Contributor: Dr. Staci-Marie Norman, PharmD, CDE
Menopause. This is a phase of life many women are not looking forward to. It historically has been talked about in hush voices, and what was talked about always sounded horrible… hot flashes, weight gain, mood swings, night sweats, disruption in sleep, and hormonal fluctuations. All of these, along with diabetes, can really cause issues for blood glucose management, but you can make it through if you know what to expect and are proactive with your health.
Hormonal fluctuation is the culprit when it comes to the many signs and symptoms of perimenopause and menopause. And with fluctuating hormones, we can also have changes in the insulin sensitivity of our body. Estrogen helps with insulin sensitivity, but unfortunately, progesterone can contribute to insulin resistance. During perimenopause as our cycles become more erratic and further apart, we are subjected to a more progesterone heavy portion of the cycle. This increase in progesterone causes more insulin resistance, meaning you might see increases in blood glucose and A1C. You may also experience weight gain, which in turn can contribute to more insulin resistance. So how can you combat this? Remember, all diabetes regimens start with a base of a healthy lifestyle, and perimenopause/menopause are no different!
- Healthy Eating - both blood glucose and weight control start with what you eat. Continue to work on eating a balanced diet with complex carbohydrates (i.e., whole grains), fruits, veggies, and low-fat dairy and lean protein. Some women find that adding soy products, with their phytoestrogen components, can help with other symptoms of menopause along with being a good source of low-fat protein. Choose healthy oils, such as olive or grapeseed, which are higher in Omega-3 fatty acids, and are also good for your cardiovascular system.
- Stay Active - exercise continues to be important for blood glucose and weight management, and can provide help with keeping your mood balanced. Find something you enjoy doing, maybe it’s taking a walk with a friend (added accountability) or yoga (added relaxation to the work-out) or go for a swim (cool water to cool off those hot flashes). Just keep moving!
- Monitor - now more than ever, it is important to monitor your blood glucose. Make sure you continue to monitor as you’ve been instructed, but you might add in a blood glucose check when you are having symptoms. This can be helpful in making changes to your medication regimen.
- Medication - this is a time when your medications to manage diabetes may change dramatically. With added insulin resistance, if you currently use insulin, the amounts may need to increase. If you are only on an oral medication, the addition of another agent or insulin may be necessary to manage your blood glucose levels. Be proactive and talk with your physician about your blood glucose levels, your symptoms, and what you are doing to stay healthy. Also, don’t be afraid to discuss medications for symptom relief, such as hot flashes, vaginal dryness, or pain during sex. Hormone replacement therapy may be an option for you. This can help not only with the symptoms but also with weight gain associated with menopause. Estrogen creams and vaginal lubricants can also be used to help with the vaginal dryness and thinning that can occur with menopause. Be aware that diabetes makes women more susceptible to urinary tract infections and vaginal yeast infections. The additional changes to the vaginal area during menopause increases these risks. The other factor to consider when thinking about medication is cardiovascular health. Diabetes increases your risk, and menopause compounds that risk. This might be a good time to review your total medication regimen with your doctor to make sure you are keeping blood pressure and cholesterol levels in check.
It may seem overwhelming, but YOU’VE GOT THIS! This should be a time in life we embrace and celebrate.
Dr. Staci-Marie Norman, PharmD, CDE received her bachelors from Purdue University (’94) and her Doctor of Pharmacy from the University of Oklahoma (’96). In 2000 Dr. Norman added to her credentials by becoming a Certified Diabetes Educator. She is currently the Clinical Coordinator and staff pharmacist for Martin’s Pharmacy. Dr. Norman is a national faculty member for the American Pharmacist Association, teaching certificate programs in both diabetes and cardiovascular disease. She serves on the advisory board that oversees development and revision of these programs. Along with teaching and development responsibilities for APhA, Dr. Norman serves as a peer reviewer for research grants and publication submission. Dr. Norman has also spoken for Abbott, Bayer, Lilly, Mannkind, and Lifescan as a diabetes specialist.