Managing diabetes during menopause

DR MAXWELL ADEYEMI

Menopause uniquely affects the management of diabetes mellitus and some opined it may contribute to the risk of diabetes.

Although the weight gain that commonly occurs during the menopausal transition is largely attributed to ageing rather than the transition itself, changes in body composition have been independently associated with menopausal status. These changes in body composition have in turn been associated with alterations in insulin sensitivity and glucose metabolism in post-menopausal women.

Menopause is the phase of life after your period have stopped, it generally starts around the age of 45 -55 years of age but may vary from person to person, a variety of situations may interplay in menopause and diabetes.

GLUCOSE CONTROL

You may feel moody sometimes and think your sugar level is low, but it may be due to the menopause symptoms, occasioned by hormone fluctuations, so check your sugar a little more regularly, eating more at these times may throw your glucose levels out of control.

HEART DISEASE

Diabetic women are four times more likely to have heart failure and twice more likely to have heart attacks – menopause further increases the risks. This is because high blood pressure, high cholesterol and increased body fat which are linked to heart disease are typical symptoms associated with this stage of life. Weight loss, blood pressure control, cholesterol control and tight glucose control will reduce this risk.

HOT FLASHES

This can be heralded by sleep disruption, racing heart and crashing headaches, believed to be due to a drop in oestrogen level which interferes with the hypothalamus (the area that regulates body temperature in the brain). Hot flashes can be worse for diabetic women because the hormonal imbalance of menopause makes it harder to control high blood glucose levels; and a sudden drop in blood glucose can lead to more intense hot flashes. You can minimise hot flashes by avoiding common triggers such as smoking, caffeine, alcohol and stress, getting regular exercise and weight loss as overweight increases the chances of hot flashes.

SLEEP DEPRIVATION

This causes glucose fluctuations – this is because sleep deprivation decreases leptin– hormone that helps control appetite – and increases ghrelin – the hormone that stimulates appetite, which causes weight gain. The associated high blood glucose also increases urine output as the body tries to eliminate excess sugar, this leads to further sleep disturbance as this causes more frequency of urination while sleeping.

SEXUAL PROBLEMS

For women going through menopause, drastic reduction in hormones can cause vaginal dryness that makes sex uncomfortable and even painful. It is worse for diabetic women because diabetes can damage nerves and blood vessels of the vagina making it harder to get aroused and have orgasm or sexual satisfaction. The vaginal dryness caused by menopause and the high glucose in diabetes causes increased risk of vaginal infections and makes sex an uncomfortable experience.

INFECTIONS

Diabetic women have a higher risk of urinary tract infections and yeast infections, because they may suffer from poor circulation, which reduces the ability of white blood cells to kill offending bacteria. Also, menopause leads to lower oestrogen levels in the bladder and vagina which leads to increase vulnerability to infection in these areas.

BLADDER INCONTINENCE

Low levels of oestrogen in menopause can lead to incontinence (where patient “wets” themselves). Too little oestrogen levels reduce elasticity in the tissue of the vagina, urethra and bladder which leads to “leaking” of urine, and because high blood glucose levels can increase urine output, the diabetic women may leak more.

DEPRESSION

Women with type 2 diabetes are almost twice as likely to have symptoms of depression because the daily stress of diabetes control can drain your spirit and make it harder to manage the disease. Handling the complications of diabetes can also erode self-esteem and dampen your spirit. These feelings get worse during menopause when low estrogen levels exacerbate mood swings, stress and depression.

DENTAL PROBLEMS

Diabetes and menopause reduce the body’s resistance to infection; hence the gums are at a double risk of gingivitis (inflammation cause by bacteria in plaque) and periodontal diseases. Diabetic women are more susceptible to oral infections and gum diseases and these dental infections tend to be more severe. The infection on the other hand makes the glucose control very difficult to achieve.

While it is not very clear if menopause increases the risk of developing diabetes. Changes associated with menopause can interfere with glucose metabolism and increase insulin resistance –a prelude to developing diabetes, Also the events associated with menopause as one can see can make the management of diabetes a challenge.

However, making lifestyle adjustments such as regular exercise, weight loss, smoke cessation (if you smoke), limiting alcohol and stress management can be of great value.

Managing diabetes can be challenging at any age, with menopause experience in women it can pose peculiar problems that need to be carefully assessed and appropriate treatment options applied. If you are having challenges managing your diabetes as a menopausal woman, you should consult with your doctor to better address the issues you may be having in a comprehensive manner.

Contact Dr Maxwell on 363-1807 or 757-5411.