My 31 year old daughter has type�1 diabetes. Birth control pills seem to be throwing her metabolism off somewhat. Can you give me any advice about her continuing to take them? She is considering getting her tubes tied so she can drop the birth control pills. Is this a good idea?

Oral contraceptives contain both a synthetic estrogen and a progesterone. Both of these hormones are known to increase insulin resistance. Therefore, they may increase insulin requirements when they are taken. To make matters more complex, the progesterone component may change during a 28-day cycle of the pill. Patients with diabetes on the pill have a variable response, in terms of their blood sugars. Some patients clearly show increase in insulin requirements during the 28-day cycle, and some do not. If your daughter is one who shows changes, she needs to address this issue with her physician treating her for her diabetes. It is clear that if she has her tubes tied, she would not have her insulin requirements complicated by the hormone therapy.

JTL

[Editor’s comment: You did not say whether or not your daughter has children or wants to have them in the future. Tubal ligation is considered relatively permanent and needs to be carefully considered. I don’t think we can judge whether or not this is a good option. Your daughter needs to explore the pros and cons of all alternatives and personally make the choice in consultation with her diabetes team and gynecologist.

SS]