Information on menstrual cycle

Hi All,

Looked into this a bit more and there should be a pattern of l:
lowest insulin requirements during menstruation
Rising requirements at end of menstruation
Highest requirements just prior to next menstruation

This is the most typical pattern, but it is not everybody's pattern. Yours may be different,it is just a question of noticing it.
I find the step wise approach useless as a result. When my period starts, I need to immediately go to my lowest dose and of course this takes ages via the step wise approach. A week of night iime and day time hypos occurs as you slowly turn the insulin down. Then the opposite occurs when I need the highest dose, I am high for over a week and feel really awful as the step wise approach is too slow in turning the dose up. We don't even ask about this with our HCP's as theres is no point if DAFNE doesn't recognise this. We discussed it ourselves and decided not to bother as ihaving read on DAFNE on - line that it is not an area for discussion then we thouoght that it would just put the educators in a position.
My course comprised young women who have not got ontrol. It seems to be the older ones and the men who manage better and I wonder if this is why. Does anyone know of any information on success rates of DAFNE. How many people actually manage to bget their BI and their ratios sorted out. I have searche dfor stuff but can't find any research on it. Was looking ofr demographic splits etc. e.g is there a difference in gender. Don't know how success is measured. how does anyone know if a patient has got control or not if this is never recorded anywhere?

Hi Athena,

Yes, variations in insulin requirements due to hormonal variation over my menstrual cycle have .... been the bain of my life. My cycle was very irregular which made it impossible to track. I only recognise this now after many years! I was on the first DAFNE course in Ireland and yes I learnt a huge amount but like you say the stepwise approach didn't work because of these variations. I used to think I was doing something wrong which didn't help motivation at all. I also have the dawn rises which I am still working on controlling with a pump.

I haven't got it sorted yet as I have a 5 week cycle with about 3 phases of insulin requirements over those 5 weeks.

However, I do believe that there should be more information available on this issue. Not knowing this has caused years of grief for me as I just wasn't getting it right(or near to it). I thought I was doing it all wrong but alot of the time it was my body. It should be mentioned in the DAFNE course even if there are no answers/research yet so that one can start to recognise this higher level pattern(over weeks/months). Maybe this was already obvious to people with regular cycles but for me I could have a 3 to 8 week cycle which meant I didn't see a pattern.

Sorry for the rant but I hope it may help others if they have the same issues.

Jackie

Hi Jackie,

Thanks so much for getting back o n this one. An irregular cycle must have made it more difficult. I don't know how you coped!
I do think that they should mention it on the course. It took me about 6 months to realise that there was a pattern going on and then for the penny to drop. Why can't they just tell us? I wonder if it is because the step wise approach doesn't work for this. It is far too slow to keep up with the hormonal c hanges and, like you, I thought that it was me who was doing things incorrectly, but I couldn't work out where I was going wrong. However, I suppose if we work outside the step wise approach, it isn't DAFNE is it? But then there is no alternative or no DAFNE educatior is suggesting one. If I follow theDAFNE approach I spend one week a month hypo, both during the day and at night. I canonly take the night itme BI down by 1 per night and of course am not allowed to change the BI during the day at the same time so have to wait until the night time one is down low enough before starting on the day time one. No diabetic in their right mind would delibereatley spend a week hypo every month, but this si what the step -wise approach dictates. tTere seems to be no way out of it but to abandon DAFNE. thena s a patient you don't know what to do as you could be deemed non-compliant is you don't stick to the DAFNE rules.

If anyone else is finding difficulties and has not yet posted, please do so as this site is the only way to raise these issues on a nation-wide basis and maybe they will eventually change it.
Interestingly, on our course, there were 7 young women and 1 man. Only the man managed to get control, the rest of us still have not managed to work out our BI and it is well after the magical year. We have only succeeeded in making ourselves ill and our quality of life is much worse now, one girl having to give up work and me being on the brink of having to give up. we are all miserable and I just feel there is no point in being alive anymore, it is just horrible having to drag yourself through another exhausting day to collapse in bed and push yourself through it all again tommorrow. I was wonering about asking for hormone tablet to shut off female hormones or perhaps ovary removal. I am so desperate.If anyone has managed to get any of these interventions then please please let us know.

take care JAckie.

Igood luck with your pump JAckie. I am curious to know if this helps with tackling the hormone problem or not. It sounds as if it would be just as difficult on a pump as not on one. I think you will easily get the dawn phenomenon sorted on a pump as they will programme your insulin to automatically rise at the right time. itis just finding the right timing and the correct rise .
Please let us knwo how it goes with the hormone thing though as I would love a pump but do wonder if this would not work well because of the hormonal variations. If anyone else is on a pump and has this sorted via it,pleaselet us all know.

I think when I first started working out my new lantus doses when I first split, I was not aware of how drastic the changes are, and it's only been since I came on to Levemir that the full extent of the problem actually came to light and the penny dropped that I would need to work hard on this problem.

Working it out progress:

I've still not quite worked out what is going on exactly, but while I am, I've found that if I draw myself up a chart, I've found it has helped me remember for next month instead of checking back in my DAFNE diary. I find that my highs start before the pill has even finished being taken (which (unsurprisingly) surprised one of my DAFNE nurses!)!

It goes like this (roughly) considering I don't have a photo handy of it (written in pencil so it's easy to edit):
Firstly, please note that I start my pill taking on a wednesday so it finishes on a tuesday. I am also on a split dose of Levemir so each change will be marked MORN or EVE. I take my insulin MANUALLY.

Thursday (before the pill finishing tuesday) EVE: 16-18 BI (I'm still unsure which it is because of mixed signals )
Friday MORN: 10 BI

Leave it until...

Thursday (first thurs after pill is finished) EVE: 11 BI
Friday MORN: 9 BI

Period starts late sat/early sun - only lasts a few days (due to pill). Leave it until...

Monday MORN: 7 BI (If I don't do this change, I have very serious hypos - so bad that I hypo twice again after treating the first hypo again! Had to fix that ASAP! This happens EVERY TIME without fail if I don't put it down from 9 BI!)
Monday EVE: 9 BI

Then when the pill starts again Wednesday EVE I'm back to "normal routine" of 6 MORN BI and 11 EVE BI.

Pill talk

I am on the Microgynon pill currently - I do believe this has helped because patterns seem to have been consistent, but I do not want to remain on this pill. I have been considering a hormone free coil but considering the shifts of non-pill users that have been brought up in the Information on menstrual cycle thread found in the HCP section of the forum, I have been a bit afraid to proceed with the change considering I don't yet understand what's happening while on a pill.

At the moment during the time of the month (TOTM), I am only adjusting my BI. Recently though, I'm beginning to doubt that my 'off TOTM' insulin is still not quite right, but I have been very stressed lately with work changing my environment again and the like, so results have been messed up yet again. I have also done a new adjustment of putting my evening meal ratio up to 1:1.5 but considering I've been 1:1 for such a long time and currently under stress, I will be keeping an eye out for hypos.

This TOTM stuff used to frustrate me no end, but it's slowly got easier... but the fact I don't understand it all is keeping the annoyance there.

Back to back pills

Before I forget, I recently went on holiday and I was expecting to have to take two pill backs back to back to prevent period... but I knew that my hormones kicked in before the end of my pill taking so I was very concerned about what would happen if I did take pills back to back.

I did ask one of my DAFNE nurses and she said that instead of risking a hypo from my body going straight back to normal doses straight away. Thankfully, I didn't have to in the end because my TOTM didn't start until after I got home so I didn't back to back in the end.

With this, has anyone established what happens? I know the doctors recommend that you only do pack to pack once or twice a year at most (because it mucks up your hormone patterns - I can vouch - I was stupid enough to do it one on, one off, for a few months) so it's not likely it will get much attention as the straight forward pill taking.

Thanks to tweety endtherapies and JWo for replying.

It was interesting to know that the pill by the sounds of it causes the same problems as not being on the pill and that it is just as much work to try to sort doses throughout the month .
It was also useful to hear that taking the pill back to back with no break is considered dangerous.

I think charting each month is the only thing that will be useful.

Does anyone know of pre-menopausal females who are managing to get control using the one BI throughtou the month and the same ratios like it is supposed to be? MAybe we are the exceptions and most people's insulin requirements are not upset by hormones.Otherewise why would it not be part of the training course or why would women of child-bearing age be allowed on DAFNE courses at all if it is a waste of time.

I am going to try the altering QA ratios on the part of the month that I cannot get sorted.
I suspect that sorting the dose during menstruation and when requirements peak is the easy bit and it is the inbetween bits that are difficult. I will try to see if I can find any research on DAFNE and this problem via the DAFNE site.If I do I will let you know.

good luck to all with this challenge!

Hi JackieB,

I was just reading your post and had a thought which might help you. This is coming from someone who is trying to conceive at the moment so that's why I thought of it...

With your cycle being so erratic, have you considered using ovulation sticks to tell you when you're ovulating? As I understand it, with a variable cycle, it's the time before ovulation that varies. Once you've ovulated then I think you have a pretty standard 14 days or so before your period starts. I may be wrong on this so please feel free to correct me if I am - I'm still learning about this stuff.

Given that your peak insulin requirements occur in the week before your period, you should be able to predict this happening around a week after ovulation.

The sticks aren't cheap unfortunately but I'm not sure if it's something that you might be able to get on prescription?

Good luck with it all.

Melissa

I think MelissaF is making a great suggestion here, gals.... What do we think?
That sort of thing would never had occurred to me to use!
Considering the cost, is any individuals prepared to give it a go? Does any one of us already have them on prescription?
I don't unfortunately, but I've not really attempted for a baby really, and don't really have any near future plans to...

We shall solve this biological puzzle! ^0^

Didn't people used to measure their body temperature to see when they are ovulating? (I feel old all of a sudden)

Think I'm in the peri-menopause now so can't really join in the discussion myself. My daughter (T1 too) seems to be settling into some sort of pattern now so will be keeping an eye on this thread

Hi Caroline,

You're absolutely right. How typical of me to think of the most expensive option first!

You need to chart your temperature when you wake up in the morning, at roughly the same time every day and before you do anything. You should notice that your temperature elevates for a few days around the time of ovulation and then drops again. Ovulation typically takes 48 hrs so I'm not sure if you would just notice two days or whether there would be an additional day or two of raised temperatures around that time as well.

You can buy charting kits in chemists for around £20 or obviously just make something up yourself. Once you've been doing it for a couple of months you might notice patterns.

This probably sounds like a bit of a pain but possibly, once you've been charting for a while, you will be able to tell when you're ovulating naturally as it might make you a bit more in tune with what your body's doing. I've never really noticed as my cycle is really irregular too but, now I'm actually recording it, I am much more aware of what's going on. Certainly a lot of my friends say that they know naturally anyway.

Once you've pinpointed that, it should be much easier to tell when you might need to raise insulin levels to cope for the impending week of PMT.

Good luck!

Melissa

Have noticed that all my BG's are affected when I'm on my period - I luckily have a regular cycle - every 4 weeks and starts on the same day every month. I constantly have hypo's while I'm on my period - however, since going on the DAFNE course I automatically lower my QA doses now - it took a couple of months for the penny to drop. Its still not quite there but is slowly calming down.

JWo - I have the same problem where I've treated the hypo then I go hypo again - and that also happens outside of the period week.

Am really happy - if thats the right word that this is being discussed - as its such an important issue.