I was diagnosed about six years ago, and honestly have not had too much trouble regulating my blood sugar. I did struggle with lows during exercise, but overall was doing pretty well. In the past month or so, things have gone haywire. I am spiking with foods I have always eaten, and going low for no apparent reason. It’s as though my body is over-reacting in both directions! I am wondering if anyone has experienced anything similar, or has any thoughts about what could be going on. I was wondering about perimenopause, or HRT which I recently started. My stress levels have not changed, and I can’t think of anything else that it could be… I am having these fluctuations despite use my CGM and have been reading “Sugar Surfing” (though honestly I was already using a lot of those tactics).
Hi @Jsich. Hormones, menopause, monthly cycles, medications, and other factors can affect our levels and our body’s responses to insulin. It may be it’s just time to make some adjustments to your settings - basal rates and/or your I:C ratio.
You should check and adjust your basal insulin first by fasting and observing your numbers, then adjusting. There are guidelines for when and how to do it, and it does not have to be done 24 hours straight - you might check from midnight-noon on one occasion, and noon-midnight on another. You should allow 3-4 days for the changes to “settle in.”
Once you’ve adjusted your basal rates by fasting you can see if your carb ratio needs to be changed. For either one I find small changes of just 0.1 unit can make a big difference, so don’t be too aggressive with adjustments - start small and work up. If you are not used to or comfortable with making your own adjustments by all means ask your doctor.
Hi Jess @Jsich, yes, I have had experiences such as what you are experiencing several times during my seven decade journey with diabetes. For me, it appears to be changes in basic body reactions to [favorite] foods and activity that naturally occur in my body - these changes also appear in people without diabetes but they don’t notice the BS shifts.
What I have done about this is to take a step back and do a restart of my insulin therapy. Just last month [now in my 80s] I needed to do some significant increase changes in my I:Cr [insulin to carb ratio] for all meals and decrease background insulin; this was more easily done with my pump but your Sugar Surfing experience will help you.
I suggest [I’m not a licensed professional] that you maintain a healthy diet and not reduce carbs unless necessary for weight control [I maintained my daily 230+ carbs] and moderately boost insulin for all meals [all I:Cr] while reducing background dose so your total combined insulin count is slightly less than what you currently use now on an average day.
Be careful and stay observant; it is okay to run a little bit higher while making these drastic shifts - for safety. Later you can readjust your background/basal dosing.
Thank you Dennis and Dorie! I think I might try changing my I:C ratio, taking more insulin at each meal. Since sometimes I react “high” and other times “low”, I am reluctant to mess with my basal (I currently take 4 units of Tresiba), but may consider increasing this (maybe instead of increasing I:C ratio?) as well. Lately my BS overnight are higher (e.g., 140+, and increasing upon waking), but every now and then go low at night, so I am hesitant to change the basal. Maybe I should start with the I:C increase, and keep tabs on the overnight numbers, If they continue to stay higher at night, maybe then increase the basal? Thoughts?
It’s not unusual to need different rates and/or ratios at different times of the day. If I suspect I need to change the carb ratio for all the meals I do one at a time and allow a few days to see how that works before moving on to the next one, to see if and how that adjustment “carries over.” Same goes for basals.
When people talk about going high - or in your case “higher” (than 140) I always wonder what number they consider high. You can certainly tweak your overnight basal if you wish but whether you should do so is a decision you need to make for yourself. Some people want tighter control than others.
For sure, my IC rates are MUCH different in the morning (1:6 or 7 grams carbs) than the rest of the day (1:15). Today for lunch I tried 1:12 which was going great until two hours after my injection when I went low (54). I think sometimes I absorb the insulin more slowly, and other times not (perhaps related to inflammation from hormones or stress), which makes the timing of my shots much trickier. In the morning I often wait 20-30 minutes after injecting and before eating, even when I start at a normal BS level.
In terms of what is “high” for me, I would say over 160 (and I used to consider high 145 or so!). Recently, I have some 200s. When I mentioned going high at night, I meant that relative to what I feel my fasting BS should be (in the morning). Lately i have been giving myself .5 or 1 unit as soon as I wake up, to head off (at least partially) the dawn phenomenon (I think my cortisol starts up around 3 am).
OUCH!, Jess @Jsich always tough going to that point without panicking and consequently over eating and bringing on a self-inflicted “too high”. I’ve been guilty of doing that many times especially in the olden times when BGM didn’t exist. What I failed to caution is that all/any adjustments should be done gradually.
Assuming your lunch is 60 grams of carb, with the 1:15 ratio you would take 4 units of insulin for the food but with 1:12 the dose is 5 - an additional full unit. When adjusting I:Cr, I look at “how much this will change” my dose for that usual meal [lunch]. I have a pretty good idea of my ISF [Insulin Sensitivity Factor] at different times of day.
What is your ISF? As a wild guestimate, based on a few things you have mentioned, I suspect your ISF might range somewhere around 70+ - meaning that 1 unit of insulin will drop your BGL by 70 mg/dl.
Have you tried correlating your numbers with what you’re eating? Fatty foods often result in a spike a couple of hours later even though you’ve bolused correctly for the number of carbs in the meal - frustrating to manage😫. It can be helpful to eat the same thing the same way for each meal (although not necessarily every one) each day as you’re testing your ratiios, to cut down in “outside nfluences.” To make things easy on myself for lunch and dinner I sometimes use packaged meals - the carbs are already determined, which cuts down on “user error.”
Exercise can have a lingering effect too - maybe you’re going low after breakfast when you worked out the day before? Just a thought.
I think my ISF is around 100. If I am wanting to lower my blood sugar between meals I take .5 unit and assume that will drop me about 50 (except in the morning, when I can take half a unit and see a drop in BS of about 20, but then it pops back up again). And yes, I am always cautious (perhaps too cautious) about corrections with carbs. I typically eat 2-5 carbs to correct a low, wait, and have more if needed. Dorie, I do think exercise factors into my variability, but the response is often so delayed, and is inconsistent. For example, yesterday I exercised more, but my sugars were actually very stable until about two hours after dinner, when I dropped to 38 (my CGM said 56, so I didn’t catch it in time. That’s rare, and partly my fault because I waited about ten minutes to correct because I wanted to finish watching Jeopardy :/. I am aware of the impact of fat, but that only throws me if I eat a VERY high fat meal. Honestly, the factors we have been discussing are all ones I am aware of (having read Think Like. Pancreas and about three other books on Type 1), but don’t account for the change I have seen in the past few months. At this point I am chalking it up to both hormonal changes due to perimenopause, and to HRT! Trying to stay flexible and roll with it.
I’m just so happy to have a cgm sensor and an insulin pump! No doubt, it has kept me alive! What a change after all those years without it. Can’t help but not be mad at those so helpful tech companies.