Three weeks out of every month, my diabetes is well controlled. But the fourth week, the one before my period, is a nightmare. My sugars are astronomically high–I can’t even look at a carbohydrate without my sugar spiking. I’m exhausted and cranky, and I can’t get comfortable.
I pride myself on being a good diabetic. I eat healthy foods in moderation, exercise every morning, diligently check my blood sugars, and routinely see my doctors. I expect to do well with this disease. Currently, however, I feel like a failure because I can’t seem to tame my diabetes. My efforts to be the perfect diabetic aren’t yielding the results I desire. I can slowly feel myself inching toward another season of diabetes burnout—a place I do not want to be.
I used to believe that I was alone in my frustrations. After all, many of my diabetic friends (mostly males) boast A1Cs in the 6% range. But after talking with other diabetic women, I discovered that the diabetes-related challenges faced by women are uniquely difficult. To answer my burning questions about those challenges, I contacted Sonia Stalker, the Diabetes Nurse Specialist at Anderson Hospital in Maryville, Illinois. Ms. Stalker was the first certified diabetes educator to help me manage my diabetes. She is experienced, confident, and positive—all characteristics that I admire and need from a person on my medical team.
Question: What’s going on with women with diabetes and hormone fluctuations? I’m so frustrated with my disease right now!
Ms. Stalker: Menses can pose special problems for women with type 1 diabetes. (During puberty, insulin requirements can increase as much as 1.5 units per kilogram per day due to the hormonal influences of increased growth hormone and sex hormone secretion.) It is common for a woman to have difficulty with blood glucose control the week prior to her period, with glucose levels being either too high or lower than expected. Why female sex hormones sometimes cause problems with glucose control is not entirely understood. One theory suggests that progesterone leads to temporary insulin resistance, while in other women estrogen increases insulin sensitivity, which could account for lower blood glucose readings. Others believe that premenstrual syndrome, with its food cravings and water retention, could be the culprit.
Question: There seem to be standard rules of care regarding diabetes, but what specific factors should women with diabetes consider in addition to these standard rules?
Ms. Stalker: I see more type 2 women than type 1 women in my practice. A good number have polycystic ovarian syndrome (PCOS), which causes insulin resistance. I also see a fair number who have hypothyroid issues. For a younger type 2 trying to conceive, the question to ask the doctor is whether PCOS could be causing difficulties conceiving, controlling blood glucose, and losing weight. Women with a family history of hypothyroidism, over the age of 40, or with symptoms of hypothyroidism could ask for lab work to check their thyroid hormones.
Question: Women, in general, are multi-taskers and tend to put their needs on the back burner to meet the needs of others (spouse, kids, employer, friends, etc.). What can a woman with diabetes do to make her health a priority?
Ms. Stalker: This is a tough question to answer because I am one of those women. My health always comes second to the needs of my family. For a woman with diabetes, I would reiterate the fact that if you do not care for yourself first, you will eventually be unable to care for those you love. It starts with a sound knowledge of diabetes-attending an ADA-recognized diabetes class, seeing a dietitian for a meal plan, and keeping informed about diabetes via the Internet and magazines.
Question: If you could offer women with diabetes one piece of advice, what would it be?
Ms. Stalker: Don’t settle. By that, I mean don’t accept an A1C over 7%, even if the problem is related to diet mismanagement. A higher A1C leads to complications. It needs to be addressed by your physician via changes—more aggressive pharmaceutical intervention and referral to a CDE, dietitian, and/or endocrinologist, if indicated. You might not feel “bad” now, but by the time that you do feel “bad,” the damage has already begun. It is never too late to “get with the program.” Don’t give up. Those who throw in the towel and give up are the people who do poorly. No one is perfect. With diabetes management, some days are good, some not so good. If you falter, just hop back on the road to better health.