WRITTEN BY: Dr. Apoorva Gomber, MBBS, MD
How it works
Living with diabetes can often result in high blood sugars during different phases of the menstrual cycle. Personally, I face many challenges and exacerbations in my blood sugars weeks before my periods. And I have heard so many young women complain about glycemic difficulties during their cycles especially during the pre-menstrual syndrome (PMS) phase.
A regular menstrual cycle has different cyclical phases usually ranging between 21 to 35 days and often varies. It is best measured by the number of days between your periods. Commonly, most have a regular cycle of 28 days which includes 3-4 days of menstruation (periods). During a month-long cycle, hormonal fluctuations results in ovulation and then menstruation. These hormonal fluctuations can affect other body systems aside from the reproductive system. Those living with diabetes may experience some unique menstrual challenges as a result of these complex hormonal interactions.
Blood sugar levels are often difficult to control at different times of the month. I often get frustrated chasing my blood sugar graphs on a continuous glucose monitor weeks before my periods — sometimes a few days to over a week. Despite taking high doses of insulin, I feel unsuccessful when I can’t achieve the levels I want. This lack of control is a real thing and I’m sure I’m not alone.
All about the hormones
There are a series of hormonal changes during our menstrual cycle and the cyclical surge and downfall of certain hormones determines the process of ovulation. After ovulation, which usually occurs around the 13-15th day of your cycle, there is an increase in the levels of the hormone progesterone . The progesterone levels are naturally higher during the second half of the menstrual cycle and are responsible for relative insulin resistance. This physiologic response is known as luteal phase insulin resistance .
Various studies have explored the link between progesterone and insulin resistance. Changes in estrogen and progesterone levels can induce a temporary phase of insulin resistance that can last for up to a few days before dropping off. Most females complain of increased insulin requirements to combat this resistance and then find themselves running high.
So how do you overcome it? It’s hard – there’s no doubt about it! I also suffer from similar challenges brought on by premenstrual insulin resistance and I am always altering basal requirements on my pump. Some days, the resistance is so stubborn that I have to double my usual dose. First thing’s first: it’s important you discuss this with your gynecologist and get a work-up to check for a condition often seen among people with diabetes called polycystic ovarian syndrome (PCOS) .
Everyone has a different experience during this phase, and some are able to manage their insulin requirements well, but other just can’t. Do not beat yourself up about it! Once the hormone levels fall back into range and that storm subsides, your insulin sensitivity improves. I often try to exercise and do some form of relaxing activity to manage this stressful time.
Irregularity + moodiness
Irregular cycles are another common complaint among those living with diabetes. The reproductive years are the years between your first period, also called menarche, and the onset of menopause, which is the time periods stop. If you are living with Type 1 diabetes you are likely to experience a slightly shorter span of reproductive years compared to people without diabetes. It has been suggested that more than one third of teenage girls with T1D will have irregular menstrual periods.
With better glycemic control and good planning with your doctor, women living with diabetes can have a normal planned pregnancy if they want to.
Coping with mood swings & periods is another necessary part of this whole thing. Different stages of the menstrual cycle may have different effects on your blood glucose levels. Mood swings and the effect can also vary from person to person and from month to month.
PMS makes some people feel moodier than usual and others bloated and achy. For some, it causes intense mood swings that interfere with daily life. While research estimates about 75% of women experience PMS during their reproductive years, only 3 to 8% develop severe depressive symptoms and anxiety.
Blame the serotonin!
Changes in estrogen and progesterone levels also influence serotonin levels. Serotonin is a neurotransmitter that helps regulate your mood, sleep cycle, and appetite. Unfortunately, low levels of serotonin are linked to feelings of sadness and irritability.
So how do you combat this?
- If you don’t already, start keeping track of your menstrual cycle and your emotions throughout its different stages.
- Supplementing with Vitamin B-6 might also help with PMS symptoms.
- Eat foods rich in Vitamin B like fish, chicken and turkey, fruit, and fortified cereals.
- Several lifestyle factors also seem to play a role in PMS symptoms like regular sleep, exercise and adequate nutrition.
- If other treatment options aren’t helping, taking an antidepressant especially Selective Serotonin Receptor Inhibitors (SSRI) may help, but talk to your doctor to figure out the best course of action.
- Hormonal pills are another possible option.
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. There are various forms of contraceptive pill available and most of them increase your body’s insulin resistance, making it harder to control your blood sugar. In general, it is considered safe to use these methods if you have diabetes, but it’s important to be aware that using a hormonal contraceptive may change your glycemic control. Make sure to pay extra attention to your blood sugar when you are starting or changing your hormonal contraceptive method.
It’s a good idea to start tracking some important things. Here is a list of some essential things to track via apps or a journal :
- Cycle length
- Period length and heaviness
- Blood sugar levels
- Any other symptoms you might be concerned about
For more detailed discussions regarding managing diabetes and your menstrual cycle, get in touch with your endocrinologist and gynecologist.