Women and Type 2 Diabetes

Being Mindful of Menstrual Cycles

No two women have the same menstrual cycle. Some women get their periods like clockwork every 28 days, while other women occasionally skip months. Some women have their periods for the average 7 days, while others may have bleeding for 3 days or 10 days. It all depends on your body — and your life at that moment.

Just as menstrual cycles differ, so do women’s experiences with their diabetes during menstruation. It’s totally unique. However, there are common themes for women with diabetes.

Watching for erratic numbers

Right before their periods, women with diabetes may notice their blood glucose numbers are erratic. The odd part: They could be high or low. Whatever the number, it’s unexpected. And it may bum you out because it comes out of nowhere.

Why is your blood glucose wacky around this time? It may have something to do with fluctuations in the hormones progesterone and estrogen, as well as other factors such as premenstrual syndrome or symptoms, before you get your period.

Not every woman notices changes in her blood glucose during menstruation. So don’t worry if you don’t notice unexpected numbers. Just keep doing all the great things you’re doing to manage your blood glucose.

The following section explains what to do if you experience unexpected highs or lows during your menstrual cycle.

Taking back control

If you consistently notice erratic blood glucose numbers right before your period begins, you may want to chart your blood glucose in relation to your menstrual cycle.

Make a spreadsheet or add an extra page in your logbook where you include the number of days in your menstrual cycle. Day 1 is the start of your period, and the last day is the final day before your next period. Write down or enter your blood glucose number(s) for each day in your cycle. Do it again the next month and the next month. After you have 3 or 4 months of data, take a look at your numbers and the days (Day 1, Day 13, Day 20) in your cycle. You may start to notice changes in your blood glucose just before your period.

If you experience highs, try to eat meals at your regularly planned times of the day and try not to skip meals. Maintaining a regular eating schedule can reduce big fluctuations in blood glucose and the accompanying mood swings. If you experience lows, try to eat more small meals throughout the day or eat an extra snack before you exercise.

Premenstrual syndrome (PMS; the physical and emotional symptoms that occur 1-2 weeks before a woman’s period begins) is no fun. Just like anyone who experiences PMS, women with diabetes can take certain actions to feel better. Not every tactic works for everyone, but they’re good tools to have at your disposal when the time comes.

If you experience PMS, try to limit sodium, which can cause bloating, by avoiding salty foods and reducing the number of meals you eat out. Use spices such as garlic powder, pepper, and cumin to give your foods a kick without salt. Take an extra walk at lunch or the stairs in the morning because exercise can improve both blood glucose and mood.

Talk to your healthcare provider about these changes and any concerns you have regarding your period and diabetes. She may have tips for you to manage highs and lows during your cycle.

Take time to discuss contraception with your provider. Women with diabetes have the same options for birth control as women without diabetes. Birth control pills, intrauterine devices (IUDs), implants, and barrier methods (diaphragms, condoms, spermicide) are all options. What you choose will depend on the needs of you and your partner. You’ll also want to consider your medical history when choosing contraception. There are some risks and side effects associated with some forms of contraception, but the risk of an unplanned pregnancy generally outweighs the risk of any individual contraception.

Healthy Mom, Healthy Baby

Women with type 2 diabetes can have healthy pregnancies and babies. The goal is to keep blood glucose in your target range. We detail those specifics later in this section.

Keeping your blood glucose on target is particularly important when you’re pregnant. You want to prevent complications for yourself and your baby. High blood glucose during pregnancy can put your baby at risk for becoming extremely large (called macrosomia) or having difficulty breathing or low blood glucose. It can also increase your baby’s risk for developing type 2 diabetes during adolescence or adulthood.

Gestational diabetes is different from type 1 and type 2 diabetes. It comes on during pregnancy and usually subsides after birth. However, women with gestational diabetes have a higher risk for type 2 diabetes in their lifetime.

Planning for pregnancy

If you have diabetes and you want to become pregnant, be sure to talk to your doctor and plan for this change. You want to be prepared and educated beforehand. Keeping your blood glucose in control before you become pregnant will help you have a healthy pregnancy and birth.

If you’re thinking about becoming pregnant, talk to your healthcare provider so you can make a plan together. You may want to continue using birth control until your blood glucose is in a certain range. The American Diabetes Association recommends an A1C of less than 6.5 percent if possible before becoming pregnant.

Lose weight, exercise, and try to get your body in the best shape possible before you get pregnant. Quit smoking. Make sure you’ve had all your regular annual tests, including a dilated eye exam (because your eye health should be tracked closely during pregnancy).

Polycystic ovary syndrome (PCOS) is a hormone disorder that can cause abnormal menstrual cycles and infertility. PCOS patients also tend to be obese. Lifestyle changes and medications can help treat PCOS. Talk to your doctor if you suspect you may have it.

Taking care of yourself and your baby during pregnancy

During pregnancy, you may have to work harder than ever before to manage your blood glucose. Your blood glucose targets will probably be lower than they were before you became pregnant. This is to protect you and your baby from health risks during pregnancy.

For a woman, diabetes increases her risk for preeclampsia, which can raise blood pressure, cause dangerous swelling and weight gain, and can even be deadly. Pregnancy — with all its changing hormones — can also cause fluctuations in blood glucose. Blood glucose levels can be high or low, depending on the woman and the stage of her pregnancy. Insulin or other medication needs may change throughout this period and must be carefully monitored. Eye and kidney problems can get worse during pregnancy, so you and your healthcare team will want to monitor your health closely.

For a baby, high blood glucose and ketones can be passed from a pregnant woman to the developing fetus, and this can increase the risk for birth defects. The first trimester is a particularly important time because this is when the baby’s organs are forming. High blood glucose in the first trimester increases the risk for birth defects and miscarriage. Babies can also be born particularly large (making delivery more dangerous for the baby and mother) and can have difficulty breathing.

Keeping your blood glucose in control during pregnancy reduces these risks for your baby. This is why it’s so important to plan ahead for pregnancy — and have your A1C on target before you decide to conceive. Talk to your diabetes care provider about how to safely and thoughtfully plan for pregnancy.

The American Diabetes Association recommends an A1C of 6–6.5 percent during pregnancy. Your before-breakfast reading should be less than 96 mg/dL. You should strive for a reading of less than 141 mg/dL 1 hour after meals and less than 121 mg/dL 2 hours after meals. These are general recommendations, so please talk with your doctor about your individual goals.

Eating nourishing, wholesome foods is essential when you’re pregnant. You’re feeding your growing, hungry body and your growing, hungry baby. Select fresh fruits and vegetables, whole grains, and lean proteins (see Chapter 11 for more about nutritious eating when you have diabetes). There is never a more critical time to be mindful about what you put into your body.

The American Diabetes Association recommends that, during pregnancy, women with type 2 diabetes who are overweight gain 15–25 pounds and who are obese gain 10–20 pounds.

Exercise is just as important during pregnancy as it is before you become pregnant (see Chapter 13 for details on exercising when you have diabetes). The types of exercise you enjoy may change during pregnancy, especially during your final trimester. Some women prefer walking, swimming, and yoga. Ask your healthcare provider if you have questions about the type or intensity of exercise.

Focus on your eyes. Women with diabetes are at risk for developing eye disease — or having it progress rapidly. You should have a dilated eye exam before you become pregnant or in the first trimester. Then you should have your eyes checked each trimester and for a year after you give birth.

Not all medications are safe during pregnancy. Insulin is the preferred medication for managing blood glucose during pregnancy because it is safe and effective. You may need to switch to insulin if you take oral diabetes medications because they may not be approved for use during pregnancy. Many diabetes drugs have not been studied well, or at all, for use during pregnancy. If you already take insulin, you may need to change your dose or timing. Your doctor will advise you on this.

Tell your doctor about any other medications you’re using, especially blood pressure and cholesterol drugs, because some are not recommended during pregnancy.

Try to breastfeed your baby if you can. It will benefit you and your newborn. Breast milk has amazing nutrients and antibodies. Breastfeeding also lowers your baby’s risk for obesity later in life.

Screening for gestational diabetes

Gestational diabetes is high blood glucose that develops during pregnancy. It is separate from type 1 and type 2 diabetes, because it usually goes away after giving birth. But keep in mind that women with gestational diabetes are more likely to develop type 2 diabetes during their lifetimes.

You cannot get gestational diabetes on top of your type 2 diabetes. Instead, gestational diabetes is a diagnosis of high blood glucose during the second or third trimester of pregnancy. In some women, preexisting type 1 or type 2 diabetes will be diagnosed during their pregnancies; the presence of diabetes in the first trimester is thought to indicate preexisting diabetes, not gestational diabetes. This can be confusing because it might seem like gestational diabetes. However, these women will continue to manage and treat their diabetes after pregnancy.

All pregnant women are screened for gestational diabetes at 24–28 weeks using simple tests in which you drink a sugary liquid and a blood sample is tested afterward. Also, you may be tested at your initial prenatal visit if you have risk factors for type 2 diabetes.

In one test, you don’t eat or drink anything with calories 8–14 hours before drinking the liquid. A provider takes a blood sample before, and then 1 and 2 hours after the drink. A fasting reading greater than 92 mg/dL, a 1-hour reading greater than 180 mg/dL or a 2-hour reading greater than 153 mg/dL could mean you have gestational diabetes.

In another test, you don’t need to prepare at all before drinking the liquid. A provider takes a sample 1 hour after the drink. A high reading means you need to come back for a 3-hour test to diagnose gestational diabetes.

Women with gestational diabetes have the same blood glucose targets as women with type 1 or type 2 diabetes. Similar to women with type 2 diabetes, women with gestational diabetes have an increased risk of unusually large babies and the resulting complications during birth.

Women with gestational diabetes may need to change their meals or physical activity, or take insulin to manage their blood glucose during pregnancy. You’ll work closely with your provider to come up with a plan for your pregnancy.

Delivering the baby

Women with type 2 diabetes or gestational diabetes are at risk for having larger babies and, therefore, more trauma during birth. However, keeping your blood glucose tightly managed during pregnancy can reduce this risk. Many women with diabetes deliver normal-weight babies.

As your delivery date nears, you’ll work closely with your healthcare team to determine the best date and method for having your baby. They may analyze your blood glucose control, blood pressure, kidneys, and other health concerns. They’ll also check your baby’s health and size.

During delivery, the nurses and doctors will work to keep your blood glucose under control using insulin. You may not need as much insulin as you start active labor.

If your blood glucose was uncontrolled during pregnancy, your newborn baby could be at risk for low blood glucose (hypoglycemia). Your newborn will be tested after birth and then monitored in the hospital. The best way to prevent this is to manage your blood glucose closely during your pregnancy. After a baby has regular feedings, her blood glucose should return to normal levels, but it should be closely monitored. There is an increased risk for birth defects in babies born to women with preexisting diabetes that is not well controlled during pregnancy.

Postpartum

After giving birth, women with type 2 diabetes may have swings in their blood glucose. This could be confusing and unsettling, but it’s normal as your body recovers from the amazing work of pregnancy and birth.

Talk to your provider about how to manage your blood glucose after pregnancy. You may need to test your blood glucose more often. It can be hard to focus on your own care when you have a new wee one, but make sure you’re diligent about your own health. Just like any new mom, try to get as much sleep as possible and eat healthy meals. Check your blood glucose often to avoid episodes of low blood glucose.

Your provider will work with you to determine which diabetes medication to take after delivery. If you’re breastfeeding, you’ll want to consider that, too. Most diabetes medications are safe to take while breastfeeding, but review all your medication’s safety profiles before you start breastfeeding your baby.

After giving birth, women with gestational diabetes may have normal blood glucose (and no longer need any medications). But they have a higher risk of gestational diabetes in subsequent pregnancies and a lifelong risk of developing type 2 diabetes. Therefore, women with gestational diabetes should have their blood glucose tested 1–3 months after giving birth, and then again every 1–3 years.

Breastfeeding

If you can, try to breastfeed your baby. The American Diabetes Association recommends that all women, whether they have type 1, type 2, or gestational diabetes, be encouraged to breastfeed. Breast milk provides essential nutrients and substances to boost your baby’s immune system.

Breastfeeding can affect blood glucose in women with diabetes, so make sure that you talk to a dietitian or other healthcare provider about it. For example, you may need to eat a snack before or during breastfeeding to prevent a low. Breastfeeding can help women lose weight gained during pregnancy (a great thing), but you’ll also want to make sure that you eat enough healthy foods and drinks to give you energy, keep you hydrated, and provide those essential vitamins and nutrients.

Every mom wants to lose the weight she gained during pregnancy. But it can be hard. Talk to a dietitian or other member of your team about your goals for losing weight after giving birth. You may need a new meal plan or exercise program that takes your goals and changed lifestyle into account.

Menopause Can Throw You for a Loop

Irregular periods, night sweats, and mood swings. Yes, these can be signs you’re going through menopause. Another sign: unusual blood glucose numbers. Hormones can affect your blood glucose during menopause just as much as they do during your menstrual cycle.

Menopause is a natural part of life in which a woman’s body makes less estrogen and progesterone, hormones that play key roles in menstruation. It marks the end of your body’s ability to reproduce.

Menopause can last 8–10 years, although it varies for everyone. It’s a process, not an event, and usually there are three stages: perimenopause (the time around the onset of menopause), menopause, and postmenopause (the time after menopause ends).

Many women begin menopause in their 40s, while others start in their 50s or 60s. The average age that an American woman has her last period is 51.

In the following sections, we cover the most common symptoms of menopause and how to deal with them when you have diabetes.

If you’re considering hormone replacement therapy (HRT) to alleviate symptoms of menopause, talk to your doctor. HRT is a personal and nuanced issue.

Preparing for unusual numbers

Many women with diabetes have unexpected fluctuations in blood glucose as they go through menopause. Why? Hormones.

As you make less estrogen, your body may become less sensitive to insulin, and your blood glucose may be higher than usual. Even though you’re doing the same things in terms of food, exercise, and medications, your blood glucose numbers can go up.

Another thing to consider is that you’re not on your typical menstrual cycle. Perhaps you’ve always had regular periods and, therefore, a regular pattern of hormone changes throughout your cycle.

Menopause can be totally different. You may have longer periods or heavier bleeding. You may get your period all of a sudden after no bleeding for more than a year. Your body’s hormones are changing, which affects your blood glucose, and there may be less predictability about how your body responds or how you feel.

To take action, check your blood glucose to see your actual numbers. Make sure you take your medications as prescribed, and ask your doctor if you feel like things aren’t working. Take the time to take care of yourself by eating wholesome foods and exercising regularly.

Recognizing that mood swings are normal

Fluctuations in hormones and blood glucose (see the preceding section) don’t happen in a vacuum. They happen in your body and mind. No wonder women going through menopause often experience mood swings and irritability. It’s totally natural.

Your emotional state is intimately connected to changes in your body. It’s directly related to hormones’ effects on the brain.

The feeling of going through change can also mess with your emotions. Some people don’t like the feeling of unpredictability that may occur during menopause. But remember that menopause is a transition that almost all women experience. Other women just like you are trying to manage their diabetes during this time.

Talk to a therapist or your healthcare provider if you feel like you need help. Seek out online or neighborhood support communities to find other women with diabetes going through menopause. (Chapter 15 offers more tips on finding support.) DiabetesSisters (www.diabetessisters.org) is an organization that offers articles and online education about women’s health and diabetes.

Facing hot flashes and night sweats

Menopause is the main culprit of hot flashes and night sweats. They can both feel like moments of intense heat and sweating, followed by wetness and chills. Doctors believe that these unpleasant experiences occur because of fluctuating or decreasing estrogen levels, not because someone cranked up your house’s thermostat. The change in estrogen may affect the part of the brain that regulates your body temperature, leading to feeling overheated.

Hot flashes can happen any time of day, while night sweats happen while you’re sleeping. Although they’re usually over after a few seconds or minutes, the after-effects such as sweaty clothes can be annoying.

Night sweats can be so intense that they wake you up from sleep, or you may wake up later with your pajamas drenched.

The thing for women with diabetes to keep in mind is that hot flashes and night sweats can feel like low blood glucose. Why does that matter? Well, you wouldn’t want to ignore a low by thinking it’s just a hot flash. Therefore, you should always check your blood glucose just to be sure.

Try to wear breathable fabrics and dress in layers so you can take off clothes if you have a hot flash.

Coping with yeast infections

Yeast infections are more common in women going through menopause. As estrogen levels fall, the lining inside your vagina changes, making it more susceptible to infection. Symptoms include vaginal discharge, severe itching, and pain while urinating and during intercourse.

The fungus Candida albicans (the culprit behind yeast infections) likes to grow in warm, moist places and thrives when blood glucose levels are high. Women with diabetes going through menopause may find that they have more yeast infections.

To avoid yeast infections, wear clothes made of breathable fabrics to encourage airflow, and keep your genitals clean and dry. Try to avoid spermicide in condoms and personal sprays or douches.

Lots of women get yeast infections, so don’t be shy about treating them. Over-the-counter antifungal creams may help in the early days of an infection, but if symptoms don’t improve in a few days, call your doctor so she can write you a prescription.

Addressing sexual discomfort

Women going through menopause may find that sex is less comfortable than usual. Falling hormone levels change the walls of the vagina, and they may become thinner, drier, and irritated.

Added to this, high blood glucose could damage both nerves and blood vessels flowing to the vagina. Nerve damage could affect sensation in the vagina, impacting arousal or pleasure. Blood vessel damage could lessen blood flowing to the vagina and, therefore, arousal. To prevent these issues, try to keep your blood glucose and blood pressure in your target range by taking medications, eating healthy foods, and exercising regularly.

Use a lubricant like K-Y Jelly to make sex more enjoyable, or ask your doctor about estrogen creams that can treat vaginal dryness and itching.

What Every Woman with Diabetes Should Know

You know that your body, mind, and heart are unique and powerful. Maybe you read other parts of this chapter and thought, “That’s never happened to me.” Or maybe you thought, “Yeah, that’s so true. Some of those things like mood swings and erratic blood glucose just happened last week.” How your body reacts to menstruation, pregnancy, and menopause is totally dependent on you, your age, and the experiences you’re going through in your life right now.

We can all agree that being a woman with diabetes has its challenges, but it also has its opportunities. Women with diabetes have never had so many options to practice safe sex and plan for pregnancy. More women than ever with diabetes are having babies. And women with diabetes going through menopause are finding other women like themselves to connect with online or in their communities.

As we wrap up this chapter, here’s one more thing to keep in mind as a woman with diabetes.

Focus on your heart

You need to pay particular attention to your heart as a woman with diabetes. Let us say that again: Take care of your heart.

We used to think that women and men had the same risk of heart disease, but it’s not true. Heart disease is the leading killer of women with diabetes. Women with diabetes have a 40 percent higher risk of heart disease than men with diabetes. Women with diabetes also have higher risk of stroke than men with diabetes.

In Chapter 8, we explain the importance of keeping your blood vessels healthy to prevent heart disease and stroke. You can keep your blood vessels healthy by losing weight and exercising. Eat nutritious foods that are low in sodium, saturated fat, and sugar (find out more about nutrition in Chapter 11). Take your medications as prescribed, including those for blood glucose, cholesterol, and blood pressure. Quit smoking.

Make sure you feel comfortable talking with your doctor about heart health. She should be just as focused as you are on preventing heart disease and stroke.

Know the signs

The most common sign of heart attacks in women are chest pressure or pain, the same as they are in men. However, other common symptoms of a heart attack such as shortness of breath, nausea, lightheadedness, discomfort in the lower chest or upper abdomen, and back or jaw pain seem to be more common in women. Extreme fatigue is also common.

Why do these other symptoms matter? It may be easier for women to dismiss these sometimes subtle and confusing symptoms as illness or an upset stomach.

Be aware of the signs of a heart attack. Don’t dismiss symptoms that may not be as dramatic as clutching your chest and falling to the floor.

Call 911 immediately if you suspect a heart attack. There are effective treatments for heart attacks when caught early, and most people go on to lead healthy, productive lives.