Female hormones are both a blessing and a curse. They make us feminine and fertile, but they upset our diabetes control. With each monthly cycle, insulin needs are influenced heavily by changing hormone levels.

The two primary female hormones are estrogen and progesterone. The levels of these hormones increase within the body during puberty and decrease at menopause. They are produced mainly in the ovaries and are important during the child-bearing years. Estrogen also plays a vital role in calcium metabolism-without estrogen, the bones lose calcium and become brittle. This is why doctors often prescribe estrogen replacement after menopause.

Other female hormones stimulate the maturation of eggs as well as the production of estrogen and progesterone.

During puberty, both boys and girls need more insulin due to their bodies' rapid growth. The rise in hormone levels when a girl begins menstruating causes her to need even more insulin. It's important to remember that, in both males and females, insulin doses should be lowered once growth stops, or weight gain might occur. But until menopause, some women must continue to adjust their doses to accommodate the fluctuations in their cycles.

At the beginning of each new menstrual cycle, hormone levels are low. This also means insulin needs are low. As the cycle progresses, hormone levels may increase as may the need for insulin. If fertilization of the egg does not occur, hormone levels drop. Correspondingly, so may the need for insulin.

Ovulation generally occurs mid-cycle, and some women notice a "sugar spike" in their blood glucose levels that day.

If pregnancy occurs, hormone levels increase and play havoc with diabetes control. This increase is not easily predictable, and a whole host of other chemicals also come into play with pregnancy. (The challenge of diabetes control during pregnancy goes beyond the scope of this article.)

Part of being a woman with diabetes is learning to live with and adjust to the fluctuations in the female cycle while maintaining blood glucose control. Good control can help ease the carbohydrate cravings and emotional swings that many women experience during their cycle. Unfortunately, both problems can complicate diabetes control.

If you monitor your blood sugars you may be aware of these fluctuations. The trick is to learn how to adjust your insulin to match these monthly changes. Depending on your body, you will find that you'll need to turn your insulin doses up during, right before, or right after your period starts.

As much as I think every person with diabetes hates keeping records, doing so helps. What you and your healthcare team need to look at are the general trends-how your glucose levels change. It usually takes several months before you see a distinct pattern and can create a workable insulin adjustment schedule.

While every women is differently affected by menstrual cycles, you may find that without dramatic glucose swings, your menstrual cycle may not be all that bad. I find sugar highs and lows more of a bother than my monthly cycle.

[Editors' note: Our advisory board points out that Fluvoxamine taken at the appropriate time of month relieves carbohydrate craving for many women.]