FUDiabetes

A 1996 Survey: Source of the main hormone advice given to women today

“Many women find their blood sugar tends to be high 3 to 5 days before, during, or after their periods.”

This sentence is everywhere. It’s often the only thing stated to give women guidance for how to manage their changing insulin needs throughout their cycle. I just copied that sentence verbatim from the 2015 edition of “A Woman’s Guide to Diabetes”. I’ve written about this sentence before:

I believe I have located the source of this sentence with the help of a citation in Type 1 Diabetes: A Guide for Children, Adolescents, Young Adults–and Their Caregivers, Third Edition by Dr. Hanas. He cites the following self-reporting survey from 1996:
https://onlinelibrary.wiley.com/doi/abs/10.1002/(SICI)1096-9136(199606)13%3A6<525%3A%3AAID-DIA123>3.0.CO%3B2-D

-124 women between 18 and 40 years old completed the survey.
-61% noticed changes in blood sugar during PMS (most commonly a rise in blood sugar).
-36% were making insulin changes based on this pattern
-There was no A1C difference between women who were adjusting their insulin vs not.
-67% of women were taking combination oral contraceptives and still noted blood sugar changes.

If 61% of women in 1996 without CGM, without all of the measuring and fine dosing tools of 2018, noticed blood sugar changes prior to menstruation, imagine what could be observed with nuance today on this topic. I imagine far more women would note insulin resistance during ovulation if they knew to look for it. I imagine far more women would note nuanced changes well before the “3-5 days” prior to menstruation if they knew to look for it. So much discussion for diabetic pregnancy focuses on increasing insulin doses to match resistance from hormones which increase throughout the pregnancy. Why on Earth this discussion has not been applied to cyclical hormones in a more meaningful way, more recent than 1996, is a bit baffling to me. And the fact that this sentence is repeated over and over and over without citation is interesting, as well.

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Wow! Great research and tracking down of that source!!!

I agree with your sentiment both about the fact that it’s crazy that 22-year-old advice is all that is stated in most books and that more research hasn’t been done on how to deal with this in that long period of time. Twenty two years ago T1D was practically a different disease compared to today, at least when it comes to management. Lantus, Levemir, Tresiba, Humalog, NovoRapid, Fiasp, CGMs, analysis software, none of this existed. Pumps and carb counting were quite rare and most people were testing four times a day and using a sliding scale if they were adjusting insulin. If a majority of women back then noticed and more than half of those who noticed were making changes to their insulin doses, I agree with you that a significant number more would notice something with the technology currently available.

I wonder if there’s anything we could do, as a patient community, to spur a research study in this area…? It would be nice to come up with actual advice and guidelines that are useful for women, just as there are myraids of advice and guidelines to choose from when it comes with diabetes and diet, exercise, sick days, medication, time-zone changes, and practically any other subject one can think of.

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I’ve been working on this angle and had initial interest…but then the momentum seems to have faded. In the meantime, I want to work as much as I (we, if others would like to) can on this topic via FUD. But by all means, if you have any ideas, I’m all ears.