Women with Type 1 diabetes come across unique challenges

When diagnosed at a young age with Type 1 diabetes, the disease affects girls and boys equally. However, that changes when girls enter puberty and women face unique challenges throughout their life in maintaining sugar levels.

"Puberty, menstrual cycles, pregnancy and menopause are all factors that affect blood sugars," said Loyola Medicine endocrinologist Sarah Nadeem, MD. "Women with diabetes face unique circumstances and need to be aware of this to manage the fluctuations in sugars accordingly."

Dr. Nadeem will be discussing some of these challenges during the 2018 Juvenile Diabetes Research Foundation Illinois TypeOneNation Summit on Friday, February 24.

Dr. Nadeem is part of the endocrinology team at Loyola Medicine, which provides exceptional care for the entire spectrum of endocrine disorders. Loyola's Diabetes Care Center is recognized by the American Diabetes Association.

Women and Menstruation

Studies have shown that blood sugars and the need for insulin varies during different parts of the menstrual cycle.

"Many women report higher sugar readings generally prior to menses," Dr. Nadeem said. "Each individual is unique but if a girl or woman is aware of this connection she can note the fluctuation and can adjust the insulin accordingly in discussion with her endocrinologist."

Blood sugar can be checked by fingerstick meter as well as continuous glucose monitors (CGMS). CGMs are physician-prescribed devices that detect and display blood-glucose levels continuously and reveal trends in these levels that often go unnoticed by using finger sticks alone. CGMs improve diabetes clinical outcomes, according to numerous studies, including a JDRF-funded CGM trial that shows that the rate of severe high blood-sugar (hyperglycemia) events among adults using a CGM fell by two-thirds over the first year of use.

Pregnancy

Dr. Nadeem urges pre-pregnancy counseling for all women with Type 1 diabetes.

"For a healthy pregnancy, diabetic control has to be much more stringent," she said.

Higher sugars are associated with incidences of miscarriage, pre-eclampsia, preterm labor and fetal malformations.

"Close monitoring and coordination with the obstetrician and endocrinologist is needed for any Type 1 or Type 2 diabetic during pregnancy," Dr. Nadeem said.

Generally, diabetic women in their first trimester have decreased insulin requirements due to an increase in insulin sensitivity. The insulin requirements increase in the following trimesters, adding to the importance of careful monitoring.

"Working with a dietitian, regular exercise, frequent blood sugar monitoring and communicating with your physicians regularly are just some of the things women can do to achieve optimal diabetic control," Dr. Nadeem said.

Menopause

Premature menopause is seen more often in Type 1 diabetics, Dr. Nadeem said.

While the risk of osteoporosis (low bone density) increases after menopause, the risk is even higher with a history of Type 1 diabetes.

The 2018 JDRF Illinois TypeOneNation Summit is Friday, February 24, 8 am to 3 pm at McCormick Place, 2301 S Martin Luther King Drive, Chicago. Admission is free but registration is required.