Hi everyone. I just got a cgm because I’ve been trying to get my A1c Below 8 for two years since getting a pump. I’ve had diabetes five years. A1c was 6.5, then 7, then 10, now 8.
Issues:
I think my basal rate slowly increases as estrogen levels increase over the month before my period. That would make sense since estrogen causes insulin resistance. I was wondering how others out there adjust for this? Do you have different basal rates settings week by week?
Next, I can’t seem to get any ratios correct. I ate the same exact one slice of bread for four days for breakfast. My post prandial glucose all four days was completely different. One day, perfect. Three days completely off. Nothing different besides my starting initial glucose. Could my correction factor be wrong? I notice myself correcting over and over again.
How long did it take you to get your A1c down by 1% after getting your dexcom? I don’t feel like I’ve come very far in three weeks yet, apart from much less anxiety and worry about hypos.
Hi Beth – I have some general advice as I’ll leave info regarding BG management during monthly female hormone cycle to those more knowledge (and experience!).
First, congrats on starting on a CGM. It is one of the best ways for you to get to know your body’s response to insulin, food, exercise and other blood glucose drivers. What has been your education regarding diabetes in general and more particular about using a pump to manage your T1D? Have you read any books like Think Like A Pancreas by Scheiner or Pumping Insulin by Walsh and Roberts or Sugar Surfing by Ponder? The utility of your CGM will greatly expand with your gaining more knowledge.
The usual course of getting a pump set up for your needs involves first getting your basal rates set so that a missed meal leaves your blood sugar line relatively flat. The basal insulin is meant to metabolize the glucose output from your liver, nothing more or less. This, of course, is an idealization of the concept but that’s what you’re targeting.
I’ve found Gary Scheiner’s basal testing protocol a good one. Take your time with this as it’s a critical skill that will serve you well for many years. It could take a few weeks to get through this but don’t give up. It’s worth it. Diabetes is a moving target and your basal needs will not stand pat over time, especially during your monthly hormone cycle. Basal rates, like most things with diabetes, are not a set-it and forget-it proposition.
Once you’re settled on your basal rates, then work on getting your insulin to carb ratio (I:C), insulin sensitivity factor (ISF also know as correction factor, and your duration of insulin action (DIA) set. All these concepts are explained in great detail in the Scheiner and Walsh books.
I apologize if this appears way too complicated for you. Once you learn these concepts, however, you will have acquired a valuable lifetime health skill. Good blood sugar control is not a simple topic and it takes time, persistence, motivation, and a good attitude to master. This is a puzzle that you can solve. Just realize that diabetes is a dynamic puzzle that changes, sometimes daily. Learn to change with it and you will have learned a potent skill that will contribute immeasurably to your quality of life and emotional health as well as your physical health. If you have any follow-up questions, I’d be happy to answer, if I’m able. Be well!
I prefer to use my Temp Basal feature rather than try to program different basal rates. I’ve done the hormonal thing, but fortunately, I am past that stage of life. I am currently on eye drops for two cataract surgeries (two weeks apart). One of the drops is Prednisone, and I swear it has caused my blood sugar to rise high. I am currently on 112% over the entire 24 hours. I’ve found that my rises from hormones and medication are not consistent enough to bother trying to find new, permanent rates. Just keep an eye out throughout the day (which we are doing anyway, right?)
I took Prednisone eye drops for two weeks following laser treatments for glaucoma (I don’t have glaucoma, but was at very high risk of developing it), and I’m also pretty sure they raised my blood sugar. I wasn’t on a CGM at the time, so it was hard to tell. Yet, I take steroid nasal spray, inhaler, and skin cream for various allergies and I don’t think those affect my blood sugar (maybe because I take them almost continuously, or maybe eye drops have some effect that other topical steroids don’t).
As to the OP, my insulin needs can vary by 25-50% throughout the month due to hormones. I tend to raise my basal rates and all ratios over a few days, but there are always a few days during the onset or hormones and return to normal that are a slightly chaotic mixture of highs and lows, so I think I could raise things more slowly. The hardest thing for me is that, by the time I figure out hormones are having an impact, I’m usually already running high. If I had some radar that could tell me a day ahead of time when I’d have to start adjustments, maybe I’d find the gradual rise easier. I don’t use temporary basal rates mostly because the changes aren’t temporary (more like two to three weeks out of every month!), and I don’t have a pre-set basal rate because my basal rates may change and also because the amount I need to increase my basal rates isn’t always the same.
My A1c dropped from 7.3% to 6.1% within two months of starting to use the Dexcom. But I worked very, very hard at responding to the trends it was giving me to try to keep more readings in range.
I wouldn’t be surprised by the prednisone. It increases cortisol levels in the body, which causes insulin resistance. (at least that is what i’ve learned as a nursing student)
As a Nurse of 30+years, I can tell you that Predisone WILL raise our Blood Sugars…How high depends on the person, as everyones Diabetes is different. Corticosteriods can reek Havoc on Blood Sugars, usually no right away, but after stopping them the Blood Sugar returns to normally rather quickly…Here’s an Article put out by th Joslin Clinic on Steroid use…it’s short but to the point, Joslin Diabetes Center – World Leader in Diabetes Care & Research. ConGrats on the new CGM…
My understanding with steroids is that the ones taken as pills or injections will raise blood sugar because they get in the bloodstream. Every web site I’ve ever read says that the topical ones (eye drops and the like) aren’t supposed to get into the bloodstream.
