Special Issues For Women
Feeling as if you're in a permanent state of PMS even if you're well past menopause? The hormonal tides of puberty, pregnancy, menstruation, and menopause are each yet another seismic force to contend with as you try to maintain balance and control of your diabetes. Remember that treatment is not a static thing; "adapt, adapt, adapt" will be your motto as you move through the stages of diabetes care.
At Pubetry
The barrage of hormones, social turmoil, fashion crises, and other adolescent dramas that spells puberty can also spell trouble for your teen's (or preteen's) diabetes control. Issues of poor self-image and of wanting to fit in with peers by acting and eating as they do may raise glucose levels, either through noncompliance with treatment or as a stress response. Hormonal changes, which magnify all of the preceding and can increase the need for insulin, compound the problem. Girls going through puberty will have an increased need for insulin as estrogen and progesterone production rev up with menarche . The peak age for type I diabetes diagnosis for girls is between the ages of ten and twelve, when puberty is often in full bloom.
At Risk For Eating Disorders
Eating disorders are more than twice as common in teenage girls with diabetes than those without. Girls with eating disorders may skip their insulin dosage a practice called insulin omission in an effort to lose weight. They are also at a higher risk for developing diabetic ketoacidosis (DKA) and poor overall control (as measured by Alc levels). •
Diabetes And Menstruation
If you are a premenopausal woman with diabetes, you may notice a rise in blood glucose levels as your menstrual period draws closer. The rise in estrogen and progesterone levels that occurs toward the end of the cycle (about a week before menstruation) can increase insulin resistance, causing a rise in glucose levels. In other women with diabetes, this hormonal change may actually increase insulin sensitivity, triggering lower blood sugar levels. And in the true one-sizefits-none nature of diabetes, some women may experience no changes at all. Tracking your glucose levels throughout your monthly cycle can help you understand if hormones are having an impact on your diabetes control (yet one more thing to keep in your blood glucose log). Discuss your results with your doctor. Adjustments in medication, insulin, exercise, and diet may be necessary to bring your glucose levels back to normal during this time.
Pregnancy: Treatment For Two
Having a baby is not a decision to be entered into lightly for anyone. For women with diabetes, the decision may be even more difficult because of the demands placed on their body, the necessity for painstaking control before and during the pregnancy, and the potential for developing or worsening diabetic complications in the process. Some complications of diabetes, including retinopathy, nephropathy, and neuropathy, can get worse in pregnancy. Your doctor will counsel you about your specific risks as part of preconception planning. Tests that may be ordered during preconception planning include:
- Thyroid
- Kidney function (serum creatinine, twenty four hour urine)
- Comprehensive eye exam
- Cardiovascular screening