I am a 40 year old female with type 1 diabetes for 36 years and on an insulin pump who has had A1cs of 7.4-7.5% but would like to have them lower. I have documented hyperglycemia eight days prior to menstrual cycle so my doctor has recommended starting oral contraceptives to help with blood glucose management. I have taken them in the past, but didn’t know at my age if it would be wise. Is this recommended for a 40 year old non-smoker? I have taken them in the past, but didn’t know at my age if it would be wise.

Unless you also need contraception, I’d first try increasing your insulin for the eight days before your menstrual cycle. Speak with your physician, but if you are high all day, the easiest might be to increase your basal rates for those days. If the main problem is going up higher, you might need to adjust your premeal bolus doses.

Oral contraceptives have been used in the past for patients who have DKA [diabetic ketoacidosis] associated with menses and are unresponsive to adjustment of insulin. Remember, oral contraceptives themselves often increase the blood sugar requiring adjustment of insulin.The risk of complications for anyone using oral contraceptives increases with age, and is always slightly higher in individual with diabetes.

TGL