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Is it harder for women to manage diabetes?

Diabetics are more likely to have complications during pregnancy, irregular menstrual cycles, and less enjoyable sex. Does the condition create an unintentional gender gap?

Two months after I was diagnosed with type 1 diabetes, my body finally started to function normally again, and my period came back.

But with the return of the monthly cycle came more than just the usual chocolate cravings and episodes of crying. My glucose sensor went through the roof, and no amount of exercise or carb-restriction seemed to bring it down.

That day, I discovered that our glucose levels are affected by more than just the amount of carbohydrates in the food we consume. I found out about the impact our emotions also have on those numbers, as well as the amount of insulin – a growth hormone produced by the pancreas – the blood can absorb to manage glucose levels and keep us energised.

Unfortunately, type 1 diabetics are already at a disadvantage when it comes to this, as we need to inject daily doses of insulin to ensure the glucose we intake is being used efficiently. But undergoing five to seven days of utter emotional rollercoasters every month on top of that takes its toll.


The monthly hormone roller coaster

Periods are perhaps the largest – although not the only – barrier to living a completely normal life that diabetic women find heightened by the need to inject insulin.

While the female population in the UK is less likely than men to get diabetes, periods, as well as pregnancy and menopause, make the condition a lot more burdensome.

Eleanor Noyce, who was diagnosed with Type 1 diabetes in 2015, says periods are a ‘huge hormone influx’. While she has never had to take more insulin to treat sudden fluctuations in her glucose levels, she will often get emotional and hormonal – and having to deal with diabetes on top of that is frustrating, she notes.

The 24-year-old sometimes experienced period pain so bad she couldn’t get out of bed. Switching to the pill a couple of years ago not only helped subside that pain, but has kept her periods regular too.

PhD student Becca Hill, 28, also finds that her period makes her a lot more emotionally sensitive, reducing her capacity to manage glucose levels. Periods also increase her body’s resistance to the insulin and her cravings for food, meaning she needs to increase her doses of the hormone too, she notes.

Hard work can go a long way, but good control during a period also relies on people having a super regular and conventional cycle, which so many people don’t have, says Celia Bergin, a 21-year-old student from the University of Warwick.

‘I think it’s something that schools and employers should be more considerate of under reproductive awareness, and that medical professionals should factor into diabetes care,’ she says.

Across the month, a woman’s hormones are constantly changing, with most finding that their blood sugar levels rise during the last stage of their cycle – three to five days before their period, explains expert nutritionist Lujain Alhassan.

She says it’s important to closely monitor blood sugar levels – especially during that time of the month – as well as exercise regularly to help manage those fluctuations.


Babies and beyond

Alhassan also notes that diabetic women are more prone to certain health complications because of pregnancy and menopause, which can really put a damper on what is often a great stage in women’s lives.

Diabetic women, for example, are 15-45% more likely to give birth to larger babies, which might mean needing a caesarean section. They are also a lot more likely to have a miscarriage, according to the NHS.

Women who have prediabetes – high blood sugar but not enough to officially have the condition – are also at risk of developing gestational diabetes during pregnancy, which is when the body cannot produce enough insulin to cope with the increased demand when carrying a child, Alhassan says.

But she adds that it doesn’t happen to women who are already diabetic and the condition will completely disappear after birth.

Noyce plans on having children, and is asked this question every time she attends her medical appointments. ‘They like to plan things like that with you closely because you need to make sure you have good control and your glucose levels are within a certain range before you even start trying for a baby,’ she says.

The 24-year-old is concerned, however, about the high risk of miscarriage and the way she may be passing on the Type 1 gene. And unless blood levels are tightly under control, she notes that accidental babies are almost never something diabetics are advised to keep.

As a queer person, Bergin says having a child is something she would have had to think about extensively anyway. But if she did want to and it was too complicated for her, she’d have the fortunate option of asking her partner to carry the child instead of her, she says.

Meanwhile, Hall emphasises how ‘incredibly expensive’ and ‘emotionally difficult’ having biological children with her partner would be, which is why they have decided not to have them for now.

She notes that her clinic has explained the immensely tight control that would be necessary if she did change her mind, but feels as though she has been discouraged from having them as a woman with Type 1 diabetes.

Later on in life and much like the menstrual cycle, the menopause hits women with a range of hormonal fluctuations, which affect diabetics’ insulin sensitivity and blood sugar levels. Alhassan notes that many women will gain weight during menopause, which can also cause insulin resistance, and they can generally struggle with increased risk of bone fractures or heart disease.

Outside of those medical risks, the menopause also affects women’s sex drive through vaginal dryness, which female diabetics especially suffer from due to damage in the nerves caused by long-term high glucose levels. The effects lessen sexual satisfaction and are exacerbated by the constant fluctuation in hormonal levels that come with menopause too.


Coping in the long-term

Noyce, Bergin and Hill were all diagnosed earlier in life, yet, years on, they feel as though they are somewhere between a six and a seven out of 10 when it comes to dealing with their general condition management.

But Noyce has learned not to get ‘too obsessed’ with the numbers.

‘I struggle with perfectionism – but you can’t always control the levels and sometimes, when stress just takes over, you can’t beat yourself up over it,’ she adds.

Bergin, who was diagnosed at aged 10, says she’s a good diabetic on the easier days but will slip up when she gets out of routine.

Meanwhile, Hill feels she could do a lot more to manage her condition. She would do better if she had more time to understand how insulin doses must change over the month, but doesn’t have the time or emotional capacity to do so, she says.

Our emotions can sometimes feel like they are swallowing our lives whole. And it’s not just on a period, during pregnancy or in menopause that they can do this – hitting our teenage years or moving away from home are both major milestones that can completely topple our glucose management, for example.

Noyce was 17 when she was diagnosed, less than a year before she left home for university. While she had mainly been in charge of her regime until that point, suddenly being faced with clubbing and drinking alcohol and the rest of the lifestyle changes that come with university life – on top of managing prescriptions and keeping on top of appointments – was tough.

Bergin also found that taking over from her mother and learning to deal with a host of new experiences with diabetes as she hit puberty and moved away from home was a challenge. But she notes that the technology that has developed to monitor glucose within this time has been incredible.

‘I’ve gone from peeing on a stick to using a tiny drop of blood to test my ketones – fats broken down by your liver when you have consistently high glucose – and I now have a pump that is essentially a remote-controlled, extravenous pancreas rather than having to inject all the time,’ Bergin says.

The technology is far from perfect, and diabetes is still an area that needs more funds and support, but it doesn’t mean it can’t be managed. And with over 4 million of us living with the condition in the UK, it is certainly not something to be faced alone.

For women who feel like it can perhaps become too much, there are so many support groups out there to join. Diabetes Support for Women on Facebook is a great place to start, for example. If you are based in the US, Diabetes Sisters is also an amazing platform looking to support women through the more challenging times with this condition.

 

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