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May 21, 2001

Other Illnesses

Question from Minneapolis, Minnesota, USA:

I am a 20 year old female who was diagnosed with type�1 diabetes almost exactly a year, and both my father and sister have type 1. At the time of my diagnosis, my blood sugar was 240 mg/dl [13.3 mmol/L], and I have only needed minimal amounts of insulin since then. I am currently only using Humalog as needed (about 1 unit per 10 to 15 grams of carbohydrate). About three weeks ago, I started experiencing low blood sugars despite significantly reduced insulin intake (for example I was taking 3 units when I normally would have taken 6)and I thought that this may have been due to menstruation as the low blood sugars and reduced insulin need occurred shortly before my period, and seem to have gone up again slightly afterwards, but this has never happened before. Is there any reason why I would suddenly start needing less insulin during menstruation? My sister usually requires more during this time. I spoke to my endocrinologist about this, and he suggested that maybe I have some type of adrenal deficiency, although I don't seem to have any other symptoms besides low blood sugars. How common is Addison's disease [adrenal insufficiency] in people with diabetes? What is the relationship between the two?

Answer:

Your endocrinologist had the same concern I had as I read your description of your situation. It turns out that some people with type 1 diabetes are also prone to other endocrine diseases because the immune system destroys the hormone-producing organ. This is the case with type 1 diabetes and Addison’s disease. It is not common, and most people with type�1 diabetes do not have this problem. However, it is worth being checked out by your doctor. Symptoms of Addison’s disease include fatigue, weight loss, dizziness upon standing up, bowel complaints, nausea, and low sugars. The diagnosis has to be made with blood tests your doctor can order.

It is usually not the case that sugars become lower during the menstrual period. Rather, it is as your sister describes. There is relatively more insulin resistance during the menstrual period. Finally, you may be experiencing a late honeymoon period.

JTL