Home Diabetes Care Tips on how to Manage Insulin and Exercise During Your Menstrual Cycle

Tips on how to Manage Insulin and Exercise During Your Menstrual Cycle

Tips on how to Manage Insulin and Exercise During Your Menstrual Cycle

There’s little doubt about it: It’s challenging to administer your blood sugar levels during exercise. Physical activity is incredibly necessary to your overall health, but it surely creates all varieties of challenges during (and after) your workout. Keeping those levels regular takes experimentation with so many variables, including your nutrition, your insulin usage, and your kind of exercise.

And guess what? Women have it even tougher, since the menstrual cycle causes hormonal changes that recurrently change how sensitive you’re to insulin. In fact we do (pardon me as I shake my head at adding yet one more variable to the combination). It’s just yet another variable making exercise just that far more difficult to administer.

There may be little research on the topic, so it’s not surprising that not all women with type 1 diabetes realize how these aspects interact, in keeping with Jane Yardley, an associate professor of Physical Education on the University of Alberta.

“Lots of women aren’t aware of this, especially the newly diagnosed or teenage girls, who’ve lots of other stuff happening.”

Dr, Yardley has devoted much of her profession to the study of exercise in individuals with type 1 diabetes. She spoke to Diabetes Day by day concerning the difficulty of managing glucose levels during and after exercise and the special challenges that ladies should cope with.

Insulin on Board

If there’s one thing Yardley wants to emphasize, it’s that the insulin we administer with syringes, pens, and pumps is fundamentally different from the insulin made by a healthy body, and that this fact has big consequences for exercise.

“Most individuals don’t understand the difference between real insulin that’s made by the body and artificial insulin. That’s the large problem with exercise. Synthetic insulin stays in circulation for several hours. Endogenous insulin has a half-life of 5 minutes. When someone without diabetes starts moving, the nervous system talks to the pancreas, and the quantity of insulin being produced drops drastically. Inside five minutes, there’s an enormous decrease in the quantity of insulin in circulation.

“So as to mimic that, individuals with type 1 diabetes should plan 90 minutes to 2 hours upfront for exercise. This doesn’t necessarily get taught thoroughly.”

The Menstrual Cycle

Women commonly experience shifting levels of insulin resistance during their monthly cycles.

“We see, from several studies, that probably around two-thirds of ladies with type 1 diabetes experience insulin resistance inside the luteal phase, which gets worse because the cycle goes on. Often that last week before the period is where we see essentially the most insulin resistance.” 

That insulin resistance can then rapidly disappear. Many ladies report that they should battle hypoglycemia in the course of the first few days of their next cycle — that’s likely because their insulin sensitivity has once more peaked, they usually don’t realize that they’re using more insulin than they really want.

“The ladies that I’ve met who’re essentially the most in tune with their cycles are conscious about these fluctuations. Women I’ve met who’re on the pump use different basal rates throughout the month.”

The one approach to really figure this out for yourself is to experiment:

“Track your cycles. Try to work out if you have got higher insulin needs during that last week of the cycle before the period starts. Should you do, bear in mind that any extra insulin on board while you start exercise could lead on to a faster drop in blood glucose levels. You’ve got to be more aware of getting those extra carbs with you in that last week of the cycle.”

Paying close attention to the calendar and to signs of ovulation can assist to accurately predict while you might need insulin adjustments. There are many apps and other methods for tracking your cycle to assist determine when ovulation occurs. Documenting blood glucose trends throughout the month to assist determine your optimal timeline for making insulin dosing adjustments. Once you start tracking, you may be surprised just how much your hormones impact your day-to-day blood glucose levels. 

Getting your insulin usage dialed in can really help preserve your reproductive health, in keeping with Yardley:

 “With each higher doses of insulin and hyperglycemia, we see more of an effect on the menstrual cycle. Polycystic ovary syndrome (PCOS) is far more common in type 1. Girls with type 1 normally start their period later, and menopause is normally a few years earlier. But when you’ve been in a position to keep your glucose levels in range, there are fewer problems.”

Puberty and Perimenopause

 All of that is even trickier, nevertheless, at the start and end of the reproductive lifespan.

During puberty, girls with type 1 diabetes have many recent variables to cope with. Girls experience more insulin resistance during puberty, and are also much more likely than boys to experience mental health issues. “All of these items can actually wreak havoc in your metabolism,” Yardley says.

At the opposite end of the reproductive lifespan it might be almost inconceivable to plan ahead in the course of the menopausal transition, which brings erratic hormonal changes: “In perimenopause, it’s really screwy. Estrogen fluctuations change how the body manages glucose. Because those are completely unpredictable — you’ll be able to go months with no period — it’s very hard.” Perimenopause isn’t spoken about and is just now finally getting the eye it needs and deserves. It will probably be a very difficult time to administer diabetes and is value discussing along with your care team.  

Insulin Management and Exercise

Most of us understand the basics of how exercise impacts blood sugar. To place it very simply, exercise, especially cardiovascular exercise, often ends in blood sugar lows (hypoglycemia). The underlying science is pretty easy: Once you’re understanding, you wish more energy, and your body’s cells will greedily take up the glucose in your blood. One approach to manage that is to eat more carbohydrates, adding more glucose to your system. One other is to scale back the quantity of insulin in your body, which is far easier to do when you’re using an insulin pump.

Yardley insists that optimal insulin management for exercise starts as early as two hours before the workout — some extent at which insulin pump users might want to scale back their basal rates.

One of the best approach to avoid glucose issues could also be to exercise very first thing within the morning, before eating, and, most significantly, before using any bolus insulin.

“Fasting is a trick that’s underutilized. Should you’re an early bird, fasted exercise might be the safest thing you’ll be able to do. Because you have got the bottom amount of insulin in circulation, and the body is releasing other hormones that cause blood sugar to rise, fasted exercise normally makes the glucose levels go up as an alternative of down, and in the event that they do go down, they go down loads less.”

Should you’ve turned your basal insulin rate right down to avoid hypos during exercise, or stopped it entirely, it is advisable to turn it back up before you complete your workout.

“What we see with aerobic activity is that while you finish the activity, you get an enormous increase in glucose for 2 to 3 hours after.

“The major source of fuel for aerobic exercise is fat. The body will release fat at the identical rate that the muscles need to make use of it. When you stop exercising, the body takes somewhat while to reply, so it’s still releasing fat for somewhat while, which implies you get a buildup of free fatty acids in circulation. This creates insulin resistance, and you wish more insulin to take care of the identical glucose levels.

“Lots of people within the exercise community with type 1 diabetes have picked up on this, and restart their basal before they stop exercising.”

Optimal insulin management doesn’t stop after the workout ends, Yardley says.

“Rather well-managed people, people who find themselves really dialed in with exercise, once they exercise later within the day they’ll decrease their basal rates overnight [if they’re on a pump]. Which is what you actually need to do, particularly if it’s a high-intensity exercise session. Should you’re doing intervals or weight lifting, you’re using the stored glucose out of your muscle and liver, and people must be paid back, and it normally takes multiple meal to pay them back. Your risk of going low overnight might be higher, unless you’re taking quite a little bit of carbohydrate before you go to bed.”

“Lots of recommendations say you need to decrease your basal by 10 percent overnight when you’ve done intense activity in the course of the day.”

It’s loads to absorb. Given all of those complexities and variables — insulin on board, food, exercise type, time of day, and hormonal cycles — it might seem inconceivable to get blood sugar management during exercise right. Yardley has some advice:

“With regards to finding the mixture, you have got to alter one thing at a time. Should you change multiple variables directly, you don’t know what change actually helped, or what was making your problem in the primary place. What we do as scientists is hold every thing consistent apart from only one variable. You’ll want to approach your body as if it’s a science experiment.”


[Diabetes Daily senior editor Ross Wollen contributed to this report.]


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