Type 1 diabetes and periods

Estrogen and progesterone are the two hormones that play the most important role in regulating a woman’s reproductive cycles. These two hormones can interact with another important hormone, insulin.

This section will explore how the interaction of these hormones can affect the lives of women living with diabetes. We will also discuss how living with diabetes can influence your sexual experiences both physically and emotionally.

Menstruation | Birth Control | Sexuality and Diabetes

Having diabetes can influence some of the major events in a woman’s reproductive life. Be sure to check out the sections on Pregnancy and Menopause.

Menstruation

Hormones control the menstrual cycle in a woman. These hormones can also affect your blood glucose. Many women notice fluctuations in blood glucose at certain times in their monthly cycle, such as an increase in blood glucose a few days prior to the beginning of their period and then a decrease once the period begins. This increase usually occurs after ovulation and before menstruation. Changes are due to two hormones, estrogen and progesterone. When these hormones are at their highest level just before your period, they affect another important hormone, insulin, which may, in turn, cause blood glucose to rise. Some women find their blood glucose rises considerably, while others do not notice a difference. In some women, blood glucose levels are lower before and during their periods. Each woman needs to discover her own pattern.

Often it is the fasting blood glucose before breakfast that tends to fluctuate the most in women with type 1 diabetes during the time just before a period begins. Adjusting your insulin often helps. When your period begins and your blood glucose levels go down, readjust your insulin back to its former level.

If you have type 2 diabetes and do not take insulin, remember regular exercise can lower blood glucose, therefore it is important to maintain physical activity during this time of the month. Besides better blood glucose levels, you will likely have more energy and have fewer unpleasant side effects from menstruation if you can be active on a regular basis.

If you notice fluctuations in your blood glucose and are not sure if these are related to your menstrual cycle, it is easy to find out. In your blood glucose record book, indicate when you start your period each month and watch for a relationship between the two.

Some women suffer more from premenstrual syndrome (PMS) than other women. It does not seem to be related to the type of diabetes you have nor is it more common in diabetes. Women commonly experience moodiness, bloating, water retention and food cravings at this time. Food cravings for carbohydrates and fats combined with a reduction in activity may contribute to fluctuations in blood glucose.

Here are a few suggestions that may help to minimize food cravings:

  • Alcohol, caffeine and chocolate may affect your mood, so omitting them from your diet may make you feel less edgy and less inclined to overindulge on high carbohydrate, high-sugar snacks.
  • Eat at regular meal times to try and avoid large swings in blood glucose and to keep you from overeating later.
  • Low fat, low carbohydrate snacks such as vegetable sticks or a cup of unbuttered popcorn may take the edge off your appetite and minimize the rise in blood glucose.

Try to maintain your regular exercise pattern as this helps to decrease blood glucose and will help you to feel better emotionally.

Birth Control

Birth control is an important issue for women with diabetes because there are greater risks for a woman with diabetes and her baby when pregnancy is unplanned.

The contraceptive options for women with diabetes are the same as for any woman and are based on individual preferences. This is a decision that should be made between you, your partner and your doctor. Talk to your partner about safer sex and how the two of you can protect each other. The regular use of condoms can prevent many sexually transmitted infections. The effectiveness of various birth control options is the same for women with or without diabetes.

There is a wide range of birth control options for women with diabetes. It is important to find the method that works best for you. Details about all of these options are offered in our Sexual Health Centre. Here is some information specific to women with diabetes.

The birth control pill is the most popular form of birth control for women, including the woman with diabetes. In the past, women with diabetes were advised to avoid taking the “pill” because of its effect on blood glucose and the risk for heart disease and stroke. These concerns were based on the doses of estrogen and progestin ( the synthetic form of progesterone) used in the “pill”. In the last 20-30 years, the doses have decreased greatly, thereby decreasing the risk for these problems. However, the risk of heart disease and strokes remains high for women who also smoke.

Today the “pill” is available in different forms: combination estrogen and progestin, or progestin alone. Some women find the lower dose combination pill can affect their blood glucose. Regular blood glucose monitoring and adjustment of diabetes medication can help resolve blood glucose fluctuations. Your doctor will assess hemoglobin A1C (average blood glucose over a 2-3 month period), total cholesterol, LDL and HDL, triglyceride levels and blood pressure before and after starting the pill. If the results are elevated, an alternative method of birth control may be necessary.

Some doctors may suggest progestin-only pills to avoid the blood glucose fluctuations that may occur with combination pills. These “mini-pills” are effective but some side effects are more common such as break-through bleeding, breast pain, weight gain and irritability. Any concerns should be discussed with your doctor.

The intrauterine device (IUD) is often a preferred option for women with diabetes who are in a stable relationship where neither partner has sexual intercourse with anyone else. In the past, there was concern that IUDs might pose an increased risk for pelvic infection or trauma to the uterine wall and that women with diabetes might be particularly vulnerable to these infections. The newer generation of IUDs appears to be safe in this respect.

The diaphragm is a barrier method that is 95 percent effective in preventing pregnancy when fitted properly and used with spermicidal foam or gel. It does not affect blood glucose but there may be an increased risk for yeast infections for women who have diabetes.

The condom, used with spermicidal foam or gel, is another barrier method that does not affect blood glucose in women with diabetes. It is 85 percent effective against pregnancy when used correctly. Where there is a risk of a sexually transmitted infection, a condom should be used even if other methods of birth control are also used.

Other hormonal contraceptives, such as Norplant or Depo-Provera, are some of the options available to women with diabetes. Norplant comes in the form of a small capsule that is placed under the skin of the arm and slowly releases medication to prevent pregnancy for approximately 5 years. Depo-Provera is given by injection every 3 months. It does not contain estrogen, therefore it is a better form of contraception if you smoke. This is not a preferred method if you find it difficult to see your doctor regularly. Both implantable options may affect blood glucose, therefore regular blood glucose testing and adjustment to diabetes medications may be necessary.

Sterilization or tubal ligation is often the method of choice for the woman who has completed her family or who does not wish to conceive. Women who already have complications of diabetes, such as advanced kidney or eye complications, may want to consider this option.

Sexuality and Diabetes

Having type 1 or type 2 diabetes can affect a woman’s sexual experience both physically and emotionally. A woman’s level of interest as well as her sexual functioning can be affected. Physical problems related to diabetes can affect a woman’s enjoyment of sex. Most of these problems can be resolved. They do not need to have a long-term impact on a woman’s sexual activities. They usually resolve with improved control of blood glucose.

The effect of diabetes on women’s sexual health is more subtle than the erectile difficulties sometimes experienced by men. Your sexual health is important to your overall health. Discuss these concerns with your doctor. Talking with your partner and physician is the first step towards finding a solution. Here are some of the specific issues affecting the sexual experience of a woman with diabetes.

Infections
Vaginal infections or urinary tract infections are more common in women with diabetes, especially when blood glucose is generally high. Vaginal infections, for example yeast infections, can lead to itching, unusual discharge and pain during intercourse, but they are responsive to treatment. A urinary tract infection can lead to cloudy or bloody urine, a burning sensation and/or a constant feeling that you need to urinate. This problem should be addressed immediately to decrease the chance of subsequent kidney infection. Your physician will prescribe an antibiotic. Until the urinary tract infection has cleared, it is best to avoid sexual intercourse.

High Blood Glucose
Persistently high blood glucose can affect a woman’s energy level and lead to significant fatigue. This in turn may decrease interest in sex. Achieving an acceptable blood glucose level can improve mood and libido.

Reduced Vaginal Lubrication
A complication of diabetes called neuropathy (nerve damage) can reduce vaginal lubrication in some women.

A decrease or loss of vaginal lubrication can make a woman uncomfortable during sexual intercourse and limit her pleasure. A decrease in, or lack of, lubrication can occur for many other reasons such as menopause, the use of birth control pills and stress. Water-based lubricants are effective in improving dryness and sensitivity to touch. For severe dryness, a vaginal suppository can be used. Learning how to relax the muscles around the vagina using contraction and relaxation exercises, or trying different positions can help decrease pain during intercourse.

During and after menopause, topical hormonal creams or an estrogen ring, which can be inserted into the vagina, may help improve sexual desire, vaginal elasticity and lubrication.

Fear of Pregnancy
Fear of pregnancy can affect responsiveness. A reliable method of contraception can remove this fear.

Heart or Kidney Disease
Heart or kidney disease can affect energy levels and increase anxiety regarding what effect sex may have on health. The intrusion of diabetes on this aspect of a woman’s life can be frustrating and upsetting for both the woman and her partner. It becomes very important to communicate these fears or concerns and discuss what works and what does not work for you.

Fear of Hypoglycemia (low blood glucose)
Women who take insulin or pills for diabetes often fear that sexual activity may lead to low blood glucose (hypoglycemia). Your body uses extra energy during sexual activity. Testing your blood glucose prior to intercourse and having some extra carbohydrate either before or just afterwards can help prevent low blood glucose from interfering with your sexual enjoyment.

Weight Issues
Type 2 diabetes is often associated with being overweight. Being overweight for some women can affect how sexually attractive they feel and reduce interest in or enjoyment of sex. This is a body image concern and not necessarily related to diabetes.

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Different stages of the menstrual cycle may have different effects on your blood glucose levels and the effect can also vary from person to person and from month to month.

Recording your blood glucose results can be helpful in finding patterns in your levels and helping you to better control your diabetes.

How will my period affect my sugar levels?

There is not a definite answer to this as periods affect each one of us differently.

However, many women report having higher blood sugar levels a few days prior to their period starting.

During your period, you may experience high blood sugar levels but some women notice a sharp drop in sugar levels so it’s best to be prepared for unexpected changes to happen.

Why does blood sugar rise before or during periods?

Before and during your period, changes in the level of the hormones oestrogen and progesterone can induce temporary resistance to insulin which can last for up to a few days and then drop off.

Some girls and women have consistent effects as to how their period affects blood sugar whereas other women may find that the effect on blood sugar varies from one month to another.

Coping with periods

The effect on blood sugar as a result of periods can change from one month to another so keeping a diary of your blood glucose numbers can help you to see if there are any patterns in your results across different months.

If you are finding your blood glucose levels go very high before or during your period, you may need to either inject more insulin (if insulin dependent) or reduce your carbohydrate intake.

If you increase your insulin, be careful to avoid hypoglycemia as your insulin sensitivity can sometimes return quickly.

Speak to your health team if you need advice on how to manage your insulin doses or carbohydrate intake.

Increased appetite

You may also experience an increase in appetite before your period. It is best to avoid refined carbohydrates (such as white bread and sugary foods) in response to cravings as these foods raise blood glucose levels which then causes further hunger.

It is better to stick to your normal balanced meals as best as you can.

Contraceptive pill and effect on blood glucose levels

If you take a contraceptive pill, you may experience a different effect on your blood glucose levels than when you weren’t taking the pill.

It is advisable to review your sugar levels through the first few cycles to see if a pattern emerges in your results.

  • Read more on the contraceptive pill and its effects on blood sugar levels

Menstruation Can Affect Insulin Needs

In some women who have type 1 diabetes, the hormonal changes that come with menstruation can cause changes in blood glucose levels. Monitoring levels and adjusting insulin accordingly is key to managing this monthly shift.

Diabetes: How Hormones Affect Blood Glucose

The same hormones that control your menstrual cycle can also affect your blood glucose levels.

“Two or three days before menstruation, as estrogen and progesterone levels are changing, a number of women — but not all — will notice that their insulin needs increase substantially because their blood glucose levels are rising,” explains Jay Cohen, MD, medical director of the Endocrine Clinic in Memphis and clinical assistant professor in the department of family medicine at the University of Tennessee.

If this happens, levels usually decrease after their period begins. Also, Cohen points out, some women don’t experience menstrual cycle-related changes in their blood glucose levels, and others may only see decreases in their blood glucose levels around the time of their period.

Diabetes: How Your Menstrual Cycle Can Be Affected

In addition to your menstrual cycle affecting your ability to control your diabetes, having type 1 diabetes can affect your menstrual cycle. On average, girls who have type 1 diabetes tend to start their periods about a year later than girls who don’t have the disease. And women who have type 1 diabetes are twice as likely as those who don’t to have menstrual problems before age 30. Specifically, having type 1 diabetes can increase your chances of:

  • Longer menstrual cycles
  • Longer periods
  • Heavier menstruation
  • Earlier onset of menopause

“In women whose diabetes is out of control, high blood sugars can put a woman at increased risk of vaginal and yeast infections, and can also affect regular menses,” says Cohen. “Once again, it is important to have good blood sugar control on a regular basis.”

Diabetes: Managing Changing Insulin Needs

It is important for a woman to realize that she may need more insulin prior to her menstrual period, says Cohen, and should have a plan in place from her endocrinologist. Whether you are taking insulin injections or are on an insulin pump, there is a good chance that you will need to increase your insulin doses for two or three days before you start your period.

After reviewing the fluctuations in your blood glucose levels throughout your menstrual cycle, your endocrinologist can help you decide what you need to do to keep your blood glucose levels under control all month long.

“That way, you can prevent those five to seven days of prolonged high blood sugars, which can lead to potential dehydration” and other complications, says Cohen.

Normal premenstrual hormonal fluctuations, along with instability of your blood glucose levels, may also put you at higher risk of having nausea and cramping around your period. If this is the case, Cohen recommends taking one or two ibuprofen (such as Motrin or Advil) as needed to help relieve your discomfort.

Talk with your endocrinologist about how your monthly hormonal fluctuations may affect your diabetes management plan. You may need to closely monitor your blood glucose levels in the days leading up to your menstrual period for a few months, until you have a good idea of how your insulin needs respond to changing hormone levels.

WEDNESDAY, April 25, 2018 (HealthDay News) — As if coping with type 2 diabetes as a teenager isn’t tough enough, it turns out that many girls with the metabolic disorder also have to deal with irregular periods.

And menstrual cycles that stray from normal can lead to very heavy bleeding and cause extra cramping, said Dr. Megan Kelsey, lead author of a new study. She’s an associate professor of pediatric endocrinology at Children’s Hospital of Colorado and the University of Colorado School of Medicine in Aurora.

In the long-term, irregular periods can also increase the risk of endometrial cancer, the researchers pointed out in the new report.

In the study of young teen girls, “menstrual irregularities affected about one in five girls with type 2 diabetes,” Kelsey said. Those girls had irregular periods even though they were all receiving a treatment for type 2 diabetes called metformin.

Kelsey noted that even in girls who made lifestyle changes or took another diabetes medication, menstrual irregularities persisted.

“They may need hormonal treatments for their menstrual dysfunction,” she said.

It’s likely, she explained, that a hormonal disorder called polycystic ovarian syndrome (PCOS) is the underlying cause of the menstrual abnormalities.

The study data was drawn from a large study of type 2 diabetes treatments in children. Researchers in that study looked at use of metformin (Glucophage) — a drug that makes people more sensitive to the effects of insulin.

Insulin is a hormone that helps usher sugar from foods into cells to be used as fuel. People who have type 2 diabetes don’t respond normally to insulin.

The original study also looked at use of metformin plus rosiglitazone (Avandia) and metformin plus lifestyle changes, and compared all three treatment regimens.

The new study included 190 girls with type 2 diabetes from that group. None of these girls used hormonal birth control, such as the pill or an intrauterine device (IUD).

The definition for irregular periods was having three or fewer periods in the last six months. The girls were around 14 years old. They had had type 2 diabetes between five and six years. Blood sugar control was similar for both groups.

Irregular Menstrual Cycles May Predict Diabetes

To Your Health Share |

Not all women have a regular four-week menstruation cycle; cycles can range from between 20 to 40 or more days, and in some women the cycle length changes regularly. Diabetes, a condition in which a person has higher than normal blood sugar, can cause damage to the heart, eyes, kidneys, nerves, and other organs.

Unusually long, extremely irregular, or infrequent menstrual cycles may be linked to insulin resistance and the development of type 2 (or adult-onset) diabetes.

To assess the risk for type 2 diabetes in women with a history of irregular menstrual cycles, the authors of a recent study in the Journal of the American Medical Association followed over 100,000 women who had reported their menstrual cycle patterns from 18-22 years of age. A “usual” cycle was considered to be 26 to 31 days; weight, race, family history, cigarette use, and other factors were also examined.

Women with long (40+ days) or irregular menstrual cycles were more than twice as likely to develop type 2 diabetes over the 10-year study period than women with usual cycles. Women with very short cycles (21 days or less) were 1.5 times more likely to develop the condition than those with normal cycles. Overweight women had a significantly increased risk for type 2 diabetes as well, but obesity could not account for the increased risk in women with irregular cycles.

Unusual menstrual cycles may indicate metabolic changes that increase a woman’s risk for insulin resistance. Insulin resistance hinders a woman’s ability to process sugars and can cause type 2 diabetes over time. If you typically have very long or short menstrual cycles, especially if your menstrual cycle is highly irregular, take extra precautions to prevent the onset of type 2 diabetes. Talk to your doctor of chiropractic about diabetes prevention, and go to http://www.chiroweb.com/tyh/women.html for more information on women’s health.

Reference:

Solomon CG, Hu FB, Dunaif A, et al. Long or highly irregular menstrual cycles as a marker for risk of type 2 diabetes mellitus. Journal of the American Medical Association 2001:286(19), pp. 2421-2426.

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My blood sugar had been running high all week. One morning it spiked to 300, and it took all day (and extra injections) before I could get it back down to “normal” levels. I was also crampy, bloated, and irritable and knew exactly why I was feeling this way. A few days later I got my period and my blood sugars returned to “normal.” I wrote about fluctuations during the menstrual cycle for a chapter in my book, The Smart Woman’s Guide to Diabetes, and yet every month I’m newly frustrated as if it’s happening for the first time.

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No woman enjoys having her period, but I’ve always felt that mine was particularly problematic. Not only do I get crampy and bloated, I also feel drained because of high blood sugars. In a 2003 study, women with Type 1 diabetes were shown to have more menstrual problems (long cycles, long menstruation, and heavy menstruation) before age 30 years than their peers without diabetes. These problems may indicate increased risk for osteoporosis and cardiovascular disease. It was also shown that women with Type 1 diabetes got their periods nearly a year later than control subjects.

I got my period the same year I was diagnosed with diabetes and never had regular cycles. I didn’t mind having irregular periods until I was trying to get pregnant and had to take Clomid to kick-start my ovulation. I bought countless pregnancy tests in hopes that the reason I wasn’t getting my period each month was because I was finally pregnant, but each test was negative. I’d heard so many discouraging stories and myths about fertility challenges for women with Type 1 (such as big babies and birth defects) that I was overwhelmed with worry. I made threats in the dark to the Diabetes Gods that if I couldn’t get pregnant, I would give up. I was tired of trying so hard to be healthy and I wanted this baby so much and I was so afraid that having diabetes was keeping me away from motherhood.

The Diabetes Gods heard my plea and I found out I was pregnant on Christmas Eve. That “baby” celebrated his fifteenth birthday last week. My second and third pregnancies happened without the help of fertility drugs, and oddly enough, at 45 years old my period has become as predictable as the tides.

The predictability of my periods doesn’t eliminate the frustration of blood sugar swings, though, so I’m forcing myself to go back to the basics. Test frequently. Monitor and record. It’s old school, but it works. Diabetes will never be as predictable as the tides, but I can arm myself with the navigational tools to manage the ebb and flow.

What accounts for the rising cost of insulin? Nurse David Spero investigates. Bookmark DiabetesSelfManagement.com and tune in tomorrow to learn more.

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Q: Our daughter is entering puberty, and her first period is probably not far off. We want to help her be prepared, especially when it comes to how menstruation could affect her blood sugar management. What should we know?

A: With the onset of pubertal changes, children — both boys and girls — develop resistance to insulin, due to increased levels of growth hormone and other hormones that interfere with insulin sensitivity. Because of this, children with type 1 diabetes may require noticeably more insulin during puberty.

For girls, monthly periods can also have a significant impact on blood sugar. Some girls will have higher blood sugar during periods, some will have lower blood sugar, and some will have a combination of highs and lows. Once your daughter starts menstruating, try to identify any consistent blood sugar patterns associated with her cycle.

To do this, encourage your daughter to keep a menstrual log, which notes the days she has menstrual bleeding, spotting, and/or cramping. There are many smartphone apps to help girls track their periods, but a written log is fine too. On your end, parents can help by keeping a log of blood sugar readings and insulin doses before, during, and after menses. CGM (continuous glucose monitor) and glucometer data can be reviewed, and all of this blood sugar data can be compared with your daughter’s log. This should be done for a few months.

If you note a pattern of highs or lows, a plan for insulin dose changes at certain times can be made with the help of your diabetes doctor or nurse. Some girls using multiple daily injections of insulin will increase or decrease their long-acting insulin dose during periods. Girls on insulin pumps will often use temporary basal rates during periods, or use a different basal pattern (e.g., Pattern A) rather than their “standard” basal pattern.

Navigating the changes of puberty can be challenging, for kids and their parents. By helping your daughter understand how her body is changing and what she can do to keep her diabetes managed when she starts her period, you’re setting the foundation for her to feel empowered about her cycles and her diabetes in the years to come.

—Laura Gandrud, M.D., is a pediatric endocrinologist with the Children’s Hospitals and Clinics of Minnesota.

How Other Parents Deal

“To have ‘the talk’ with our daughter about changes she would notice during puberty as a young woman with type 1 diabetes, our CDE recommended piggybacking on her health class at school. The day that her health teacher had a separate class with just the girls to talk about menstruation, I followed up at home with a mini lesson about what all these changing hormones could mean for her T1D. Because she was taking on more independence in her care tasks, I wanted her to know that any fluctuations she might see when her period arrived were not her fault, and just something we needed to deal with as her body changes.”

—Liz R., Bryn Mawr, Pa., mom of 19-year-old Erica

Related topics:
In the Spotlight: How Teen Hormones Affect Blood Sugar
People in the Know: Growth Spurts
When Tweens Become Teens: Parental Guidance Suggested

See more People in the Know questions and answers >

Disclaimer: The information in these articles is not intended as medical advice. Families should check with their healthcare professionals regarding individual care.

If you’ve noticed higher blood sugar levels shortly before or during your period, or if your blood sugars are bouncing up and down as you approach menopause, join the club.

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Diabetes and your menstrual cycle are closely intertwined, thanks to fluctuating levels of hormones.

In fact, if you’re a woman who has diabetes or who is at risk of diabetes, brace yourself for a somewhat bumpy ride as you navigate your menstrual cycle over the course of your life. The good news? There are steps you can take to help ensure smooth sailing.

Hormones 101

Two main hormones regulate your menstrual cycle: estrogen and progesterone. These two hormones are secreted by the ovaries. Estrogen thickens the lining of the uterus in preparation for a possible pregnancy. It has other functions, too, such as regulating bone and vaginal health. Progesterone is also needed to prepare the uterus for pregnancy, and it helps to maintain the lining of the uterus throughout pregnancy. These hormones can affect how your body responds to insulin, and are responsible for the blood sugar ups and downs that you may notice at different times of the month, or when you are nearing or in menopause.

Premenstrual syndrome (PMS)

As you approach “that time of the month,” you might experience premenstrual syndrome, or PMS. PMS starts about one to two weeks before your period. It affects about 90% of women at some point in their lives, bringing a combination of physical, emotional, and psychological factors with it. Symptoms include irritability, mood swings, depression, fatigue, bloating, breast tenderness, and food cravings.

PMS is likely caused by changes in hormone levels, as well as chemical changes in the brain. Both can, in turn, cause erratic blood sugars. In addition, changes in appetite, food cravings, and feelings of fatigue can make it more likely that you stray from your eating and exercise plans.

What you can do:

• The severity of PMS can vary from woman to woman. If your symptoms are severe, talk with your doctor about medicines that can help, including birth control pills.

• If you take insulin, you may need a temporary increase in your dose during this time to help keep your blood sugars in a healthy range.

• Try to establish a regular physical activity routine, including aerobic (cardio) exercise, as well as resistance or strength training.

• Choose healthy foods, and limit salty or sugary foods, caffeine, and alcohol, which can worsen symptoms.

• Get enough sleep (at least 8 hours each night).

• Find ways to better cope with stress, including exercise, journaling, yoga, meditation, or massage.

• Dietary supplements, such as folic acid, vitamin E, vitamin B6, magnesium, and calcium may help relieve symptoms, as can certain herbal supplements, such as black cohosh, chasteberry, and evening primrose oil. But check with your doctor first before taking any of these.

A few days before your period starts, you may notice that your blood sugars are higher (maybe even much higher) than usual. Once again, you have estrogen and progesterone to thank for this. In general, the balance of these hormones prior to menstruation increases insulin resistance, although some women notice the opposite effect: increased insulin sensitivity. If you have Type 1 diabetes, you may notice that your periods last longer and your flow is heavier than women who don’t have diabetes.

Higher blood sugar levels can increase the risk for developing a yeast infection, too.

• One of the best ways to deal with monthly blood sugar fluctuations is to track them. In other words, keep tabs on your cycle and how your blood sugars respond. A calendar or a journal can work, and yes, there are apps for this. Check out Clue, Period Tracker, or Glow. Figuring out patterns may take a few months.

• If you’re particularly plagued by swings in blood sugars, consider using a continuous glucose monitor (CGM). A CGM measures glucose levels in real time throughout the day and night, providing readings at any time and helping you and your health-care team spot trends. CGMs are generally covered by insurance for most people with Type 1 diabetes, and are starting to be covered by some plans for those with Type 2. Professional CGMs are also available through your provider to wear for a few days to help you get a better picture of your blood sugars.

• Once you identify the “nuances” of your cycle on your blood sugar, check with your provider or diabetes educator about actions you can take. If you take insulin, for example, you’ll likely need to increase your dose. By how much and for how long will depend on your cycle. If you have Type 2 diabetes and are not taking insulin, it’s possible that you’ll need a medication adjustment (if you take diabetes pills, for example).

• Focus on lifestyle adjustments, as well — physical activity, cutting back on carbs, dealing with stress and cravings, and getting enough sleep can help.

Perimenopause and menopause

The “change of life” is a bittersweet time for most women. Dealing with emotional and physical changes can be challenging, as can managing diabetes. The time leading up to menopause (perimenopause) involves unstable levels of estrogen and progesterone; as a result, you may be dealing with an increase in both insulin sensitivity and insulin resistance. In addition, many women find that they gain weight before and during menopause. Weight gain can occur because of hormonal changes, but also due to a change in muscle mass and lifestyle factors. Weight gain can, in turn, cause higher blood sugar levels. To top it off, hot flashes and night sweats can make it harder to manage blood sugars. On a side note, perimenopause and menopause cause a drop in estrogen, which raises the likelihood of urinary tract infections (UTIs) and yeast infections.

• Checking your blood sugars regularly (maybe more often than usual) is a key step in identifying patterns and trends. This information can help you and your provider make decisions about tweaks to your diabetes treatment plan. As mentioned above, using a CGM can be helpful, as well.

• Talk with your provider about ways to manage menopausal symptoms, including hot flashes and night sweats. Weigh the risks and benefits of using hormone replacement therapy (which are the same for women with and without diabetes), as well as non-hormonal therapies (which also have risks and benefits).

• Consider using an app to help you track symptoms and come up with a treatment plan. MenoPro, myPause, and Menopause View are a few to check out.

• Be prepared for other health issues that can appear at this time, such as heart disease, osteoporosis, urinary incontinence, and changes in sexual function. Keep up with regular provider appointments and exams to help catch and treat problems early on. Ask your provider about cholesterol-lowering medications, if necessary, as well as medications to prevent osteoporosis.

• Focus on establishing a healthful eating and physical activity plan. Your calorie needs will likely drop, along with muscle mass. Changing how much, when, and the types of foods that you eat can prevent or minimize weight gain. Staying active helps you maintain your muscle and bone mass, manage your weight, and better cope with stress and other emotional aspects of menopause.

Want to learn more about diabetes and menopause? Read “Menopause” and “Diabetes and Hot Flashes.”

How You Can Help Your Child

The changes of puberty and diabetes management can be a lot for a kid to handle, so your child will need your help.

Because his blood sugar and insulin needs will change during puberty, he’ll need to test and track his blood sugar regularly. That will help his doctor look for trends and figure out the best insulin plan. It’s important to find the right routine because growth hormones make it harder for children’s cells to use insulin.

The problem is that kids in puberty are also dealing with changing social lives, mood swings, and more independence. That can mean that managing diabetes slips lower on their list of priorities. To help him stay on track:

  • Try to get him involved in his diabetes care early on. The more he understands about how insulin works, why things are changing, and why it’s important to manage his blood sugar, the better he’ll be able to handle the condition on his own.
  • Explain that it’s still important for him to pay attention to his health. If his blood sugar is too high or too low, he might not be able to do the things he wants to do.
  • Help your daughter understand that sharing her blood sugar logs with you can help you and her doctor make it easier for her to manage her diabetes during her period.

If there are any sudden, unexplained changes in your child’s blood sugar, call the doctor. It might be time for everyone to sit down and come up with a new diabetes plan.

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