Periods and T1D - 4 things you need to know
Periods and T1D - 4 things you need to know
Periods? Not always fun. From cramps to cravings, irritability to insomnia, periods often throw up health challenges. If you live with type 1 diabetes, this can feel even more complicated to navigate. Maybe you’ve noticed differing insulin sensitivity across the month - maybe you go high before you bleed. Maybe you go low. Perhaps you have long-ish cycles. Maybe you don’t notice any issues at all. Maybe you skip cycles.
If you’re reading this, chances are you’re looking for some expert advice around managing diabetes and your menstrual cycle. I get it. I’ve been there. If you’re new around here, I’m Beth and I’ve been living with type 1 diabetes since I was 9. I run an online clinic helping people with diabetes and their families make life with this tricky health condition a bit easier to manage. Back to periods…
Read on for 4 key things I’d love all t1ds to know!
Periods and t1d both involve lots of hormones
Periods and type 1 diabetes both involve lots of hormones, so it's no surprise our menstrual cycles affect and are affected by our t1d. You might find your blood glucose levels trickier to manage. Lots of clients I work with find that a few days, or a week before their bleed, they’re more resistant and struggling with sticky highs that are hard to shift. Then, once day 1 of their period kicks in (first day of bleeding) they’re more sensitive and struggling with hypos. What the dickens in going on here? I hear you cry.
This is to do with two of our female sex hormones, oestrogen and progesterone, and their relationship to our insulin signalling pathway:
PROGESTERONE rises in the second half of the menstrual cycle (also called the luteal phase). Progesterone can make us more resistant to insulin, cue those sticky highs a few days before your period is due. On day 1 of your bleed, progesterone drops and oestrogen starts to build.
OESTROGEN rises during the first half of the cycle (follicular phase) and typically makes us more sensitive to insulin, cue those hypos during your bleed.
Researchers have described what happens with progesterone and increased insulin resistance as ‘menstrual cycle phenomenon’ (Gamarra & Trimboli, 2023), which is similar to how we’d describe and think about the ‘dawn phenomenon’ (you can read more about that here). The challenge, however, is that there’s such limited research - studies around the menstrual cycle (MC) phenomenon have been underpowered in clinical practice, and the methods to define both menstrual cycles phases and their duration vary from study to study, so it’s hard to gain consensus.
That being said, even if the evidence base requires further robust research, we see a clinical need for lifestyle support, nutrition focus, and insulin dosage adjustment during different phases of the menstrual cycle.
As a reminder, some people find their glucose levels and sensitivity don’t vary across their cycles - that’s OK too.
2. Glucose levels are associated with period variability
Studies show that if glucose levels sit in the target range (usually 4-10 mmol/l) for 70% or more, you may have a more regular menstrual pattern. Spending time outside of the target range is associated with period variability, which might include heavier or longer cycles, or missed periods, or lighter bleeding.
This is because glucose variability impacts how our hormones work - think of the endocrine system as one big orchestra. Every instrument has their place, and they all need to tune up together to make the best sound.
3. Is there a link between T1D and PCOS?
Polycystic ovary syndrome (PCOS) is the most prevalent endocrine disorder in reproductive-aged women. One of the key features of PCOS is irregular cycles or no periods at all, but you might also experience: excess facial or body hair (which is to do with excess androgens), weight gain, oily skin, difficulty getting pregnant, thinning hair from your head.
The cause(s) of PCOS is/are unknown but it’s thought to be linked to abnormal hormone levels, and insulin resistance.
Latest research indicates that the prevalence of PCOS in those with type 1 diabetes is 26%, which means that 1 in 4 people with t1d may also be experiencing PCOS symptoms (Bayona et al., 2022).
If you have a PCOS diagnosis, or feel you’re living with PCOS symptoms and would like some support, get in touch to find out about 1:1 person-centred programmes.
4. Nutrition and lifestyle factors can help
So what can you do to support yourself?
Firstly, tracking periods can be a great starting point. I would suggest using an app on your phone i.e. Flo and make use of the notes section so you can record info about your glucose levels alongside. Or get into the habit of reviewing your CGM data at specific points in your cycle. Check to see if there are any robust patterns there, for example, are you finding more highs during your luteal phase? If so, speak to your medical team about tweaking basal rates at different points across cycle.
When you find yourself in a sticky resistance patch, think about your toolkit that can promote insulin sensitivity - this would include gentle nutrition (read my blog here on my fave sensitising foods), mindful movement, stress management and optimal sleep.
We know that foods with low glycaemic loads and polyunsatured fats can support the insulin signalling pathways, and promote insulin sensitivity.
Resistance training, like lifting weights or circuit training, can also promote insulin sensitivity.
Managing stress levels and ensuring optimal sleep can also help to dial down the insulin resistance, especially in the luteal phase
5. BONUS tip
If this all sounds good but you’re looking for a bit more help, check out my self-led e-book all to do with boosting insulin sensitivity, or apply to become one of my 1:1 clients - find out more here!