I started my period today.
I know it’s not polite conversation to talk about such things, but diabetes doesn’t really give two hoots about polite conversation, does it? It affects everything, including something that is already painful and annoying enough as it is.
Over the years, I’ve seen a lot of questions pop up in the diabetes community about whether or not women have issues with their blood sugars around their period. And the answer is: hell yes it does.
For the most part, the pre-period hormones, progesterone and estrogen, can cause insulin resistance during the week to 10 days before the period starts. Personally that’s when I noticed my blood sugars going up the most and it’s a fairly consistent pattern. One study at the University of Buffalo positively identified progesterone and estradiol as impacting insulin resistance. However, anecdotally I’ve heard of some women who deal with low blood sugar before and during the period, but I’m not entirely sure what would cause that because biologically, hormones cause insulin resistance (seen most commonly in the dawn phenomenon).
One thing I have found helpful is tracking my menstrual cycle using an app called Period Tracker (I use the Lite version). I enter when I start and stop my cycle, and the app predicts based on my previous cycles when I should start the next one. It allows you to track a few things, like your symptoms, as well as your fertility (if you’re trying for a baby). I haven’t spent much time tracking my insulin resistance or other PMS symptoms using the app, but I imagine it could be helpful to see how far in advance you typically start having issues so you can be on the lookout. You can set the app to remind you when your period is about to start, so having the head’s up could be useful.
Right now, my app is set to alert me four days before I’m due to start my period so I can be on the look-out for any suspicious rises in blood sugar. I haven’t really tracked when my insulin resistance typically starts, but observationally I haven’t noticed any consistency. If I notice unusual high blood sugars, then I’ll check the app to see how far out I am. If it’s a week or so before my period, I attribute any strange blood sugars to my cycle. But if it’s more like two or three weeks before, then I know it’s something else. Most of the time my insulin resistance will go away the day or so before my period starts, but typically I noticed things calming back down after my period actually starts.
To deal with the insulin resistance, I’ve tried a combination of things. I’ve used temp basal rates, usually about 30 to 50% more, but I usually end up tanking after awhile. There are a lot of mountains and valleys! Something I’ve noticed more recently is that my insulin-to-carb ratio and my correction factor needs tweaking, as my blood sugar will not come down with a correction or it will go up after a meal and not come down all the way.
Unfortunately, Omnipod doesn’t allow me to have various pre-set insulin-to-carb ratios or correction factors, so I tend to be pretty lazy about this. I don’t think any of the other pump companies do this either, but someone correct me if I’m wrong! I end up just being more aggressive with correcting, taking additional units of insulin even when my pump says I have enough insulin on board.
The Diabetes UK website mentions that some women can notice that this phenomenon varies from month to month, and as I mentioned earlier, I have noticed that my hormone levels do not consistently affect my blood sugars. This is one reason that I find the Period Tracker app so useful. I have occasionally started my period without having dealt with any insulin resistance at all. Because it’s not always predictable, it can be easy to get lazy about tracking what’s going on.
Before I started tracking my cycle, I would have days of insulin resistance that felt like a complete mystery because I couldn’t tell if it was associated with my menstrual cycle or not. Now that I’m tracking, it’s easier for me to spot the correlations between my blood sugar and my cycle. I also know that if my blood sugars are going up from my menstrual cycle it means I can leave my normal basal rate alone. It can seem like there are new patterns in blood sugar that need fixing, but in reality it’s just a temporary blip that doesn’t require a complete basal and bolus overhaul.
Although it’s incredibly frustrating, it’s nice to know that if you think your blood sugars are going up before your period, you are not going crazy. Well, you might be going crazy, but that’s just normal PMS. Nothing to do with diabetes (or so we think…).