Wil Dubois

There are plenty of factors affecting the "diabetes rollercoaster" -- and hormones are certainly not the least thereof. Today at our diabetes advice column Ask D'Mine, veteran type 1, diabetes author and community educator Wil Dubois is taking on menopause (no, really!) and how women with diabetes may best be able to navigate that time of life.

{Need help navigating your life with diabetes? Email us at AskDMine@diabetesmine.com}

 

Nicky, type 1 from the U.K., writes: I’ve been experiencing blood sugar fluctuations throughout my cycle for six years now (I’m 52). Low blood sugars for the first half of the month, then once ovulation happens, the levels skyrocket. I’m taking 50% extra insulin at these times, and that doesn’t always cover it. When my period starts, they fall back down again, quite suddenly, and this can be a problem if I’m full of Lantus, particularly when my cycles are unpredictable and can vary between 17 and 40 days at the moment. Neither my GP or diabetic consultant has been able to offer any help. It’s very demoralizing feeling on the back foot all of the time and having to respond when the goalposts keep moving constantly. Wil, can you reassure me that my levels will return to “normal” once menopause is reached?

Wil@Ask D’Mine answers: Well the good news is, that given your age, you should be entering menopause any minute now. And then, yes, things will settle down. Ah… hopefully. Because while that’s apparently true for most women, in some ladies the symptoms leading up to menopause can carry over afterwards and linger on for, well, forever. But before we dig into that, for the sake of the younger women in the audience (and all the male readers) let’s back up and get everyone on the same page about Aunt Flo.

Menopause itself is actually sort of a non-event defined simply as having gone twelve consecutive months with no period. All the “menopausal” symptoms we tend to think of—hot flashes, emotional swings, sleep disturbances, and vaginal dryness—are really symptoms of pre-menopause, officially called perimenopause. Apparently, the symptoms can range from “barely noticeable” to “debilitating;” depending on the woman.

In D-ladies, it’s the ebb and flow of the primary girl hormones of estrogen and progesterone during perimenopause that causes those crazy-ass blood sugars that are often seen during this time in a lady’s life, and that you’ve been seeing yourself. How’s that work? Well, estrogen fuels insulin sensitivity, while progesterone drives insulin resistance, and supplies of both shift like quicksand under your feet during the period leading up to menopause. Right now, from your description, it’s pretty clear that you are in perimenopause (the phase leading up to it), and have been for the last six years. That’s longer than the average four-year period between the “normal” cycles of young ladies and the ovaries closing up shop and retiring forever, but it’s hardly the record-breaker, either. In some women the preimenapausal phase can stretch up to 15 years!

To paraphrase our friend Bennet: Your perimenopause and menopause may vary.

For what it’s worth, the “usual” age for menopause is “late 40s to early 50s,” according to my friends at the famous Cleveland Clinic. And having menopause and diabetes at the same time is charmingly called “A Twin Challenge” by the Mayo Clinic staff. (One has to wonder if a man or a woman wrote that bit.)

Anyway, as you come out of perimenopause and fully into menopause, you can expect to gain weight, you might be moreMenopauseLane prone to vaginal infections than in the past, your bones will be more brittle, your risk of cardiovascular disease increases, and you might have urinary problems. But on the bright side: The hormone surges will settle down, and with them your blood sugars should even out. Will they return to normal as you hope for? No. At least not your old normal. Too much has changed. But a new normal is likely. 

What I mean by that is that I doubt your old settings will work on the far side of menopause. But at least if you are cruising in calm seas, you can create new settings and expect to have the level of diabetes control that you used to have, just with different volumes of insulin, and different delivery and correction ratios. So I do think your future is brighter.

But in the meantime (because, in theory, you could have nine more years of this crap to deal with), and for all you other lovely cougars who are just entering perimenopause, can I suggest an insulin pump? Now there are a lot of good reasons for using a pump and a lot of good reasons for not using a pump, and I’ve tended to flip-flop a lot on this issue over the years, going back and forth on my therapy—but perimenopause is prime pumping.

You mentioned being "full of Lantus" as your period ends, and having epic lows. Well, the fact is that once the Lantus is in, you can’t get it back out. With a pump, however, you can reduce the level of that constant drip of rapid-acting insulin or you can suspend insulin delivery altogether for a time. Sure, there’s still that four-hour tail of action of the end of the last drop of bolus insulin pumped into your body, but that’s still 20 hours of less trouble.

But wait, there’s more. Every pump on the planet is equipped to deal with multiple basal patterns (and some, such as the t:slim, can even handle multiple carb ratios and correction factors tied into the various basal programs). This allows you to create pre-programed pump settings for various phases of your period. In your case, in addition to your “normal” pattern, you’d have a pre-ovulation pattern that would deliver all insulin (basal, bolus, and correction) much less aggressively during that phase of your period, and an ovulation pattern that would deliver all insulin much more aggressively during that phase of your period. You might have a rocky day or two turning the transition between the programs, but you’d be automatically optimized to ride out each phase once you got there.

Of course, the pump is no magic bullet. It won’t make for perfect blood sugars in the face of a hurricane of shifting hormones, but it’s a great tool that can make the preimenapausal battle a little bit easier.

Hey, if the goal posts are going to shift on you, the best play is to keep the goalie in motion. Ummmm…. OK, So I’m better with diabetes than sports analogies, but stay in the game, use the best plays, and you’ll be a winner. I can assure you of that.

 

This is not a medical advice column. We are PWDs freely and openly sharing the wisdom of our collected experiences — our been-there-done-that knowledge from the trenches. But we are not MDs, RNs, NPs, PAs, CDEs, or partridges in pear trees. Bottom line: we are only a small part of your total prescription. You still need the professional advice, treatment, and care of a licensed medical professional.

Disclaimer: Content created by the Diabetes Mine team. For more details click here.

Disclaimer

This content is created for Diabetes Mine, a consumer health blog focused on the diabetes community. The content is not medically reviewed and doesn't adhere to Healthline's editorial guidelines. For more information about Healthline's partnership with Diabetes Mine, please click here.