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2. Let's cut to the chase. How to maintain control.

So, now that we have established that it is normal for a woman to experience changes in blood glucose before and during her menstrual period, what can we do about it? We definitely do not have to just "grin and bear it".

If you are on Multiple Daily Injections, talk to your doctor about increasing the amount of long-acting insulin you take during this time. (If you experience premenstrual hypoglycemia you should decrease the long-acting insulin.) Usually blood sugar returns to normal during the first day or two of menstruation and insulin doses should be restored to the normal levels at that time.

If you are using an insulin pump you can increase (or decrease) your basal rates. Assuming you have a problem with elevated blood sugars, try increasing your basal rates by 1 or 2 tenths of a unit. To help determine what is the correct basal rate for you, try setting a temporary basal rate one-tenth of a unit higher than you usually run. If, after three to four hours, your blood sugar levels have descended into an acceptable range, go with this as your "premenstrual" basal rate increase. Adjust all of your basal rates by this increment. You may find that a one-tenth unit increase is not enough. If this is the case, adjust it upwards by another tenth of a unit. (Note that this is now two-tenths of a unit above your original basal rate.) Wait another three hours and check again. Continue increasing by one-tenth unit increments until your blood sugar levels stabilize into an acceptable range.

Once you have determined what your premenstrual basal rates should be, you could continue to run a temporary basal rate, but the hourly beeping might drive you batty. If you are using a Disetronic pump the beeps can be silenced. Refer to your pump user's manual for instruction on how to do this. If you are using a MiniMed 507 pump, the beep volume can be turned down but not turned off altogether. Once again, refer to your user's manual. Another problem, besides the beeping, is the fact that temporary basal rates are just that: temporary. You need to keep resetting them until your blood sugars return to normal after the beginning of your period.

An alternative is to reprogram your basal rates as if it were a permanent change. Then, at the first sign of a "low" after your period begins, restore them to normal. This is nice because the increase in basal rates is usually needed for three to five days. It is much easier to reprogram the basals for this length of time than it would be to continually set temporary basals. The onset of menstruation should be enough of a reminder for you to be on the lookout for the inevitable drop in blood sugar. If you decide to pursue this route, I advise you to write down the start times and amounts of your basal rates before you reprogram them. This will make both reprogramming and returning to normal much easier for you.

If you are a Disetronic pump user and possess two pumps, you could program one of the pumps with your "premenstrual" basal rates and keep the other pump set up for the rest of the month. Of course this would mean changing insulin cartridges to your alternate pump when it is time for the switch.

Changes to your insulin regimen should be made with care. Readers are advised to check with their health care team before making significant changes.

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