Menopause can be an even more difficult transition than the onset of menstrual periods for several reasons. Here are a few key changes associated with menopause:
i It's preceded by the perimenopausal years when there's a great deal of irregularity in your menstrual periods due largely to hormone fluctuations that affect your blood glucose.
i Estrogen, which makes the body more sensitive to insulin, declines during menopause, resulting in decreased insulin sensitivity.
i If your diabetes hasn't been controlled, complications including eye disease, kidney disease, and nerve disease (see Chapter 5) complicate control. For example, visual difficulties may make exact administration of insulin more difficult, and gastroparesis due to autonomic neuropathy, which slows emptying of the stomach, may make it harder to judge the correct insulin dose and when to take it.
The way you manage this difficult time is no different from managing your diabetes at any other time: insulin, diet, and exercise, along with lots of self-testing of the blood glucose. You have one other consideration during menopause, however: the question of hormone replacement therapy.
One question that may occur to you as you reach this passage from menstrual function to menopause is whether your T1DM needs to be as well-controlled at age 51 as it was at age 31. The answer is a definitive yes. You may have 30 or more years of life ahead of you, so you definitely don't want to be blind in ten years or on hemodialysis for kidney failure at age 60. There are plenty of women and men with T1DM in their 70s and 80s who are free of complications of diabetes and live high-quality lives.
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All you need is a proper diet of fresh fruits and vegetables and get plenty of exercise and you'll be fine. Ever heard those words from your doctor? If that's all heshe recommends then you're missing out an important ingredient for health that he's not telling you. Fact is that you can adhere to the strictest diet, watch everything you eat and get the exercise of amarathon runner and still come down with diabetic complications. Diet, exercise and standard drug treatments simply aren't enough to help keep your diabetes under control.