Diabetes, menstruation, and the uterus

Menstruation in women with diabetes Effect of menstruation on diabetes ‘Hia – just wandered how many others suffer with high BS’s before their period and how long for beforehand? My blood sugars start to rise anything between 7–10 days before my period starts. Im on a pump and today I have needed to increase my basal rate to 120% in the morning and then 140% in the afternoon as they had climbed to 12 after tea time. The trouble is I cant just leave the rates on because the additional insulin in required at random times throughout the day/night. They are just so high and erratic – very very frustrating!!’ [sic].1 Among women aged 18–40 years with type 1 diabetes 61% had perimenstrual changes in glucose control, mostly premenstrual hyperglycaemia. Half of them had adjusted their insulin dose accordingly. Changes in glucose control occurred in 67% of women using fixed-dose oestrogen/progesterone oral contraception.2 Women with type 1 diabetes experienced less hypoglycaemia (10.7% versus 15.8%) and more hyperglycaemia (28.5 versus 22.8%) in the luteal phase than in the follicular phase.3 Catamenial hyperglycaemia may be due to increases in circulating progesterone reducing insulin sensitivity.4 Increased appetite may contribute. The relative insulin lack may be severe enough to precipitate diabetic ketoacidosis – catamenial diabetic ketoacidosis – which may recur before patient or diabetes team recognise the cause.5 A woman with usually well-controlled type 1 diabetes on continuous subcutaneous insulin infusion had recurrent catamenial diabetic ketoacidosis. She required a four-fold insulin dose to control premenstrual hyperglycaemia.6 If female patients have unexplained hyperglycaemia, ask if it is linked to their menstrual cycle (remembering that many diabetic women have irregular periods). Consider catamenial hyperglycaemia as a cause for diabetic ketoacidosis or recurrent diabetic ketoacidosis.