I'm currently on Ortho Tri Cyclen Lo, which is a low estrogen triphasic birth control. I picked this one years ago because it was low estrogen and had the same progestin that's known to decrease acne. Plus it comes in a pretty nifty diskette...mine has a flower on it in fact. I only stayed on it for six months back then though because it wasn't really helping with the cramping that I was having. Nor did my acne seem to improve.
I went back on it a few months ago because of the Accutane regimen that requires birth control use. It seemed the safest option after Seasonique left me with 21 days of breakthrough bleeding. This is my second completed pack. And I think I'm beginning to see a pattern with my blood sugars.
It seems like the first week of the pack averages about 160 to 170. The next week bumps to 180 to 190. Then the third week soars to the 200's. I'm not sure if this is exasperated by the Accutane or if this might persist...I don't remember this issue when I was on it previously.
This past week, I've been running low. I'm currently on 26 and 16 units of Lantus. Which leaves me with 49 morning numbers and random afternoon drops. So far, I haven't changed anything for fear of the 200s that I just saw a week ago. But i can't persist at 49 fasting...it's too dangerous for me.
I'm not really sure what to do about this except trial and error. I suppose I'll stay at 26 units in the morning and maybe lower my evening dose to 15 units. Then just play with it each week until it seems to work.
Here's the breakdown of the insulin and averages according to week:
- Week 1 of the pack: 20 morning units and 14 evening units of Lantus with averages at 163; 23 morning units and 14 evening units with 166 averages.
- Week 2: 21 morning units and 15 evening units of Lantus with averages at 213 (New Year's Eve was during this week which kept me high for quite awhile between the fancy food and champagne); 24 morning units and 14 evening units with averages at 191.
- Week 3: 24 morning units and 14 evening units of Lantus with averages at 217; 25 morning units and 15 evening units of Lantus with an average of 215.
- Placebo weeks: these numbers drop back into the 160 to 169 range with bad lows mixed with highs.
It's tough to say because this is only two cycles. Plus there has been a lot mixed into these weeks. Like New Year's Eve throwing me into the 200 and 300 range for almost six hours. There's the Accutane which has caused issues from the beginning. I was on antibiotics for two of these weeks. I took the dexamethasone suppression test which made me stay in the 300s for almost three days. I've also moved the Lantus times twice during this time period.
But it does seem pretty likely that this is the pattern for this specific birth control (at least with the Accutane mixed in for now). It's just a matter of what to do about it. I've used different Lantus rates and still see high averages. Maybe I need to work with my carb rates during these times. But obviously, Lantus has SOMETHING to do with the amount of lows I have. Just what exactly is that something?
Diabetes is so frustrating. And being a woman with diabetes is even more frustrating. How am I supposed to account for changing hormone levels? This disease is so overwhelming because it is so ever-changing.
When people say that insulin isn't a cure, they forget to mention that sometimes insulin isn't even a management technique. If insulin needs are constantly changing, how do we ever get a break?
It isn't like we get a diagnosis, pop a pill for the rest of our life, and go our merry ways. It isn't even like we take an injection for the rest of our life and go on our ways. That I could live with. It's this constant change, constant interference that is so frustrating and mind boggling. And why don't I have a medical degree with this amount of experience?
I guess I'll keep lowering the Lantus until I see fewer lows at such inconvenient times. Maybe I'll hook up to the pump to test my carb ratios if I can get the energy and will power. And maybe I'll just wait until these next 45 days are up and I'm off the Accutane. I wonder if the effects would be immediate or if it will take time. The highs came pretty quickly after starting, so hopefully going off will be quick as well. Oh the next month and a half cannot come fast enough!
My past experience with NPH and later Lantus forced me to eat on a specific time schedule. If I did not eat nearly the same amounts each day, it would tend to make managing diabetes more difficult.
With my insulin pump, I am not getting the time-release insulin, I am getting small divided doses of fast-acting insulin. I suspect this is the reason a lot of unwanted lows no longer happen -- because time-release insulin is given in large doses at a time once or twice a day, therefore in the meantime they are constantly slowly bringing down blood sugar levels at about the same rate 24 hours each day, no matter whether levels are high or low, the time-release insulin still notches down the levels little by little all the time.
Higher doses speed up the process.
Now I myself use to take about 60% time-release to 40% fast-acting insulin. My endocrinologist was a little concerned because he thought the ratio should be more 50/50.
But I always ate light meals (requiring small boluses) and in between meals I always had a very light snack (not requiring a bolus because the time-release insulin took care of it).
But now that I am on an insulin pump, I have found a basal amount of insulin per day that I could start the day at 120, not eat anything all day, and go to bed around 90. So in the case of the pump, the basal is not actually pulling sugar levels down but instead holding it at about the same place all the time. But you know what? My ratios are still 60/40 like when I was on Lantus. And my endocrinologist sees that over the years this is perfectly fine for me, and gives me the okay to continue.
I don't know how helpful my commentary has been, and I certainly do not presume what worked for me would necessarily work for anyone else, but maybe it was somewhat helpful, to someone, somewhere. :-)
"When people say that insulin isn't a cure, they forget to mention that sometimes insulin isn't even a management technique."
This is a great line. And it's pretty much what I start muttering to myself whenever my insulin needs nearly double over the second or third weeks of my cycle. And it's not like there's a little read-out on my abdomen that tells me what the new doses should be, either. No one outside the community of Type 1's (and their parents and spouses) has any idea how much guesswork this is.
Thank you so much for your blog. You're really putting out there how hard this can be, even for a smart, engaged patient that's working hard to get it right.
Best of luck and hope things start getting easier!