The treatment of diabetes in females is influenced by the different phases of life with their typical biological changes as well as the aims and needs of these patients. During puberty, optimal glycemic control is often difficult due to physiological and psychological factors, menarche is often delayed and cycle disorders are more common than in teens without diabetes. Since the complication rate is high in pregnancy if diabetic control is not optimal prior to conception, women with type 1 diabetes should ideally plan their pregnancy. Nevertheless, unplanned pregnancies are even more common among young women with diabetes, which underlines the importance of adequate counselling regarding the topics of pregnancy and contraception. Hormonal contraception is possible in the absence of angiopathy. Progestins may slightly worsen glucose tolerance which may require adjustment of insulin dose; alternatives are hormone-free contraception or progestin-coated intrauterine devices (IUD) which cause extremely low systemic serum levels of progestin. Because pregnancy poses a special challenge due to the tight metabolic control needed for healthy maternal and fetal outcome and variable insulin requirements in the different stages of pregnancy, close medical, emotional and motivational support are extremely important. Late complications, particularly nephropathy and the higher prevalence of obstetrical complications require frequent interdisciplinary monitoring and counselling. Delivery should be planned in a perinatal center with experience in managing type 1 diabetic pregnancies. Breast-feeding should be encouraged for these mothers. During perimenopause, increased fluctuations of estradiol levels prior to menopause may cause problems in glycemic control, while during the postmenopausal years, continuous hormone therapy in physiological doses may help to improve insulin sensitivity.
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The treatment of diabetes in females is influenced by the different phases of life with their typical biological changes as well as the aims and needs of these patients. During puberty, optimal glycemic control is often difficult due to physiological and psychological factors, menarche is often delayed and cycle disorders are more common than in teens without diabetes. Since the complication rate is high in pregnancy if diabetic control is not optimal prior to conception, women with type 1 diabe...
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