Women: How do you manage your blood sugars throughout the month

Continuing the discussion from How many units of basal insulin do you take per day?:

I feel like we’ve had several places in the Forum recently where women are talking about the fluctuations in their blood sugar during different times of the month and how hormones affect their control, so I thought I’d start a new topic on the subject.

I don’t remember having wild fluctuations myself. I did a little looking around, and it seems to be sort of like Dawn Phenomenon - some do, some don’t. What’s been your experience? Do you have separate profiles programmed on your pump for pre-menstruation or just during your period? What’s your strategy, and any tips would be appreciated!

That’s a good topic. I notice a 30% decrease in my insulin sensitivity post-ovulation that resets to my follicular phase levels abruptly with onset of menses. I am on MDI and this sudden shift to my normal insulin response is a definite drawback to using Lantus. I experience my most wicked lows around menstruation where my hypo awareness is also slightly compromised. But it does follow a simple pattern directly related to progesterone activity. I track my cycles with sympto-thermal observations and when my basal temperatures are high, my insulin needs go up as well.

I don’t have a pre-set program for hormone fluctuations because it just varies too much. Shortly before I start my monthly I just set a temp basal rate. It can range anywhere from 120% to 200% and can last anywhere from a day to a week. I have a history of erratic periods, mostly very heavy and lasting ten to fourteen days. After having my levothyroxine increased, however, they are more normal, if not a little sparse (6 weeks in between and only lasting 2 or 3 days). This has helped greatly with the hormonal bs fluctuations.

Anyhow, my advice is to roll with the punches. You cannot always predict hormones and sometimes it’s just a matter of checking more often and correcting when necessary.

I have PCOS and PCOS made my life unbearable. Unpredictable periods. Skipped periods - 3 months without, then I’d bleed for weeks (or months, and become anemic!), stop for a couple of weeks, start again, stop, skip another few months, and then do the whole thing again. My BGs of course were just as wildly crazy with the hormonal swings that came with it.

My OB/GYN decided that I just didn’t need to have a period, since I wasn’t TTC, and put me on 10mg of Medroxyprogesterone - continuously - instead of the normal 14 on/10 off schedule. Yes, the progesterone probably increased my insulin resistance slightly - but not as much as the huge swing of hormones I was dealing with. And now I don’t have to deal with a period at all, either.

I know there was a BC pill that was being marketed for awhile where women could have their period only 4x a year. Honestly, if I didn’t have PCOS, I’d probably consider that as an option to make life easier and only have to deal with the swings 4X a year instead of 12.

I find that I have to make massaive changes to not only my basal rates but also my ratios. So a temporary basal rate wouldn’t work—especially because the timing and the amount things need to be changed isn’t always consistent. This month, for example, I’ve been struggling for days and have just recently gotten things under control by raising my basal rate by about 10 units and halving all of my ratios. My insulin dose has almost doubled. Other months, it’s not quite so dramatic, but usually does require some major shifts. It seems that I can never go for more than about a week without my blood sugar going haywire (either high or low) and having to make major adjustments to settings accordingly.

I recently started a LCHF diet and was hoping that this would help improve this issue of having to adjust settings so often and dramatically, but it seems to have made no difference. Clearly, food is only one factor that influences my blood sugar.

I started taking the pill just to make my cycle super predictable. One less factor to be guessing about. I go up on Lantus basal (to ~120%) for a few days before the period starts (whenever I start having stubborn highs) and drop to ~75% basal after day three. I return to normal when I stop feeling like I’m dropping low all the time.

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And then, of course, there’s the other problem of monthly hormones: cravings. And cravings for carbs. I sat around all day today wishing for carbs, and finally walked to the gorcery store and back today for the sole purpose of picking up carbs. I knew full well what I was doing. I picked up chocolate, corn chips, and blueberries. Came home and bolused for 80 grams and dug in. I guess since going on a low-carb diet I’ve really become sensitive to carbs, because even eating 30 grams at a meal now will spike me into the double digits even bolusing enough for it. Well, eating 80 grams spiked me into the 20s, even though I bolused for it. Yup. I’m now sitting at 23.3 and waiting for that to come down… So not only do we have to deal with harder-to-control blood sugars, we (or at least I!) have to deal with craving the very thing that makes things even worse!

I swing wildly every month. Several days leading up to my period I am in the 300’s and cannot for the life of me bring it down. I’m setting loads and loads of temporary basals to keep on top of it. As soon as my period starts I’m crashing all day long and struggle to stay on top of it. I’m so done. I’ve had a tubal, but I’m going into my family dr. tomorrow to try a birth control pill that eliminates the period entirely. I brought this up with my endo who remarked, “there might be some research that indicates female hormones cause a slight change in bg.” What the #@#$%?! Seriously. I do like my endo, but really now. I track my cycle using an app, but even if I didn’t it’s so painfully obvious based on my numbers each month alone. Something must be done!

I try to adjust based on my morning numbers. So far, it look like I need to increase up to 150% and it last around 1-2 days after my last birth control pill. Some week, I need to decrease to 75% for 2 days during menstruation. I usually only change the basal rate and I adjusted my bolus or corrected after a meal based on size of meal, activity level, etc.

I get those too. All I want to eat is something sweet or chocolatey.

LOL I’m pushing for that hysterectomy. I’m 40 plus and sure don’t want more kids.

The problem with the hysterectomy idea is that the hormonal changes come from your ovaries. You’d have to take everything out - which means instant menopause, with all the hot flashes and fun times that come with that. Blech. We just can’t win!

I brought up the issue of having BG swings sometimes up to 2 weeks before my period to my endo at my last appointment. My BG levels will trend upward during that time no matter what I do/eat (I eat pretty low carb) and I become very IR. I will also have horrible food cravings sometimes in which I crave mainly meet and cheese. When it’s really bad, I will also have horrible episodes of compulsive binge eating as well (I’ll binge on low carb food but will eat so much in one sitting that my BG will spike for many hours after due to high protein and fat).

All my endo suggested was going back on birth control pills. She didn’t agree to prescribe me metformin because I normally don’t take large doses of insulin due to my low carb way of eating.

I don’t think I want to go back on the pill. I’m 34 and heard it’s not so safe at my age, plus I’m not even sure it will really improve the situation. Last I was on the pill, many many years ago, my type one diabetes was pretty out of control and I wasn’t monitoring it much so I can’t even say if it had any effect on my BG levels before my periods.

Does anybody else here find the pill to be effective in this situation at all?

I’ve had people suggest this to me (by some people here years ago, not my by doctors), but I’m the same age and don’t like the idea of taking it just for the sole purpose of diabetes management. I have no past experience to share, though. It sounds like you and I experience pretty similar things, except I crave carbohydrates. :slight_frown:

The risk of blood clots and other risk associated with birth control is exactly why, for controlling my period issues associated with PCOS, my OB/GYN opted to put me on Medroxyprogesterone. There’s different ways of prescribing progesterone. It can be taken as a progesterone-only-contraceptive,, or in my case I’m on Medroxyprogesterone round-the-calendar. I simply just don’t have a period anymore unless I forget my pill for a day or two. Yes, progesterone can make you a little insulin resistant - but at least it’s consistent and predictable if you’re on a schedule rather than swinging around every which way whenever, and there’s progesterone in regular BC pills too along with estrogen which can also increase IR if I remember right.

A hysterectomy will not change BG fluctuations that are caused by hormones. You’d need to undergo a bilateral oophorectomy to accomplish your goal.

I will say that with the Mirena I didn’t get the IR before my period (which I still got, yay weird body!) but as soon as I had it removed my IR increased. I just realized that’s what kicked off my increased insulin needs.
Mirena is progesterone only, so @BeastOfGevaudan may be on to something there.

I’m 36 and just started BC pills. I really needed to do something different! I can’t handle the swings from 400-70 anymore around my cycle! I’ll let you know!

Same boat. I’m 33 and it’s the week before my period. Yeah stubborn highs (I think I’m still honeymooning because my highest has been 170). But it’s frustrating because not only do I have to account for EVERYTHING. else…now before and after my period. This post helped a ton. I was put on bc after getting a copper iud out after 5 years (that was pure hell). Some days I wish I could get a hysterectomy but that wouldn’t help and create more havoc. I’m 33 and don’t want to be on Bc forever due to potential complications. what do you do after 35 for bc? I wish my husband would get a vestectomy already (he says that will never happen). Arghhhhhh :stuck_out_tongue_closed_eyes: