Because sex organs are formed before the onset of T1DM in females, they're usually normal. However, several studies, including a paper in The Journal of Diabetes Complications in July 2006, have shown that the onset of menstruation is delayed in girls with T1DM to an average age of 15 (a girl without T1DM usually starts having periods around age 12 or 13). The earlier the onset of diabetes, the later the onset of menstruation.
After you start to have periods, your blood glucose levels rise and your insulin needs increase and then decrease as you go from day 1 to day 28 of your menstrual cycle. The changes in blood glucose and insulin occur because of the production of progesterone and estrogen until just before your period, when they fall dramatically. (What's the reason for this drop? If an ovulated egg isn't fertilized, progesterone secretion ceases and the uterus sheds its lining, producing a menstrual period.)
Blood glucose control tends to be worse in women with premenstrual syndrome (PMS); one possible reason for the irregularity of the control is the constellation of symptoms that accompany PMS: bloating, irritability, water retention, depression, and craving for carbohydrates.
It can be challenging to manage insulin during your menstrual cycle. As always, the best way to deal with this challenge is with more information — do more blood glucose tests! Test before meals, an hour after meals, at bedtime, and at 3 a.m., and adjust your insulin intake appropriately (see Chapter 10). You'll find that everything isn't actually random but rather that there's some sort of pattern that you can adjust to. As you adjust your insulin intake to the pattern, your overall control will improve as shown by lowering of the hemoglobin A1c. Irregularity of periods tends to be greater as your hemoglobin A1c is higher. The better you control your diabetes, the less this will be a problem. (See Chapter 7 for full details on hemoglobin A1c and testing blood glucose.)
If you suspect that PMS is to blame for tough control of your blood glucose, make some changes that may reduce the symptoms. Stick carefully to your dietary program; avoid salt, alcohol, chocolate, and caffeine; and increase the amount of exercise you do.
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