The Manual No One Gives Us
I received a thick, red manual when I entered the hospital after my initial diagnosis. It helped me through sick days, dosage calculations, and meal planning. When it was finally retired for newer books (and newer information about treating diabetes), it was dog-eared, well read, and still, this hefty document was missing some important sections.
Let's be frank. No one likes to talk about the more "delicate" issues of being a female diabetic. The doctors and nurses concentrate on the basics: insulin, blood sugar monitoring, food, exercise, and if you're lucky, the emotional aspects of our illness. Unless we bring it up, nothing is ever mentioned about how we're affected by some of the "joys of being a woman": yeast infections and menses.
So, here are some of my additions to the manual they never gave us:
Humans are carriers of all different types of fungus and bacteria, including a yeastlike fungus called Candida albicans. Normally, it just happily hangs out in our body, not bothering us or even making its presence known.
When our blood sugars are out of range, our body secretes glucose. (Remember that the name "diabetes mellitus" translates into "sweet urine".) In addition, out of control blood sugars tends to make our bodies weaker in the infection-fighting category. Anyone who has taken a home economics class knows that yeast grows well in a warm, moist environment after sugar is added. So, with a weakened immune system and excess sugar available, innocuous yeast can suddenly become a female diabetic's worst (and itchiest) nightmare.
The good news is that there are treatments that can help control the yeast growth, and many are available as over the counter treatments. There is also an oral medication that can be prescribed by your doctor. It is important that you talk to your medical team about your yeast infection suspicions, especially if it's the first time you think you have one, so it can be diagnosed and treated properly. (You could also have a bacterial or urinary tract infection, which need different treatment.)
There are things we, as diabetics (and as women) can do to help prevent yeast infections. The most obvious is to keep our blood sugars stable and within normal ranges. (I know…duh.) Tight fitting clothing, pantyhose, wet bathing suits, and non-cotton underwear can contribute to retaining moisture (Remember that Moisture + Heat + Yeast + Sugar = Yeast Infection!), so if you're prone to these types of infections, many experts recommend a keeping the area dry and using loose, natural fiber clothing.
If you're taking steroids, antibiotics, or birth control pills, there is an increased chance of developing a yeast infection. Be on the lookout and don't be afraid to talk with your medical team.
Not only do we get to endure zits, cramps, irritability, and a desire to eat sweet and salty foods (often together and in large quantities), but diabetic women also have the pleasure of trying to keep blood sugars stable before and during our menses. For some, blood glucose runs higher than normal, and for others, like me, hypoglycemic reactions come seemingly out of left field.
Hormones are to blame – and it's good to have something (rather than someone) to blame during this time of the month! Estrogen and progesterone tend to influence blood sugar levels, making control more difficult. The key here is to determine the pattern and ask the appropriate questions: "Do my blood sugars creep higher in the days before my menstrual cycle begins?" "Do my hypoglycemic episodes coincide with PMS?" "Do I really need to stuff my face with potato chips?"
Checking blood sugars more frequently before and during menses can help to shed some light on how you can counter the effects of a natural part of being a woman. Realizing that we may need to make adjustments in insulin (especially if we change our eating habits) can only be done if we have hard data. Tracking the fluctuations over several months and showing your medical team the results will help in determining what can be done to keep blood sugars stable.
Of course, as we age, how we react each month may change. I've switched from battling lows to highs and am now back to lows. (I'm sure this is just my body's way of saying: "Keep sharp! Things change!") The tracking I've done has allowed me to make quick changes and prevent days of bouncing blood sugars.
Even though new treatments and regimens have come to light over the past number of years, it's the knowledge that we share with each other (whether private or embarrassing) which can help us cope with diabetes. Manuals are just tools. We can refer to them when needed, as I have, but we can also rely on others' experiences and wisdom. Don't be afraid to speak up to your medical team about the complex dynamics that play into being a diabetic woman. You may find that solutions may be simple and easy to manage.
dLife's Daily Living columnists are not all medical experts, but everyday people living with diabetes and sharing their personal experiences. While their method of diabetes management may work for them, everyone is different. Please consult with your diabetes care team to find out what will work best for you.
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As I mentioned in an earlier post, one of the benefits that made it cost-effective for me to go with the real healthcare (HSA) plan rather than the phony (HRA) plan is that my company is now covering "preventative" medicines at $0 copay. The formulary for these, as stated by CVS/Caremark (my pharmacy benefits provider), covers all test strips, lancets, and control solutions. I dutifully get my doctor to write up prescriptions for all of my testing needs, submit...