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Changing Glucose Levels during the Menstrual Cycle as Observed in the Type 1 Diabetes Exercise Initiative Study.

INTRODUCTION: Evidence suggests that glucose levels in menstruating females with type 1 diabetes change throughout the menstrual cycle, reaching a peak during the luteal phase. The Type 1 Diabetes Exercise Initiative (T1DEXI) study provided the opportunity to assess glycemic metrics between early and late phases of the menstrual cycle, and whether differences could be explained by exercise, insulin, and carbohydrate intake.

RESEARCH DESIGN AND METHODS: One hundred and sixty two adult females were included in the analysis. Glycemic metrics, carbohydrate intake, insulin requirements, and exercise habits during the early vs. late phases of the menstrual cycles (i.e. 2-4 days after vs. 2-4 days before reported menstruation start date) were compared.

RESULTS: Mean glucose increased from 8.2±1.5 mmol/L (148±27 mg/dL) during the early follicular phase to 8.6±1.6 mmol/L (155±29 mg/dL) during the late luteal phase (p<0.001). Mean percent time-in-range (3.9-10.0 mmol/L [70-180 mg/dL] ) decreased from 73±17% to 70±18% (p=0.002), and median percent time >10.0 mmol/L (>180 mg/dL) increased from 21% to 23% (p<0.001). Median total daily insulin requirements increased from 37.4 units during the early follicular to 38.5 units during the late luteal phase (p=0.02) and mean daily carbohydrate consumption increased slightly from 127±47 g to 133±47 g (p=0.05), but the difference in mean glucose during early follicular vs. late luteal phase was not explained by differences in exercise duration, total daily insulin units, or reported carbohydrate intake.

CONCLUSIONS: Glucose levels during the late luteal phase were higher than the early follicular phase of the menstrual cycle. These glycemic changes suggest that glucose management for females with type 1 diabetes may need to be fine-tuned within the context of their menstrual cycles.

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