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

Abstract

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.