Women and Hormones
How changes in women’s bodies affect blood glucose
You know that many things can wreak havoc on your blood glucose levels. For women, there’s something that may not be on your radar: your hormones.
“The rise and fall of reproductive hormones at various times in your life can affect your diabetes,” says Andrea Dunaif, MD, chief of the Hilda and J. Lester Gabrilove Division of Endocrinology, Diabetes, and Bone Disease for the Mount Sinai Health System. This is because your body’s two main reproductive hormones—estrogen and progesterone—can affect your blood glucose by changing how your body reacts to insulin. When estrogen levels are high, for example, your cells become more sensitive to insulin. But when estrogen is low and progesterone is high, you can experience insulin resistance—that is, you need more insulin to help your cells take in glucose from the blood. As a result, you’re more likely to develop higher blood glucose.
There are three times when these effects are most pronounced: before your period, during pregnancy, and during menopause. Here’s a look at what’s going on in your body, how that affects your blood glucose levels, and what you can do to smooth that sometimes-rocky road.
Hormonal Havoc: Your Period
The hormonal swings that make menstrual cycles a challenge for any woman can be particularly tough for women with diabetes.
Your cycle starts on the first day of your period. (The average menstrual cycle is about 28 days, but anything between 21 and 35 days is considered normal.) At this time, both estrogen and progesterone are low. Throughout the first half of your cycle, estrogen levels gradually rise, which increases your sensitivity to insulin. As a result, you may notice that your blood glucose is easier to manage or that you’re prone to low blood glucose (hypoglycemia).
But that changes about three weeks into your cycle, when progesterone levels peak. “This hormone impairs the function of insulin, making you more insulin resistant,” says Dunaif. The result: You may require more insulin to keep your blood glucose close to your target range than you did in the weeks prior.
In the last week of your cycle, progesterone levels drop. This can cause PMS-related symptoms, such as irritability and an increased appetite. You may crave refined carbs like cookies and potato chips. Resist the urge to give in—these foods can raise blood glucose levels.
Thankfully, your appetite and mood will stabilize once your next period begins. Your insulin sensitivity will increase then, too.
Tips to Try
Track Your Cycle
If you keep tabs on your blood glucose during your menstrual cycle, you may detect a pattern of higher levels during certain weeks. To do so, log not only your glucose levels but also events during your cycle, such as when you experience premenstrual symptoms or the dates your period starts and finishes. You can use a journal or an app (try Period Calendar, Clue, Glow, Eve, Period Plus, or the iPhone Health app) to help you keep track of your period. Continuous glucose monitors (CGMs) can help you track glucose levels and detect patterns. If you don’t already use a CGM, your doctor may be able to lend you one for a few weeks. Once you know how and when your glucose levels react to hormonal shifts, you can plan for medication or activity changes during certain times of the month.
Tweak Your Medications
If you notice specific patterns—for instance, it becomes harder to manage your blood glucose in the second half of your cycle—talk to your doctor or diabetes educator. If you take insulin, you may need to increase your long-acting and/or mealtime doses.
Get Enough Z’s
More than 50 percent of women report worse sleep either the week before or during their period, according to the National Sleep Foundation. Headaches, cramps, bloating, anxiety, and other period-related discomforts may be the culprit.
Your body temperature is about half a degree higher in the second half of your cycle. That might sound insignificant, but even small changes are enough to trick your body into thinking it’s not yet ready for bedtime, keeping you awake. When you’re sleep deprived, your body pumps out more stress hormones (such as cortisol) to compensate, and that can drive up your blood glucose. Keep your bedroom cool—between 60 and 67 degrees.
Hormonal Havoc: Pregnancy
Early in pregnancy, your body tends to be more sensitive to insulin. Not only that, but even if you have type 1 diabetes, you may actually produce some insulin during the start of your pregnancy. (Yes, really!) Though the immune system destroys most insulin-producing beta cells in people with type 1, pregnancy may suppress this process. The result: You might make insulin, which could lead to lower glucose levels. In fact, you may find that your blood glucose level is going too low, especially if you’re experiencing morning sickness that’s preventing you from eating.
The further along you go in your pregnancy, the more insulin resistant you become. “Pregnancy is essentially a state of insulin resistance,” says Dunaif. “One reason is because your body produces large amounts of progesterone, which causes insulin resistance. But another reason is that the placenta produces a second hormone, placental lactogen, which also triggers insulin resistance.” (Don’t worry: Soon after delivery, your blood glucose levels get back to normal.)
Blood glucose management during pregnancy is crucial. Before you try to get pregnant, be sure your blood glucose is tightly managed. High glucose levels in the first weeks of pregnancy can result in serious birth defects, including those of the heart, brain, spine, and kidneys. High blood glucose increases the risk of premature birth, a large baby (macrosomia, which can lead to complications during delivery), and the chance of your newborn developing breathing problems or low blood glucose levels. Elevated glucose also puts moms at greater risk of preeclampsia, a life-threatening condition that can develop in the second half of a pregnancy and involves high blood pressure and too much protein in the urine (which indicates kidney damage).
Be sure to choose an OB-GYN who specializes in high-risk pregnancies (women with diabetes are automatically considered high risk) and who has experience working with mothers with diabetes.
Tips to Try
Monitor Your Blood Glucose
Your body’s ability to maintain target glucose levels may change multiple times throughout your pregnancy. It’s important to check your blood glucose levels as often as your diabetes care team advises, even if you feel fine. You may also want to ask your doctor about using a CGM. When pregnant women with type 1 diabetes used the device, their blood glucose was more likely to stay in their target range and their newborns were half as likely to develop complications, according to a study published in 2017 in the medical journal The Lancet. Using a CGM “allows a woman to take immediate action when she’s faced with either very high or very low blood sugar,” says Asha Thomas, MD, director of the Division of Endocrinology at the Sinai Hospital of Baltimore.
Adjust Your Meds
Insulin is the first-line treatment for diabetes during pregnancy and is considered safe because it doesn’t cross the placenta, which means the baby won’t get the medication. If you have type 1 diabetes, you’ll probably need to increase your insulin dose, especially during the last three months of pregnancy, when insulin resistance is at its highest. If you have type 2 and are taking another diabetes medication, your doctor will probably have you switch to insulin during the span of your pregnancy, says Thomas.
Focus on Diet and Exercise
“A lot of pregnant women throw healthy eating to the wayside, but if you have diabetes, it becomes even more important that you watch what you eat to help keep blood glucose in check,” says Mache Seibel, MD, a reproductive endocrinologist at Harvard Medical School. Remember, you need to increase your intake by only about 300 calories each day, so focus on foods that will keep you and your baby healthy: fruits, veggies, low-fat dairy products, and lean protein.
And don’t forget to move. Regular physical activity has been shown to help manage blood glucose levels, especially after meals. One Australian review of studies, published in 2015 in the World Journal of Diabetes, found that women with gestational diabetes (a type of diabetes that develops during pregnancy) who exercised regularly during pregnancy better managed their blood glucose and needed less insulin than women who didn’t. Stay safe by running your fitness plan by your doctor. If you’re able, aim for 30 minutes of exercise, such as walking or swimming, most days of the week, plus strength training two to three times a week.
Hormonal Havoc: Perimenopause & Menopause
On average, women go through menopause—marking the end of menstruation—at age 51. The years of menstrual irregularity leading up to it are called perimenopause, a time when levels of estrogen and progesterone fluctuate, which in turn affects blood glucose levels. Many women gain weight during this time, which can increase the need for diabetes medications. Also wreaking havoc: menopausal hot flashes and night sweats. They can keep you tossing and turning, which raises cortisol levels. That, in turn, can impact blood glucose.
Tips to Try
Exercise increases insulin sensitivity, and it may relieve menopausal symptoms, such as hot flashes, according to a study published in 2017 in the medical journal Menopause. Yoga can help, too, suggests a review of studies published earlier this year in Maturitas.
Review Your Medications
If your blood glucose levels are creeping up, you may need to either increase your current diabetes drugs or start taking new ones. Your doctor may also recommend cholesterol-lowering medications such as statins because people with diabetes are at an increased risk of developing heart disease. Hormone-replacement therapy may be an option if your menopausal symptoms are making you miserable. “It also has the added benefit of helping to improve blood sugar control and prevent weight gain,” says JoAnn Pinkerton, MD, professor of obstetrics and gynecology at the University of Virginia and director of the North American Menopause Society. “But there are concerns about raising the risk of heart disease, especially among women with diabetes.” Whether the benefits of hormone-replacement therapy outweigh the risks is something you’ll want to discuss with your health care provider.
Make Sleep a Priority
One drug-free solution to the sleeplessness caused by hot flashes is cognitive behavioral therapy, a type of counseling that teaches coping strategies—such as relaxation techniques—to help promote sleep. Both menopausal and postmenopausal women who used cognitive behavioral therapy showed significant improvements in insomnia two to three months later, according to a study published in 2017 in the medical journal Sleep.