The Menstrual Cycle And Diabetes
Fluctuations in hormone levels occur through the menstrual cycle and these fluctuations can affect blood sugar control. When estrogen levels are naturally high, your body may be resistant to its own insulin or injected insulin. Many women find their blood sugar tends to be high 3-5 days before, during or after their periods.
Since everyone is different, the only way to manage blood sugars in a setting where sensitivity to insulin changes is to test and record blood sugars four or more times a day the week before, during and after your period for at least 2 or 3 months to find your own pattern. This allows you to adjust your insulin doses and carb intake both before and during this time to better control your blood sugar.
Premenstrual symptoms (PMS) can be worsened by poor blood sugar control. It helps to chart your feelings such as tenderness, bloating, grouchiness for a week before, during and after your period. Charting will help you know when your PMS reach their peak during your period so that before your PMS is most severe, you can check your blood sugar more often and take extra insulin or exercise to bring high blood sugars down.
Food cravings during PMS are triggered by an increase in progesterone and can make it more difficult to control your blood sugar. Usually, the craving is for chocolate or sweet foods. Give in to your cravings by trying sugar-free and fat-free versions, such as chocolate pudding. Take extra insulin or increase your exercise to compensate.
You may feel less like exercising during your period. If so, extra insulin may be a good choice for keeping your blood sugar from rising. The extra insulin needed to overcome insulin resistance during this time will not cause weight gain. Treat yourself well during this time and keep your blood sugar controlled as well as possible.
Polycystic Ovary Syndrome or PCOS affects 6 to 10% of women in the United States and is part of the Insulin Resistance Syndrome. Women who have it typically experience two or more of these symptoms: obesity, acne, infertility, irregular menstrual cycles, ovarian cysts, and hair growth on the face, chest, and back. They often have insulin resistance and other features of IRS, or even Type 2 diabetes. While all women produce some male hormones such as androgens and testosterone, women with PCOS typically produce higher levels than normal.
Because many of the symptoms of PCOS can be caused by other medical conditions, PCOS is diagnosed by comparing a person’s history of symptoms and experiences with the results of a physical exam and lab tests. Ovarian cysts may be seen on a pelvic ultrasound and a blood test can be done to measure hormone levels to find out if PCOS is the cause.
PCOS is caused by a blend of genetics and lifestyle factors. Similar to insulin resistance and Type 2 diabetes, PCOS improves with weight loss, exercise, and healthier eating habits. These lifestyle changes are often combined with hormones, insulin-sensitizing medications and sometimes androgen-blocking drugs. These, combined with low-estrogen birth control pills, help bring hormone levels under control, and can improve acne and unusual body and facial hair. Insulin sensitizing medications, such as Avandia or Actos, look promising for approval in the future to treat PCOS. Metformin is useful because it turns off the production of glucose by the liver, and improves insulin sensitivity. Metformin may help weight loss and have the positive side effect of increasing fertility and enabling pregnancy.
Birth Control and Diabetes
There are many forms of birth control available. In general, the choice you make can be based on the same reasons a woman without diabetes would make it. The only difference is the risk for blood clots may increase with Type 2 diabetes and oral contraceptives.
The risk for blood clots also increases if you smoke, don’t exercise, are overweight, are over age fifty, have high blood pressure, or high cholesterol. If you have these risk factors and choose to use an oral contraceptive anyway, be sure to use a low-dose pill and have your cholesterol and blood pressure checked regularly.
Menopause and Diabetes
The major question all women face regarding menopause is whether to take Hormone Replacement Therapy (HRT). Again, the benefits and risks for a woman with diabetes are similar to those for a woman without diabetes. Until recently, a good reason to take HRT was to protect you from heart disease. Recent research suggests that it may not protect you against heart disease so this isn’t a reason to use it alone if you have other reasons not to use it.
Anyone with the following conditions who uses HRT is at some risk of difficulties and should think twice about using it: sickle cell anemia, high blood pressure, migraines, uterine fibroids, a history of benign breast conditions such as cysts or fibroadenomas, endometriosis, seizures, gallbladder disease, a family history of breast cancer, and a past or current history of smoking,
The Sexually Healthy Woman
From simple to serious, all women can have sexual health problems. They occur in women with Type 1 diabetes at about the same rate as women without diabetes and are somewhat more common in women with Type 2 diabetes. Careful diabetes management and good glucose control can help prevent problems such as these:
Vaginal dryness: poor vaginal lubrication can be caused by low hormone levels; blood vessel damage; or nerve damage (which prevents arousal and fluid production). Stress, age, pregnancy, and certain medications can also reduce the production of lubrication. Lubricants are an easy solution. Hormonal therapy may also be appropriate.
Infections: yeast infections (vaginitis) are caused by a fungus, and high glucose in the bloodstream helps it grow faster. If not treated, they can lead to more serious urinary tract infections. These painful, itching infections can be treated with creams and medications. Better blood sugar control is essential.
Vaginal tightness (vaginismus): caused by muscle spasms around the vaginal opening, vaginismus can make it difficult or painful to have sex. “Kegel” muscle-relaxation exercises can help. Practice by tightening the muscles to stop the flow of urine, then relaxing. Use this technique before or during sex.
Trouble reaching orgasm: the above problems can cause painful or uncomfortable sex, making it hard to reach orgasm. Additionally, nerve damage can reduce the pleasure that leads to orgasm. Psychological concerns can also decrease sexual desire. Be sure to mention to your gynecologist or family doctor if you are having problems.
Excerpted with permission from THE MONITOR, A Healthy Lifestyle Journal For People With Diabetes from LifeScan, Inc., A Johnson & Johnson Company, Vol 7/No.3 Summer, 1997