Managing type 1 diabetes and the menstrual cycle

At first glance, it seems like managing type 1 diabetes (t1d) is all about what you eat — but it's not that simple. For those in the know, it's obvious that many factors can affect blood glucose levels.

One such factor that's frequently unpredictable involves hormonal shifts. For those who menstruate and live with t1d, the monthly cycle can cause frustration alongside variability. While puberty and menopause can bring their own challenges, the in-between years require an understanding of how to manage t1d and the menstrual cycle.

Observing the impact

Throughout the 21-35 days of one's menstrual cycle, hormone levels typically ebb and flow, impacting blood glucose levels differently in each phase. There are four phases of each cycle: menstruation, follicular, ovulatory, and luteal phases. The four hormones that fluctuate in each phase (progesterone, estrogen, luteinizing hormone, and follicle-stimulating hormone) can create resistance to insulin, similar to how cortisol might cause a sustained blood sugar spike on a stressful day. Hormonal contraception is another related factor that can contribute to increased insulin resistance.

Many women experience premenstrual syndrome (PMS), a series of symptoms that can crop up a week or two before their period begins. During this time, it's not uncommon to deal with mood swings, cravings, an increase in appetite, and fatigue. These hormonal changes can also cause breast soreness, bloating, cramps, and gastrointestinal discomfort, among other issues.

Knowing how to prepare

Preparing to deal with hormonal changes can help soften the impact on managing type 1 diabetes. Here are a few things you can do to stay aware and prepared throughout your cycle:

• Track your cycle. You can make this as simple as writing down the notable days throughout the month, or use period-focused apps that can help you be more mindful of what's going on inside your body. While most women use these apps to either aid conception or prevent pregnancy, women with t1d can also benefit from layering their continuous glucose monitor (CGM) data over the information about the hormones. Especially when in the specific phases of the cycle, the data can help observe the overall impact and inform management decisions.
• Anticipate your needs. Your insulin will likely need adjustment at some point during your menstrual cycle. If you appear to be dealing with increased insulin resistance, you'll need to develop a plan to increase your dosage. Your care team can help you determine whether more long-acting insulin or higher basal is needed, perhaps in addition to changes in your insulin to carb ratio. Meanwhile, insulin pump users can set up and save a special setting profile that meets the needs of their menstrual cycle.
• Support your well-being. Other lifestyle factors, including diet, sleep, stress management, and physical activity, can all have an effect during a menstrual cycle. For example, on one hand, cravings for foods that are high in carbohydrates are common before and during menstruation. On the other hand, it may be a bigger struggle to manage blood sugar while eating a large number of carbs during a period of insulin resistance. Finding balance in food choices is one way to manage the challenges of hormone fluctuations.
  
• Can we also add a bullet point here about mental health and the menstrual cycle and how to manage alongside t1d? For ex: some women get PMDD which can cause more severe mood swings and even depression symptoms. This may be extra challenging alongside managing t1d, lows, etc.

Riding it out

Like everything else about managing type 1 diabetes, the way your body experiences the menstrual cycle will ultimately be unique to you. Your body's reaction to the hormonal changes of your cycle may even vary from month to month.

During these times, listen to your body, make adjustments as needed, and remember that your care team is there to help if you're not sure how to deal with potential issues that come up during your cycle. Although you might not know many other people in your exact situation, you're certainly not alone. Don't hesitate to reach out for assistance and support when you need it.

Did you know that estrogen and progesterone aren't the only hormones that can affect your approach to diabetes management? Learn more about hormonal changes and blood glucose fluctuations from the Edgepark Health Insights blog.