Diabetes and menopause
Menopause and type 2 diabetes
From late 30s onwards women make less of the hormones oestrogen and progesterone. These hormones regulate our periods. They also affect how cells respond to insulin, the hormone that moves glucose (sugar) from our bloodstream into our cells.
Perimenopause and menopause don’t cause type 2 diabetes. But hormonal changes in some women can lead to menopausal symptoms like carrying more weight round the midriff – and higher blood pressure. Both are risk factors for type 2 diabetes – which also include age and ethnicity.
An article in the official journal of the North American Menopause Society, reported on results of a study that looked at 124,300 post-menopausal women and reported a higher risk of women developing type 2 diabetes if:
Their final period was before the age of 46 (25% higher) or
Their final period was after 55 (12% higher)
It appears there is an association between the length of women’s reproductive cycle (from your first to last period) and the risk of developing type 2 diabetes.
The average reproductive cycle is 36 to 40 years, and the risk of type 2 diabetes is higher if:
Your reproductive cycle is less than 30 years (37% higher)
Your reproductive cycle is more than 45 years (23% higher)
Low levels of oestrogen post-menopause are linked to increased body fat, increased appetite, decreased metabolism and high blood sugar levels.
Type 2 diabetes in the main is preventable and the charity Diabetes UK advise that women in midlife should consider their lifestyle choices to reduce the risk of diabetes during menopause.
How to reduce the risk of type 2 diabetes in menopause:
Being active, stopping smoking and eating a healthier diet are the recommendations by Diabetes UK to:
Help your body use the insulin your body makes or the insulin you take – if you have diabetes – more effectively.
Help blood sugar levels be more stable whether you have diabetes or not.
Reduce your risk of type 2 diabetes.
Reduce your risk of heart disease and boost bone strength (falling oestrogen levels during perimenopause can increase your risk of heart disease and weaken bones)..
Diabetes UK recognise that the impact of changing hormones on diabetes management isn’t well understood, and that this is holding back care. There’s an urgent need for research in this area to help inform new guidance and better support people, especially those that have lived with type 1 diabetes prior to reaching the complex time that of perimenopause when hormones are in flux.
The complexities of coping with type 1 diabetes during menopause
Some people living with diabetes report that the advice and support for managing the condition through the menopause just isn’t there.
Claire Duncan is an Animas ‘One Touch Hero’. Positive Pause spoke to her to learn more about how she manages her blood sugar levels and fluctuating hormones as a type 1 diabetic going through perimenopause.
Claire’s involvement with the greater world of diabetes started through her association with the makers of the Animas Insulin Pump (part of Johnson & Johnson). She took part in the launch of their newest waterproof insulin pump by joining a team of type 1’s to swim a relay across the English Channel (a great way to prove beyond doubt that the pump was waterproof!). She then became an 'Animas Hero' (an ambassador for the company) and as such has participated in many sports and diabetes weekends, Claire says "I have a love of endurance sports from marathons to Ironman triathlons and long bicycle adventures". She's done several events at hospitals as an 'expert patient', training new pump educators in the hospital diabetes department. She also gives presentations to hospital staff and diabetes company employees and other diabetics about the use and impact of their products.
PP: Can you tell us about your diabetes diagnosis and how it’s impacted on your life?
CLAIRE: I was diagnosed with type 1 diabetes at the age of 23. I had the classic symptoms of extreme weight-loss, thirst and lethargy. I eventually went to the GP as I had a blocked hair follicle that refused to heal. I was sent to hospital for day surgery which involved a routine pre op blood test and the first I heard of my diabetes was getting a telling off from the nurse for not having my blood glucose levels under control! I skipped the surgery and went straight to the Diabetes department and had my first injection of insulin there and then.
My initial feelings were “well that explains why I’ve been feeling so rubbish and at least this can be treated”. After a few hours of hanging around the hospital waiting room however, I began to panic about the most common complications, blindness (diabetes is the biggest cause of blindness) and amputations. Luckily, the results of a 10-year study had just been released (DCCT study) which suggested that if you can keep fit and healthy with good blood glucose control, diabetes complications were not a forgone conclusion. Hence my love of exercise began and I educated myself on nutrition.
PP: Have you had any scary moments being diabetic?
CLAIRE: Yes, many scary moments! I suppose in the short term; bad hypos can be scary (hypoglycaemia / low blood sugar). If your body is short on fuel, your brain literally starts to shut down in order to preserve the main organs. Symptoms of this include slurred speech, double vision, lack of physical coordination and difficulty in thinking. This is most terrifying when it happens at night as when I am asleep I miss the early warning signs and I wake up very confused and disorientated, often thinking my dream is real life! Long term, I worry about each set of test results at my diabetes MOT, with the fear that the complications are starting.
PP: Are you pre, peri or post menopause and what, if any symptoms have you had to cope with?
CLAIRE: I am 48 and I suppose peri menopause is the best description of where I am currently at. My periods are a little erratic (currently about every 3 weeks) and my hormones are fluctuating, so yes, insulin also being a hormone, my requirements for insulin are fluctuating too.
PP: Have you experienced any of the more typical symptoms that can adversely impact on women with diabetes?
CLAIRE: I am finding that I am struggling to stay asleep these days and I miss the fact that I am no longer a heavy sleeper, it is extremely frustrating being so tired and wide awake! I am also finding I have to work harder at keeping my weight under control and I am currently a stone heavier than this time last year. The fluctuation of oestrogen and progesterone levels makes a huge difference with my insulin requirements and at times I can need double my usual dose. I can adjust my insulin myself using my insulin pump but it is not predictable each month and I can only work out the correction once it has started to shoot off the scale in the first place. This can lead to exhausting days of chasing high and low blood sugar readings which makes me feel lethargic and grumpy! I am sure everyone has days where they feel they have more or less energy but I am chasing that with extra insulin or carbohydrates to try and keep my energy levels on an even keel. The insulin dosage can be a difficult equation and it has often been joked about that a menopausal diabetic’s insulin requirements should be on the PHD mathematics syllabus!
PP: Do you check insulin levels more regularly than before?
CLAIRE: I have always checked my blood sugar levels (and the necessary insulin dose) several times a day. The main difference now is that I use a CGM (Continuous Glucose Monitor) at times when I am finding control difficult. This is a small implantable sensor that estimates a blood glucose reading every 5 minutes and sends the information to me via a radio frequency that I can read on my insulin pump. This allows me to set alarms to let me know when I am going out of my target range, essential for sports time or holidays when I am not sure what I am eating. I am extremely lucky that I have had a good education in how to use this newer technology through a few courses I have been lucky enough to participate in and I am very grateful for it!
PP: What, if any, lifestyle changes have you made in light of menopause?
CLAIRE: As ever in my life as a type 1 diabetic, sport and diet form the basis of keeping a healthy lifestyle. There are a few changes I have made with peri menopause in mind. I have massively upped my protein intake (I read an interesting book called “Roar” by Stacy Sims that talks a lot about women and nutrition, including changes through the menopause). I have also added weights to my exercise routine to try and offset decline in muscle mass and I allow myself greater recovery time as I definitely don’t bounce back like I used to!
PP: Have you sought any specific medical advice for managing menopause?
CLAIRE: I have spoken to my diabetes consultant about changes I have noticed. She is about the same age as me and so was an understanding ear! My consultant was also able to educate me a little more on the effect of the hormonal changes and what I might expect with regard to my insulin requirements.
PP: Have you got any advice for other women on coping with diabetes through menopause?
CLAIRE: Knowledge is power! Read all you can and gain from others experience. You cannot prevent the changes that are happening but you can try to understand them and arm yourself with different tactics to deal with them. There are some great forums out there, I refer to several Facebook groups to ask questions or pick up tips if I feel the need. I also monitor things more closely in terms of cause and effect, it is odd that there are many references to the effects of grief or stress on the body and the impact on your diabetes but not so much on menopause. Acknowledge that it is a real physical and psychological issue and give it the respect and time it deserves in your treatment regime.
November 2018
