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DIABETES AND THE MENOPAUSE

Diabetes is a serious condition in which people have too much glucose (sugar) in their blood. Having glucose is essential – it’s what gives us our energy. We get glucose when our bodies break down the carbohydrates that we eat or drink and that glucose is released into our blood.

This article was included in issue 83 (winter 2019/2020) of The Menopause Exchange newsletter.

We also need a hormone called insulin, which is made by our pancreas. It’s insulin that enables the glucose in our blood to enter our cells and fuel our bodies. If you don’t have diabetes, your pancreas senses when glucose has entered your bloodstream and releases the right amount of insulin, so the glucose can get into your cells. But if you have diabetes, this system doesn’t work.

Symptoms of diabetes
When you’ve got Type 1 diabetes, you can’t make any insulin at all. If you’ve got Type 2 diabetes, it’s a bit different. The insulin you make either can’t work effectively or you can’t produce enough of it. In both types of diabetes, glucose can’t get into your cells and it begins to build up in your blood. This causes a lot of different problems. To begin with, it can lead to symptoms such as:

  • going to the toilet a lot, especially at night
  • being really thirsty
  • feeling more tired than usual
  • losing weight without trying to
  • genital itching or thrush
  • cuts and wounds taking longer to heal
  • blurred vision

Risk factors
Six in ten people don’t present with symptoms when they’re first diagnosed with Type 2 diabetes. That’s why it’s so important to know your risk, so you don’t unknowingly develop complications. There are a number of risk factors that we know affect your predisposition for developing the condition. These include:ethnicity, age, weight, and family history.

You’re more likely to get Type 2 diabetes if you’re over 40 or if you’re South Asian and over 25. There are things you can do to reduce your risk of developing the condition. Currently, 12.3 million people in the UK are at an increased risk of developing Type 2 diabetes. But around three in five cases can be prevented or delayed by maintaining a healthy weight, eating well and being active.

Type 1 diabetes isn’t affected by your lifestyle or your weight. That means you can’t affect your risk with lifestyle changes. The condition just happens, and doctors still aren’t sure what causes it. People up to the age of 40 are more likely to be diagnosed with Type 1 diabetes, but it’s predominantly found in children.

Type 2 and the menopause
If you’re going through the menopause, you’re at an increased risk of developing Type 2 diabetes. This is due to a number of factors, such as your age, hormones and weight distribution. Research shows that the menopause is associated with weight gain and an accumulation of fat, especially around the middle.

Gaining weight around the middle can increase the circulation of specific substances in your body, such as cytokines, and some hormonal changes, such as an increase in androgens. These can affect the way insulin works and lead to insulin resistance. Additionally, when the menopause occurs, there’s a drop in oestrogen activity that can also contribute to insulin resistance. Insulin resistance means the pancreas has to compensate by working harder to control blood glucose levels, and over time this can lead to Type 2 diabetes.

If you’ve already been diagnosed with Type 2 diabetes and you’re going through the menopause, this may be a challenge for your blood sugar management and you may need new medicines to help with the transition. Monitoring your blood sugar levels will help to identify the best approach for you.

Type 1 and the menopause
For women with Type 1, the menopause is likely to begin a few years earlier than women without diabetes. The menopause can affect your diabetes management in these ways:

  • Changes in hormone levels can make your blood sugars erratic
  • Weight gain can mean an increase in the medication you take
  • Hot flushes and night sweats can affect your sleep, so you feel less able to cope with the pressures of everyday life, including looking after your diabetes

Managing diabetes while going through the menopause can feel like a twin challenge for most women, due to the combined effects that each condition can have on the body. Don’t suffer in silence. Talk to your diabetes team about how your diabetes is going, and your GP can help with any menopausal symptoms. You can help yourself too – keep to a healthy balanced diet, keep active and, if you test your sugars at home, keep a check on them to assess the result of any changes you’ve made.

What do we recommend?
There’s some evidence that postmenopausal HRT seems to be either neutral or beneficial to the risk of Type 2 diabetes, but further research is needed. First and foremost, if you’ve not yet been diagnosed with diabetes we would recommend finding out your risk. Finding out your risk of Type 2 diabetes only takes a few minutes and it could be the most important thing you do today. You can find the tool on Diabetes UK’s website and it will help you to figure out which risks you may be able to modify.

Whether or not you have diabetes, the best course of action is to stick to a healthy balanced diet and to keep active, as this will either reduce your risk of developing the condition or make it easier for you to manage your blood glucose levels if you already have it. As menopausal women are more at risk of osteoporosis, we particularly recommend weight-bearing exercise, such as walking or dancing, to strengthen your bones as well. We also recommend including plenty of calciumrich foods in your diet, such as leafy green vegetables, dried fruit, tofu and yoghurt.

For more information
Diabetes UK is the UK’s leading diabetes charity, with the aims of preventing Type 2 diabetes, supporting everyone affected by diabetes and funding research. For information, visit www.diabetes.org.uk or call the charity’s helpline on 0345 123 2399.

Created Winter 2019/2020 

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