It is common for women with type I diabetes to have difficulty with blood glucose control during the week prior to their menstrual period, with glucose levels being either higher or lower than usual. This problem seems to be more prevalent in women who say they suffer from the symptoms associated with premenstrual syndrome (PMS).
The culprits appear to be the female hormones estrogen and progesterone, although the reason they have this effect isn't entirely understood.
During the first half of each cycle, levels of these hormones are relatively low. During the second part of the cycle, after ovulation, estrogen and progesterone levels increase, causing the lining of the uterus to thicken in preparation for nourishing a fertilized egg. If fertilization does not happen, the ovary stops making these two hormones, and their sudden loss causes the uterus to shed the lining that is not needed; this shedding is known as menstruation.
Some investigators believe that in some women, high levels of progesterone leads to temporary insulin resistance, with insulin less able to bind to receptor proteins on the surface of cells, causing higher than normal blood glucose levels, while in other women, high estrogen levels increase insulin sensitivity, leading to blood glucose levels that are lower than normal. Other researchers believe that it is the bloating, water retention, irritability, depression and cravings for carbohydrates and fats typical of PMS that are to blame for blood glucose control gone out of whack.
To see what effect your menstrual cycles may be having on your blood glucose control, check your daily blood glucose charts over the past few months, marking the day your period started each month. Then see if there is a pattern--for example, blood glucose levels that are consistently higher or lower than normal during the week before your period. (If you are not recording your blood glucose levels, why not start now!)
There are some measures you can try if you find a relationship between poor blood glucose control and your menstrual periods.
If you think your abnormal blood glucose readings may be due to PMS, first try to address your PMS symptoms: Stick with your meal plan and eat at regular intervals as much as possible; limit salt intake (salt contributes to bloating), and cut back on alcohol, chocolate and caffeine, which can affect not just your blood glucose level but your mood as well. And keep up your regular exercise to help reduce mood swings and weight gain.
Even after addressing PMS symptoms, you may still need to make changes in how you handle food, exercise and even medication in the days prior to your period in order to achieve good blood glucose control. It is best to make one change at a time, so you will know which adjustments are most effective.
If your blood glucose levels tend to rise before your period, add some extra exercise to your daily routine, avoid eating extra carbohydrates, and talk to your doctor about temporary, gradual increases to your insulin dose. (You will need to work closely with your doctor to adjust the dosage so it is right for you.)
If your blood glucose levels tend to be too low before your period, you can try reducing your exercise and increasing your carbohydrate intake (with healthy, not junk, foods). You may also want to talk to your doctor about a temporary, gradual decrease in the amount of insulin you take.
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