Glycemic changes during menstrual cycles in women with type 1 diabetes

Herranz, Lucrecia; Saez-de-Ibarra, Lourdes; Hillman, Natalia; Gaspar, Ruth; Pallardo, Luís Felipe

doi:10.1016/j.medcle.2016.05.034

Cited by 11 publications

(11 citation statements)

References 15 publications

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“…According to these reports, luteal hyperglycemia occurs in 58.4% of women, while in 52.2% of women hyperglycemia manifests from the early follicular phase (days 1-5 of the 28-day menstrual cycle) [9], similar to our patient.…”

Section: Discussionsupporting

confidence: 86%

23-Year-Old with Recurrent Diabetic Ketoacidosis: A Case of Catamenial Hyperglycemia

Gómez¹

2017

Ann Womens Health

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Diabetic ketoacidosis is a medical emergency with somatic and psychological implications in patients with type 1 diabetes mellitus (DM1). Menstrual cycle-related glycemic change is rarely described as a precipitant of diabetic ketoacidosis. We present a case of a 23-year-old female with a history of DM1, on her second day of menstruation, who presents with diabetic ketoacidosis. In absence of other precipitating factors, examination of the time pattern of her recurrent diabetic ketoacidosis was consistent with catamenial diabetic ketoacidosis. To date, the reports of catamenial diabetic ketoacidosis are few and without consistent results. Moreover, most of the reports investigated only women with tight glycemic control. Systematic studies of catamenial hyperglycemia suggest variation in hyperglycemic patterns among individuals and even inconsistent glycemic variability patterns with consecutive cycles, making the management of catamenial hyperglycemia challenging. This case illustrates recurrent adverse outcomes (including diabetic ketoacidosis) due to complexities in DM1 management influenced by catamenial hyperglycemia. The complexity of diabetes management suggests the need of closed-loop glucose control systems that self-adjust basal insulin patterns to respond to the glucose management needs throughout menstrual cycles, which may ultimately prevent the risk for catamenial diabetic ketoacidosis, improve overall glycemic control, and reduce psychological burden of DM1.

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Section: Discussionsupporting

confidence: 86%

23-Year-Old with Recurrent Diabetic Ketoacidosis: A Case of Catamenial Hyperglycemia

Gómez¹

2017

Ann Womens Health

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“…Of those, 7 were excluded for an inadequate population studied, overlapping data, lacking data or study design, and 12 were included. Another two studies were also included, one selected from the references of retrieved articles [ 19 ] and one known by the authors of this review [ 9 ]. Finally, 14 studies [ 7 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 20 , 21 , 22 , 23 ] were included in the systematic review ( Figure 1 ).…”

Section: Resultsmentioning

confidence: 99%

“…Second, the phenotype of the glycaemic worsening found in the luteal phase is unclear. Since, according to some studies, this worsening affects postprandial glucose [ 13 , 19 , 22 ], it would be preferable to change meal boluses and the IS factor for corrections rather than basal insulin. However, according to other studies, the worsening occurs mainly in fasting glucose due to the accentuation of the dawn phenomenon caused by progesterone [ 22 , 34 ], with adjustment of basal insulin being the preferred strategy.…”

Section: Discussionmentioning

confidence: 99%

Menstrual Cycle, Glucose Control and Insulin Sensitivity in Type 1 Diabetes: A Systematic Review

Gamarra

Trimboli

2023

JPM

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The correlation between the menstrual cycle and glucose control in type 1 diabetes has been the focus of several studies since the 1920s, but a few critical aspects made it particularly challenging to reach conclusive evidence. The aim of this systematic review is to reveal more solid information about the impact of the menstrual cycle on glycaemic outcomes and insulin sensitivity in type 1 diabetes and highlight the less researched areas. The literature was searched by two authors independently using PubMed/MEDLINE, Embase and Scopus (last search on 2 November 2022). The retrieved data did not allow us to perform a meta-analysis. We included 14 studies published between 1990 and 2022, with sample sizes from 4 to 124 patients. We found a wide heterogeneity in the definition of the menstrual cycle phases, glucose metrics, techniques for determining insulin sensitivity, hormonal assessment and other interfering factors considered, with an overall high risk of bias. There is no conclusive evidence, and published data do not allow us to achieve quantitative results. In a subset of patients, a possible worsening of insulin sensitivity and hyperglycaemia in the luteal phase could be observed. From the clinical standpoint, a cautious strategy based on patient-specific patterns can be considered until new, solid evidence is obtained.

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“…Indeed, there are research data illustrating a heterogeneity among women with T1DM in terms of glucose metabolism during the catamenial cycle. 30,31 Hence, an individualised approach to insulin therapy is necessary. Nonetheless, identifying glycaemic variability during the menstrual cycle in susceptible patients could result in improvements in blood glucose management.…”

Section: Implications For Glucose Managementmentioning

confidence: 99%

The effect of menstrual hormonal fluctuations on the glycaemic control in women with type 1 diabetes mellitus

Milionis,

Ilias,

Venaki

et al. 2023

Practical Diabetes

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Information on physiological processes that affect insulin action and glycaemia is of paramount importance in the treatment of type 1 diabetes mellitus because optimal blood glucose control can prevent or decelerate microvascular complications. In insulin‐deficient premenopausal women, sensitivity to exogenous insulin seems to be lower during ovulation and in the luteal phase compared to the follicular phase. This difference directly affects glucose management. The risk for hyperglycaemia is oftentimes higher in the second half of the catamenial cycle, while hypoglycaemic events may occur more often in the follicular phase. Ovarian steroids (oestradiol and progesterone) are probable modulating factors in insulin action. Rising oestradiol during midcycle and high progesterone in the secretory phase of the menstrual cycle may contribute to insulin resistance. The underlying physiological mechanisms are largely unknown. It is possible that progesterone enhances gluconeogenesis in the liver and oestradiol binds to insulin and its receptor, thereby increasing resistance to insulin. These actions remain to be clarified. Additional factors related to the catamenial cycle may also facilitate variability in insulin sensitivity. The presence of glycaemic changes during the menstrual cycle is not consistent among premenopausal women with type 1 diabetes. The variability of blood glucose throughout the menstrual cycle should be considered when adjusting insulin dosage in susceptible subjects. Copyright © 2023 John Wiley & Sons.

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Glycemic changes during menstrual cycles in women with type 1 diabetes

Cited by 11 publications

References 15 publications

23-Year-Old with Recurrent Diabetic Ketoacidosis: A Case of Catamenial Hyperglycemia

23-Year-Old with Recurrent Diabetic Ketoacidosis: A Case of Catamenial Hyperglycemia

Menstrual Cycle, Glucose Control and Insulin Sensitivity in Type 1 Diabetes: A Systematic Review

The effect of menstrual hormonal fluctuations on the glycaemic control in women with type 1 diabetes mellitus

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