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wilko99

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Hello, I was wondering if any of the females in this group are type 1, not allowed on HRT and how they manage high sugar levels.
Thank you
 
Hi and welcome to the forum.

Have you been diagnosed long? Which insulin(s) are you on and do you inject or have an insulin pump?
I am currently on HRT but when I was initially diagnosed I wasn't. I managed my levels the same as anyone else in that when they are high I use more insulin. Some basal insulins can be more suitable to managing female hormones than others and I think most of us feel that the shorter acting basal insulins like Levemir are more flexible to manage hormonal changes. I love my Levemir but you do have to learn how to use it to best advantage.

Do you have a CGM (Constrant Glucose Monitopr) and if so could you show us a graph from it (screenshot perhaps) which highlights the problems you are having?
If you haven't got a CGM, then I would ask if that is through choice or that you have not been offered one. In England, all Type 1 diabetics are entitled to a CGM on prescription, so hopefully you do already have one...
 
Thank you.
I will tryvand increase my levermr.
I moved to Ireland 2 years ago and still waiting to see a specialised.
I lived in Guernsey where I was diagnosed 7 years ago and had great support .
Of course now with the menopause I have problems.
Thanks
 
Do you take your Levemir once a day or twice and if twice, do you have an equal split or unequal? Many people find they need less insulin at night than during the day so they take more in the morning and less at night, but there are a few people who need more at night and less in the morning. We are all different and you have to lkearn what your body needs. Most of us here on the forum believe that we need to become the expert in out own diabetes through trial and learning which may involve some errors here and there but the important thing is keeping ourselves as safe as possible even when errors happen and learning from them.

Have you ever done a basal test, to check that your Levemir doses are holding you steady in the absence of food and meal time insulin? To do this you skip a meal each day in rotation, so one day you might skip breakfast and see if your levels stay steady until lunchtime or rise or fall. Then the next day you have breakfast but skip lunch and another day you have breakfast and lunch but skip your evening meal and see how your levels perform during those periods of fasting and that will show you if your Levemir doses are holding yu steady of if they need tweaking. I find my evening Levemir dose is particularly sensitive to exercise, so if I do some exercise during the day, I need to reduce my evening Levemir dose. Other people find that they need to reduce their morning Levemir dose for planned exercise or take more unbolused carbs before exercise if they haven't reduced their morning dose. Normally I need 22units in the morning as soon as I wake up and before I set foot out of bed, but just about 3 units on an evening before bed but if I have had a very active day or done exercise, I need to reduce my evening dose and I am currently not needing any evening Levemir because I am doing quite a lot of physical activity. It can change from one day to the next and I have learned whch things affect it and how to adjust it by watching how my levels change using my Libre.
Do you have Libre or some other CGM like Dexcom or are you just finger pricking to get your readings which makes it more challenging to figure out what your body needs?
 
Thank you.
I take leve.ir in the evening and have learned to adjuster it depending of my level of activity.
it is the constant highs begore evening meal which are the problem isince the menopause arrived.
up until 2 years ago my Sugars were really good.
Before coming to Ireland I had the libra which was great as I new what direction my sugar was going.
However here in Ireland the Libra is not free and costs over €70 every 2 weeks.
I am still waiting to see a specialist who may or may not allow me to have it free.
It is very frustrating as I and the diabetic team in Guernsey worked hard to get things right after I was diagnosed.
I will try your suggestions.
Thank you


rebrascora said:
Do you take your Levemir once a day or twice and if twice, do you have an equal split or unequal? Many people find they need less insulin at night than during the day so they take more in the morning and less at night, but there are a few people who need more at night and less in the morning. We are all different and you have to lkearn what your body needs. Most of us here on the forum believe that we need to become the expert in out own diabetes through trial and learning which may involve some errors here and there but the important thing is keeping ourselves as safe as possible even when errors happen and learning from them.

Have you ever done a basal test, to check that your Levemir doses are holding you steady in the absence of food and meal time insulin? To do this you skip a meal each day in rotation, so one day you might skip breakfast and see if your levels stay steady until lunchtime or rise or fall. Then the next day you have breakfast but skip lunch and another day you have breakfast and lunch but skip your evening meal and see how your levels perform during those periods of fasting and that will show you if your Levemir doses are holding yu steady of if they need tweaking. I find my evening Levemir dose is particularly sensitive to exercise, so if I do some exercise during the day, I need to reduce my evening Levemir dose. Other people find that they need to reduce their morning Levemir dose for planned exercise or take more unbolused carbs before exercise if they haven't reduced their morning dose. Normally I need 22units in the morning as soon as I wake up and before I set foot out of bed, but just about 3 units on an evening before bed but if I have had a very active day or done exercise, I need to reduce my evening dose and I am currently not needing any evening Levemir because I am doing quite a lot of physical activity. It can change from one day to the next and I have learned whch things affect it and how to adjust it by watching how my levels change using my Libre.
Do you have Libre or some other CGM like Dexcom or are you just finger pricking to get your readings which makes it more challenging to figure out what your body needs?
Click to expand...
 
If you are only taking Levemir once a day in the evening, then it is likely running out before your evening meal the next night, unless you are taking a very large dose. Levemir doesn't generally last 24 hours and is designed to be split into 2 doses which generally overlap. It also doesn't have a flat profile of activity, so you get a peak of activity between 5 and 8 hours which then tails off and might run out altogether after about 16 hours but will generally have very little action left after that time unless you are on much larger doses.
There is a 3 dimensional graph which shows it's activity profile depending upon your units/kg body weight which I will endeavour to find for you as it quite useful to see so that you can understand what is happening after you take it. Your single dose of Levemir running out in the evening would be my guess for your problems. It may be that the menopause has created a need for more basal insulin which has then highlighted the problem with the L:evemir running out, whereas before you might have covered it with daytime activity of evening meal bolus.

Do you mind saying how much Levemir you take on an evening?
 
I know it is a bit mind boggling to look at but if you divide your dose by your body weight in kg you get the Y axis and then you follow it across the graph in hours to see where it peaks and where it tails off.
 
wilko99 said:
Hello, I was wondering if any of the females in this group are type 1, not allowed on HRT and how they manage high sugar levels.
Thank you
Click to expand...

Welcome to forum @wilko99

There’s some information about HRT and meopause / perimenopause here which may help

Menopause and diabetes

Hormonal changes in the perimenopause – the lead up to the menopause – can affect your blood sugar levels. This can make it harder for some women to manage their diabetes during the perimenopause. Menopause is usually reached when a woman has stopped having any periods for 12 months. It is...
www.diabetes.org.uk www.diabetes.org.uk

HRT isn’t appropriate for everyone. Is it something you’ve discussed with your Dr?
 
wilko99 said:
Thank you.
I take leve.ir in the evening and have learned to adjuster it depending of my level of activity.
it is the constant highs begore evening meal which are the problem isince the menopause arrived.
up until 2 years ago my Sugars were really good.
Before coming to Ireland I had the libra which was great as I new what direction my sugar was going.
However here in Ireland the Libra is not free and costs over €70 every 2 weeks.
I am still waiting to see a specialist who may or may not allow me to have it free.
It is very frustrating as I and the diabetic team in Guernsey worked hard to get things right after I was diagnosed.
I will try your suggestions.
Thank you
Click to expand...

rebrascora said:
If you are only taking Levemir once a day in the evening, then it is likely running out before your evening meal the next night, unless you are taking a very large dose. Levemir doesn't generally last 24 hours and is designed to be split into 2 doses which generally overlap. It also doesn't have a flat profile of activity, so you get a peak of activity between 5 and 8 hours which then tails off and might run out altogether after about 16 hours but will generally have very little action left after that time unless you are on much larger doses.
There is a 3 dimensional graph which shows it's activity profile depending upon your units/kg body weight which I will endeavour to find for you as it quite useful to see so that you can understand what is happening after you take it. Your single dose of Levemir running out in the evening would be my guess for your problems. It may be that the menopause has created a need for more basal insulin which has then highlighted the problem with the L:evemir running out, whereas before you might have covered it with daytime activity of evening meal bolus.

Do you mind saying how much Levemir you take on an evening?
Click to expand...
Thank you,
I take 14 units in the evening if very active.
 
So 14 units in total of Levemir in one dose in the evening and what time do you take it?
And do you mind giving your weight in kg, so that I can work out your unit/kg of body weight, so that I can look on the graph and give you an idea of when your Levemir likely runs out and see if that ties in with your levels rising....
 
rebrascora said:
So 14 units in total of Levemir in one dose in the evening and what time do you take it?
And do you mind giving your weight in kg, so that I can work out your unit/kg of body weight, so that I can look on the graph and give you an idea of when your Levemir likely runs out and see if that ties in with your levels rising....
Click to expand...
I am 7 stone and 4 foot 12 inches, and walk 7 miles a day's, briskly

Thanks
 
So that gives a figure of about 0.35units/kg so your Levemir dose will peak in activity between 6-12 hour period after injection and run out about 18-20hrs after injection, so about 6 hours before you are due to inject it, it will likely be running out or at least have very minimal activity left in it by then.
The options to deal with it would be to split your Levemir dose and take some at night and the rest in the morning, or you could use your bolus insulin on an evening to make up the shortfall by increasing your insulin to carb ratio, or simply injecting x amount of extra units with your evening meal depending upon how high your levels go. I do this on a morning to deal with Foot on the Floor syndrom where my liver releases extra glucose into my blood stream as soon as I get out of bed, so I inject my morning Levemir plus 2 units of fast acting insulin to deal with that glucose that my liver churns out. It is kind of a correction in advance in that I know my levels will rise as soon as I get out of bed, often by as much as 6mmols in the space of an hour, so I inject 2 units of Fiasp to deal with it, because the Levemir will not get going quickly enough to sort it out and my night time dose has to be very low (or none existent otherwise I hypo during the night) You clearly have a similar problem in the evening although yours is likely because the Levemir is running out but your liver is releasing more glucose than there is Levemir to deal with it. If you increase your Levemir dose in the evening there is a very real risk that you will hypo overnight or in the morning, so that is not a good option to deal with it.

It might be worth doing some basal testing on an evening, so not having anything to eat after lunch and seeig what your levels do in the evening in the absence of food, just to confirm that it is the Levemir running out.
 
wilko99 said:
I am 7 stone and 4 foot 12 inches, and walk 7 miles a day's, briskly

Thanks
Click to expand...

rebrascora said:
So that gives a figure of about 0.35units/kg so your Levemir dose will peak in activity between 6-12 hour period after injection and run out about 18-20hrs after injection, so about 6 hours before you are due to inject it, it will likely be running out or at least have very minimal activity left in it by then.
The options to deal with it would be to split your Levemir dose and take some at night and the rest in the morning, or you could use your bolus insulin on an evening to make up the shortfall by increasing your insulin to carb ratio, or simply injecting x amount of extra units with your evening meal depending upon how high your levels go. I do this on a morning to deal with Foot on the Floor syndrom where my liver releases extra glucose into my blood stream as soon as I get out of bed, so I inject my morning Levemir plus 2 units of fast acting insulin to deal with that glucose that my liver churns out. It is kind of a correction in advance in that I know my levels will rise as soon as I get out of bed, often by as much as 6mmols in the space of an hour, so I inject 2 units of Fiasp to deal with it, because the Levemir will not get going quickly enough to sort it out and my night time dose has to be very low (or none existent otherwise I hypo during the night) You clearly have a similar problem in the evening although yours is likely because the Levemir is running out but your liver is releasing more glucose than there is Levemir to deal with it. If you increase your Levemir dose in the evening there is a very real risk that you will hypo overnight or in the morning, so that is not a good option to deal with it.

It might be worth doing some basal testing on an evening, so not having anything to eat after lunch and seeig what your levels do in the evening in the absence of food, just to confirm that it is the Levemir running out.
Click to expand...
Thank you.
I will try your suggestions .
 
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