1 Periods, Menstrual Cycles, and SugarsPMS Periods, Menstrual Cycles, and Sugars Mary Wright, RN, CDE, NP April 22, 2017
2 Objectives Provide an overview of puberty in girlsReview the pubertal hormones and how they affect insulin needs Review the effect pubertal hormones & diabetes can have on emotions Review the menstrual cycle and how hormonal changes within a month can affect insulin need Discuss pregnancy with type 1 diabetes and importance of planning pregnancies Review contraceptive options available to females with type 1 diabetes
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4 What is puberty? Puberty is the process of growing from a child to an adult It involves increasing hormones, which are special chemical messengers that help your body do certain things, like grow up These hormones make insulin not work as well, so you need more insulin Puberty hormones start about years BEFORE your period Puberty can start earlier in African American girls and has been starting earlier in general for girls over the past few decades The timing of puberty and 1st period is best predicted by age of mom’s 1st period
5 Puberty Puberty usually starts sometime between 8 and 13 years of age for girls, usually a little later for boys Within these ages, whenever you start is just right for you There can be physical, mental, emotional, and social changes you experience Each girl changes at her own pace
7 Estrogen Estrogen has many effects on the bodyOne important role estrogen plays is triggering breast development (one may get larger faster than the other) and skeletal growth at the start of puberty Estrogen stimulates a thin, white, non-foul-smelling vaginal discharge that typically begins 6 to 12 months before your 1st period Increased estrogen is largely responsible for breast development, helping to build uterine lining, and changes in the distribution of body fat in girls going through puberty
11 Insulin Changes by Time of DayBefore puberty, many kids need more insulin between 9pm and midnight, when hormone levels are highest During puberty, hormone levels tend to be quite high from 3-7am so insulin need tends to be highest at that time instead If you’re on a pump, this may mean you will have higher basal rates at these higher hormone times If you’re on shots, sometimes you have to get creative to work around these hormone spike times
12 Ex: Puberty & Increased Insulin NeedAge Weight Insulin dose/kg Total Daily Insulin 4 yr old 20 kg 0.25 u/kg/day 5 units/day 7 yr old 30 kg 0.5 u/kg/day 15 units/day 12 yr old 50 kg 1 u/kg/day 50 units/day 14 yr old 70 kg 2 u/kg/day 140 units/day 18 yr old 70 units/day
13 Puberty & Insulin Need You can see there is a huge increase in insulin need when the hormones go up This happens even in people without diabetes, but their bodies automatically up their own insulin CAUTION FOR PARENTS: Don’t blame! Supervise and support your teen, adjust insulin frequently or call diabetes team to help with adjustments CAUTION FOR TEENS: These highs during hormone surges are NOT YOUR FAULT. Your job is to keep checking your blood sugars so we know that you’re high and can adjust the insulin.
14 Puberty & Feelings There are so many changes that take place with thebody, mind and lifestyle during puberty, it’s normal to have strong and fluctuating feelings. Some contributing factors are: Pubertal hormones Coping with diabetes High blood sugars Parental worry or pressure Normal teen stressors
15 For T1D Teens Remember, the mind and body are connected… so ignoring diabetes can make people feel worse, and ignoring depression and anxiety can make it hard to manage diabetes all together Connect with others who have diabetes- nobody expects you to handle diabetes by yourself! Reach out to someone who can help you create strategies to relieve some of the burden (parents, doctors, therapists, friends)
16 More For T1D Teens Find ways to relieve stress- exercise, yoga, writing, drawing, painting; take time to do something you love Stay motivated, not “perfect”- forgive yourself for having occasional blood sugar fluctuations Know when to seek professional help- if you have symptoms of depression, extreme mood swings, helplessness or extreme anger You can find information on depression at and typing in adolescent depression
17 Puberty, Emotions, and DiabetesT1D can add additional complexity, confusion and challenges for not only the teen, but the entire family as well. It’s completely normal for both the teen and the parent to feel frustration at times during these years. However, it can also be a time for teens and parents to develop a much more collaborative and trust-based relationship.
18 For Parents of T1D Teens Helping a teen with this complicated disease is the best thing you can do for their physical, emotional and social outcomes. As teens gain diabetes skills (self-testing and injecting) and greater overall independence, caregivers often allow them more freedom with their diabetes. However, teens don't often quite have the "emotional muscle" to safely care for their diabetes completely on their own. Taking care of diabetes requires people to control their impulses, plan ahead and organize- skills that typically aren't developed until late adolescence or even early adulthood. Additionally, if teens are given responsibility too early, they often burn out and don't have a foundation of supported-experience in managing diabetes that they can rely on later in life
19 More for Parents Asking teens if they took care of their diabetes does not work and can also lead to problems between parents and teens. Instead of asking if BG or injection/ bolus was done, supervise directly. It is important to talk to your child about how blood sugars are not "good" or "bad", they are simply decision making points. They provide the information needed to take care of yourself- do you need sugar, insulin or nothing. A non-judgmental approach works best for diabetes. Let your teen know that you're proud of them for trying, not necessarily because of their blood sugars number. Don't set unrealistic expectations. It is normal for BGs to continually vary. Sometimes you do the same thing every day and see very different BG readings.
20 Puberty & MenstruationDuring puberty, ovaries begin releasing eggs for the first time The egg travels through the fallopian tubes and in to the uterus If the egg is not fertilized, the uterine lining is not needed to support a baby The lining flows out through the cervix and vagina in a process called “menstruation” (also called: period)
21 Diabetes & Periods The average period comes every 28 days but maybe be longer, shorter, or irregular at first Diabetes, especially with more exposure to high blood sugars, can delay the onset of puberty and your periods, and can make them irregular
22 Insulin Need by Time of MonthThe week before period you might need more insulin, and the week of period you might need less insulin than usual. This is mostly because of progesterone. Your monthly pattern might look different. Check BG & look for patterns. Ovulation Period Progesterone Day 1 Day 14 Day 28
23 Monthly Insulin AdjustmentIf you notice you are higher at certain times of the month (like the week before your period), you might need more Lantus/Levemir or basal If you notice you are lower at certain times of the month (like the week of your period), you might need less Lantus/Levemir or basal Women on pumps can try using 3 different profiles, restarting temp basal every 1-3 days, or manually adjusting You might find you need to adjust carb ratio and correction factor as well
24 Pregnancy, STDs & DiabetesIndividuals with diabetes have the same risk of contracting sexually transmitted diseases (STDs) and becoming pregnant as those without diabetes. Abstinence (not having sex) prevents STDs and pregnancy If you are sexually active, condoms reduce your risk of STDs and pregnancy It is very important if you are sexually active to use birth control because high blood sugars can be dangerous to a developing baby Some T1D patients find birth control helps monthly glucose/insulin fluctuations, even if they are not sexually active There are many types of birth control that are safe for teens & adults with T1D
25 Birth Control IUD: May not alter insulin need much, low hormone exposure, long term protection, don’t have to remember to take anything, lasts 5-10 years Implant: May cause irregular bleeding, lasts 3 years, may not affect insulin need much Ring: May require less insulin adjustment than pills/patch, may forget to replace monthly Pills & Patch: May require more insulin, may not, may forget to take it Shot: Every 3 months, may cause weight gain and increased cholesterol & insulin need, Irreversible for 3 months if side effects or BG variability Progestin-only pill: risk for pregnancy if miss exact time daily, may require more insulin Plan B: This is a big dose of hormone if you have unprotected sex, must take within 72 hours, may cause temporary higher BGs
26 Diabetes & Pregnancy Women with diabetes can have healthy babiesIt is extremely important to have blood sugars in range as much as possible before becoming pregnant because a baby’s organs start to develop almost immediately after a woman becomes pregnant… even before she knows she’s pregnant In the later stages of pregnancy, high blood sugars can increase the risk of having other complications in the baby or mom High blood sugars can make pregnancy a little more risky, that’s why it’s so important to talk to the diabetes team and OB before & throughout pregnancy
27 Diabetes & Having ChildrenIf you want to be a parent some day, diabetes shouldn’t stop you Wait to have a baby at a time when that child can be the focus of your life When it’s time & you are physically mentally, emotionally & financially ready: YOU CAN HAVE DIABETES AND HAVE KIDS!
28 Resources Diabetes Behavior Insitute: http://behavioraldiabetes.orgParents of Teens with T1D: “Cowboys and Horse Whisperers: Changing Paradigms of Diabetes Education and Care” by Barbara Anderson “How to Parent an Adolescent with Diabetes” by Barbara Anderson Contraceptive Options for Women with Diabetes Mellitus: