#592 Diabetes Variables: Menopause

December 10, 2021Scott Benner

#592 Diabetes Variables: Menopause

Scott and Jenny Smith, CDE share insights on type 1 diabetes care

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DISCLAIMER: This text is the output of AI based transcribing from an audio recording. Although the transcription is largely accurate, in some cases it is incomplete or inaccurate due to inaudible passages or transcription errors and should not be treated as an authoritative record. Nothing that you read here constitutes advice medical or otherwise. Always consult with a healthcare professional before making changes to a healthcare plan.

Scott Benner 0:00
Hello friends, and welcome to episode 592 of the Juicebox Podcast

well today we have another episode of the variable series. There's actually two more left counting this one. Today's episode is diabetes variables. Menopause. If you experience a hot flash during this episode, please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan, or becoming bold with insulin. Today I'll be speaking with Jenny Smith. Jenny has had type one diabetes since she was a child for over 30 years. She also holds a bachelor's degree in Human Nutrition and biology from the University of Wisconsin. She is a registered and licensed dietitian, a certified diabetes educator and certified trainer and most makes and models of insulin pumps and continuous glucose monitors. She's also Jenny from the Juicebox Podcast. So show some respect. Now there's like 15 seconds of music left here. Go with it. Just sway your hips. bob your head? I don't know. Pretend you're making your own personal tic tock video

this episode of The Juicebox Podcast is not sponsored. I haven't run out of sponsors. I've just fulfilled my requirements for this year. Huh? This is weird, isn't it? Um, what do I want to do here? You should check out the Yeah, I don't want to say hold on a second. Just stick with me. Are you looking for those diabetes pro tip episodes, the ones that begin at episode 210? Well, they're available right here in your podcast player, or at Juicebox Podcast comm they're also available at diabetes protip.com. And if that wasn't enough, at those same links, you'll find the defining diabetes series how we eat algorithm pumping afterdark there's so many to choose from. Let me also throw a little shout out here to the private Facebook group Juicebox Podcast type one diabetes as it crests, 18,000 members. The only thing that's missing is you go home, I'm recording now. Let me let me take a look and make sure that they're what I think they are. Because we did that. I'm recording. So we did that. Bubba we did that variable episode, the width was just kind of going through the rest of the list that didn't seem like they needed their own episodes. And while we were pulling through that we found just a couple that needed their own. So I'm gonna pull those

Unknown Speaker 2:59
up a little more discussion we did. Yeah, we are

Scott Benner 3:03
gonna finish up the variables, which took us all of 2020 long. weird to think of

Unknown Speaker 3:10
it. Yes. That's that's really weird to think. Yeah.

Scott Benner 3:13
Yeah, it is. It's an incredibly strange thought that you and I started this at the beginning of 2021. In here at the end, we're going to finish it up. So, ladies choice you want to do alcohol or menopause. First.

Unknown Speaker 3:28
Let's do menopause. Okay.

Scott Benner 3:31
Well, I don't know how much help I'm going to be with this. Really out of my wheelhouse. Now I don't have diabetes, and I don't have any lady parts. So

Jennifer Smith, CDE 3:44
and you have well and you have no experience helping a lady with menopause. Right?

Scott Benner 3:49
So I don't put Well listen, you're right. I don't. But my but I have a little bit of I mean, maybe I'm starting to but I don't see what it has to do with diabetes. But we'll see because there's a fan in my house now. A year ago,

Unknown Speaker 4:05
a fan like a ceiling fan, or a fan or we're talking about

Scott Benner 4:10
a year or two ago at Christmas time. I bought my wife a ceiling fan for our bedroom. But no lie has got to have a wingspan of maybe six feet. I like my two of them, I could get something off the ground. And it creates such a downdraft in my bedroom that if she turns it up too high, and I get in bed, my eyes begin to water and my lips chat. And I'm freezing like you can't leave your extremities outside of the blankets because they start to get numb. And I look over at her and she's barely got a sheet on it. She's like it's hot in here, right? So yeah, maybe I have some tiny bit of experience with this. I'm not sure. But how does this impact people with type on?

Jennifer Smith, CDE 4:55
Well, for what I mean they're multiple stages right to what we're kind of What we've typically classify as menopause, right. And I think another important thing to consider is, research has proven that women with diabetes tend to enter menopause earlier than women without diabetes. So it's a piece in the mix, not, you know, 100% of women, but many people, many women experience it starting sooner than later. So in terms of adjustments, we tend to start to see changes in monthly cycles, they either get longer, or they might get heavier, the, I guess, pain that may be associated with it cramping, and that kind of stuff can become more intense. And cycles can also become less regular. If you were the typical, like 32 days between my cycles, you might be 26 days and 35 the next month, so things kind of get a little bit wonky. And in terms of what's impacting blood sugar, then, if you had a pretty typical turnaround in insulin need, and you figured it out with a normal cycle, then this change in how your cycle is, you know, occurring now may get disrupted as well, your insulin needs may change, you may not need more insulin for a whole seven days before your cycle starts. You might need it for two days before and then you might need it during versus your insulin needs falling like a typical cycle.

Scott Benner 6:37
Okay, question. Let me Yeah, so you said it might start earlier, but age wise? Yes. Is there an amount of like, like, 10% earlier two years earlier? Like, is there any way to track it? Or? And how do you even know what earlier is right?

Jennifer Smith, CDE 6:52
Yeah, I mean, most, most menopause kind of perimenopause. And then once you're completely through, and you've no longer had a cycle you consider yourself sort of, into menopause is when you've had a cycle. We've not had a cycle for a year, 12 month time period without any normal cycle. So perimenopause can start and usually does over about the age of 45 to 50, for most women without diabetes could even be later. And some of that may have to do with like just genetics. You know, my mom started menopause at 55. If I didn't have diabetes, maybe I'd probably be in about that same bucket of time to consider it starting right. But some of the research that I've looked at actually shows that menopause or perimenopause, the beginning of changes to the cycle can actually be in like the mid to late 30s.

Scott Benner 7:48
Oh, wow. How long does perimenopause last? There's no way to know either.

Jennifer Smith, CDE 7:53
No, it's a big cycle of shift and change, like I said, So you, a good way to know is some of the symptoms, as you mentioned, you know, buying a big ceiling fan for your wife. Some of those are common symptoms in terms of like the hot flash, that's one that most people think about in terms of menopause is I get hot, or I get cold really easily or whatever. So you may have some symptoms that are also cueing you in but a big one, again, as you've been probably tracking and following based on just insulin adjustments that you typically need, if your cycle starts to become irregular, for no reason. And you're in the age group where you could be of an age that IP menopause starting, you know, then tracking even more and paying attention because insulin needs will shift and they really shift mainly because one of the big hormones in a woman's cycle is estrogen. Right. So as estrogen estrogen levels kind of fall as you move through perimenopause, menopause, you can see your insulin sensitivity shift as well.

Scott Benner 9:14
Okay. And shift in likely in the in the way of needing more. Okay, yes. Does any of this stop after menopause? Like once the

Jennifer Smith, CDE 9:27
there's more from the women that I've worked with who are definitely through menopause or I've been working with them? Well, after you know, they've no longer had a cycle. There is more. There's more stability in their numbers because hormones aren't fluxing like they would have been before Right? So there's not this ebb and flow tonight I need more I need less now etc. There's more stability unless something else variable wise changes like weight or their exercise level or you know their eating habits or Those kinds of things. So in terms of during, there's a lot of shift and adjustment. And from what I honestly see, for women working through it, there's a lot of navigating insulin changes that just look weird.

Scott Benner 10:16
Monthly, like, yes. Okay, so, you know, one, one month, it could be seven days before your period starts, you need a lot more than next month, it could be four days, or not quite as much, there's gonna be a lot of you being flexible through this,

Jennifer Smith, CDE 10:31
right. And it might even be, you know, if you knew ahead of time, you know, prior to this expected change happening, if you were needing, I need to adjust my insulin up by seven days before and I needed to adjust it for the whole seven days before my period started. In that perimenopause kind of stage, you might find a flux up where seven days before you need a little bit more. But as you get closer to your period, starting maybe the day before or two days before is when you're really needed the excess, you know, amount of insulin comparative to it just being a steady increased need for those days as it was previously.

Scott Benner 11:13
Okay, so is this because I'm going to ask you, at some point next year to do a pro tip about, about periods, and okay, male hormones in general, the whole thing's just like, I mean, the best I've been able to figure out around Arden is that, you know, like you said, coming up on her period, she needs a little more, it does seem to get, you know, a little more gradual towards the period. It used to be once she had her period, it just like it, it almost got easy during the period. But now she now she's on a birth control pill. That doesn't seem to happen as much anymore. So she's a little more consistent through the month now. And then when she gets through a period, it's not this like, like her period was almost like time off from paying attention to to, to insulin, it was just really easy. And yeah, now it's not as easy that and I realize she's not even getting the hormones, right. Hold on. Let me think about this. Yeah, usually she gets her period, right as you get to the placebo. Right? It's about how it's supposed to work. So then through the period, she's on the placebo. And, and she's not getting the hormone at that point

Jennifer Smith, CDE 12:28
outside of her normal cycle of hormones her normal body doing what it's supposed to do, right. Yeah.

Scott Benner 12:34
And she's taking them because she had no. I mean, like, Arden almost didn't have any quality of life without birth control. Like she was getting her period on this constantly. Too frequently. Yeah. And for like 11 days at a time. And they get like a two or three day break, and it would come back again. Yeah, so it completely depleted her of iron, made to get her a couple of infusions because of that. And just in general, it's it's, you know, it's, I mean, I don't know, but I live with a couple of women who don't look fun. So. Right. So doing it constantly looks a little, a little less fun. Let me ask you, is there any impact on menopause, if you also have a thyroid thing? Where are those things not connected? Well,

Jennifer Smith, CDE 13:23
I would expect that they would be connected in terms of thyroid having just relation to overall metabolism, right. And as your body cycling through a change in hormone production, with menopause, then you're going to have changes. I mean, many women experience weight gain during menopause, even who don't have thyroid issues. So I would expect them to impact each other. So obviously, just as you would normally do continue to have your thyroid levels checked, continue to adjust your medication kind of as needed. One time period of the day. That's interestingly, a time that many women going through like perimenopause into menopause often find more consistent lows is in the overnight time period. Oh, wonderful. Where insulin needs may need to go down overnight to decrease the chance of lows. I mean, thankfully, today, we've got a lot of technology and devices that obviously you know, you can watch things you can set alerts, you can adjust things much more precisely for that. But it is something to definitely know is you're not crazy if you think your insulin needs overnight are much lower than they are during the daytime as we age, we tend to need less insulin. If you look kind of at charts of insulin dosing. Insulin needs overnight are typically highest for like the young and like the teens. And then as you move into adulthood and then later adulthood into kind of like that menopause age. The overnight insulin needs are lower than the younger population, let's say

Scott Benner 15:05
okay, so alright. Yeah, because there's not as much growth hormone. A lot of other Hey, yeah, yeah, I want to say this real quickly before we say goodbye. If you haven't if you have a thyroid issue and you haven't heard episode 413 thyroid disease explained with Dr. Addy, Benito, you should listen. And if your doctors telling you that your four TSH or your six TSH or eight TSH is in range, you probably should find a different doctor who wants your TSH to be more like two or lower. So, but there are plenty of people Jenny's got a horrified look on her face. But there are plenty of doctors who are like you're fine. You're in range and in range they think of as up to like 10. Yeah, yeah, that's not okay.

Unknown Speaker 15:44
Yeah, no, that's not okay. No.

Scott Benner 15:47
All right. Okay, so the wrap up on menopause is it's going to be variable could change month to month, May last years. And I'm going to add probably going to be easier if you have a pump, and a CGM.

Jennifer Smith, CDE 16:02
I would agree it would be easier from a dose adjustment standpoint, yes, also allows you to track kind of shifts in in your, your needs a little bit more, especially if you have any of the sort of automated kind of or augmented insulin delivery systems that you can actually see your data. And you can see where insulin is being adjusted up or down based on your glucose shifts, that can make it a little bit easier to follow and see what your changes look like.

Scott Benner 16:32
Yeah, I'm saying that because if you have an increased need an insulin that goes 24 or 48 hours before you even realize it before, you don't think oh, maybe my you know, maybe I'm just you know, people are like I'm gonna maybe it'll go away. And then now you're right now you're significantly behind and this curve is going up and up. By the time you put in more Basal injected and figure out how to be more aggressive with it. You could be five days into your into this portion almost through the need. Yeah, by the time you by the time you see it, it might be too late. And that could really put you in a position where you start ignoring it, which I don't think you should do at all. So Okay. All right. I appreciate you doing this. Thank you very much. Yes, sure.

If you're interested in learning more about Jenny Smith, she works at Integrated diabetes, and you can hire her to help you with your type one. After Jenny, there's no one really to thank because there's no sponsors here today. Let me just remind you again, private Facebook group Juicebox Podcast type one diabetes, diabetes, pro tip episodes, defining diabetes stuff. I mean, the podcast is chock full of great information. If you're using insulin. I hope you check it out. Follow us on a podcast app, subscribe, tell a friend leave a great review somewhere. Have a nice holiday. I'll talk to you soon. When I'm back with another episode of The Juicebox Podcast