There are a lot of factors (read: a practically endless list) that affect blood glucose levels, which in turn affect how we manage our type 1 diabetes. Here are a few examples of what influences blood sugar*:
- Overestimating/underestimating mealtime insulin dose
- Basal rate or long-acting insulin dose too high or too low
- Physical activity
- Altitude changes
...but perhaps one of the sneakiest factors that can affect blood glucose, for girls and women in particular, are the hormonal fluctuations that take place beginning in puberty and continue on throughout the lifecycle. The menstrual cycle is one of the wild cards in managing type 1 diabetes. A standard cycle lasts 28 days, so basically the length of a month, which means a lot of attention should be placed on how to handle this aspect of diabetes management, since it can affect a large majority of time.
Unfortunately, this is a topic that is just barely beginning to get the attention that it deserves. Since getting one's period is a somewhat "taboo" topic, and not much formal research has been done on its effect upon women with type 1 diabetes, its effect on T1D is often only discussed after being brought up by the patient, to other patients, who have anecdotal wisdom to share. With technology like continuous glucose monitoring and insulin pumps, we can see how our BG fluctuates during this time and then adjust our ratios and basal rates to smooth out the peaks and valleys as a result.
This was something I came to realize on my own, after beginning to utilize my CGM. I found that the best information and advice on this topic came from other women with T1D. As someone who feels more comfortable keeping these types of personal conversations between myself and my doctor, or those very close to me, knowing how little it was being discussed made me feel more open to having the conversation a little bit more often and with people outside of my inner circle. Discussing what are otherwise "inside voice" topics with other people became important to me because I did not want anyone to feel as alone as I had when I realized that my menstrual cycle had a huge influence on my diabetes management, but there were no readily available doctor-approved fixes that would work for me for this purpose.
When I had the opportunity to visit with Scott Benner, father of a preteen daughter with T1D, author of blog Arden's Day, on his Juicebox Podcast, to discuss the menstrual cycle's influence on life with type 1 diabetes, I had to accept. Something I have learned in my T1D journey is that the things that make us uncomfortable are worth pursuing if we can continue to learn from them, and more importantly, if our pursuit can benefit others. My goal for my time as a guest on the podcast was to let other girls, women, and their families know that they are not the only ones experiencing these hormonal fluctuations, and to share my experience to help educate. Scott did a great job of keeping the conversation light and humorous (while using a myriad of euphemisms for "that time of the month"). If you have been quietly curious about this topic, I recommend you click the link to pop over onto Arden's Day and take a listen to the Juicebox Podcast, Episode #109: Code Red.
*A more extensive list can be found in Type 1 Diabetes Caregiver Confidence, Chapter 3: What Causes Blood Glucose Fluctuations?