Q: Our daughter is entering puberty, and her first period is probably not far off. We want to help her be prepared, especially when it comes to how menstruation could affect her blood sugar management. What should we know?
A: With the onset of pubertal changes, children — both boys and girls — develop resistance to insulin, due to increased levels of growth hormone and other hormones that interfere with insulin sensitivity. Because of this, children with type 1 diabetes may require noticeably more insulin during puberty.
For girls, monthly periods can also have a significant impact on blood sugar. Some girls will have higher blood sugar during periods, some will have lower blood sugar, and some will have a combination of highs and lows. Once your daughter starts menstruating, try to identify any consistent blood sugar patterns associated with her cycle.
To do this, encourage your daughter to keep a menstrual log, which notes the days she has menstrual bleeding, spotting, and/or cramping. There are many smartphone apps to help girls track their periods, but a written log is fine too. On your end, parents can help by keeping a log of blood sugar readings and insulin doses before, during, and after menses. CGM (continuous glucose monitor) and glucometer data can be reviewed, and all of this blood sugar data can be compared with your daughter’s log. This should be done for a few months.
If you note a pattern of highs or lows, a plan for insulin dose changes at certain times can be made with the help of your diabetes doctor or nurse. Some girls using multiple daily injections of insulin will increase or decrease their long-acting insulin dose during periods. Girls on insulin pumps will often use temporary basal rates during periods, or use a different basal pattern (e.g., Pattern A) rather than their “standard” basal pattern.
Navigating the changes of puberty can be challenging, for kids and their parents. By helping your daughter understand how her body is changing and what she can do to keep her diabetes managed when she starts her period, you’re setting the foundation for her to feel empowered about her cycles and her diabetes in the years to come.
—Laura Gandrud, M.D., is a pediatric endocrinologist with the Children’s Hospitals and Clinics of Minnesota.
How Other Parents Deal
“To have ‘the talk’ with our daughter about changes she would notice during puberty as a young woman with type 1 diabetes, our CDE recommended piggybacking on her health class at school. The day that her health teacher had a separate class with just the girls to talk about menstruation, I followed up at home with a mini lesson about what all these changing hormones could mean for her T1D. Because she was taking on more independence in her care tasks, I wanted her to know that any fluctuations she might see when her period arrived were not her fault, and just something we needed to deal with as her body changes.”
—Liz R., Bryn Mawr, Pa., mom of 19-year-old Erica
Disclaimer: The information in these articles is not intended as medical advice. Families should check with their healthcare professionals regarding individual care.