Question #6: What gets in the way of you doing better with it?
PMS!!! Sorry guys, but it must be discussed. Pre-menstrual syndrome (PMS) and diabetes are a bad combination. For about one-third of women with diabetes, blood glucose levels rise during the 7 to 14 days prior to menstruation. Another third see their blood glucose levels fall and the final third don’t notice a difference. Things seem to settle in and normalize (if there’s such a thing as normal) once she gets her period.
I am in the first group. My blood glucose goes up – annoyingly – like clockwork at day 14 of my cycle. By day 18 or 19 I have to increase my basal insulin (Lantus) dose or I am left chasing blood glucose levels all day. When I give in to what I like to call “hormonal eating” my numbers are truly all over the place.
PMS is pretty well known for causing women to have mood swings and food cravings. Add diabetes to the mix and watch out! Food cravings can cause elevated blood glucose, which can cause mood swings (without even considering hormonal mood swings). Chasing high blood glucose with insulin can lead to low blood glucose levels. (This is called “stacking insulin,” where someone takes insulin to bring down a high blood glucose, but there was still insulin working. When all that insulin kicks in the blood glucose can plummet.) All that bouncing around of blood glucose levels can also cause mood swings – typically irritability!
I once asked a friend with diabetes how her blood glucose responds during PMS and she said, “I don’t know, because that would requiring checking it!” What a good point – during PMS, the last thing we feel like doing is checking blood glucose levels. Can you see how this is just a setup for disaster?
I have actually worked hard to figure out my blood glucose patterns during PMS, and I know for a fact that it goes up – even without extra food. It shows up most often after meals, so I need more insulin to cover carbs. I find that taking more basal insulin (again, Lantus for me) gives me a better starting point, so I don’t need quite as much rapid-acting insulin at mealtime. This is certainly easier to manage with an insulin pump – when I’ve used a pump, I always had a separate pattern or basal setting for “PMS.” I would just program my pump to deliver that basal rate for the 7-10 days before my period. It certainly helps if your cycle is regular, but it is possible to figure it out either way. If you wear a pump and don’t know how to program a separate basal rate like this, talk to your diabetes care professional.
So what gets in your way? Guys, if you stuck with it and read all the way through this, I’m impressed!