Hi There,
This question is mainly for women with Type 1 who take MDI, but I am open to anyone’s advice.
I have had Type 1 for over 20 years. Lantus one time a day worked well until I had my son 5 years ago.
It seems no matter what I do I get an increase in BG around 2 am- it goes up into the high 200’s. This seems to only happen consistently right after ovulation until I get my period. That’s about 10 days a month. Pretty sure it’s hormonal- one dr recommended going on birth control to stabilize hormone fluctuation, but I’m not sure about that?
I tried Tresiba ( too many lows in the day) and taking a morning and evening dose of Lantus and then switching to Levemir and taking two doses as well. I’ll take any advice. It’s exhausting having to take a correction dose of humalog every night and I’ve also noticed during this time I need more humalog to correct at this time of day (early morning hours).
Usually, I have to bump up the amount of insulin that I take all day long, during this time, not just overnight. You only need a bump up at 2am? You could bump up the dose and just know that you will need to eat snacks throughout the day.
You could pump, but that may not be less exhausting upfront. New tech takes some time and effort to adjust to.
I am a guy so may not be applicable to you but my DP or lack thereof is totally dependent on the number of carbs I eat after lunch which is why I am on 1 meal a day (OMAD). So, you may want to test not eating any snacks or meals after a noontime lunch for 1 or 2 days and see if that partially or totally mitigates your problem during that time of month.
If you try metformin again, you could prob start at 500 and go up to 1000mg specifically at bedtime (might even be able to do more since 2000mg is max daily dose but that’s usually when taken 2x/day) since you’re only targeting the overnight period, and only take it for part of your cycle. It may or may not work though. Definitely the ER version!
Hormonal bc certainly could stabilize it, but it can also affect a ton of other things and have lots of side effects. Sometimes that works well for people (clearer skin, for example); sometimes not (depression, weight gain, etc). Also there are so many hormonal bc options, I’d definitely consult with someone knowledgable about them with your goal in mind (you would want something that suppresses ovulation, so a hormonal IUD probably wouldn’t do the trick, for example).
Contraceptive steroids such as those in hormonal combination birth control pills, the patch, the shot, or the hormonal IUD will all override your natural cycle, stop ovulation and with it natural progesterone secretion. But I am not a fan either because they come with cardiovascular risks. Why did twice-daily Levemir not work in addressing the 2-am excursions? I up my nighttime Levi on luteal phase nights with great results.
I wish I knew why it won’t work. I think maybe I am being too conservative in the increase bc I am scared of nighttime lows. Can I ask everyone how many more units of Levemir they are increasing ??
My lowest p.m. dose for basal is 4 units just prior to Ov. That is when my sensitivity is high. At ov I reset to my standard profile and take 5.5 u p.m. basal. I actually watch my resting temperatures throughout the luteal phase because I noticed a correlation between temp peaks and IR peaks. When I have those temp peaks I increase my p.m. basal to 7 u. I was just talking about this with another member in another thread, I use symptothermal method to adjust my insulin profiles. There are two markers for the hormones that interfere with my insulin response, estrogen increases my sensitivity and progesterone lowers my sensitivity. I am not going lie because I know it’s scary to increase nighttime basal but I have been tracking my hormones for 20 years so I know what I am doing. I will link the other thread Periods and diabetes: what you need to know - #8 by Jen
The hormonal IUD does not stop ovulation in many people, FYI, and may not suppress the cycle adequately to prevent cyclic changes in insulin resistance. You will want to take a pill or something with higher hormone levels that is designed to stop ovulation specifically if that’s the goal.
Thank you for catching my sloppy presentation of the drug action of this device. Hormonal IUD containing levonorgestrel do interfere primarily with the cycle by changing fluid charasteristics and only in some women stop the release of the ovum altogether so that when an ovum is released natural progesterone production causes IR. This device would therefore not be precribed to stop cyclical fluctuations in insulin response.
