hormones and girl stuff

It's hard work being a woman.  But you already knew that. Thanks to our lovely ovaries, we have an extra little gremlin to battle in the diabetes stakes.  Unless you had a very cool, probably female, endocrinologist or educator who diagnosed your diabetes, girl stuff and how diabetes affects it probably wasn't mentioned.  Reality Check to the rescue!

What do hormones have to do with diabetes?

Insulin is a hormone!  And the clever thing about hormones is that they interact with everything and anything, and each other, going up and down in response to the millions of processes which go on inside our bodies every minute. 

There are several hormones that are released at different times through all women's menstrual cycles.  For women with diabetes, these hormones will interact with the insulin we are injecting or pumping and therefore might affect our blood glucose levels. 

Is there a regular monthly pattern?

Everyone is different but a common pattern is that 3-5 days before our periods start, our body becomes resistant to the insulin that we are injecting or pumping.  This is caused by the high estrogen levels produced at this stage of our menstrual cycle.  Many women find that for a few days before their period, blood glucose levels are high; we have what's called "insulin resistance" at this time. 

As you start to bleed a few days later, and the estrogen levels drop away, many women's blood glucose levels will drop, sometimes quite dramatically.  Be very careful to look out for hypos on the first day of your period.

How do you deal with it?

It is a bit tricky to manage at first.  Different women can have very different experiences: some hardly notice it at all and others have quite dramatic highs and lows through their cycle.  But you will generally find that you have your own pattern that is the same or similar for you each month.  By keeping a note of blood glucose levels a week either side of your period for about three months, you can generally identify a pattern and then, if you need to, work with your endo or educator to adjust your insulin doses to work around this pattern.  Some women find that hormonal contraception, such as the Pill, can be very helpful to counter the hormones causing rises and falls in blood glucose levels, even if you don’t need it for contraception.

What about contraception?

There is no single method of contraception perfect for everyone. The same warnings and conditions apply for contraception as for all women. 

If you identify wild swings in blood sugars, or any irregularities with your menstrual cycle, you may wish to see a gynaecologist who specialises in treating diabetic women.  

Some women find that altering the type of contraceptive pill they take, or starting on a pill or one of the newer forms of injected or implanted contraception, can provide some hormones that "smooth out" the effect of their menstrual cycle on their blood glucose levels.  Even if you’re not wanting or needing to take the Pill for contraceptive reasons, the hormones in various types of hormonal contraception can help to moderate other hormones your body releases through your monthly cycle.   It's worth investigating.  Chat to your endo or educator.

... and Babies?

Women with diabetes can have healthy babies.  But you need to know that pregnancy for women with diabetes is considered high risk.  You have an equal chance of having a healthy baby if you become pregnant at a time when your diabetes is tightly controlled and general health is good.  It is highly recommended that women with diabetes plan their pregnancies. 

There are specialist diabetes and pregnancy clinics at all major women's hospitals in Australia.  You can attend these clinics while you are planning a pregnancy, as well as during your pregnancy. You will see both diabetes specialists and obstetricians who specialise in working with diabetic mothers.   

For more information about diabetes and pregnancy:

Can I have a healthy baby? Free booklet available by emailing kate@realitycheck.org.au or phone Renza on 03 9667 1732.
Visit www.realitycheck.org.au/babies.htm for a download of the booklet, and many women with diabetes' stories of pregnancy.

Thanks to Dr Jennifer Conn, consultant endocrinologist at Royal Women's Hospital, Melbourne for her assistance in preparing this information. <

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