T1D in Women

Men and women face different challenges managing type 1 diabetes (T1D). Issues women may need to consider include: 

  • Menstruation 
  • Contraception 
  • Sexuality 
  • Pregnancy 
  • Body image and weight management 
  • Menopause 
  • Osteoporosis 

Menstruation 
We all know how powerful hormones can be in controlling menstrual cycles, so it’s no surprise that they can also affect blood glucose levels. These changes are due to two hormones, estrogen and progesterone. When these hormones are at their highest level just before your period, they affect insulin, which may cause blood glucose levels to rise. 

Some women with T1D find their blood glucose rises considerably, while others do not notice a difference. In others, blood glucose levels are lower before and during their periods. You need to discover your own pattern so you can adjust your insulin accordingly. Often it is the fasting blood glucose before breakfast that tends to fluctuate the most. Also, being physically active the week before your period can help control fluctuations in your blood glucose levels. 

Contraception 
Birth control is an important issue for women with T1D because there are greater risks for themselves and their baby when pregnancy is unplanned. The contraceptive options for women with T1D are the same as for any woman, and are based on individual preferences. The effectiveness of various birth control options is the same for women with or without T1D. 

It used to be that women with T1D were advised to avoid taking the birth control pill because of an effect on blood glucose and the risk for heart disease and stroke. However, changes to the level of hormones in the pill in the last few decades have greatly decreased the risk of these problems.

In the past, there was concern that Intra Uterine Devices (IUDs) might pose an increased risk of pelvic infection or trauma to the uterine wall, and that women with T1D might be particularly vulnerable to these infections. The new generation of IUDs appears to be safe in this respect. Using a diaphragm does not affect blood glucose levels, but there may be an increased risk of yeast infections for women who have T1D. Speak with your doctor and diabetes educator about suitable contraception options. 

Sexuality 
Living with diabetes can influence your sexual experiences, both physically and emotionally. Your sexual health is important to your overall health, and it is important that you discuss any concerns with your doctor and diabetes educator. 

Infections 
Vaginal infections and urinary tract infections are more common in women with diabetes, especially in those whose blood glucose is generally too high. Vaginal infections, such as yeast infections, can lead to itching, unusual discharge, and pain during intercourse, but they are easily treated. A urinary tract infection can lead to cloudy or bloody urine, a burning sensation, and/or a constant feeling that you need to urinate. This should be treated immediately to decrease the chance of subsequent kidney infection. Your doctor will prescribe an antibiotic and your pharmacist can provide over-the-counter remedies to reduce any associated pain.
 
High blood glucose 
Persistently high blood glucose levels can influence your energy level and cause significant fatigue. Unsurprisingly, this in turn may decrease your interest in sex. Achieving a good blood glucose level can improve mood and libido.

Reduced lubrication 
After having diabetes for many years, some women experience a complication called neuropathy (nerve damage), which can reduce vaginal lubrication. This can make sex uncomfortable. A decrease in or lack of lubrication can occur for many other reasons such as menopause, the use of birth control pills, and stress. Water-based lubricants are effective in improving dryness and sensitivity. For severe dryness, a vaginal suppository can be used. 

Pregnancy 
In the past, women with T1D were discouraged from becoming pregnant because they faced increased risk of complications, including miscarriage, stillbirth, and birth defects. Thankfully, this is no longer the case, and women with T1D can expect to have a healthy baby. The key, as with all aspects of T1D management, is planning. Women with T1D must plan their pregnancies and be prepared to put in a little extra work during pregnancy to ensure a healthy baby. You will need support from a team of health professionals, who will help you plan a healthy pregnancy.
 
During pregnancy and birth 
Pregnancy can present some particular challenges for women with T1D. Achieving very tight blood glucose control throughout your pregnancy can be extremely stressful and demanding. Your insulin requirements will change as you battle morning sickness and your pregnancy progresses. You might find your usual early warning signs for hypoglycemia change or disappear completely. Persevere though— it will be worth it! Seek the support and understanding of family, friends, and your health care professionals.
 
You will need to visit your endocrinologist and obstetrician more regularly than women without T1D. Your doctor will provide you with a schedule of check-ups and tests. Certain complications are aggravated by pregnancy (e.g., nephropathy and retinopathy). Your doctor will closely monitor you during pregnancy. 

The growth of your baby also needs to be closely monitored. Babies of women with T1D are at risk of developing a condition known as macrosomia, which means large body. If your blood glucose level is high during pregnancy, extra glucose crosses the placenta. Your baby will produce its own insulin from around 15 weeks into gestation. The extra glucose stimulates your baby’s pancreas to make increased levels of insulin. This, in turn, makes the baby grow faster and store extra glucose as fat. The baby may also have problems with low blood glucose levels at birth as it continues to make extra insulin for a day or two. Keeping your blood glucose levels within target will significantly reduce the risk of these problems occurring.

There is no reason for you not to expect a normal birth. Many women with T1D carry their baby to full-term and go into labour on their own. Some women are advised to have their baby early for various reasons, including diabetes control or the baby becoming too large. Most women with T1D have a vaginal delivery, although they have a slightly elevated chance of having a Caesarean section (C-section), compared to women without T1D. You will be able to discuss all options with your obstetrician and make a plan for your baby’s birth toward the end of your pregnancy. 

If you wish to breastfeed, there is no reason why you will not be able to do so. You will just have to watch for fluctuations in your blood glucose levels. 

Body image and weight management 
Many factors affect our body image, and one of them is the presence of an illness. In diabetes management, the constant focus on diet and weight management can also impact body image. Weight and diabetes are intertwined. 

Some women find administering insulin causes significant weight gain, while others find weight gain difficult to achieve, particularly when blood glucose is elevated. 

Sometimes our lifestyles are unhealthy because of the time demands we face in our daily lives. Sometimes we use food to relax, for comfort, or to help us cope with negative feelings such as anger, boredom, fear, loneliness, or a sense of inadequacy. 

If you struggle with maintaining a healthy weight, it may be helpful to separate the issue of how much you weigh from the behaviours you want to adopt to stay healthy. It may help if you work with a dietitian to develop a plan of action that will help you stay healthy. Then try to focus on the plan, and not just your body size. Are you able to meet your goals for eating and activity? Let this be the measure of your success, not how your body looks. 

You may feel you need more help and support to deal with these concerns. It can be useful to have professional counseling to help you examine the barriers to your health, and how you can change your thinking and behaviours. If this is the case for you, talk to your doctor or health care team and ask them to recommend a therapist to help you resolve some of these issues. 

Menopause 
Women with diabetes may experience menopause earlier than other women. Like menstruation, menopause will cause your hormone levels to change and this can also cause blood glucose levels to fluctuate. In fact, hypoglycemia can be one of the first signs of menopause for a woman with T1D. In the years leading up to menopause, surges and reductions in estrogen and progesterone can affect women in various ways, such as mood changes, increased premenstrual syndrome (PMS) signs, menstrual periods that are more or less frequent, and heavier or lighter blood flow during menstruation. For some women, the hormonal changes are scarcely noticeable; however, for others, fluctuations in blood glucose levels can mean that they need to test more frequently and adjust their insulin. 

One of the major difficulties is that some symptoms of diabetes and menopause can be very similar. Both menopause and low blood glucose can cause dizziness, elevated body temperatures, moodiness, and short-term memory loss. High blood glucose, like menopause, can cause fatigue. The only way to tell if your symptoms are diabetes-related or menopause-related is to test your blood glucose. 

During menopause, it is important to maintain an active lifestyle. Some women stop exercising and begin to gain weight, which in turn affects their ability to absorb insulin and control their blood glucose. Sometimes, during menopause, women find they have negative side effects, such as vaginal dryness, an increase in yeast infections, and urinary tract infections. See your doctor to discuss how you can manage these side effects with possible hormone replacement therapy or changes to your insulin regimen.

The key to staying healthy after menopause for women with T1D is the same as for women without T1D. Try to eat regular, well-balanced meals; stay as physically active as possible; have regular check-ups with your doctor; and ensure that you manage your diabetes as well as you can. While there may be times when you ignore some (or all) of these recommendations, remember that it’s what you do most of the time that counts.

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