it, thanks for your reply.

Avi

 

[kegstore]

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.

 

[avi]

Hi
Yes, my carb ratios vary at different times of the day to, breakfast at the mo is one and a half to one, lunch is two to one and tea three to one, however at different times of the month these change as does my BI back down to 14 units from 16 and the carb ratios are 1:1 breakfast, 11/2 to 1 lunch, and tea 1 1/2 to one. I also get highs in the morning as I said and have been testing through the night to try and sort these out with some sucess at times.
Avi

 

[LittleSue]

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.

 

[LittleSue]

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.

 

[ma5on]

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

 

[avi]

Hi
Well I went to see my GP yesterday, I felt no-one was helping having only seen my own consultant in March last year and a locum in January, problem with a backlog of patients apparently. I'm even more confused now he reckons I have a problem with my BI Lantus which might be causing all these fluctuations instead of a hormonal one. He made me phone the diabetic nurse who thinks it might be as well, and she suggested splitting my BI, which I have already tried anyway, but will humour her and see how I go when she phones me next week. I posted as well in the Type 1 forum with this problem and have learned quite a bit about the effects Lantus can have. Its good to know others have the same issues, but I am totally confused as to what is now causing this.

Avi