Birth Control & Type 1 Diabetes
Choosing the right birth control method while living with type 1 diabetes can get complicated! Hormonal birth control can impact insulin resistance and therefore lead to higher blood glucose levels, but hormones affect everyone differently. Some people already see an example of this when they experience higher insulin needs or higher blood sugar levels right before their period.
But just like every case of diabetes is different, every experience of birth control is different too! Here are some things to keep in mind to make the right choice for your body.
There are several different types of IUDs; each interact with the body differently. Each must be placed and removed by a healthcare professional. IUDs in general are not recommended for people who contract pelvic infections easily. People with higher A1Cs (consistently elevated blood sugar) may be more susceptible to such infections.
The first type is a copper IUD—also known as ParaGard—which causes an inflammatory response in the uterus, preventing pregnancy. Some people prefer the ParaGard because it is hormone-free. The small device is inserted into your uterus by your doctor and can last for up to ten years.
Some people who have copper IUDs report heavier bleeding and more intense cramps and back aches. Because of these potential side effects, people with diabetes should consider the impact this could have on blood sugar management. Taking care of blood sugar levels is difficult enough without more intense cramping!
Hormonal IUDs are small plastic devices that contain the progestin hormone levonorgestrel. There are several different strengths and sizes of hormonal IUDs—variations are suggested for folks who may be more sensitive to hormones or who have a smaller or larger uterus due to genetics, already having had a child, etc.
Mirena is most commonly used, but other brands/types available are Skyla, Liletta, and Kyleena. Depending on the level of hormones, hormonal IUDs can last from three to five years; your doctor will let you know when yours needs to be replaced. Like with any hormonal treatment, hormonal IUDs can cause blood sugar changes as well as acne, weight gain and mood swings.
The vaginal ring is a flexible device that is inserted into the vagina and worn for the three weeks during which menstruation (period bleeding) is not happening. It is removed for the week of the period, then a new vaginal ring is placed. This ensures hormones to prevent pregnancy are being released during sections of the cycle when pregnancy could happen. The vaginal ring must be prescribed by a doctor, but a healthcare provider is not needed for placement and removal.
The hormones in the ring are absorbed directly into the vagina. This makes it easier on the body, as it does not need to metabolize the medication through the digestive system like with the birth control pill. For many people, this can lead to less impact on blood sugar levels. This is a key reason why some healthcare providers recommend the vaginal ring to people with diabetes.
Warning: The makers of NuvaRing advise that people who have kidney, eye, nerve, or blood vessel damage caused by diabetes complications should not use the ring.
Birth control pills are taken daily and contain active hormones that—when taken consistently—prevent pregnancy. There are MANY types of birth control pills with many hormonal formulations. People with diabetes should speak with their doctor about their specific needs—because every body is different, every body has different hormonal needs and tolerances. People may find that one type of birth control has no side effects, while another type may wreak havoc on blood sugar control or mental health.
Like with any other medication, people with diabetes should pay close attention to blood sugar levels and how they are feeling physically and mentally in the weeks and months following a new hormonal birth control method.
For people with diabetes, birth control pills that contain synthetic estrogen and a type of progestin hormone called norgestimate are the most widely recommended (the brand ortho tri-cyclen is an example). This type of pill contains less or no androgens, steroid hormones that give men their “male” characteristics and can impact insulin resistance and therefore blood sugar control.
Due to variations in hormone levels, some people with diabetes have reported their insulin needs nearly doubled when starting on the pill, so be prepared to adjust insulin requirements as needed. According to the University of Colorado, this rise can be attributed to the estrogen found in birth control pills.
Additionally, the pill is not recommended for people who suffer from heart disease, blood clots, high blood pressure, and people who smoke or are over the age of 35. People who have a history of depression, anxiety, or other mental health variations should keep a close eye on their symptoms as well, as the hormones in birth control pills can also impact the balance of brain chemicals.
Hormones to prevent pregnancy can be injected, but have a higher risk of weight gain, which can cause more insulin resistance. These hormone injections are done with Depo-Provera, which utilizes the drug depot medroxyprogesterone acetate (DMPA), a synthetic (lab-made) version of progestin. Depo-Provera blocks ovulation (when an egg releases from the ovaries).
Morning After Pill
There are two types of morning after pills, meant to be utilized when other birth control methods failed or were forgotten. If you find yourself in this situation, you can go to any drug store or pharmacy, where it will be in the aisle or behind the counter (just ask the pharmacist). You do not need a prescription and the medication is usually around $50.
The first type of morning after pill is called ella and contains the hormone ulipristal acetate. It is the most effective morning after pill. Folks who weigh 195 pounds or more should speak with their doctor about dosing, as this pill is known to be less effective for people with higher weights.
The second type of morning after pill has multiple brands, such as Plan B, AfterPill, etc. This type of pill contains the hormone levonorgestrel. Folks who weigh 155 pounds or more should speak with their doctor about dosing, as this pill is known to be less effective for people with higher weights.
While preventing an unplanned pregnancy is a vital and prioritized outcome, planning ahead so that you can avoid using the morning after pill is ideal for people with diabetes. The flood of hormones can create severe blood sugar swings in the days following. Keep a close eye on insulin needs to keep yourself safe and well!
Diaphragms, Barrier Devices, Condoms and more
Barrier devices are safe for people with diabetes, as they do not contain any hormones. Do read labels and ensure you know about any other chemicals used alongside your barrier device of choice; the spermicides used in some of these devices can increase risk of urinary tract infections.
Overall, talk to your doctor or another healthcare provider you trust about the birth control that may right for you. This list is not exhaustive and is ever-changing.