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\u201cHow on earth would birth control help manage diabetes? I\u2019m not an expert, but I\u2019m pretty sure those two things don\u2019t go together.\u201d  <\/em><\/p>\n<\/blockquote>\n\n\n\n

This comment was recently posted in an online parenting group I belong to.  <\/p>\n\n\n\n

A woman had asked whether she should follow her doctor\u2019s recommendation to put her teen daughter on birth control to hopefully regulate symptoms associated with Type 1 Diabetes. This mother had reservations about that suggestion, and turned to the group for help. This wasn\u2019t a group specifically about diabetes, but the question elicited numerous comments like the one I featured above.  <\/p>\n\n\n\n

Most women are in the dark about how the menstrual cycle affects metabolism and blood sugar <\/span><\/h2>\n\n\n\n

As I read through all of the comments on the diabetes\/birth control post, what became apparent to me is the same thing I encounter time and time again in the Type 1 Diabetes groups which I joined after my daughter was diagnosed with T1D last year.  The fact of the matter is: most women are completely unaware of the role that our cyclical hormones can play in our metabolism and in insulin resistance<\/a> [1]. This is especially true for girls and women with diabetes.<\/p>\n\n\n\n

For Type 1 Diabetics, studies have shown<\/a> that about half of women experience elevated blood glucose levels in the days following ovulation [2], suggesting that cycle phases should be taken into account<\/a> when figuring out proper blood sugar management [3]. <\/p>\n\n\n\n

Since receiving my daughter\u2019s diagnosis and seeing how many desperate parents do<\/em> turn to birth control to help with their daughter\u2019s insulin management, I\u2019ve now become \u201cthat period lady\u201d in some of these groups\u2013 encouraging mothers to help their daughters learn how to chart their cycles and work with their body\u2019s natural hormones, instead of overriding them and eliminating their cycles altogether. It\u2019s a very niche corner of the internet where my certification and experience as a Natural Family Planning instructor, teen cycle educator, and mom to a T1D warrior all collide.  <\/p>\n\n\n\n

The intersection of Type 1 Diabetes and the menstrual cycle <\/span><\/h2>\n\n\n\n

What I\u2019d like to offer now is some basic guidance for parents of girls who may be experiencing the acute challenges of T1D blood sugar management and teen cycles. My hope is that it will help you make informed decisions for your family in light of the fact that most providers do tend to counsel towards birth control as an option for these girls.  <\/p>\n\n\n\n

Type 1 Diabetes is an autoimmune disorder<\/span><\/h3>\n\n\n\n

Type 1 Diabetes is an autoimmune condition in which the body attacks and effectively destroys otherwise healthy islet cells within the pancreas. Without islet cells, the pancreas is unable to produce insulin to assist with blood sugar management. As a result, individuals with Type 1 Diabetes are necessarily insulin-dependent and require regular doses of insulin to avoid the build-up of unprocessed sugars in the bloodstream that eventually contribute to diabetic ketoacidosis (DKA). But, as every T1D knows, finding the right dosage of insulin for proper management can be very complicated! <\/p>\n\n\n\n

Maintaining healthy blood sugar levels with Type 1 Diabetes require a two-pronged approach <\/span><\/h3>\n\n\n\n

Maintaining relatively healthy blood sugar levels as a Type 1 Diabetic requires navigating two primary concepts: delivering accurate boluses (insulin doses) to cover meals and<\/em> establishing appropriate baseline levels of \u201cbackground\u201d \u2013or basal\u2013 insulin. If a diabetic is using multiple daily injections (MDI), they will usually have a mix of long-acting and short-acting insulin shots delivered at different times of day. For individuals using a pump or a pod, background delivery of insulin is achieved through micro-doses throughout the day which are coupled with larger doses to cover meals.  <\/p>\n\n\n\n

How the menstrual cycle impacts blood sugar balance<\/span><\/h3>\n\n\n\n

The menstrual cycle can be understood in terms of two ovarian phases<\/a>: the follicular phase (when an egg is maturing prior to ovulation), and the luteal phase (after the egg has been released at ovulation) [4]. During the follicular phase, estrogen<\/a> is the primary hormone being produced in response to the maturing egg follicle. After ovulation, progesterone<\/a> is the primary hormone being produced by the now-empty follicle (called the corpus luteum). As stated above, girls and women can experience varying levels of metabolic activity and insulin sensitivity during different cycle phases. This means that naturally cycling girls and women (i.e., those not on birth control) cannot always maintain consistent basal insulin rates, or carb ratios and correction factors. Instead, they will need to make adjustments<\/a> any time they experience major hormonal shifts throughout the cycle.  <\/p>\n\n\n\n

Naturally cycling girls and women (i.e., those not on birth control) cannot always maintain consistent basal insulin rates, or carb ratios and correction factors. Instead, they will need to make adjustments<\/a> any time they experience major hormonal shifts throughout the cycle.  <\/p><\/blockquote><\/figure>\n\n\n\n

It might be simpler to put teens with Type 1 Diabetes on birth control, but is it healthier? <\/span><\/h2>\n\n\n\n

When you think about diabetes management in this way, you can see why many doctors, parents, and teens come to the conclusion that everything would be much simpler if they just took out the complicating factors of cycle phase-dependent changes. And, of course, the way to do that is through the cycle-suppressing, synthetic hormones found in birth control. But the way I see it, there are at least two serious problems with this line of thinking: 1) We still don\u2019t have a very robust understanding of exactly how and why these synthetic hormones affect blood glucose levels; and 2) there is plenty of evidence to suggest<\/a> that birth control can actually complicate diabetes management instead of making it easier [5].  <\/p>\n\n\n\n

There is plenty of evidence to suggest that birth control can actually complicate diabetes management instead of making it easier.  <\/p><\/blockquote><\/figure>\n\n\n\n

So at a minimum, I think it\u2019s appropriate to challenge the notion that diabetics will always have an easier time if they suppress their cycles with birth control. It\u2019s just not that simple. And yet, the teen years are particularly difficult for diabetes management in general<\/a> [6] \u2013so it\u2019s worth taking a look at why teen menstrual cycles are so challenging, so we can make better decisions about management by taking hormones into account. <\/p>\n\n\n\n

Why menstrual cycles are more complicated for teens vs. adult women <\/span><\/h2>\n\n\n\n

As I\u2019ve written before<\/a>, when we\u2019re talking about menstrual cycles, teens just tend to have a more complicated set of issues going on than grown women do (that is, until perimenopause!). Of particular importance for diabetes management are two key points:  <\/p>\n\n\n\n