A woman with type 1 diabetes writes: A letter to diabetes researchers and tech companies

I first published this article on Medium.

Photo by Hanna Pad: https://www.pexels.com/photo/pink-and-white-flowers-on-white-wooden-table-8534381/

Dear diabetes researchers and tech companies,

My name is Aisha, and I have been living with type 1 diabetes (t1d) for 30 years. Diabetes technology has come a long way, and I am very grateful for all the advancements that help me to live life more fully with this disease. I now use a continuous glucose monitor (CGM) instead of a glucometer and an insulin pump instead of taking multiple daily injections. This makes it faster and easier for me to take care of my diabetes so that I can shift my focus to other things in life.

The Problem

There needs to be more research on diabetes in females, and we need improved technology and data visualization. In some female patients with insulin dependent diabetes mellitus, hormonal fluctuations throughout the menstrual cycle have been shown to have an impact on blood glucose (BG) levels that are not well-understood.(1–5) At least a subset of women experience increased hyperglycemia during the luteal phase. I often hear the advice of using menstrual cycle calendars to track periods, and many females with type 1 diabetes do that.(6) I use a menstrual cycle tracker, but when I keep hearing how it will help me manage my BG levels, I feel very annoyed. Yes, it helps, but it’s not enough, and the research shows that I’m not alone in thinking that.(6)

Look, it’s 2025, but currently, our method of understanding the menstrual cycle makes me feel like I’m stuck in a cavewoman era, while NASA is currently working on getting man on Mars by the 2030s! Type 1 diabetes requires constant vigilance, but tracking the menstrual cycle gives me data that I can only use retrospectively. For example, due to the danger of potentially triggering hypoglycemia, many females (and this is true for me) report being reactive rather than preventative when managing their BG levels even when tracking their menstrual cycles.(6)

Menstrual cycle tracking for women with diabetes reminds me of at home urine tests. Before 1975, at home urine tests that measured glucose and ketones were often used to estimate BG levels, but they were not a reliable method.(7) Personally, menstrual cycle trackers are not always accurate at timing my menstrual cycle events. Even if these menstrual cycle trackers were completely accurate and able to tell me exactly when to start adjusting my insulin, it doesn’t tell me exactly how much to increase or decrease my insulin. I always hear “find your patterns,” and that is not helpful to me either. There is an assumption being made that my body will do the same thing every month at the same time, and that is not true for me. I need constant, reliable, real-time data — when 1 single unit can, in my experience, drop me about 45 mg/dL and make a difference between a dangerously low BG reading and an in-range BG reading. So, you see, I am always playing catch-up and chasing the highs and lows instead of proactively getting ahead of them.

What helps me

I still use a menstrual cycle tracker app, but the thing that helps me the most is a low carb diet — especially as I am getting older and my insulin sensitivity seems to fluctuate more drastically than when I was younger. When I eat very little carbs, I take much less insulin, and the magnitude of error in my insulin dosages decreases. However, not every female with type 1 diabetes is able to or should go on a low carb diet. We need better ways to help females with insulin-dependent diabetes, and I think that starts with more research and better technology and data visualization.

Suggestions for future research

After reading through various research publications on diabetes in females, I have some suggestions for future research.

1. I think that the menstrual, proliferative, ovulatory, and secretory phases should be compared, as these seem to be the most punctuated phases for my BG levels and lines up with the inflection points on the menstrual cycle graphs. I have seen research that only compares the follicular to the luteal phases.(1)

2. I don’t think BG or interstitial glucose levels should only be analyzed as separate measurements from insulin dosages because the two are inversely related. For example, if I take too little insulin, I will have high BG levels, but the high BG levels are not necessarily from the menstrual cycle. The opposite is true as well when taking too much insulin. When taking the correct amount of insulin, I will have in-range BG levels, but that does not mean that my BG levels are not affected by the menstrual cycle; I might have adjusted my insulin dosage perfectly in response to the menstrual cycle, and so the data are misleading in that they will not show the effect of the menstrual cycle. There has been research that accounted for this by multiplying the average daily glucose levels and the insulin dosages during a 24-h day.(3,5,8) I hope that methodology will be replicated in future research on this topic.

3. I think studies on diabetes in women should take into consideration any research that has been done on how to standardize studies of the menstrual cycles, especially regarding data collection and analyzing between-subject compared to within-subject variance of the menstrual cycles.(9)

4. I hope to see future research on diabetes in women use instruments that measure blood or interstitial ovulatory hormones in real time instead of using methods such as the menstrual cycle tracking apps that are not always accurate. An example is a continuous hormone monitoring device that is being developed by a start-up called Level Zero Health.(10)

Simple solutions for right now

Is there anything we can do in the meantime to help women? To all the diabetes technology companies out there, can you please visualize the diabetes data in a more helpful way for females? When I log into my account of the platform that centralizes my diabetes data, I am amazed at how many ways the data are displayed, but there is a lack of visualizations to help me line up my menstrual cycle data with my diabetes data. However, there is a CGM that is currently available that incorporates the menstrual cycle data, called Vively, but it is not a diagnostic tool and cannot be used to treat health conditions.(11) It is my hope that an FDA-approved option for females with type 1 diabetes will exist soon.

I appreciate how far we have come with our current diabetes management tools and the recent efforts to improve women’s health. I hope that we continue these efforts, improving the methodology of research on diabetes in women, diabetes and women’s health technology, and diabetes data visualizations. If you would like to learn more, please view my website, heedherhealth.com, where I post content about the female experience of living with multiple chronic illnesses.

Sincerely,

Aisha

References

1. Widom B, Diamond MP, Simonson DC. Alterations in glucose metabolism during the menstrual cycle in women with IDDM. Diabetes Care. 1992;15(2):213–220. doi:10.2337/diacare.15.2.213

2. Lundman B, Asplund K, Norberg A. Metabolic control, food intake, and mood during the menstrual cycle in patients with insulin-dependent diabetes. Int J Nurs Stud. 1994;31(4):391–401. doi:10.1016/0020–7489(94)90010–8

3. Goldner WS, Kraus VL, Sivitz WI, Hunter SK, Dillon JS. Cyclic changes in glycemia assessed by continuous glucose monitoring system during multiple complete menstrual cycles in women with type 1 diabetes. Diabetes Technol Ther. 2004;6(4):473–480. doi:10.1089/1520915041706062

4. Brown SA, Jiang B, McElwee-Malloy M, Wakeman C, Breton MD. Fluctuations of hyperglycemia and insulin sensitivity are linked to menstrual cycle phases in women with type 1 diabetes. J Diabetes Sci Technol. 2015;9(6):1192–1199. doi:10.1177/1932296815588226

5. Coons A, Shubrook JH. The interaction between the female reproductive system and type 1 diabetes. Ann Infert Rep Endocrin. 2021;4(1):1026.

6. Mewes D, Wäldchen M, Knoll C, et al. Variability of glycemic outcomes and insulin requirements throughout the menstrual cycle: a qualitative study on women with type 1 diabetes using an open-source automated insulin delivery system.” J Diabetes Sci Technol. 2023;17(5):1304–1316.

7. American Diabetes Association. Tests of glycemia in diabetes. Diabetes Care. 1998;21(suppl 1):S69-S71. doi:10.2337/diacare.21.1.S69

8. Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia. 1985;28(7):412–9.

9. Schmalenberger KM, Tauseef H, Barone JC, et al. How to study the menstrual cycle: practical tools and recommendations. Psychoneuroendocrinology. 2021;123:104895. doi:10.1016/j.psyneuen.2020.104895

10. Level Zero Health. Accessed October 9, 2025. Available from: https://www.levelzerohealth.com/

11. Vively. Updated May 15, 2025. Accessed October 9, 2025. Available from: https://www.vively.com.au/post/a-world-first-real-time-cycle-and-blood-sugar-tracking-insights-for-women#:~:text=Vively%20is%20a%20metabolic%20health,whether%20Vively%20may%20suit%20you.