The Practical Aspects

Diabetes & Menstruation: Need For Care

The Background

Over quite a long period of observation, it has been found that for women with diabetes, have difficulty with glucose control during the week prior to their menstrual period. In such conditions, their blood glucose levels could either be a little higher or lower than the normal. This is often referred to as a premenstrual syndrome (PMS).

Studies have shown that the levels of these hormones during the first half of each cycle are relatively low. On the other, estrogen and progesterone levels increase during the second part of the cycle, after ovulation. This leads to a thickening of the uterus lining in preparation for nourishing a fertilized egg. In the absence of an ovulation, the ovary stops the production of these hormones resulting in the shedding of the lining, which is no more needed. This is what is called menstruation in medical terms.

As mentioned above, clinicians have reported that it is not uncommon for some women to experience hyperglycaemia just before and during the menstrual period. It could be characterized by higher insulin sensitivity and lower insulin requirements. The inherent risk in such conditions is that poor glycaemic control may result in irregular menses. Fortunately enough the cycle tends to be normalized when glycaemic control is improved.

The Underlying Factors

The underlying reason for this anomaly seems to be female hormones estrogen and progesterone. Although such speculations do the rounds in medical circles, the whole operating mechanism is yet to be understood.

One theory, which tries to explain the PMS, says that the increased levels of progesterone cause increased insulin resistance and subsequently, hyperglycemia. Mostly, women report an increase in blood sugar during the menstrual period, a few experience hypoglycemia. Doctors speculate that it could be the high levels of estrogen that is causing increased insulin sensitivity.

One other frequently given explanation is that the increased appetite that accompanies PMS causes elevated blood sugars. Women might have increased appetites and cravings during the days immediately before menstruation but experts argue that this cannot be the sole reason for premenstrual hyperglycemia

Some investigators believe that it is the bloating, water retention, irritability, depression and fats typical of PMS that are to blame for erratic blood glucose control.

Managing It

Doctors often suggest that it is important to check the effect of menstrual cycles on your blood glucose control. The easiest way to do this is to check your daily blood glucose levels over a few months, then compare this with the days of your periods in each month. Look for a pattern that might point to consistently higher/lower blood glucose levels during the week before your period.

Once such a relationship is found, it is important to take measures to address this undesirable condition. A couple of simple things that anybody can do are described below.

• Try, as much as possible to stick to your meal plan
• Eat at regular
• limit salt intake (salt contributes to bloating)
• Cut back on alcohol, chocolate and caffeine (These can affect not just your blood glucose level but your mood as well.
• Keep up your regular exercise to help reduce mood swings and weight gain.

Preventive Measures

It is quite possible that you might need to make changes in your eating habits, even after addressing PMS symptoms. Exercise in the days prior to your period for better glucose control is an effective way of preventing PMS. One aspect that must be kept in mind is that you should make only one change at a time, so that you will know what adjustments are having what effects.

Suppose the blood glucose tends to rise before your period then do a bit of extra exercise, control your food intake and in consultation with your doctor consider temporary, gradual increases in your insulin doses. The last mentioned step has to be taken cautiously after talking to your doctor and discussing your problems.

On the other hand, if the blood glucose tends be lower than normal before your period, then try cutting down on your exercise routine and increase your food intake. Similarly, you should consult your doctor about a temporary, gradual decrease your insulin doses.