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Diabetes Knowledge

Diabetes and Menstruation - a bloody mess

3/2/2020 by Ilka Gdanietz

Diabetes and Menstruation - a bloody mess

Girls! Does your monthly cycle regularly mess with your blood sugar levels? Sometimes us ladies don't have it easy

In addition to the many things that can affect your blood sugars, we can also add the female menstrual cycle every month, which can make blood sugar regulation extra challenging.

 Just a quick reminder: the menstrual cycle begins on the first day of menstruation and ends with the following menstruation. This process is repeated every 21-31 days if everything goes smoothly.

Hormones are responsible for the blood sugar mess during menstruation.

The menstrual cycle consists of two phases, the estrogen phase and the progesterone phase, and both have an impact on insulin sensitivity. Sure, there are a lot of hormones involved, but to be more specific, the sex hormones estrogen and progesterone are the two culprits responsible for the “Bloody Mess” which occurs monthly.

The concentration of these two hormones is higher than usual a few days before the start of your menstrual period (i.e. in the second phase), which can be noticeable through increased blood sugar levels. Isn’t it bad enough that you already have to deal with PMS, increased irritability, binge eating, and mood swings. Of course diabetes has to get involved in the mix.

 The reduced insulin sensitivity impacts every person’s blood sugar differently. I personally notice higher blood sugar levels or a stronger insulin resistance about 3-5 days before the start of my  period.

Monthly cycle and diabetes connection is often underestimated

Honestly, how much support do you get from your team of HCPs when it comes to managing blood sugars before and during your cycle? Have any of them asked what phase of your cycle you’re in while talking about insulin adjustments? They probably should! 

Pink monster illustration holding a tampon


Relationship between menstruation and blood sugar fluctuations have been known for a long time

The connection between menstruation and blood sugar metabolism has been known for decades. More precisely, since the 1940s, when researcher H.I. Cramer shared his findings on the relationship between the monthly cycle and blood sugar fluctuations in the Canadian Medical Association Journal.

So why is there so little discussion and training on it? Shouldn't we be able to expect it as a standard of diabetes education and that it’s routinely considered during therapy adjustments?

There are almost 200 million women with diabetes in the world. And it's the way it is, women have menstruation. Women with diabetes are also more often affected by polycystic ovarian syndrome (PCOS) than women without diabetes. These include, for example, irregular bleeding, period pain, a very strong and / or longer period, as well as skin problems.


Documentation of cycle helps to prepare

Of course, none of us are keen on lousy blood sugar levels. Luckily, menstruation patterns are not too surprising each month. Nevertheless, it makes sense to track your cycle so that you are always well prepared.

 I personally track all my blood sugar data ​​in the mySugr app, which I log during my cycle, with the appropriate day (see photo). By adding this additional detail I can explain a lot of my unusual blood sugar fluctuations much better, or I can immediately explain to my endocrinologist how one of the outliers in the blood sugar data came about. I also use the "Clue" cycle app, which, along with many other helpful features, predicts my next cycle, or the next menstrual period, fairly accurately and reliably. On a side note, Clue also published a nice article about diabetes and menstruation a while back.


mySugr App showing menstruation tag

Menstrual cycle and adjustment of diabetes therapy

Knowing your cycle is definitely important, because this is the only way to counteract the fluctuations in blood sugar. For example, I personally need more basal insulin in the week before my menstrual period and then let the basal rate run at 130% - 150% percent (pump users are of course at an advantage here).

Many people with diabetes have created an additional basal profile in their insulin pump for this time, so that all they have to do is just switch to it at the appropriate moment.

Then, as soon as hormone concentration decreases, less insulin is needed in most cases. The extent to which the therapy must be adapted to the cycle is very individual and it takes a little time to work it out optimally.

This is precisely why accurate documentation and a well-trained team of doctors are so important and helpful. What are your experiences? Does your cycle affect your blood sugar levels? And what about therapy adjustments? Do you get support and advice from your diabetes team?


Finally, a few (fun) facts about menstruation:

  • A woman bleeds a total of 6 years of her life
  • There is a Disney film about menstruation
  • Menstrual cramps can be as painful as a heart attack
  • Menstruation is deemed impure in many religions
  • Cold temperatures can negatively affect the strength of flow and length of menstruation
  • May 28th is World Menstrual Day
  • On the other hand, it is often mistakenly shown in advertising, but menstrual blood is not blue but red! ;)


With this in mind, Power to the Period!


Paper is for origami

The mySugr website does not provide medical or legal advice. mySugr blog articles are not scientific articles, but intended for informational purposes only.

Medical or nutritional information on the mySugr website is not intended to replace professional medical advice, diagnosis or treatment. Always consult a physician or health care provider with any questions you may have regarding a medical condition.

Ilka Gdanietz

She's a diabetes veteran, Nutella lover and pump user all rolled into one. Ilka is mySugr's communications person for the German side of things and in her spare time writes a blog