Challenges for Women & Girls with Diabetes

The Hormonal Influence

From the onset of puberty, your hormone levels as a woman shift constantly, affecting various aspects of your health, including blood glucose levels, insulin sensitivity, and weight.  

Your hormone levels change every week, and this also changes with age! The teen years are significantly different from your 20s and 30s. These years might also include pregnancy, which is an intense week-by-week hormonal management game of its own. 

By the end of your 30s and into your 40s, many women notice new changes in insulin sensitivity throughout the month, thanks to perimenopause.

And then, menopause — which evolves over nearly a decade for most women. Lastly, post-menopause ought to bring some calmness to the hormonal rollercoaster.

Diabetes in Young Women: Key Insights

Research continues to shine a light on the different challenges girls and women face in type 1 diabetes (T1D) compared to boys and men:

Higher A1C levels

Girls tend to have higher A1C levels at diagnosis and throughout their lives than boys. In addition to hormone fluctuations, menopause and pregnancy, other contributing factors include stress,  body fat distribution and iron deficiency. 

Increased risk of DKA 

Girls have a higher risk of diabetic ketoacidosis (DKA), and when it occurs, it’s often more severe than in boys.

Higher insulin needs

Girls typically need more insulin than boys due to menstrual hormones, particularly the role of estrogen, which can affect how the body uses insulin. 

Higher risk of complications and comorbidities

Girls are more likely to develop diabetes-related complications like yeast infections and autoimmune diseases, such as thyroid conditions, celiac disease, and polycystic ovary syndrome.

Increased diabetes distress

Girls tend to have higher levels of diabetes-related stress (also known as burnout). One explanation could be a combination of diabetes being more challenging with the fact that girls are more likely to express their feelings compared to boys. 

Research also suggests that women with T1D and type 2 diabetes (T2D) experience more challenges than men:

Reduced quality of life

Women with T1D generally report a lower quality of life compared to their male counterparts.

Mental health challenges

Women with diabetes are more likely to experience depression and anxiety.

Higher A1C levels

Like girls, women with T1D tend to have higher A1C levels compared to men.

Increased risk of T2D

Women have a higher risk of developing T2D and insulin resistance, with research linking this directly to stress.

Higher risk of insulin resistance

Hormonal changes, especially during perimenopause and menopause, can definitely contribute to weight gain and insulin resistance.

Heart health concerns

Women with T2D have a higher risk of heart attacks and are often treated less promptly than men for heart-related issues. Heart attacks are mistakenly thought of as a condition that mostly affects men. This misconception has prevented many women from addressing the symptoms of a heart attack quickly and from getting life-saving care as quickly as possible.

Overall, yes, it’s an uphill hormonal battle that starts in the teens and evolves until post-menopause. Let’s dig into those hormonal phases of life and their impact on diabetes management. 

Puberty

Oh, the joys of puberty! For girls with T1D, puberty is the unwanted gift that keeps on giving. Here are the key factors that affect insulin sensitivity and blood sugar levels:

Testosterone

Girls and women produce less testosterone than boys and men. Testosterone is like a super fuel when it comes to burning fat and building muscle, which contributes to insulin sensitivity. Less testosterone means more insulin resistance.

Estrogen

Estrogen encourages the body to store more fat. In teen girls, estrogen levels are rising rapidly, which means increasing levels of insulin resistance and rising insulin needs. Both of these factors make blood sugar management more challenging.

Growth hormone

Growth hormone affects both genders, but teen girls are juggling growth hormones on top of rising estrogen levels and lower testosterone levels. 

Birth control

Birth control can absolutely affect insulin sensitivity and blood sugar levels, but it’s often overlooked in the doctor’s office.

Menstrual Cycles

The menstrual cycle is remarkably complicated, especially for women with T1D and T2D. Fluctuating hormone levels can significantly change a woman’s sensitivity to insulin and baseline insulin needs.

1.     Menstruation (Days 1-7): Insulin resistance often peaks, making blood sugar control difficult.

2.     Follicular Phase (Days 1-14): Estrogen rises, usually with less impact on insulin sensitivity.

3.     Ovulatory Phase (Days 14-15): Hormonal changes can lead to slight variations in insulin needs as the body prepares for a possible pregnancy.

4.     Luteal Phase (Days 16-30): Insulin resistance can increase again, especially in the days leading up to menstruation.

Trying to track and pinpoint when you might need more or less insulin during your menstrual cycle isn’t simple—some changes you can’t predict precisely enough to anticipate. Instead, women are often left to react as soon as they notice the changes in blood sugar levels and insulin sensitivity. 

For example, many women experience a noticeable spike in blood sugar levels the moment their period starts. Predicting this exact timing is nearly impossible.

Pregnancy 

Well, this can’t be summed up easily in a few paragraphs — pregnancy with T1D is remarkably complex, thanks to fluctuating hormone levels. Insulin needs can change multiple times per week or every few weeks. Some phases of pregnancy lead to significant insulin sensitivity, while other phases are defined by increasing insulin resistance.

In simplest terms, it looks something like this, but every woman’s pregnancy experience will vary slightly week by week. 

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[woman very pregnant]

Early Pregnancy

Unexplained insulin resistance may be one of the early signs of your pregnancy, but months two and three typically involve significant insulin sensitivity.

Mid-Pregnancy

As the baby grows, insulin needs typically escalate due to hormonal changes in the placenta. The mother is also gaining weight, which increases insulin needs. These are signs of a healthy pregnancy, but expecting mothers are encouraged to maintain helpful exercise and nutrition habits to keep insulin resistance.

Last Trimester

The last trimester usually brings significant insulin resistance and can be the most challenging for the mother with T1D. Insulin doses can be two or three times as much as her non-pregnant doses. Each pregnancy is unique, requiring constant glucose monitoring and adjustments in insulin doses to maintain your A1c goals with support from your healthcare team! 

• Learn more: Pregnancy with Type 1 Diabetes

Breastfeeding

It doesn’t get easier after the baby is born! Instead, breastfeeding brings a new type of blood sugar fluctuation and constant changes in insulin sensitivity. Producing breastmilk after every nursing session is like going for a power walk. The body works very hard to replenish your milk supply for the baby’s next meal. This means you might be more sensitive to insulin in the hour after nursing — and very hungry, too! 

Many mothers find it difficult to manage their insulin needs while nursing. While it’s a celebrated and encouraged method of feeding your newborn, it comes with significantly less predictable blood sugars.

As a nursing mother, work closely with your healthcare team to minimize low blood sugar. After months of managing tight blood glucose levels during pregnancy, you may need to lighten up on the pressure to “perfect” to prevent lows.

Menopause

The challenges of all those hormones don’t come to a screeching halt with the arrival of menopause. Instead, it’s gradual and equally frustrating.

During menopause, your body’s estrogen and progesterone levels decrease while your LH and FSH levels actually increase.

• Perimenopause is the start of this process. While your periods may not change much, the impact of hormone fluctuations on your blood sugar levels can be noticeable. For example, some women report experiencing insulin resistance related to starting their periods a full week earlier than usual.
• Menopause is official when it’s been one full year since your last period, but that can take years, which means the impact on your insulin sensitivity can take years, too.
• Post-menopause can bring some calm to the hormonal storm. Some women report that blood sugar management is easier at this point because their hormone levels no longer fluctuate throughout the month.

In Conclusion

Yeah, women are incredible. If you find yourself frustrated with your menstrual cycle and its impact on your blood sugar levels, start by taking careful notes. Get a calendar and note both the changes in your insulin needs and the symptoms and signs of your menstrual cycle.

While you may never be able to manage every detail, you might find a bit of consistency so you know what to expect each month. (That is, until it changes again, thanks to perimenopause or menopause.)